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Posts Tagged ‘Biopsychiatry Illuminated’

The Only Known Chemical Imbalances In the Brain Are Caused by Psychiatric Drugs


Peter R. Breggin M.D. conducts a private practice of psychiatry in Ithaca , New York , where he treats adults, couples, and families with children. He also does consultations in the field of clinical psychopharmacology and often acts as a medical expert in criminal, malpractice and product liability suits. Before moving to Ithaca in November 2002 he was in practice for nearly thirty-five years in Washington , DC and Bethesda , Maryland . He has written dozens of scientific articles and many professional books, including Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime (2008), and is on the editorial board of several journals.

In 2010 Dr. Breggin and his wife Ginger formed a new organization that continues their emphasis on bringing professional and laypersons together to share their concerns about the hazards of contemporary biological psychiatry while promoting more caring and empathic approaches to personal conflict and suffering. The new organization will sponsor an annual meeting each April in Syracuse, New York empathictherapy.org


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Medication Nation

Source: Ecologist
Date: January 2006 

Medication Nation

Too fat, too thin, too sad, too happy…Whatever the problem Biotech is developing a vaccine or a pill to cure us. Mark White examines the consequences of a world where all our worries can be medicated away

It may be known as ‘retail therapy’, but the next edition of the American Psychiatric Association will recognise being a shopaholic as a clinical disorder. At Stanford University, trials held on the SSRI anti-depressant Citalopram concluded that the drug was a ‘safe and effective treatment for Compulsive Shopping Disorder’.

The rise of compulsive spending mirrors the obesity time bomb slowly detonating in the richest countries of the world, according to psychologists. A recent study found that women in their twenties had gained an average of five kilograms in the last seven years.

In the last six months clinics to treat internet addiction have opened in the US and China. Meanwhile, a Scottish teenager was treated recently by an alcohol trust for addiction to electronic messaging. He spent £4,500 on texting in a year, and quit his job after he was found to have sent 8,000 emails in one month. That’s 400 a day, or about one a minute, every minute of the working day.

It’s kind of comforting when you get [a message],’ he told the BBC. ‘I like it, it’s like a game of ping-pong, as you send one and get one back.’

So many new addictions, but the old ones remain. The hardcore smokers can’t ditch their coffin nails. Alcoholics young and old litter streets and hospitals, and there’s scarcely a pub toilet left in the land without a residue of cocaine smeared across the nearest flat surface. It’s enough to make you stay in bed and stare at the ceiling, mind racing about climate change, that lifestyle you can’t quite afford, and the next big terrorist attack.

Mind racing… a Buddhist would tell you how to cure that by meditating on the impermanence of existence – and that the racing mind is the result of man’s failure to achieve Enlightenment. But Big Pharma has a better idea: in the first week of May a $60 million advertising campaign began in the States for Lunesta, an insomnia drug to cure… a racing mind. All you need is a prescription and a glass of water.

Swiss biotech company Cytos has 25 research programs underway, including its ImmunodrugTM nicotine vaccine CYT002-NicQb, along with vaccines for chronic diseases including obesity, hypertension, allergy, psoriasis and rheumatoid arthritis. The company was granted a US patent in early 2005 for vaccines against different drugs of abuse, and hopes to release its nicotine vaccine in 2010. The vaccine antibodies prevent dopamine, the chemical that leads to a feeling of pleasure, from flooding the brain. They have a half-life of 50 to 100 days, meaning the response could be a boosted by a further injection. The rewards are huge: Decision Resources estimated the ‘stop smoking’ market in America alone will be $1.5bn by 2007, and as China and India become richer, with more people smoking, eventually more people will want to stop smoking too.

Cystos’ obesity vaccine works on a similar principle with an antibody against ghrelin, a small protein that regulates appetite. If you inject extra ghrelin into people it makes them hungrier. Fat people who lose weight develop extra ghrelin, leading to yo-yo dieting. The theory is that by stopping the uptake of ghrelin it will be easier to stick to a diet. Cytos is to be running trials with 112 obese volunteers on a six month treatment of the vaccine or a placebo, and at the same time counselling them about healthy eating and encouraging exercise. While obesity is a leading cause of preventable death in rich countries, it is also, in every sense, a growing problem, with rich nations becoming fatter and fatter, and less and less happy about it. A successful vaccine would be worth billions.

The military are in on the act, naturally, sponsoring research into drugs that will keep their soldiers awake without the jittery, glittery rush of adrenaline that follows amphetamine use. And then there are mood-enhancing drugs to combat the rise of depression, a disorder that the World Health Organisation estimates will be the biggest health problem in the industrialised world by 2020.

‘Tomorrow’s biotechnology offers us the chance to enrich our emotional, intellectual and, yes, spiritual capacities,’ says David Pearce, a leading transhumanist philosopher (transhumanists favour using science and technology to overcome human limitations). I think there’s an overriding moral urgency to eradicating suffering. This ethical goal eclipses everything else.’

Zack Lynch, a leading expert on the biotech industry and publisher of several blogs and neurotechnological market reports, dismisses concerns about side effects: ‘Future neurotechnologies will have the capacity to extend all aspects of what makes us human, from self-centredness to radical empathy.’ Eradicate suffering? Making people less self-centred?

Radical empathy? Sounds great. So why does the idea of pills that will eradicate angst give so many people, well, angst?

If people were satisfied they wouldn’t need to try to improve themselves. But our societies are based on the concept of endless growth, so they rely on us never being satisfied. Alexis de Tocqueville made this observation in his 1848 classic Democracy in America. ‘In America I saw the freest and most enlightened men, placed in circumstances the happiest to be found in the world; yet it seemed to me as if a cloud habitually hung on their brow, and 1 thought them serious and almost sad even in their pleasures.’ Maybe it’s the price you pay for living in a society based round not happiness per se, but its pursuit.

The notion of ‘progress’ has brought a million fresh hells trailing in its wake. As Lynch notes in an entry on his Corante blog from December 19, 2003: ‘Our extensive global connectedness has created new problems for modern humans. While many people question the uneven distribution of power that exists in today’s world, others are disillusioned by the happiness that wealth was supposed to bring. In every culture, feelings of uncertainty, depression, anger and resentment have surfaced on a vast scale.’

For Lynch the solution is an extension of modernity, or our systems of control over the physical environment, inwards to our mental environment: ‘We now need new tools to address the mental stress that arises from living in a highly connected urbanised world… new tools [that] represent our best hope in a world seemingly out of control.’ Those tools are new drugs that, for him, are a means towards sharing our emotions to create a more empathetic society.

