Rumblings in Psychiatry

In a recent Mad in America column Philip Hickey, PhD placed a hickey on Jessica Gold, MD (a resident in psychiatry) with a 10-point denunciation on the demerits of psychiatry, which I will capsulize as follows:

1.  Psychiatry’s definition of mental disorder embraces every significant problem of thinking, feeling, and behaving and thus medicalizes problems that are not medical in nature.

2.  Psychiatry presents illnesses as causes of specific problems, which are merely labels and provide no insight into the nature or essence of the presetting problem.

3.  Psychiatry has routinely deceived us with these vaguely defined problems but have no known neural pathology.

4.  Psychiatry has promoted drugs as corrective measures when it is “well-known” that no psychiatric drug corrects any neural pathology

5.  5. Psychiatry has conspired with big pharma to demonstrate that their products are safe and effective and suppress negative results, short term follow-up, suppress marginal results and suppress revealing of adverse effects.

6.  A great many psychiatrists accepted large sums of big pharma money in various gifts and inducements

7.  Psychiatry’s labels are disempowering by using notions that the “diseases” are incurable and require drugs for life. This encourages long-term dependency and mediocrity.

8.  Psychiatry’s treatments are destructive and damaging in the long term

9.  Psychiatry’s self serving medicalization of mental problems undermines resilience and foster powerlessness, uncertainty, and dependence.

10.      Psychiatry’s primary agenda over the past four decades has been the expansion of the list of mental illnesses and the assignment of these illnesses to more and more people. 

Before addressing these 10 issues by Dr. Hickey, one by one, it should be pointed out that something went way south long ago.

When I entered psychiatry after 10 years as a country doctor in Mississippi I was moving toward the specialty because of the psychiatrist that I brought into Natchez Mississippi gave so many people electric shock treatments(ECT) that he wore out his welcome. I knew I made a mistake when I realized that he did not like to listen to people.  I thought I could do better by just listening, if nothing else. 

Near the end of my life I find that many issues such as mental illness have a historical quality that are ignored because the claims and counter-claims missed the scene of the accident by decades. When psychiatrists discovered that they could get in on the medical insurance bonanza they jumped in with partially hatched and poorly incubated disease labels. But they failed to catch up because the labels were a house of cards. So to this extent I agree with Dr. Hickey on his list of complaints of 1, 2 and 3(seen above). Dr. Hickey has not, however, offered a viable solution as often happens when one arrives on the scene 20 plus years after the accident. It is as though a container ship was built to carry containers that had not been described but only vaguely glimpsed. Most of our severe problems span more than 100 years. not the least of which relates to the phenomena known as spiritual healing (will be discussed more in a later blog).

Points 4 and 5 by Dr. Hickey have been cited in the current issue of Scientific American which is available https://www.scientificamerican.com

And look for

Psychiatrists Must Face Possibility That Medications Hurt More Than They Help

 

Items 6,7,8,9 and 10 point to a issue raised by Malcolm Gladwell called moral licensing . Gladwell explains that moral licensing occurs when one gives themselves permission to act immorally because they feel empowered because they have recently done good things for others as one example. When I was in practice big pharma reps would often comment on how poor people could be help by getting free samples failing say that the drug was cost an arm and a leg as soon as the samples were gone. Gladwell explains that someone told him that they were not prejudiced racially because they had a black friend.

Although I agree with Dr. Hickey on the 10 points he offers no solution. So I contend that there are bottom-up methods of human interaction, which have not come into widespread usage because they require work, and a method of start-up.  

In 1958 we set out to solve the problem of schizophrenia as a post-sophomore research fellow for the National Institutes of Mental Health. Little did I know then and just a wee bit more do we know now. My colleague, Dr. Baringer and I thought we could narrow the focus to the study of a copper-bearing enzyme (ceruloplasmin) thought to be a problem in schizophrenia. Six decades later we still don’t know much about ceruloplasmin and its role in schizophrenia. We did gain a large dose of humility.

When psychiatry began working on the DSM III in 1974 it was not until 6 years later that a finished product was published. The six years was fraught with much gnashing of teeth and a house of cards was waiting to be blown away. Dr. Baringer and I contended in 1958 was that the interactions of personality with biologic and genetic forces did not give an adequate foundation for a medical diagnostics scheme. With the advent of the gene mapping we are left even more out on a shaky limb. Now in 2016 with one in every 6 Americans taking a prescribed medication for a mental health problem we are truly awash in doubt.

In my opinion the major players in the development of the DSM III were the big pharma psychiatrists, the child psychiatrists and a few psychoanalytic psychiatrists who remained alive but could not keep pace with the new order. What needed to be understood was the role of personality in healing from the vagaries of modern life. We needed to understand child development and the role of faulty and/or inadequate development in mental problems. we needed to find methods to emulate natural healing as well as find schemes of spiritual healing. Finally we needed to give space for the emerging arena of genetic factors. It was a tall order abut when the smoke cleared we faced a cosmetic nightmare. 

So we are left with a mess and the probability of the medications that are being promoted by psychiatry are covering up problems in the short run and deepening problems in the long run. Meanwhile eighty years of trial and error in Alcoholics Anonymous coming from the bottom–up rather than the top-down have focused on each person facing their character defects and vowing to make restitution while their group views their progress with empathy. Though painful it appears to work as well now as it did 80 years ago. What the AA scheme does address is the power of our individual genetics to mold our future. The power of AA is to use group support to help each individual cope with their own gene-behavior. Can you imagine for a moment what it would take for Trump to modify his genetic-greed behavior? Now after 34 years in AA I can tell you that modifications come with serious work on my part and serious help from my AA friends and sponsors on their part.The Double Circle Group is but a method in continual trial and error to assist in learning to work with a sponsor, getting the group help to navigate thorny issues of personality, and discovering how to get the most out of bottom-up processing. I favor a kind of sponsorship that depends on the principle of helping each other achieve sobriety and mental well being while gaining a more evenhanded personality. As of this writing many AA sponsors use an autocratic way of sponsorship.

In the past twenty  years AA groups working from the bottom-up have gradually brought into their fold those with a variety of disorders on a person by 
person basis. AA Central Office has only peer related input into this phenomenon. 

From the AA opening meeting statement; "Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who will not or cannot give themselves to this simple program......"