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Posts Tagged ‘mental health’

Humane Psychiatry – Dr. Dan L. Edmunds

Life Coach, and author, A.J. Mahari, interviewed Dr. Dan L. Edmunds on the Psyche Whisperer Radio Show Monday August 30 at 7pm EST. Biopsychiatry violates the first oath and ethic of medicine for all doctors, including psychiatrists, “first do no harm”. Dr. Dan L. Edmunds views biopsychiatry as “supposed treatment” and doesn’t believe in the common pratice of using toxic psychiatric drugs and especially when it come to children who are then made life-time psychiatric patients. He maintains it is cheaper to “treat” with drugs rather than actually address the reasons for patient’s distress. He believes that science and ethics must become consistent and that the entire mental health system needs to be deconstructed. The medical model needs to replaced with a model of compassion. Maybe then, we can have a humane system wherein abused of the past and current abuses could become things of the past.

This episode is now available below

Listen to internet radio with Psyche Whisperer AJ on Blog Talk Radio

 

Dr. Dan L. Edmunds

Professor Dr. Dan L. Edmunds is a radical psychotherapist, a friend and advocate of psychiatric survivors, and a critic of the mental health establishment.

Dr. Edmunds is a voice for the marginalized and for the many who lack a voice within the psychiatric system. A person of deep compassion and principle, Dr. Edmunds is a noted psychotherapist, child development/behavioral specialist, Comparative Religion scholar, sociologist and counselor working with both children and adults.

Dr. Edmunds speaks truthfully and directly and has posed critical questions to the psychiatric establishment and to society as a whole. He has developed approaches towards helping distressed individuals that are compassionate and empowering and encourage self-determination and autonomy. He has been an advocate for social justice, informed consent, and for human rights in the mental health system.

Dr. Edmunds has become deeply concerned with the medicalization of human experience and how mental health services have often become ‘mechanical’, not seeking to truly be caring and empathic, limiting consumer choice, and often not providing informed consent. He has sought for care that is recognizes people’s experience and treats them as people, care that is holistic,which recognizes the mind-body-spirit connection, and which takes into account issues of social injustice and how they impact our emotional well being and often shape our possibilities and who we become. Dr. Edmunds has challenged the mental health system establishment to respect persons experience and once again a common healing ground betwen the therapist and client. His writings have often focused on the need for building of community, holistic approaches, and the role of the family as well as social and political processes that lead towards emotional distress. He has challenged stigmatizing labels and exposed the violence that is often inflicted upon individuals by those who claim to be in the role of ‘helper’. He encouraged a mental health system which does not force people into treatments that they do not want, which respects their dignity, and which allows their experience to be heard and validated.

Dr. Dan L. Edmunds has a blog at: danledmunds.blogspot.com

Dr. Dan L. Edmunds is the author of the following books available at: His Site Storefront and more books at his Lulu.com Storefront

DRUG FREE APPROACH TO ADHD – COMPREHENSIVE STUDY DRUG FREE APPROACH TO ADHD- COMPREHENSIVE STUDY – Study of the efficacy of a drug free approach to ADHD

 

 

 

 

 

 

POST PSYCHIATRY JOURNAL – Center for Meaning and Relationship POST PSYCHIATRY JOURNAL – Center for Meaning and Relationship. A compilation of articles from mental health professionals and psychiatric survivors challenging the bio-psychiatric paradigm.

 

 

 

 

 

CHILDREN OUR TREASURE: Meeting Our Children’s True Needs Outside of the Bio-Psychiatric Paradigm CHILDREN OUR TREASURE: Meeting Our Children’s True Needs Outside of the Bio-Psychiatric Paradigm (book) – History of psychiatry, exploring psychiatric human rights abuses and the impact of psychiatry on children. Offers way to create a more humane mental health system.

 

 

 

EXPERIENCE: THE SOUL OF THERAPY EXPERIENCE: THE SOUL OF THERAPY – Exploring the the importance of experience in the therapeutic process.

Dr. Edmunds has been interviewed on local and nationally syndicated radio programs in regards to these important issues.

Dr. Edmunds was born in Tampa, Florida and spent much of adolescent years in Fort Collins, Colorado where he graduated from Fort Collins High School. From his youth, he became active in community and civic affairs and social and political change. Dr. Edmunds seeks for a society that places people before profits and treats all with compassion and equanimity. He served as a director of the Students for Peace and Justice and was involved in various political campaigns as a teen. In 1991, he served as the youngest legislative aide in the Colorado State Senate, serving in the office of State Senator (later U.S. Representative) Robert W. Schaffer. He later became the youngest registered professional lobbyist, being registered in the States of Colorado, Wyoming, and Arizona. He was a volunteer for the Larimer County, Colorado Office of Veterans Affairs. In 1992, he obtained the permission of then Mayor Nicholas Fortunato to develop the Ormond Beach, Florida Youth Commission. He served as a county campaign coordinator for U.S. Representative Corrine Brown’s campaign in 1992. This accorded him the opportunity to transport Martin Luther King III, the son of the slain civil rights leader, to an event at Bethune Cookman College and exposed him to diversity, civil rights, and social justice concerns. As a public intellectual and left libertarian, Dr. Edmunds continues to remain active in political and civic affairs and encouraging a society that is based on equality, peace, and justice. In 2008, Dr. Edmunds organized the Humanist Center for Freethought and Social Activism in order to encourage an end to oppression, ecological responsibility, freedom, equality, and respect for diversity.