There is an alternative view, explored by philosopher Carl Elliott in his essay Pursued by happiness and beaten senseless: Prozac and the American Dream, that looks at alienation in societies – the ‘mismatch between the way you are living a life and the structure of meaning that tells you how to live a life… it makes some sense (though one could contest this) to say that sometimes a person should be alienated – that given certain circumstances, alienation is the proper response. Some external circumstances call for alienation.’ He gives the example of Sisyphus pushing the boulder up the mountain. He may be happier on Prozac and his psychic well-being would be improved. But his predicament is not just a matter of the wellbeing of his mental health, but how he is living his life. If someone’s life is making them sick, then you can make them well by cither changing how they live their life or by making them fit in with what made them sick in the first place. It is, of course, a lot easier to give someone a pill and hope they’ll adapt to their circumstances, just like housewives in the 1950s popped a Valium, cleaned the house, cooked dinner, and waited for their husband to come home from a hard day at the office.

Better than well

Not that the meticulous unravelling of human biology stops there. The real kicker is the class of experimental drugs developed by Cortex Pharmaceuticals, known as ampakines, that boost the levels of glutamate in the brain – a neurotransmitter implicated in the consolidation of memory. The drug’s obvious therapeutic use is to treat people with Alzheimer’s or dementia, but why stop there? A report in New Scientist earlier this year described the effects of the Cortex Pharmaceuticals ampakine CX717 on 16 healthy male volunteers at the University of Surrrey who were kept awake all night and then put through tests. Even the smallest doses of the drug improved their performance, and the more they took the more alert they became and the better their cognitive performance. The ampakine users remained alert and with none of the jitters associated with caffeine or amphetamines.

Psychologist Peter Kramer was one of the first professionals to discuss the implications of drugs that could ‘change’ personalities in his 1993 book Listening to Prozac. He became interested after prescribing Prozac to patients and seer radical shifts in how they interacted with the world. Some said they had become the person they always wanted to be. Others felt that Prozac had robbed them a deeply valued sense of self. If the drug could cause such a shift in identity to people who needed therapy, said Kramer, what could it do as an enhancement to people who were basically fine? Could it make them ‘better than well’?

This notion of being better than well causes unease in western societies, particularly ones with Protestant roots where the notion of getting something nothing is thought to be a sin. It’s being called ‘cosmetic neurology’, a phrase coined by Dr Anjan Chatterjee, fromt University of Pennsylvania, in a paper the September 2004 issue of Neurology. He argues from the slippery slope, saying that: yes, we are getting a boost without doing the work, but we already live in homes with central heating; yes, such drugs could change people’s personalities, but steroids and mind-altering drugs do that already; yes, the rich will have better access to such drugs than the poor, but we already accept huge inequalities in society; and yes, I government, religions and journalists will urge restraint, but they are likely to be | overwhelmed by a ‘relatively unrestrained [market’ and the military.

Patients, he says, will demand the right of access to a drug designed to raise their baseline level of happiness. ‘If social pressures encourage wide use of medications to improve quality of life, then pharmaceutical companies stand to make substantial profits and they are likely to encourage such pressures,’ he says,’… it does not take much imagination to see how advertisements for better brains would affect an insecure public. Gingko Biloba, despite its minimal effects on cognition, is a billion dollar industry.’

There’s certainly money to be made, as the following comments on neuroinvestment.com about Cortex’s ICX717 show: ‘Given that schizophrenia is the most clinically advanced program, we believe that this particular indication would be the most valuable in a licensing deal… Cortex plus Organon’s schizophrenia rights (throwing in depression as a sweetener) would look great in a Big Pharma’s Christmas stocking.’

David Pearce poses a thorny question by email: ‘Should people be compelled stay the way they are? After all, the reason we’re so discontented a lot of the time is because of the legacy of our evolutionary past – making their vehicles discontented helped our genes to leave more copies of themselves in the ancestral environment. Potentially, the new drug therapies and genetic interventions will be ’empowering’ in the best sense of the term. A lot of people today just feel imprisoned in brains, bodies and personalities they didn’t choose and aren’t happy with at all…’

This brings two competing notions of happiness to a head: Eastern, which comes from accepting each moment as being neither good nor bad, but just as something that is, and the Western one, the pinnacle of consumerism and materialism, that of having your desires satisfied. I asked Pearce if he thought it was good for people to have their needs met at all times, and he replied that if those needs don’t adversely affect the wellbeing of others, then yes.

The comment reminded me of a quote in Elliott’s essay from Walker Percy’s Signposts in a Strange Land. Writing of a Geriatrics Rehabilitation Unit where old folks grow inexplicably sad despite having all their needs met, he says: ‘Though they may live in the pleasantest Senior Settlements where their every need is filled, every recreation provided, every sort of hobby encouraged, nevertheless many grow despondent in their happiness, sit slack and empty-eyed at shuffleboard and ceramic oven. Fishing poles fall from tanned and healthy hands. Golf clubs rust. Reader’s Digests go unread. Many old folk pine away and even die from unknown causes like a voodoo curse.’

All technologies have mission creep and unintended consequences. Chatterjee dismisses concern about drug safety with the blithe phrase ‘in general, newer medications will continue to be safer’, despite little evidence to that end – and recent evidence with fen-phen, Vioxx and’ the hiding of negative SSRI drug data by Big Pharma pointing in the other direction. The debate is framed in such a way as to make cosmetic neurology sound like an extension of evolution, when it’s about as natural as a GM tomato containing a fish gene. This kind of technological arrogance is what’s dooming the ecosphere, not saving it. ‘I’m not prepared to say they can’t be a good thing,’ wrote Elliott, by email. ‘They may well be. But I guess my feeling is that while the benefits are obvious, the possible drawbacks are not, and need to be thought about more carefully. There are also a lot of people out there with a financial interest in hyping the benefits and downplaying the risks.’

Take enhanced memory. Sounds great. We’ve all seen elderly relatives get lost in a fog of misfiring neurons, and it can be incredibly sad. But whether you believe in an intelligent designer or your starting point as the Big Bang, something has led the human brain to its present state of nature.

‘We understand little about the design constraints that were being satisfied in the process of creating a modern human brain,’ says Martha Farah, from the Centre for Cognitive Neuroscience at the University of Pennsylvania. ‘Therefore we do not know which “limitations” are there for a good reason… normal forgetting rates seem to be optimal for information retrieval You could, in effect, remember too much: the hair colour of the person who sat in front of you in the cinema, the smell as you passed the bakery on your way to work, what you had for dinner every night of the last year – memory after memory too readily accessible.

