Monday, November 20, 2017

Comments by Mark L. Ruffalo, LCSW

Showing 9 of 9 comments.

  • Like Francesca above, I use the term “mental illness” (and other synonyms) out of convenience. A much better term to me is “problems in living” (a Szaszian phrase). Surely, the experiences exist. And in many cases those experiences are problematic, either for the person himself or those around him. But “mental illness” is a metaphor; the mind is not an organ and thus cannot be diseased. There is no inherent harm in using metaphors to describe human suffering except for the risk that some people take the metaphors literally.

  • Thank you for your comment. You are right that drugs treat disease. But drugs have also been used for thousands upon thousands of years to ease suffering. I never said that psychiatric drugs “do nothing.” To the contrary, many people seem to find relief in them, although the reasons for this are complicated. Unlike many associated with “anti-psychiatry,” I believe in an unregulated free market in psychiatric drugs. If a person wants Prozac or lithium, he should be able to walk to the pharmacy and buy it without a prescription. The reason for this is simple: I believe in freedom. This is the view of Thomas Szasz, who said the same thing for electroshock, lobotomy, etc. Any other view infantilizes the patient (person) and limits his autonomy even further. There are no psychiatric diseases, and psychiatric drugs don’t treat diseases. But this is not sufficient justification for restricting them from people.

  • We are in agreement there that most “anti-medication” psychiatrists are actually just “anti-excessive medication.” I am not a drug doc. In fact, I am not even a psychiatrist–I am a psychoanalyst. What you say about Szasz is actually mistaken. He believed people should be free to seek psychiatric drugs, just as they should be free to seek alcohol, cocaine, or marijuana. He just did not want any part in prescribing them. I am of a similar belief. Some people may find some relief in medication, and who am I to keep that from them? Szasz had no interest in banning psychiatric drugs, unlike some of the others associated with “anti-psychiatry.” His book Antipsychiatry: Quackery Squared reveals these beliefs.

  • Thank you for your comment. We may disagree here. I would much rather have outpatients who are free to refuse medications than inpatients who are civilly committed and unable to refuse drugs, electroshock, etc. While Kline’s work opened up the door for what later became an out-of-control biological psychiatry, he alone cannot be blamed for this, as he was very clearly cautious about the widespread use of psychotropics.

  • Thank you for the comment here. I am in agreement that most psychiatrists do not enter the field with the intention of doing harm or controlling their patients. As someone who teaches psychiatry residents, I think most are sincerely looking to help the human condition. My position on drugs is simple: as long as the patient consents to them and is informed that they are not treating any known diseases, I am okay with them. In my opinion, any other position negates the patient’s autonomy and self-responsibility.

  • Excellent article. Do you see the pendulum swinging back towards a more psychosocial psychiatry in the coming years, or do you believe the biopsychiatric approach will predominate indefinitely? I teach young psychiatry residents and supervise them on their psychotherapy cases, and many (but not all) seem to recognize the limitations of the reductionistic somatic approach and yearn for instruction on the basics of psychodynamics and psychotherapy. Some even recognize the utility of psychotherapy in working with so-called schizophrenic patients. The history of the field is marked by major paradigmatic changes. Could we see one occurring in the next thirty or fifty years?

  • Thank you for your comment. While I agree that the problems we label “psychiatric disorders” are metaphorical in their nature (and nondiseases), like Szasz I resort to the traditional terminology out of convenience. A much better term is “problems in living.” And the use of the term “patient” is intentional. A person need not suffer from any disease to be a patient, though the term “prisoner” is more appropriate for those cast into the patient role unwillingly.