Dr. Edmunds is on the Board of Advisors for the Society for Laingian Studies. The Society for Laingian Studies is directed by Dr. Brent Potter and includes advisors who had direct collaboration with Dr. R.D. Laing such as Andrew Feldmar and Theodore Itten. The Society for Laingian Studies seeks to further the humane approaches towards understanding and helping distressed persons that was begun by Dr. R.D. Laing. Society for Laingian Studies

Dr. Dan L. Edmunds, Ed.D.,B.C.S.A.
Tunkhannock, Pennsylvania, USA
DoctorEdmunds@DrDanEdmunds.com

PSYCHOTHERAPY FOR CHILDREN, TEENS, AND ADULTS ***DRUG FREE RELATIONAL APPROACHES TO ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)***CONSULTATION AND ASSISTANCE FOR EXTREME STATES OF MIND (SCHIZOPHRENIA, SCHIZOAFFECTIVE, BIPOLAR)***ASSISTANCE WITH POST TRAUMATIC STRESS***AUTISM/DEVELOPMENTAL DIFFERENCES SERVICES***LECTURES/SEMINARS AND WORKSHOPS FOR SCHOOLS AND PARENT ORGANIZATIONS***PSYCHO-SOCIAL ASSESSMENTS***FUNCTIONAL BEHAVIORAL ASSESSMENTS***FORENSIC ASSESSMENTS***FAMILY THERAPY/MARITAL COUNSELING

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Notes on a critique of biological psychiatry by Dr. Niall McLaren

Introduction: Throughout the world today, the dominant approach to mental disorder is what is known as the biological model. This says simply that all forms of mental disorder are, at base, physical disorders of the brain. It does not identify mental disorder – that is determined by the individual society – but it claims to be able to explain all cases of mental disorder as a matter of disturbed brain function. As such, it is an example of what is called physical reductionism, the philosophical system that says that all complex matters can be explained in terms of the subsystems that make them up. In biology, reductionism says that the complex behavior of a large organism can only be understood in terms of understanding the cells that make up the organism. In turn, the functions of a cell can be reduced to matters of biochemistry. Therefore, the correct approach to mental behavior is to analyze it in terms of the cells of the brain, known as neurons. Since, it is claimed, disturbed behavior is always and only due to disturbances of neuronal function, treatment of mental disorder will consist of interventions at the chemical level, meaning using drugs and occasionally physical treatment such as ECT, magnetic stimulation or even brain surgery. Modern psychiatry does not consider there may be other explanations of mental disorder.

 There are, however, many people in the world who are not happy with this idea. It is possible to object to the biological model in psychiatry on a number of grounds:

1. The first and most obvious objection is to deny that mental disorder exists. This is most commonly identified with the Hungarian-born American psychiatrist, Thomas Szasz. Over some sixty years, he has taken a rigid and uncompromising line that there is no such thing as mental disorder, that it is an artificial construct which is of no value to the individuals, even if it helps society (by getting rid of nuisances) and enriches the various mental health professions. However, denial is very much a product of the twentieth century.

2. The oldest objection would be the ancient view that mental disorder has religious significance. People who act strangely are not sick in any accepted sense of the word but are undergoing some sort of supernatural experience which should either be allowed to take its course or should be treated within a strictly religious framework. Disturbed people may be seen as victims of possession by evil spirits, so that treatment would therefore consist of exorcism by qualified practitioners. They may be seen as victims of evil magic of some sort, which can only be countered by correctional incantations and so on. Finally, the experience itself may be seen as a beneficial experience or spiritual journey for the individual, who is encouraged and assisted in the passage for the knowledge the experience may yield. If the altered state continues, the person may even be granted a special status in the society as a person (shaman) who can communicate with or intervene on behalf of supernatural powers in ways that are not open to ordinary members of the community.

In modern Western society, there are only one or two minor groups taking an extreme religious view. Others include the less-defined but still large group of people who see dissatisfaction or unhappiness as a matter of imbalance between the individual and some sort of cosmic ideal, or what are often called New-Age practitioners, even if there is nothing new about it. On the other hand, orthodox Abrahamic religions do not normally encourage religious objections to biological psychiatric treatment, but tend to support it. This is possibly because they see the soul as the direct product of the divinity, meaning that if anything goes wrong in mental life, it cannot be a fault within the soul itself as that would mean the divinity had created a faulty soul. They have no problem with the idea that, if anything disturbs mental life, it must be in the body, because bodies are very faulty. By this means, they can allow people who claim to be the son of god to be treated humanely because otherwise, they would have to be punished.

3. It is possible to object to biological psychiatry on what are called esthetic or moral grounds, the notion that it isn’t fair or decent to lock people in secure buildings and force them to take unpleasant drugs against their will. Essentially, this is a human-centered approach which does not appeal to a divine authority or any force stronger than the question: “How would you feel if this were done to you or your wife/son/mother?” It says that humans are not just cattle but have feelings which have to be taken into account and not crushed underfoot for bureaucratic convenience. The moment words like decent, reasonable, considerate or humane are used, then they are appealing to our esthetic sense of what ought to be done to humans just because they are creatures with feelings. It is, of course, very difficult for these people to argue against the idea that cattle can be treated like cattle just because they aren’t humans, and most of them would not try. Fairness and decency, they would say, are universals which cannot be applied arbitrarily. 