A class of drugs used to treat Parkinson’s disease gained the nickname ‘the Las Vegas pill’ after it was found to turn a small but significant number of its patients into compulsive gamblers – ironically by stimulating the dopamine-producing area of the brain that the addiction drugs are aimed at quietening down. The Doogie mice are another case in point. These smart rodents were genetically engineered to have enhanced memory and learning skills. They were better at recognising and locating objects and remembering painful experiences – but when pain was induced it lasted longer. They found it hurt to be made smart.

There’s a wider point at stake here: if nature is something worthy of respect, then why not human nature? Our belief that we are set apart from the world has led us to treat our environment as a plaything for the fulfillment of our desires, though we forget that the demands of our egos are never-ending and monstrous. Can we ever be too happy? Too rich? Too thin? Too satisfied?

Zack Lynch believes that humans are social animals wired for social acceptance. ‘I see no indication that the majority of individuals will not choose to enhance aspects of themselves to make them more giving, caring and empathetic towards each other and the rest of the biosphere,’ he writes, by email, choosing not to highlight the increasingly aggressive, competitive economic and social world that we are building for ourselves and future generations. Millions of people already alter their reality by taking mood-altering drugs like ecstasy, or sink a bottle of wine, or hammer a bong, and there’s little evidence of an upsurge in love.

Rats exposed to cocaine will keep on self-administering the drug, to keep the pleasurable chemicals swirling around their brains, no matter what happens. That wiring for social acceptance is being rewired for social status, and you can see the results just by looking around you. Futurist Ray Kurzweil has named 2045 as the point at which humans reach Singularity, the moment when the barrier between our minds and computers disappears and the non-biological portion of our intelligence predominates.

And then? Author Michel Houellebecq, when not scandalising the French establishment, keeps returning to issues of identity and humanity. He did it in The Elementary Particles, and in his next book The Possibility of an Island he describes a cult that thinks of genetic engineering as a path to immortality. The main character’s girlfriend explains: ‘What we’re trying to create is an artificial humanity, a frivolous one, that will never again be capable of seriousness or humour, that will spend its life in an ever more desperate quest for fun and sex – a generation of absolute kids.’

Pearce believes that drugs that make us happier will rip up most of philosophy: just think, no more Nietzsche or Camus. ‘Most of the philosophical tradition is based on grief and suffering. The same is true of traditional “great” literature too,’ he wrote. I asked him if he thought art needed suffering to be created, and he wrote back with a link to a book called Touched with Fire: Manic-Depressive Illness and the Artistic Temperament. It contains Lord Byron’s famous quote: ‘We of the craft are all crazy.’

Houellebecq’s main character knows where the world is headed: ‘Nothing was left now of those literary and artistic works that humanity had been so proud of; the themes that gave rise to them had lost all relevance, their emotional power had evaporated.’ So, what an improvement the post-human will be. We will feed our desires and remove all the insecurities and blunt edges and pain and art, and as the sky boils and the ice caps melt and the fish all die and the land is fouled and the bombs keep exploding we will, at least, have a smile on our faces and a happy feeling in our hearts.

Mark White is a freelance journalist

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Biopsychiatry Illuminated

THE CANDLELIGHT PROJECT
by Bob Collier

24 November 2003
Issue 69Pseudo-Science Among Us
by Dean BlehertPart 1

INTRODUCTION:

Increasingly one sees articles about the overprescription of psychiatric drugs like Ritalin and Prozac among school children. Even the New York Times got into the act recently, despite its bias towards the large pharmaceutical companies who pay so much for ad space and would prefer to pretend the controversy doesn’t exist. When even the Times decides that this news is fit to print, the issue is getting too hot to ignore.

In the following article, I want to shift focus from debates about how much of a drug is too much to the basic scientific validity of the psychiatric labels — alleged disorders – that lead to the drugging of millions of children in the United States. I want to remove from the discussion some assumptions that make it difficult for us to see what’s before us. The main assumption is that because a great deal of science (especially chemistry) is involved in psychiatric medication, the psychiatric programs are, themselves, scientific. By analogy, if a mass murder killed millions of people by use of highly “scientific” weaponry designed in advanced laboratories (a la Lex Luthor), one would conclude that the killing of millions of people was part of a “scientific program”. That sounds absurd, but prominent Nazi psychiatrists running experiments in the death camps tried, with considerable success, to persuade themselves and their colleagues that the killing was the extension of a “valid” scientific program (euthanasia of the insane and handicapped).

And in particular, I’d like to make it clear exactly what is meant when someone argues that various alleged psychiatric conditions (for example, Attention Deficit Hyperactive Disorder, ADHD) do not exist. Obviously children can be found who manifest the symptoms attributed to ADHD. How then can it be argued that ADHD does not exist? No one denies that some people are tired, but we would probably not be willing to call “tiredness” a psychiatric disorder. Why not? And what would happen if we did? And is the psychiatric classification (ADHD, for example) liable to lead to trouble? I’ve tried to answer these questions below.

Finally, it is my intention to provide an overview, not a scholarly study full of references to studies, but a view of the logic — the science or lack thereof — behind the current scene in psychiatry. Most articles on the subject concentrate on horror stories, pro and con: Mother fears her child won’t get the Ritalin that has helped him so much (how much? No scientific assessment available), or mother claims her son has been ruined by Ritalin. Such stories impinge, but tend to paralyze thought and observation. First of all, we know that many people with ADHD and other conditions get huge gains when given placebos (pills that are known to do nothing). Often, in the tests submitted to the FDA (Food and Drug Administration) to prove the effectiveness of new drugs, people given placebos (e.g., sugar tablets) show nearly as much improvement as those given the new drugs. Often the drug companies must nurse the statistics considerably to be able to claim a significant difference.

And many of the drugs now in use were tested with inactive placebos. That is, the “control group” is not supposed to know it is receiving a placebo. It is supposed to think it is receiving a potent drug. When sugar tablets are used as placebos, the people taking them, noticing that there are no obvious physical side effects, know they are receiving placebos. Studies have shown that when people are given active placebos — pills that are known to have no effect on the disorder being treated, but that have noticeable side effects (e.g., itching or dry mouth) — they give a much higher rate of “improvement” than do sugar tablets, because the control group is convinced it is receiving a potent drug. The point is, the fact that some people claim gains from, say, Ritalin, is meaningless in the absence of statistics on the gains themselves and on what proportion of users receive them and over what period of time. And even then, gains must be closely defined: What a teacher calls a gain (child sitting still in class) may have little to do with the welfare of the child, but may please the parents, since the child is given a glowing grade.

