Sunday, December 8, 2019

Comments by Ffrosti

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  • As a freshly graduated MD three decades ago, I was deciding between internal medicine and psychiatry, as career options. Psychiatry prevailed, because it seemed to be up-and-coming and was promising to explain disorders such as schizophrenia, mania, and depression that medicine did not understand. The “diseases” were difficult to treat, med school taught me, but now drugs existed that offered not only effective treatment, but also permanent cure.

    In training the emphasis was on teaching us, residents, how to “elicit” symptoms and observe signs of those diseases. DSM classification made the process appear scientific. Much later, a realization would come; in the absence of objective tests, little else other than my personal judgement and experience qualified symptoms and signs of illness that I was observing. I would decide if, and to what end, the observed and/or reported phenomena should be accepted as evidence of “mental illness” in the person before me.

    Trainee doctors were encouraged to talk to the “mental patients,” of course, mostly as a means of getting at all the symptoms that might be hiding under a thin veneer of pseudo-normalcy, waiting to be unearthed by well rehearsed (leading) questions. Empathic understanding of the patient on the human level, on the other hand, was secondary to the diagnostic enterprise.

    When sufficient “symptoms and signs” were collected and put down on paper, i.e., documented, settling on the “correct” diagnosis was not difficult. And once established, that diagnosis would remain on the record forever, seldom if ever revised downward, though sometimes upgraded, if the patient failed to develop “insight,” i.e., agreement with his psychiatrist on the nature of his illness.

    In my practice, general practitioners would refer patients, expecting me to manage their long-term care. There was a sense of empowerment, solemn responsibility, and accomplishment in this work. After all, I was protecting unfortunate individuals from the ravages of disease that had the potential to ruin their lives. I was eliminating their suffering, or so I thought.

    It did not take long for another realization to dawn on me (and most of my colleagues, I’m sure). The acclaimed psychiatric drugs produced effects that were short-lived at best, or nonexistent entirely once the placebo effect was discounted. Patients would improve, but their “symptoms” tended to return, usually as a result of medication “noncompliance” due to drug toxicity, referred to routinely as “side effects.” If they did comply fully, they could not function and were on the way to chronicity.

    Family or law enforcement agents would often enter the picture somewhere along the way, insisting that treatment be continued against the patient’s will, if necessary. Employers preferred to steer an employee, with psychiatrist’s help, toward a disability status, less likely to be challenged than outright dismissal would be. I soon learned that to stand up to the family and state agents in support of my patient’s autonomy was asking for trouble. Taking the family or government agency’s side was entirely problem-free, on the other hand.

    At some point, the scales of med school indoctrination started to come off from my eyes. Something I was led to ignore became obvious. The diagnostic system I followed was arbitrary and subjective; psychopharmacology had nothing to offer beyond sedative-like drugs for acute states and stimulant-like drugs masquerading poorly as “antidepressants.”

    Emotional suffering was real and had many forms. It responded only to genuine empathy. Time spent with the “patient,” listening and being a sounding board to him, was a form of treatment intervention better than most, I realized. It was liberating for this psychiatrist to “come in from the cold” – the diktat of DSM-style diagnosis and ineffective, toxic, biologic treatments, so called.

    It was liberating, except… Outside my office door, alive and well, lived the dogma that treatment by empathy was not scientific and/or sufficient, unless accompanied by a bottle of expensive pills of the “second generation,” preferably, prescribed as the actual remedy. My newfound freedom collided head-on with expectations of the medical powers that be: I should practice psychiatry “by the book.” Fending against accusations of unscientific practice became part of my own “Psychiatry Reborn” experience, unfolding still.

  • As a psychiatrist, I congratulate you on the article. Unfortunately, the sandcastle of psychiatry as we know it may not crumble any time soon. Many more people will be hurt by psychiatry before the demolition is accomplished.

    Psychiatry’s raison d’etre is the modern belief that getting away from problems of living quickly and painlessly is possible. Hence the notion of the “happy pill.” Worse still, psychiatry has become a problem-solving instrument for the state. The state welcomes the psychiatric product and employs it as a means of extra-judicial control over difficult people. And, in its quest to make money, Pharma has taken unscrupulous advantage of the demand for the psychiatric idea.

    Generations of physicians have been indoctrinated in the falsehoods of psychiatry. Young medical doctors have chosen psychiatry as a specialty in the belief that it is a legitimate branch of scientific medicine. I know I did. It was my daily work that disabused me of the pseudo-scientific notions of psychiatry much later. It did not happen overnight.

    Psychiatrists have been and will be among victims of psychiatry. Thomas Szasz and Peter Breggin’s stories come to mind and there are others, not publicized. It is difficult to get “on the right side of history” for the psychiatrist who has discovered mid career that his specialty is hardly scientific, that psychiatric diagnosis is a contrived label, and that drugs do all kinds of things except one – make a person well. To go public with this kind of knowledge can be a career-ending move for a psychiatrist today.

    Psychiatrists with integrity nevertheless buck the trend by acknowledging the anti-therapeutic effects of most pharma-promoted ministrations. Few of them think, however, that it is practical to make oneself a target for the establishment that takes no prisoners. Those psychiatrists need encouragement to come out of the closet and speak up. It will neutralize the enemy’s fire and the sandcastle of psychiatry will come down faster.