4. People can object to biological psychiatry on the rational basis that any claim about mental disorder being a chemical imbalance of the brain is not a scientific statement because it ignores the notion that humans are creatures with a private but crucial mental life. The psychological model says that mental disorder is a feeling state induced by intrapsychic disturbances in the mind, not chemical disturbances in the brain, and chemistry is therefore only of marginal significance in psychiatric disorders. These days, the analogy that is used is that most problems with computers are not in the hardware but are in the software. Therefore, they would say, the correct form of treatment is not to suppress mental symptoms with drugs because they are important pointers to the actual intrapsychic problems to be rectified, and treatment can only be done via psychological means, essentially talking and learning. Talking and learning are not effective if the distressed person is heavily sedated.

5. More recently, people have been taking objection to the usual methods of biological psychiatry, meaning involuntary institutional psychiatry, on the basis that it breaches the individual’s human rights. This doesn’t say anything about how the mental disorder arises but says that, in a given legal framework, certain activities are illegal and cannot be carried out without the patient’s informed consent. This doesn’t actually prohibit biological psychiatry but places major restrictions on it and forces it to adhere to a particular standard of treatment. The same standard will also apply to psychological or religious treatment, so that disordered people cannot be forced to participate in, say, rebirthing rituals or exorcisms if they don’t like them.

6. Finally, and most recent of all, there are rational-logical objections to biological psychiatry. This is my particular field and it attacks the central notions of biological psychiatry, i.e. that mental disorder can be reduced to a special case of brain disorder. This is not popular among orthodox psychiatrists because one of their strongest arguments has always been: “Ah yes, but we have the science. We have the actual facts about mental disorder and not just silly sentimentalists.” By a lengthy process of analysis of all the claims on which biological psychiatry can logically be based, I have concluded that, in fact, they don’t have the science. I have shown that the central claims of biological psychiatry are false, that it doesn’t make any sense at all when it is examined closely and that it is pure ideology, in the bad sense of the word. My case is based in the philosophy of science, meaning that I use only the same standards of science as are used in all other fields of investigation, and biological psychiatry fails the lot. It is rational in the sense that it takes the predetermined rules of what constitutes a science and applies them uniformly with no favoritism. It is logical in the sense that it dismantles the superstructure of biological psychiatry (all the claims about this drug being better than that, or this group of patients doing better than that, and so on) and looks only at the fundamental claims of the actual model of mental disorder. Of course, it finds that there isn’t one.

Biological psychiatry, which wanted so much to be part of orthodox clinical medicine, is the only medical specialty that doesn’t have a formal, articulated model of pathology (in this case, mental disorder) to guide its daily practice, its teaching and its research. The vast output of the huge academic-pharmaceutical-bureaucratic industry dedicated to finding and treating “chemical imbalances of the brain” is a gigantic exercise in pseudo-science. It is no longer irrational to challenge the scientific basis of modern psychiatry.

Conclusion: Objections to biological psychiatry are valid. This is partly because anybody is allowed to object to any part of western science, because criticism is an essential part of the scientific tradition. If there is no institutionalized criticism, then there can be no scientific progress. It is valid partly because no one group can monopolize the thought processes of a civilization (diversity breeds progress) and also because modern western science makes no claims about mental life qua sentience. Western materialist science cannot handle mentality, so it tries to get it out of the equation.

Any person who sees a psychiatrist is entitled to ask this question: “What is the name of the model of mental disorder you use to guide your daily practice, your teaching and your research? Please give me three seminal references where it is set out as a series of axiomatic propositions which can be tested against the canons of science and which have direct predictive value.” All you will ever get is a frustrated stare, followed by a quick exit.

© Dr. Niall McLaren for biopsychiatry.ca – All rights reserved.

Dr. Niall McLaren is a psychiatrist who lives and works in Australia. He is the author the following books:

 

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Need Some Help? How to Choose a Counselor

Are you needing some professional help or guidance? Are you feeling stressed out? Perhaps you have been diagnosed with a mental illness and what does that mean?

Before you assume you know or that the diagnosing psychiatrist knows or  has your best interests in mind in an ethical way you will benefit from reading this essay by Dr. John Breeding who is a psychologist in practice in Texas.

Biopsychiatry, fronting for the pharmaceutical industry is marketing pseudo-science to you under the guise of it being treatment. Under the guise of being “treatment” that will help you. Before you get caught up in the medication nightmare of biopsychiatry do your homework and research what’s really going on behind the marketing message of “studies” that are “proving” things claimed without actually having proven anything. Advocate for yourself and for your rights as a mental health consumer. Too many people believe the first thing they hear that they think they need and that they think will help them get better, feel better, find their way to wellness. The reality is that, more often than not, that first message you hear may well be the big marketing machine of big pharma that has biopsychiatry as its main advocate and messenger. Marketing, advocates, and messengers that are well paid by pharmaceutical companies. Many mental health professionals, mainly, psychiatrists – biopsychiatrists are not only well-paid in various ways by pharmaceutical compaines raising questions about their lack of ethics but they are also paid spokespeople for one or in many cases multiple drug manufactures.

© A.J. Mahari, August 16, 2010 – All rights reserved.

 

I am often asked for advice on how to choose a counselor. This essay is one response.