Similarly, stories of horrors (suicides, children taken from parents who won’t let the children be drugged, etc.) are moving, but hard to evaluate without knowing how many others are helped by the drug. And in most cases the pharmaceutical companies have pat, almost indisputable answers to any claimed bad side effects, one or more of the following:

1. You can’t prove it was caused by our drug.

2. Of course he killed himself; he was depressed to begin with. That’s why he was taking our drug. He simply came to us too late.

3. He shouldn’t have stopped taking the drug.

4. Yes, there are bad side effects, but they occur in only a tiny percentage of cases.

The last answer is particularly clever, because, though doctors are supposed to report bad side effects they observe, surveys of doctors in recent years have shown that few of them know they are supposed to do this or know how to do it. What the drug companies really mean is “…in only a tiny percentage of cases, so far as we know, based on the few reports we get and based on our eliminating from the statistics any bad effects that we feel can’t be PROVEN to be connected with our drug.” Where people have sued pharmaceutical companies because someone has, for example, taken Prozac, then gone berserk and killed people, the companies nearly always try to settle out of court on the condition that the settlement be kept confidential, then claim that it has not been proven that their product was at fault.

Similarly, where children have shot up their schools, psychiatrists and the pharmaceutical company agents are always on the scene to ensure that the medical records of the shooters are sealed under medical privacy laws, so that it is difficult to ascertain whether the shooters were under psychiatric treatment or on psychiatric drugs. In most cases, we’ve eventually learned that they were, but the information came from relatives or friends. In the case of Eric Harris (the Colorado shooting), we learned about his psychiatric medication (Luvox) from the Army, where he’d tried to enlist.

It is hard, perhaps impossible, to get all the data needed to weigh the anecdotes. It is easier to find statistics on the abuses than on the gains, which is suggestive, since one would think that pharmaceutical companies, earning billions and claiming their drugs are safe and effective, would be able to produce proofs of their long-range effectiveness – long-range since children are expected to take these drugs for years — but no such proofs exist.

The battle of anecdotes is no doubt worth fighting, but here my intention is to get behind the anecdotes to the scientific basics: What is it that psychiatry calls a disorder? How does it determine this? What science is behind this? How are the medications developed? When we debate the effectiveness of Ritalin in treating ADHD, is this analogous to debating whether a particular anti-biotic can subdue a known microbe? Or is it more like debating whether to cure an invasion of evil spirits by throwing pepper over one’s right shoulder or one’s left shoulder. (And my apologies to the witch doctors for this analogy, since studies exist that show they have as high a cure rate as Western psychiatrists and psychologists.)

I simply want to put the debate in the correct perspective: Are we debating about science, and should we defer to people who call themselves scientific authorities and who know much more than most of us know about brain chemistry and symptoms of disorders? If not, let’s find out what it is we’re debating.

A final note: Little in what follows is new or original. Much of it can be found in longer, more detailed works by Thomas Szasz and others. I am trying to simplify and highlight a few key points and make them as clear as I can for as many people as possible.

DSM IV:

DSM IV: that is, edition 4 of the Diagnostic and Statistical Manual — sounds scientific. What is it? It’s a list of conditions, including various supposed types of anxiety, depression, phobia (fear of flying, coffee, colors, women, etc. — over 500 fears), bad handwriting, difficulty with mathematics, too much religious belief, too active, too inactive, angry, upset after pregnancy, upset before or after menstruation, difficulty reading, etc. — thousands of fears, angers, beliefs, emotions, attitudes. It is the Bible of organized psychiatry and the envy of organized psychology.

Each condition is described by a list of symptoms (each such list being a “syndrome”) that one is supposed to use to diagnose the condition. Each condition is said to be a disorder, a lapse of mental health. Statistics accompany these lists that purport to say what percentage of the population of the United States suffers from each disorder. (Someone put the statistics together and concluded that in the United States, many times the number of people there are in the United States suffer from one or more mental disorders.) The statistics are alarming, but shouldn’t be, since they have no scientific basis. They are simply pulled out of a hat. The current figure — if it hasn’t increased as I write — tossed about by the media as being an estimate from the American Psychiatric Association (APA) is that 50,000,000 Americans need psychiatric help. Years ago (in the 50’s), the announced statistics were “one in 25”. A decade later they were “one in 10” and later “one in 3”. The sources of these statistics have never provided evidence for them, nor have the sound-byte-hungry media ever demanded evidence. After all, they are statistics, and they come from the authorities on mental health.

The definitions of the various conditions often overlap. No objective tests for the presence or absence of these conditions is given. Definitions are loose enough and conditions numerous enough that it is possible to find a description that will fit ANYONE. Thus, by use of DSM IV, any person can be found to suffer from a mental health disorder requiring treatment. Any person can be said to be either too active or too inactive, too anxious or too serene, too religious or too cynical — whatever you happen to be is (or may easily be made to seem) a disorder (or dysfunction, a sexier term). There are even disorders that apply to a person who disagrees with the validity of such diagnoses. In other words, if you think the DSM is bunk, you are, per the DSM, mentally ill.

Who compiled this manual? A committee of psychiatrists on behalf of the APA. How did they compile it? By proposing new disorders (the manual expanding greatly with each edition) and voting them into the manual. One member of the committee later vented her disagreement with the process publicly, stating that she was astonished at the lack of scientific discussion and scientific evidence. She said it seemed as though they were voting on whether to order Chinese or Italian for lunch, not creating a standard list of mental illnesses.

The development of this manual from edition to edition has mostly consisted of the creation of new conditions, but where politically expedient, conditions have been removed. For example, early editions included homosexuality, but when this became politically incorrect (and with no scientific justification either for the inclusion or the exclusion), homosexuality was removed from the DSM. Remember those words, “politically expedient”. They answer a lot of questions. If women’s organizations (e.g., NOW) raised enough stink about conditions like Post Menstrual Syndrome being listed as a mental disorder, it would vanish from the next edition — with no new studies to justify the change.

Scientific Basis:

What, then, is the scientific basis for defining these conditions as disorders, diseases, syndromes? To begin with, what constitutes “scientific basis?” Most people confuse “science” with anything scientific sounding. Thus, when medical wisdom called for the bleeding of sick patients to rid them of excess “humors” (a theory in vogue with the very best authorities for centuries), this seemed quite scientific to the general populace, because it was propounded in big words (like “propounded”) by recognized medical authorities, and because it was associated with all sorts of scientific trimmings. For example, to bleed someone, a surgeon had to know where to apply leeches, how the circulatory system worked, etc. Similarly, lobotomies (which cut out or sliced up frontal lobes and made vegetables out of people to cure them of depression) were extremely scientific: It takes surgical knowledge to slice up a brain without instantly killing a body or badly disfiguring it. It takes enough knowledge of the brain to know which slices will leave the motor controls intact (so that one gets a vegetable that can still walk), and so forth. Doesn’t the word “lobotomy” sound more scientific than “torture” or “slicing up brains”? And it’s done by people in white lab coats on operating tables.