 A Note on Language

I prefer the word counselor over therapist because therapist comes from therapy, which is presumably a treatment for some form of illness. As the concept of mental illness is so fraught with problems, I think counselor is a better choice. As a second note, let me briefly mention that this is a specific instance of a general problem with the use of language in psychology and psychiatry. Thomas Szasz is the master when it comes to decoding this language, and I highly recommend that everyone spend some time reading his work (www.szasz.com ); as he puts it, “Although linguistic clarification is valuable for individuals who want to think clearly, it is not useful for people whose social institutions rest on the unexamined, literal use of language” (1993, p. 1). As a quick example, consider that civil commitment really means incarceration of a citizen who has not been charged with a crime. In any event, the hard work of rehabilitating one’s language is an absolute prerequisite in gaining clarity about the so-called mental health field.

This essay includes two main sections. Part 1 addresses some of the basics that come to mind in choosing a counselor. Part 2 goes into issues of structure that are vital to understand in thinking about our mental health system.

Part I  The Basics

 

Two Initial Recommendations

My first thought about choosing a counselor is related to the above point about language. It is necessary to educate yourself. Given all the propaganda and false data, there is absolutely no substitute for intense research and investigation, most definitely outside the mainstream channels of “expert” authority on “mental health,” to approach the truth.

My second recommendation is very simple. Word of mouth, from trusted sources, is the best referral. If not immediately available, effort at finding trustworthy allies, is well-spent.

The Counselor’s Own Work

The huge and vital question in choosing support has to do with the personal experience of the counselor. One teacher of mine uses the term “body pilot,” but however you say it, the point is that the best counselors are those who have done and are doing their own personal work. “Talking heads” who have not faced and taken responsibility for their own distresses and challenges, and moved into the realm of body and emotion, are often seriously limited in their ability to remain intelligent and at ease in the face of client distress. Counselors need to be authentic, which means being open and aware of their own inner dynamics. This sometimes means navigating challenges in the relationship between counselor and client, and greater awareness helps enormously. It also means that counselors who have done a lot of their own work tend to have more space or “slack,” and are able to be in that wonderful state of relaxed confidence even in the face of intense grief or terror—this helps enormously! In the biopsychiatric climate of today’s system, when the going gets hard, it is all too easy to turn to drugs and coercion out of fear and doubt. So it is fine to ask a counselor about their own personal work, as well as their work experience. It is also important to take note of their attitude and how it feels to you. Does the counselor appear at ease? Is she confident in your process? Does he seem to someone you can trust?

Perspective on a Good Life

It helps a lot to put counseling in perspective. There is plenty of theory and jargon that can make counseling sound like some kind of elaborate technical “therapy” that requires a specialized degree to understand and “practice.” I think this tends to create a problematic expert dynamic that can undermine a client’s power and responsibility, and distort a counselor’s simple humanity. I like the Re-evaluation Counseling (www.rc.org) teaching that professional counseling is really just more of a one-way expression of what we naturally do in life; talking and listening to each other helps enormously in releasing and processing distress.

Life is big and challenging. Our society is very highly distressed; there are massive social and economic justice issues that make it hard for all of us and virtually impossible for many to have a good life. Most of this is not a counseling issue. Most of our life stresses and difficulties are not because of our flawed psyches. There is no point of nirvana or enlightenment or, heaven forbid, mental health, where all the upsets are gone and melancholy, grief, fear, anger, and challenges of love and work no longer exist. My point is that a counselor who interprets everything as your personal issue, especially one who pathologizes, is immature and unaware, and may be dangerous. I am not saying that personal work makes no sense. I am a professional counselor; I think sometimes it can be helpful. But it can be not only an imaginary panacea, but also a distraction and avoidance of facing the reality of life head on. A key aspect of psychiatric oppression is that a mental illness perspective both blames the victim and distracts all of us from taking on social and economic justice issues for the common good.

On a personal level, counseling can also enable avoidance of the challenging, but rewarding task of figuring out and moving forward with creating a good life for ourselves—authentic self-care and self-discovery, deep and rewarding relationships, meaningful study and purposeful work that contributes to the common good.  It is probably wiser to look more to people like Scott and Helen Nearing (www.goodlife.org) for inspiration and guidance on how to live a good life, than to someone who sits in an office all day talking to people!

 

The Heroic Client

Barry Duncan and Scott Miller wrote the book, The Heroic Client, and have devoted a lot of their professional energy to the removal of the counselor from center hero stage, and the proper placement of client as the hero of his or her own life, including counseling. They summarize the counseling outcome research, showing four factors of change that contribute to a positive outcome. The first and most significant are client factors, which are “extratherapeutic,” meaning they operate independently of the counseling relationship. 40% of improvement during counseling is due to client factors such as persistence, openness, a supportive grandfather, or getting a new job. As the authors put it, “neither guru therapists nor their carefully acquired silver bullets are the defining factors of change” (2000, p. 57).

The next most significant change factor, accounting for 30% of the difference in outcomes, is the relationship, as rated by the client. The alliance between counselor and client is more predictive that diagnosis or counseling method or “therapist” or anything else—not the theory or method, but the relationship. One thing this means is that the counselor accepts client goals without reformulating them to a pet theory, and that the counseling is guided accordingly.

The third factor, expectancy and placebo accounts for about 15% of the outcomes. This is about confidence and hope, and a client’s perception of the credibility of the counselor and her approach.

Last, again contributing to 15% of change, are the model and technique factors. These are the unique beliefs and practices of specific counseling theories. So the theory and techniques play a role, but a relatively minor one. It is much more important to be flexible and adjust according to the client’s goals, and to what works, than to cling to a set method. Good counseling is not about models or the perfect counselor. People go through stuff in life, their life, and can sometimes use a counselor’s support.

Counselor Policy

When it comes to the nitty gritty, a good idea is to go ahead and get basic policy parameters. Where do they work? How long is a session? What do they charge? Is there any flexibility in time and money? That kind of thing. Then there is the actual counseling.

Views on Counseling

Once put into perspective, the actuality of counseling is quite simple. It is something that we do naturally. We are born to cry when hurt or sad, and to tantrum when upset or frustrated. And we are oriented to listen and respond supportively to our crying babies. We talk and listen with our friends and family as we vent our daily challenges and upsets. We even have built-in ways of discharging and working through trauma. This is counseling, and one grassroots group (www.rc.org) has created a community of re-evaluation counselors to support and encourage this process among peers. In any event, I think professional counseling may be helpfully seen as a one-way version of this natural co-counseling process of exchange by talking and listening. The RC theory is very simple. The starting assumption is that wee humans are inherently intelligent, zestful and loving. When we are physically or emotionally hurt, however, we experience distress that interferes with our thinking and relating, and we tend to think less well and get a bit mean-spirited, unkind or withdrawn. The good news is that we have a built-in way of restoring ourselves, and that is by expressing our thoughts and emotions—crying, storming in anger and shaking with fear are some of the ways we naturally release or discharge distress. A good counselor is someone who allows, supports and encourages this process. So expression is huge, and “falling apart” is alright.

As Janet Foner, Mental Health Liberation Reference Person for the RC community put it:

There is no such thing as “going crazy.”

You can’t “lose your mind.”

What is “mental illness” really? It’s a very long “session” seeking discharge or having lots of discharge, without a counselor.  

Consider putting to rest the notion of needing an expert, and be choosy if you decide to use a professional. There are good ones out there, and I list a few resources in the reference section.

RC is one basic, simple theory that I find valuable, but there are many theories of counseling. Other favorites of mine include Arny Mindell’s process work (www.aamindell.net), and certain experiential psychodynamic and transpersonal approaches. What they have in common for me is trust in a natural process of growth, recovery and re-emergence for people. As noted earlier, the evidence suggests that a particular theory is not the key to positive results.

A good counselor is someone who sees you as an individual and who trusts and supports and respects your goals, your intentions, your process. A good counselor does not presume to know what is best for you. They convey an attitude of relaxed confidence, but are authentic when something else comes up. They are not afraid or shy about supporting you to confront distress, but they are not desperate or urgent about it. They ask permission, they may make suggestions, mostly they try to support and encourage your natural process of self-discovery and recovery. They stand guard and provide safety while you can let down your guard and dive into your process.

Good counselors try to be fully present and authentic. It is not the counselor’s session to work on his or her stuff, but it is a relational experience and so I think it is important for a counselor to be real and not too rigidly bound in an “expert professional” role. Trust your experience on this; talk about it with your counselor as seems right for you, but don’t hesitate to discontinue if you feel unsupported or that your counselor is projecting their own agenda or distress into the sessions. This is most likely going to be an issue when things get hard, and sorting it out can be difficult. You may be in your fear and distress, the counselor may be in their fear, it is sometimes hard to sort out. At the very least, the counselor ought to be willing to talk to you about it, and to look at himself. He should also be supportive of your talking with other people about it, maybe even consulting another counselor. It is your process that is important here, not the counselor’s ego.

I highly recommend Oriah Mountain Dreamer’s incredible poem, The Invitation (www.oriahmountaindreamer.com), as a reference point in choosing a relationship; here is one stanza:

It doesn’t interest me

who you know

or how you came to be here.

I want to know if you will stand

in the centre of the fire

with me

and not shrink back.

Doing It

Self-education is important, and word of mouth is usually the best referral guide. Beyond that, it is a good idea to ask a few preliminary questions. This can be done over the phone; also many counselors offer upon request a free 20 or 30 minutes to meet and do a brief interview.

There is no right or wrong way to do this. Here are a few thoughts about questions.

What are your basic policies and fees? Any flexibility on those?

What are your guiding principles?

How do you see counseling and personal growth and transformation?

What is your training?

What are your guiding theories?

What kind of personal work have you done? What kind of work are you doing now?

What do you think about biological psychiatry? About psychiatric drugs? About withdrawal from psychiatric drugs?

What are your privacy policies?

Anything else that you want to know, that is significant for you!

Here is what I recommend on beginning counseling. Once a decision is made to have an initial session, go for it. Many times, a client actually only wants or needs one session, and that’s it. If there is a need or desire for more work, if it feels right, and the counselor seems like someone you can trust and work with, then I recommend you commit to 3 or 4 sessions. By that time, you will have an experience you can evaluate and see if this is really helping to meet your goals. Then you can go from there. You’re the boss.

Part II On Structure

In this section, I want to lay out a few structural issues about our mental health system that are vital to understand. The structure of our “mental health system” is severely misguided, distorted and dangerous. As a result, many people have lost hope in finding a good counselor; one man asserted to me just yesterday that 99.5% of “therapists” were bad, and asked whether I agreed. This is an extreme statement, but of course extreme does not mean false. In this case I think it as at least a small exaggeration—there are good counselors out there. Nevertheless it is true that a large percentage of mental health professionals do more harm than good, and psychiatry as a whole is exceedingly dangerous. So we must address structure to approach clarity.