In this sense of the word “scientific”, everything to do with psychiatry and DSM IV is thoroughly scientific. The scientific trimmings are gorgeous: Every psychiatrist is an MD, and most can talk persuasively about double-blind studies and chemical imbalances. (Note: “Double-blind study” is one where neither the people dispensing the drugs nor the people receiving the drugs know which are receiving the “real” drug and which are receiving the “fake” drug or placebo. That way the psychiatrist isn’t biased by his knowledge so that he “sees” improvement only in the subjects receiving the “real” drug.)

But the sense of “scientific” we usually mean when we speak of a scientific basis for something is a great deal more than jargon and trimmings. For example, in traditional (that is, non-psychiatric) medicine, a disorder or disease is typically defined as follows: First a set of symptoms is observed repeatedly. Then research is conducted to locate the cause of the symptoms — for example, a germ, a nutritional deficiency, a toxin. Then a remedy is found. Such a set of symptoms is not labeled a “disease” until the various similar sets of symptoms have been linked to a common cause.

Why not? First, because it is dangerous to equate similar symptoms to a single illness, for example, to assume that because two people suffer from headaches, they must both have the same illness. What if one person’s headache derives from a vitamin deficiency, while another’s derives from a brain tumor? The second person may die of his tumor while being treated with vitamins to remedy a non-existent deficiency. The first person may die under the knife (for surgery to remove his non-existent tumor) because his immune system is weakened by the unremedied vitamin deficiency. They have similar symptoms, but until these symptoms are found to be from the same cause, it is dangerous, possibly fatal, to assume that they are the same disease.

The cause is that which, when remedied, eliminates the illness. Medicine defines a condition tentatively, then searches for the cause, then the remedy. Medicine proves out a proposed diagnosis by verifying that every time the symptoms that are supposed to define the condition are present, the identical causes are also present. Thus, if a man has a headache and cramps, since several different causes may lead to these symptoms, the doctor must look for other symptoms to better diagnose the condition. There are, then, objective tests (observable, repeatable, with predictable results) for a medical condition, once it is understood. A person either has the condition or does not. Any treatment of a condition not thus understood is experimental at best. (By that standard, all psychiatric treatments and medications are experimental at best.)

Second, inventing names for “syndromes” in the absence of such understanding creates the illusion that something is known about the cause of the supposed condition when nothing is known, only a list of symptoms. This creates a medical elite exalted by medical jargon, their status having no basis in useful expertise. It substitutes a superstition (Scientism?) for science.

The Scientific approach, then, would be (and I know I’m repeating this ad nauseam, but it’s a key point, if we’re to have scientists, not high priests) to identify a possible illness (set of symptoms), find (by verifiable experiments) a cause, then develop a cure that handles the known cause. A non-scientific approach might be to chant spells over patients, and if one of the patients gets better, use the spell that apparently worked on every patient. Since many conditions are entirely or partly psycho-somatic, this will often work, just as a placebo will often work as well as the “real” medicine. One highly effective treatment is to have Mummy kiss it and make it well. And there are many other non-scientific approaches.

Some are perhaps more scientific than we think. That is, studies not yet done may one day show us the scientific basis of having Mummy kiss it and make it well. (Or the studies may have existed for years but not found publication in professional journals. After all, how would 12-year-educated experts make money if any mother had as much expertise as they?)

Copyright © Dean Blehert

Source: adhd-report.com

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The Rise of the Hegemony known as biologic psychiatry

As a practicing psychiatrist, I have watched with growing dismay and outrage the rise and triumph of the hegemony known as biologic psychiatry. Within the general field of modern psychiatry, biologism now completely dominates the discourse on the causes and treatment of mental illness, and in my view this has been a catastrophe with far-reaching effects on individual patients and the cultural psyche at large. It has occurred to me with forcible irony that psychiatry has quite literally lost its mind, and along with it the minds of the patients they are presumably supposed to care for. Even a cursory glance at any major psychiatric journal is enough to convince me that the field has gone far down the road into a kind of delusion, whose main tenets consist of a particularly pernicious biologic determinism and a pseudo-scientific understanding of human nature and mental illness.

By David Kaiser, M.D. from Psychiatric Times

As a practicing psychiatrist, I have watched with growing dismay and outrage the rise and triumph of the hegemony known as biologic psychiatry. Within the general field of modern psychiatry, biologism now completely dominates the discourse on the causes and treatment of mental illness, and in my view this has been a catastrophe with far-reaching effects on individual patients and the cultural psyche at large. It has occurred to me with forcible irony that psychiatry has quite literally lost its mind, and along with it the minds of the patients they are presumably supposed to care for. Even a cursory glance at any major psychiatric journal is enough to convince me that the field has gone far down the road into a kind of delusion, whose main tenets consist of a particularly pernicious biologic determinism and a pseudo-scientific understanding of human nature and mental illness.

The purpose of this piece is not to attempt a full critique or history of this occurrence, but to merely present some of the glaring problems of this movement, as I believe significant harm is being done to patients under the guise of modern psychiatric treatment. I am a psychiatrist trained in the late 1980s and early 1990s, and I use both psychotherapy and medications in my approach to patients. I state these facts to make it clear that this is not an antipsychiatry tract, and I am speaking from within the field of psychiatry, although I find it increasingly impossible to identify with this profession, for reasons which will become clear below.

Biologic psychiatrists as a whole are unapologetic in their view that they have found the road to the truth, namely that mental illnesses for the most part are genetic in origin and should be treated with biologic manipulations, i.e., psychoactive medications, electroconvulsive treatment (which has made an astounding comeback), and in some cases psychosurgery. Although they admit a role for environmental and social factors, these are usually relegated to a secondary status. Their unquestioning confidence in their biologic paradigms of mental illness is truly staggering.

In my opinion, this modern version of the ideology of biologic/genetic determinism is a powerful force that demands a response. And when I use the word ideology here, I mean it in it’s most pernicious form, i.e., as a discourse and practice of power whose true motivations and sources are hidden to the public and even to the practitioners themselves, and which causes real harm to the patients at the receiving end.

Biologic psychiatry as it exists today is a dogma that urgently needs to be unmasked. One of the surest signs that dogmatists are at work here is that they rarely question or attempt to problemitize their basic assumptions. In fact, they seem blissfully unaware that there is a problem here. They act in seeming unawareness that they are caught up in larger historical and cultural forces that underwrite their entire “scientific” edifice.