          Family/Systems Work

It is worth noting right up front that psychology and psychiatry are focused on individuals, and there is a very strong argument to be made that this emphasis has serious drawbacks. It is beyond the scope of this paper, but there is a robust theoretical and practical domain of family and systems work that cogently argues, and often demonstrates, that the best way to help people is to work with their families and other community systems in which they are engaged. The range of these ideas runs from direct family counseling to social economic policies and practices such as those that provide jobs and housing. Real improvements in job and housing opportunities for citizens would have way greater impact on the lives of people who get caught up in our mental health system than any kind of “treatment” program.

          Coercion

Most crucial to see is that psychiatry is rooted in coercion. It has long been decided that it is necessary, right and proper to coerce citizens who are deemed mentally ill. Well over a million (Lee Coleman estimated 1.5 to 2 million (Citizens Commission on Human Rights International, 2005).

United States citizens are incarcerated and forcibly treated—almost always with toxic brain-damaging drugs, sometimes with brain-damaging electroshock. All forms of oppression are justified by claims to virtue—the argument for coercion in psychiatry is that these citizens are sick and incompetent, and that such “treatment” is for their own good. This cloak of benevolence hides the truth of deprivation of liberty and freedom of mind and body of citizens who certainly have not been afforded the due process rights given in the penal system.

Furthermore, as long as overt coercion, in the form of “involuntary commitment and treatment” is an integral part of the system, there can not be truly voluntary participation in that system. Countless so-called voluntary “patients” are really there because of overt threats of coercion or covert pressure. Very many have discovered, to their dismay and disillusionment, that once in the system, “voluntary” is simply a word that means, “As long as you agree that you are ‘mentally ill’ and that our ‘recommended’ treatment is best for you, you are voluntary.” “Noncooperation” very often leads to a judgment of “incompetence” and court-ordered coercion.

There are many faces of this charade, but most common is a result of the societal and professional ethic that judges suicidal ideation as prima facie evidence of insanity and need for coercion. This results in massive violation of liberty interests. Regrettably, it also seriously aborts the possibility of real change as fundamental conditions of transformation—safety, free choice, acceptance and expression of distressing thoughts and emotions—are inhibited.

Private and Public

A private system requires exchange—usually professional attention for money—and is often prohibitive for people. For many others, it is not prohibitive, but seen as not so valuable. This is, of course, a valid choice as either a financial or substantive decision. Often, however, there is a trust and dependency on the private health insurance company’s decisions about who they will pay to provide services to their customer. This dependency often overrides genuine discernment as consideration of the beliefs and qualities of individual services is secondary or even irrelevant, and the only question is who the insurance will pay.

When insurance, or any third party, is involved, some degree of privacy is by definition compromised. While it is at least in theory possible to find a private counselor who truly honors the word private, it is difficult to find one who deliberately eschews, for example, the professional ethic that “obliges” the counselor to become coercive in the face of a conversation about suicide.

In the private system, one can also find, albeit with difficulty, counselors who reject the mental health system model of biological psychiatry. In the public system, that is mostly impossible because one has to at least accept the model and resultant practices to even be employed. So one very important thing to know in choosing a counselor is where they stand on biopsychiatric theory and practice.

BioPsychiatry

Modeled after the practice of medicine, biopsychiatry has all the trappings of language that we associate with scientific medicine. Biopsychiatry has the language, but not the science (Breeding, 2000). The basic assumptions of biopsychiatry are as follows:

   1. Adjustment to society is good.

   2. Failure to adjust is the result of “mental illness.”

   3. “Mental illness” (Depression, schizophrenia, bipolar disorder, etc.) is a medical disease.

   4. “Mental illness” is the result of biological and/or genetic defects.

   5. “Mental illness” is chronic, progressive, and basically incurable.

   6. “Mental illness” can (and must) be controlled primarily by drugs; secondarily, and for really severe “mental illness,” by electroshock.

   7. People with “mental illness” are irrational, and unable to make responsible decisions for themselves; therefore, coercion is necessary and justified.

The primary pillars of biopsychiatry are the chemical imbalance theory and the bad gene theory (Colbert, 1996). Neither is scientifically validated. To understand psychiatry today, it is necessary to be very clear that it is not about medicine; it is really about social control.

The application of this theory in the form of psychiatric drugs has become ubiquitous, with millions upon millions of adults and children of all ages taking billions upon billions of dollars worth of various psychotropic drugs. The resulting carnage in physical, emotional and mental damage and dysfunction is sufficient to justify my attorney friend’s coining of the term pharmacaust. The bottom line can be summarized from Robert Whitaker’s excellent new book, Anatomy of an Epidemic, which is a thorough and up-to-date review of the scientific literature on various classes of psychiatric drugs:

1)    Scientific research fails to validate biopsychiatric theory;

2)    Psychiatric drugs generally do not work any better than placebo;

3)    Psychiatric drugs are very damaging, creating all kinds of real biological damage and disease;

4)    Use of psychiatric drugs makes positive growth and transformation less likely;

5)    Use of psychiatric drugs is largely responsible for the fact that approximately 1 in 50 adult Americans are now on permanent disability due to “mental illness;” hence the book title, Anatomy of an Epidemic.

A client needs to know whether a counselor is going to support an adventure of personal growth and self-discovery or interpret their life challenges and distresses—their patterns of thought and behavior and relationships—as symptoms caused by brain disease. The latter leads to drugs, especially when the going gets at all tough and uncertain, where fear is present. 

On Withdrawal from Psychiatric Drugs

Biopsychiatry is ubiquitous, and tens of millions of United States citizens of all ages are taking various psychotropic drugs, and various combinations of such drugs. As just mentioned, the drugs cause untold damage and they tend not to work. So it is understandable that a very many people want to get off them. Given that these drugs are highly addictive, and that withdrawal reactions are often intense and difficult. I and others have written at length on the subject of withdrawal, but here I just want to emphasize that, if this is an issue for you, be sure and find a counselor who will truly support you in your decision. One vital understanding a counselor absolutely needs to have is that there can be many difficult physical and mental symptoms of withdrawal; it is amazing and troubling how even doctors often fail to recognize withdrawal, and instead misinterpret withdrawal symptoms as evidence of an alleged “mental illness.”  The main general recommendation is to withdraw gently and gradually. On an emotional level, emotions of fear, shame and hopelessness tend to be the greatest challenges (Breeding, 1998). It can be very helpful to have a counselor who provides a little hope in knowing that it is possible to withdraw and live well off the drugs. Regarding fear, I cannot say enough about this bugaboo. In this case, a counselor who knows about fear, who can be relaxed and supportive as you work on your fear, and who is confident that you can get through it can be a huge help. My book, The Necessity of Madness, has a chapter on withdrawal. Peter Breggin is an important voice challenging biopsychiatry; the book he co-authored with David Cohen, Your Drug May Be Your Problem, is a good one for this subject.

Note to Family

Although it may seem obvious as I point it out, we often fall prey to the illusion of individualism, and do not think enough about the effects of all this on friends and loved ones, especially the family of a person getting “mental health services.” It is one thing to become a client making a private agreement with a counselor for support or discussing and working on whatever. It is an entirely other matter to be an “identified patient” who has a “mental illness” and needs “treatment.” The latter tends to activate coercion, which as mentioned earlier, destroys the possibility of real help, but is also very destructive to personal relationships, creating dependency, resentment, distrust, etc. The turning of a family member into a damaged and disabled “chronic mental patient” has profound effects on a family, and they are not good. Groups like the National Alliance on Mental Illness (NAMI), seen ostensibly as support for family of people with “mental illness,” are largely funded with corporate pharmaceutical money and tend to be true believers in biopsychaitry. The main message is that the patient needs to accept their illness and take their medicine (Colbert, 2009).

This attitude is supposed to provide hope and absolution—hope that there is help by medicine, and absolution that you are not responsible since mental illness is a brain disease. This is really a false hope as is clear by the epidemic of deterioration and disability caused by the practice of psychiatry; remember that people who stay or get off the drugs tend to have much better outcomes. The absolution is also false. Not only is it based on a faulty premise—the chemical imbalance theory—however you want to explain life and relationship challenges and distress, they do not happen in isolation. There is always relationship! The way out is not to wash our hands of responsibility anymore than it is to collapse in self-blame and guilt. A useful saying for personal work is that “the way out is through,” and this applies to relationships as well. A deep address of family is beyond the scope of this essay, but I will mention two references. Some of the very best outcomes for dealing with even most serious “mental illness,” so-called schizophrenia, are apparently found in certain areas of Finland where a systematic community and family-based approach has had outstanding results, both for individual recovery and in dramatically lowering incidence in the area (reported in Robert Whitaker’s Anatomy of an Epidemic). Second, A Way Out of Madness, by Daniel Mackler and Matthew Morrissey, is written with advice and stories for people dealing with their families, but would also be very good for anyone who has family members who want or are judged as needing help. 

While the focus of this paper is on adults seeking a counselor for themselves, the basic ideas I present also apply to families seeking counseling for themselves and their children—the same pitfalls, the same need to ask questions and find a good counselor. As the drugs are especially dangerous for children, that part is if anything even more important. My website, www.wildestcolts.com,  and my books, The Wildest Colts Make the Best Horses (2007) and True Nature and Great Misunderstandings (2003) provide guidance for parents.

© August 2010 – Dr. John Breeding – published here with Dr. Breeding’s permission.

 

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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 – Mental Illness as “Brain Disease” – the major problem with modern psychiatry

Have you heard that mental illness, according to some in the profession of psychiatry (mainly in the United States) is “brain disease”? What do you think? Is it a coincidence that many studies aiding in these theories of what is known as biopsychiatry are being made on the basis of the outcomes of studies that are largely funded by pharmaceutical companies in the United States? Do you think that all psychiatrists or even all psychologists agree with this un-proven conclusion? Many do not agree. One very well known opponent of his own profession’s all-too-common practice in recent years is Australian psychiatrist, Dr. Niall (Jock) McLaren. I interviewed Dr. McLaren on Friday July 23, 2010, at 7pm EST on The Psyche Whisperer Radio Show on blogtalkradio.com

Niall (Jock) McLaren, MD, is an Australian psychiatrist, author and theoretician. His work opposes the mainstream view in psychiatry to the extent that he argues modern psychiatry has no scientific basis whatsoever. However, he insists that he is not “anti-psychiatry,” but a committed scientist following his duty of criticizing the prevailing models in his field in order to improve it. He is the author of the two books, Humanizing Madness: Psychiatry and the Cognitive Neurosciences. 2007; and Humanizing Psychiatry: The Biocognitive Model. 2009. He is working on another book due out later this year.