These forces include the medicalization of all public discourse on how to live our lives, a growing cultural denial of psychic pain as inherent in living as human beings, the well-known American mixture of ahistoricism and belief in limitless scientific progress, and the growing power of the pharmaceutical and managed care industries. These self-proclaimed visionaries, oblivious to all of this, boast of real scientific progress over what they consider to be the dogma of psychoanalysis, which had up until recently reigned as psychiatry’s premier paradigm.

Now, it is not my intention to defend psychoanalysis, which had its own unfortunate excesses, although I do use psychoanalytic principles in the kind of psychotherapy I do. However, it is quite clear to me that the grandiose claims of biologic psychiatry are wildly overstated, unproved and essentially self-serving. Biologic psychiatry has had its successes, particularly with recent antidepressants like Prozac and newer antipsychotic medications such as Clozaril. Medications can effectively improve depression, relieve severe anxiety, stabilize serious mood swings and lessen psychotic symptoms. These successes are real in that they improve the quality of life of patients who are genuinely suffering. But in reality, i.e., the reality of treating patients, medications have profound limitations. I know that if the only tool I had in treatment was a prescription pad, I would be a poor psychiatrist. The center of treatment will always need to be listening to and speaking with the patients coming to me. This means listening seriously to what they say about their lives and history as a whole, not merely listening for which symptoms might respond to medications. Although it seems astounding that I would have to state this, biologic psychiatrists as a whole really only listen to that portion of the patient’s discourse that corresponds to their biologic paradigms of mental illness. It is the nature of dogma that its practitioners hear only what they want to hear.

So what are the limitations of biologic psychiatry? First of all, medications lessen symptoms, they do not treat mental illness per se. This distinction is crucial. Symptoms by definition are the surface presentation of a deeper process. This is self-evident. However, there has been a vast and largely unacknowledged effort on the part of modern (i.e., biologic) psychiatry to equate symptoms with mental illness.

For example the “illness” major depression is defined by its set of specific symptoms. The underlying “cause” is presumed to be a biologic/genetic disturbance, even though this has never been proven in the case of depression. The errors in logic here are clear. A set of symptoms is given a name such as “major depression,” which defines it as an “illness,” which is then “treated” with a medication, despite the fact that the underlying cause of the symptoms remains completely unknown and essentially untreated. I have seen repeatedly that, for example, in the case of depression, once medications lessen the symptoms, I am still sitting across from a suffering patient who wants to talk about his unhappiness. This process of equating symptoms with illnesses has been repeated with every diagnostic category, culminating in perhaps one of the greatest sophistries psychiatry has pulled off in its illustrious history of sophistries, namely the creation of the Diagnostic and Statistical Manual (currently in its fourth incarnation under the name DSM-IV), the bible of modern psychiatry.

In it are listed all known “mental disorders,” defined individually by their respective symptom lists. Thus mental illnesses are equated with symptoms. The surface is all there is. The perverse beauty of this scheme is that if you take away a patient’s symptoms, the disorder is gone. For those who do serious work with patients, this manual is useless, because for me it is simply irrelevant what name you give to a particular set of symptoms. It is an absolute myth created by modern psychiatry that these “disorders” actually exist as discrete entities that have a cause and treatment. This is essentially a pseudo-scientific enterprise that grew out of modern psychiatry’s desire to emulate modern medical science, despite the very real possibility that psychic pain, because of its existential nature, may always elude the capture of modern medical discourse and practice.

Despite its obvious limitations, the DSM-IV has become the basis for psychiatric training and research. Its proponents claim it is a purely phenomenological document stripped of judgments and prejudices about the causes of mental illness. What in fact it has done is the defining and shaping of a vast industry of research designed to validate the existing diagnostic categories and to find ways to lessen symptoms, which basically has meant biologic research. Virtually all of the major psychiatric journals are now about this, and as such I find them useless to help me deal with real patients. Patients are suffering from far more than symptoms. Symptoms are the signs and clues to direct us to the real issues. If you take away the symptoms too quickly with medications or suggestion, you lose the opportunity to help a patient in a more profound way. As an aside, modern psychiatrists, because they have forgotten or dismissed the real power of transference, vastly underestimate the extent to which symptom reduction is caused by mere suggestion. Not that patients should be left to suffer needlessly from what are often crippling symptoms. Relief from symptoms is a part of treatment. Modern psychiatry would have us believe that this is all treatment should be. Meaning, desire, loss and death are no longer the province of the psychiatrist. In this process patients are reduced to something less than fully human, as they become an abstract collection of symptoms without meaning to be “managed” by technicians called psychiatrists.

This is in the service of medical progress and enlightened scientific thought. The biologic psychiatrist will not make the mistake of imposing their value systems on patients like in the bad old psychoanalytic days. This is, of course, a sham. Modern psychiatry now foists on patients the view that their deepest and most private ills are now medical problems to be managed by physician-psychiatrists who will take away their symptoms and return them to “normal functioning.” This is more than a bit malignant.

One of the dominant discourses that runs through the DSM-IV and modern psychiatry in general is the equating of mental health with “normal” functioning and adaptation. There is a barely concealed strain of a specific form of Utopianism here which blithely announces that our psychic ills are primarily biologic and can be removed from our lives without difficulty, leaving us better adapted and more productive.

What is left completely out, of course, are any notions that our psychic ills are a reflection of cultural pathology. In fact, this new biologic psychiatry can only exist to the extent it can deny not only the truths of psychoanalysis, but also the truths of any serious cultural criticism. It is then no surprise that this psychiatry thrives in this country presently, where such denials are rampant and deeply embedded.

I am constantly amazed by how many patients who come to see me believe or want to believe that their difficulties are biologic and can be relieved by a pill. This is despite the fact that modern psychiatry has yet to convincingly prove the genetic/biologic cause of any single mental illness. However, this does not stop psychiatry from making essentially unproven claims that depression, bipolar illness, anxiety disorders, alcoholism and a host of other disorders are in fact primarily biologic and probably genetic in origin, and that it is only a matter of time until all this is proven. This kind of faith in science and progress is staggering, not to mention naive and perhaps delusional.

As in any dogma, there is no perspective within biologic psychiatry that can effectively question its own motives, basic beliefs and potential blind spots. And thus, as in any dogma, there is no way for the field to curb its own excesses, or to see how it might be acting out certain specific cultural fantasies and wishes. The rise and fall of biologic determinism in a culture likely has complicated and interesting causes, which are beyond the scope of this paper. A few comments will have to suffice.