“McLaren has never held an academic post and has had practically no involvement in teaching, either medical students or post-graduate trainees in psychiatry. At the beginning of his training in psychiatry, he was interested in the biology of mental disorders but soon realized that many of the claims being made by biological psychiatrists were simply not supported by the state of neurosciences. At the same time, he developed an interest in psychotherapy and delved into psychoanalysis but soon reached the same conclusion, that analysts were making claims which went beyond the available evidence. In particular, he noted the way they quoted from Freud, analysed the quote and determined it was correct. This led him directly to the philosophy of science and the philosophy of mind, as well as studies in history and epistemology. When he was accepted as a PhD candidate, he had no training or qualifications in philosophy but was required to complete several philosophy units before proceeding. His books are the culmination of a long and, he says, lonely journey. The response of mainstream psychiatry in Australia to his work ranges from indifference to hostility. The author does not claim to be “anti-psychiatry.” As a psychiatrist with 35 years diverse experience in difficult and remote areas (including extensive work with veterans and aboriginals), he insists his interest lies in building the foundations for a better psychiatry: “A critical analysis of the logical status of modern psychiatry shows that psychiatry has no rational basis to its practice, its teaching and its research. At best, it is a protoscience.” In his view modern psychiatry is currently operating within the Kuhnian realm of “normal science.” He regards psychoanalysis and behaviorism as historical aberrations, eighty-year deviations which could have been averted if psychiatrists had looked critically at what was being offered.”

“Similarly, he argues that biological psychiatry is “mere scientism,” the inappropriate application of scientific methods and procedures to questions with no empirical content. The claim that mental disorder can be reduced to a matter of brain disorder is, he insists, a metaphysical claim which cannot be resolved by brain scans or blood tests: “The claim that all mental disorder is due to a chemical imbalance of the brain is an ideological claim, where ideology preconceives reality.” He emphasizes that the major problem with modern psychiatry is that it lacks a unified model of the mind and has become entrapped in a biological reductionist paradigm. The reasons for this biological shift are intuitive as reductionism has been very effective in other fields of science and medicine. However, despite reductionism’s efficacy in explaining the smallest parts of the brain this does not explain the mind, which is where he contends the majority of psychopathology stems from. An example would be that every aspect of a computer can be understood scientifically down to the very last atom, however this does not reveal the program that drives this hardware.” (Source – Wikipedia)

Personality Disorder – (From Wikipedia – by Paige Lovitt )

[In his book Humanizing Psychiatry] “He begins with defining personality as “the distinguishing, habitual forms of interaction between the individual and her environment in the stable, adult modes of behavior…personality just is a set of rules” and argues that previous methods of defining personality are but mere typologies (i.e., personality as described by behaviorism). Typologies do not describe or determine the roots of personality but merely put personality into groupings which can then predict future actions based on previous actions. From a psychiatry perspective this falls short because the therapist’s goal is to modify behavior by reconciling the personality and guiding it.

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However, the output of personality is not static and can vary depending upon the situation and the largely unconscious rules which guide it. An example in the book reveals “consider Mr. James Smith, a man of normal intellect and no compelling idiosyncrasies, who is sitting quietly on a park bench somewhere. He brings to his bench a personal background, a huge, rich history of events dating almost from the day he was born. His head is full of rules derived from his myriad life experiences, some of which he could tell you but most of which he couldn’t. These rules amount to his personality (note I didn’t say rules are identical with personality,; a generative mechanism is not the same as its output, of which more later). When something happens near him, his reaction is determined by a high-speed and unreportable interaction between what he sees and his unique set of rules. some of his rules are more or less fixed and won’t vary much from one year to the next, but some are more fluid, even a little unpredictable. If, today, a man comes past and asks him for money, Mr. Smith may be inclined to smile indulgently and hand over a few coins. However, another day, he may have had an argument with his wife or his boss and not be feeling so chipper; this time, the same wheedling request may elicit only a snarl to get a haircut and a job. His personality hasn’t changed, and the inconsistency doesn’t mean he has a personality disorder, he’s just being normal. Normality is a huge, multidimensional range and behavior is only disordered at the extremes.” Additionally, since personality is guided by rules coded in memory “therefore, anything that interferes with memory can affect the rules we call personality, and anything that affects current computational capacity will affect the application of those rules.”

Personality disorder is then defined, “if the rules governing a person’s life are internally inconsistent, or there are so many of them that he can’t reach a decision, or they generate disabling emotions or cause repeated conflict with his neighbors, then we say he has a personality disorder.” However, the major problem with personality disorders is that the “distorted rules give rise to the disordered behavior and generates an output state which serves to reinforce the rules. That is, either directly or indirectly, the individual’s behavior or emotions are such as to convince him that his beliefs or rules are correct (therefore creating a positive feedback loop of psychopathology, ie a vicious cycle). Of course, he doesn’t refer to them as rules; he simply knows what is right.” The author lists several examples but one of widespread significance is “I’m stupid, ugly and worthless. I hate myself.” which leads to “if my girlfriend looks at another man, she’s probably thinking of leaving me.””

The author argues that the path of mental wellness should involve replacing destructive rules with more adaptive standards. He contends that in general religion, the Freudian model, relaxation therapy, and many other therapies fall short because they seek to “suppress the output without changing the pathological factors generating the output.”

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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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