This is a culture increasingly obsessed with medical science and medical health as a sign of virtue. It is not surprising that our psychic ills would be pulled into this dominant medical discourse, essentially medicalizing our specific forms of psychic pain. It seems to me that modern psychiatry, in step with a culture which created it, assumes any suffering to be unequivocally bad, an impediment to the “good life” of progress, productivity and progress. It is now almost heresy in psychiatry to say that perhaps suffering can teach us something, deepen our experience, or point us to different possibilities.

Now, if you are depressed or anxious, it has no real meaning, because as a biologic illness similar to say diabetes, it is separate from the world of meaning and merely is. Now any thoughtful person knows that something as fundamental as depression has meanings such as loss, facing mortality, unlived desires, lack of power or control, etc., and that these meanings will continue to exist even if Prozac makes us feel better. There is much more to life than feeling better or living without pain, and only a superficial and pathologic culture would need to deny this. Yet conclusions such as “depression is a chemical imbalance” are created out of nothing more than semantics and the wishful thinking of scientist/psychiatrists and a public who will believe anything now that has the stamp of approval of medical science.

It seems to me that modern psychiatry is acting out a cultural fantasy having to do with the wish for an omniscient authority who, armed with modern science, will magically take away the suffering and pain inherent in existing as human beings, and that rather than refusing this projection (which psychoanalysts were better able to do), modern psychiatry has embraced the role wholeheartedly, reveling in its new-found power and cultural legitimacy.

I would be remiss if I left out the obvious economic factors in psychiatry’s movement toward the biologic. Pharmaceutical corporations now contribute heavily to psychiatric research and are increasingly present and a part of psychiatric academic conferences. There has been little resistance in the field to this, with the exception of occasional token protest, despite its obvious corrosive and corrupting effects.

It is as if psychiatry, long marginalized by science and the rest of medicine because of its “soft” quality, is now rejoicing in its new found legitimacy, and thus does not have the will to resist its own degradation. The fact that drug companies embrace and fund this new psychiatry is cause enough for alarm. Equally telling is a similar embrace by the managed care industry, which obviously likes its quick-fix approach and simplistic approach to complicated clinical problems.

When I talk to a managed care representative about the care of one of my patients, they invariably want to know what medications I am using and little else, and there is often an implication that I am not medicating aggressively enough. There is now a growing cottage industry within psychiatry in advocating ways to work with managed care, despite the obvious fact that managed care has little interest in quality care and realistic treatment approaches to real patients. This financial pressure by managed care contributes added pressure for psychiatry to go down a biologic road and to avoid more realistic treatment approaches.

What this means in real terms is that psychotherapy is left out. There has thus been a triple partnership created between this new psychiatry, drug companies and managed care, each part supporting and reinforcing the other in the pursuit of profits and legitimacy. What this means to the patients caught in this squeeze is that they are increasingly overmedicated, denied access to psychotherapy and diagnosed with fictitious disorders, leaving them probably worse off in the long run.

It is quite depressing to listen to the discourse of modern psychiatry. In fact, it has become embarrassing to me. One gets the strong impression that patients have become abstractions, black boxes of biologic symptoms, disconnected from the narratives of their current and past lives. This pseudo-scientific discourse is shot through with insecurity and pretension, creating the illusion of objectivity, an inevitable march of progress beyond the hopeless subjectivity of psychoanalysis. Psychotherapy is dismissed and relegated to nonmedical therapists.

I actually have no objections to real science in the field, if, for example, it can help me make better medication decisions or develop newer and better medications. But in general biologic psychiatry has not delivered on its grandiose and utopian claims, as today’s collection of medications are woefully inadequate to address the complicated clinical issues that come before me every day. This is all not terribly surprising given what I have outlined in this piece. There will be no substitute for the difficult work of engaging with patients at the level of their lived experience, of helping patients piece together meaning and understanding in the place of their pain, fragmentation and confusion.

Patients these days are not suffering from “biologic illnesses.” What I generally see is patients suffering from current or past violence, traumatic loss, loss of power or control over their lives and the effects of cultural fragmentation, isolation and impoverishment that are specific to this culture at this time. How this manifests in any individual is absolutely specific; therefore, one should resist any attempt to generalize or classify, as science forces us to do. Once you go down the route of generalization, you have ceased listening to the patient and the richness of their lived experience.

Unfortunately what I also see these days are the casualties of this new biologic psychiatry, as patients often come to me with many years of past treatment. Patients having been diagnosed with “chemical imbalances” despite the fact that no test exists to support such a claim, and that there is no real conception of what a correct chemical balance would look like. Patients with years of medication trials which have done nothing except reify in them an identity as a chronic patient with a bad brain. This identification as a biologically-impaired patient is one of the most destructive effects of biologic psychiatry.

Modern psychiatrists seem unaware of what psychoanalysts know well, namely how powerful are the words that a patient hears from an authority figure like a psychiatrist. The opportunity here for suggestion, coercion and manipulation are quite real. Patients are often looking to psychiatrists for answers and definitions as they struggle with questions such as who am I or what is happening to me. Of course we all struggle with these questions, and the human condition is such that there are no definitive answers, and anyone who comes along claiming they have answers is essentially a fraud.

Biologic psychiatry promises easy answers to a public hungry for them. To give a patient nothing but a diagnosis and a pill demonstrates arrogance, laziness and bad faith on the part of the psychiatrist. Any psychiatrist needs to be continually aware of the very real possibility that they are or can easily become agents of social control and coercion.

The way to resist this is to refuse to take on the role assigned through cultural fantasy, namely the role of omniscient dispenser of magical potions. As a whole modern biologic psychiatry has enacted this role with particular vigor and enthusiasm. At the level of individual patients this means a growing number of overdiagnosed, overmedicated and disarticulated people less able to define and control their own identities and lives. At the level of our culture this has meant an impoverishment of the discourse around such questions as what is wrong with us, as “scientific” answers replace more potentially fruitful and truthful psychological and cultural questioning. If psychiatry is to regain any semblance of legitimacy and integrity, it must strip itself of false and hubristic scientific claims and humbly submit itself to the urgent task of listening to individual patients with patience and intelligence. Only then can we have any real sense of what to say back to them.

The sole philosophic basis for this new psychiatry is the championing of empiricism above all other measures of truth. Something is valid only if it can be demonstrated through experimental method, otherwise it is disregarded or relegated to “subjective” experience, which is presumed to be inferior. Now, of course, this dominance of empiricism is not limited to psychiatry, and one can easily trace the invasion of the experimental method of the “hard” sciences into the “soft” or social sciences.

On a larger cultural level this can be detected in the public’s infatuation with “studies,” statistics and so on. This hegemony of empiricism over other ways of thinking and knowing represents an unprecedented modern achievement which has thoroughly infiltrated the cultural psyche, to the point now where the average person believes easily the claims of the biologic psychiatrist.

Now as is clear from my views already expressed, a social science dominated by empiricism is a vulgar science, and there is a vast tradition in philosophy from Plato to Nietzsche which in my view irrefutably demonstrates this. However this is well beyond the scope of this piece. Suffice it to say that modern psychiatrists, like all “scientists” these days, have no time for the basic philosophic questions that have engaged the most brilliant minds of the past. Who needs questions about virtue when there is important data to collect? These biologic psychiatrists never think to ask themselves whether their own precious methods are perhaps standing on very shaky ground, say their own disavowed prejudices about what constitutes the good life.

Empiricism is one way of knowing, but certainly not the only or best way. Biologic psychiatrists often use the standards of empiricism to answer their critics, in effect saying that their claims are scientifically “proven” and thus unassailable, clearly a tautological argument. I would further add that in my view many of the claims of biologic psychiatry do not even hold up to their own standards of empirical science, for example their claims about the biologic and genetic basis of many mental illnesses.

In my view, the methods of experimental science are inappropriate and misplaced when it comes to understanding the complexity of the human psyche, as they can only objectify the mind and remove subjectivity from the heart of human experience, thus creating an abstract entity in place of a human mind. It is no wonder that psychiatry declared the 1980s the decade of the brain instead of the decade of the mind. In their pursuit of the human brain they have quite literally lost their minds.

One way to unmask the dogma that is biologic psychiatry is to ask the question what kind of human being is being posited as desirable, “normal,” or not disordered. Judging by the DSM-IV, it would be a person not depressed or anxious, without perversions or sexual “dysfunction,” in touch with “reality,” not alienated from society, adapted to their work, not prone to excessive feeling states and generally productive in their life pursuits. This is, of course, the bourgeois ideal of modern culture. We will all fit in, produce and consume and be happy about it. Anyone who dissents by choice or nature slips into the realm of the disordered or pathologic, is then located as such by medical science and is then subject to social management and control.

Now, psychiatry has always provided this social function, as admirably shown by Foucault and others. I would submit, however, that modern psychiatry, under the guise of medical and “scientific” authority and legitimacy, has surpassed all past attempts by psychiatry to identify and control dissent and individual difference. It has done this by infiltrating the cultural psyche, a psyche already vulnerable to any kind of medical discourse, to the point where it is a generally accepted cultural notion now that, say, depression is an illness caused by a chemical imbalance.

Now when a person becomes depressed, for example, they are less able to read it or interpret it as a sign that there may be a problem in their life that needs to be looked at or addressed. They are less able to question their life choices, or question for example the institutions that surround them. They are less able to fashion their own personal or cultural critique which could potentially lead them to more fruitful directions. Instead they identify themselves as ill and submit to the correction of a psychiatrist, who promises to take away the depression so they can get back to their lives as they are. In short, the very meanings of unhappiness are being redefined as illness. In my view this is a dismaying cultural catastrophe. I do not mean to suggest that psychiatry is solely to blame for this, given how wide a cultural shift this is. However, I do think that psychiatry has not only not resisted its role here, but actually has fulfilled it with considerable hubris.

Thus in my view the whole phenomenon of biologic psychiatry is itself a symptom or acting out of a larger, underlying cultural process. Unhappiness and suffering are not seen as resulting from real cultural conditions; for example, the collapse of traditional institutions and the ever increasing hegemony of rampant consumerism in American culture.

Nor is suffering seen in the context of what it means to exist as a human being in any historical period. Historical and existential discourse about unhappiness is increasingly supplanted by medical discourse, and biologic psychiatry has served as one of the major mouthpieces for this kind of pseudo-scientific and frankly pathetic medical discourse about what ails us.

I am increasingly astonished about how unable the average patient is now to articulate reasons for their unhappiness, and how readily they will accept a “medical” diagnosis and solution if given one by a narrow-minded psychiatrist. This is a cultural pathologic dependence on medical authority. Granted, there are patients who do fight this kind of definition and continue to search for better explanations for themselves which are less infantilizing, but in my experience this is not common. There is a frightening choking off of the possibility for dissent and creative questioning here, a silencing of very basic questions such as “what is this pain?” or “what is my purpose?” Modern psychiatry has unconscionably participated in this pathology for its own gain and power. It is a moral, not scientific issue at stake here, and in my view this is why many astute Americans rightfully distrust this new psychiatry and its Utopian claims about happiness through medical progress.

So what kind of psychiatry am I advocating here? First of all, I think it is unclear whether the field can extricate itself from its current infatuation with technology and its own power to use it. When one reads psychiatric journals now, one senses a dangerous giddiness about the field’s “discoveries” and “progress,” which in my view are wildly and irresponsibly overstated. All the momentum, which is mainly economically driven, is pushing psychiatry toward further biologism.

Having said this, what I am advocating is a psychiatry which devotes itself humbly to the task of listening to patients in a way that other medical practitioners cannot. This means paying close attention to a patient’s current and past narrative without attempting to control, manipulate or define it. From this position a psychiatrist can then assist the patient in raising relevant questions about their lives and pain.

The temptation to provide answers or false solutions should be absolutely avoided here. Medications are used judiciously for lowering painful symptoms, with considerable attention paid to the psychological effects of medication treatment. Diagnosis should play a secondary and small role here, given that little is known about what these diagnoses actually mean. Above all suggestion, coercion, normalization and control need to be assiduously guarded against, as these are natural temptations that arise out of the dynamics of power that exist between psychiatrist and patient.

A more humane psychiatry, if it is even possible in today’s cultural climate, must recognize the powerful potential of the uses and abuses of power if it is not to become a tool of social control and normalization. As I have outlined in this piece, these abuses of power are by no means always obvious and self-evident, and their recognition requires rigorous thought and self-examination. The psychiatrist plays a particular role in cultural and individual fantasies, and an intelligent psychiatrist must be aware of the complexity of these fantasies if he is to act in a position outside these projections and fantasies. This requires real moral awareness on the part of a psychiatrist who wishes to act intelligently. What I am advocating for in outline form as stated previously are the minimal requirements necessary for the field of psychiatry to reverse its current degradation. What is essential at this time is for psychiatrists and other clinicians to speak out against the ideology known as biologic psychiatry.

Dr. Kaiser is in private practice in Chicago, and is affiliated with Northwestern University Hospital

 

 

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Psychiatry – Making a Killing

Source: Truthfultv on YouTube.com


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