A modern psychiatry

If you want to know how your average reasonable mainstream medical psychiatrist thinks about mental illness, Aeon magazine has a good piece that captures where many are coming from.

Now before you (yes you) Dr average reasonable mainstream medical psychiatrist, says that you don’t agree with all of it, I’m not suggesting it’s a manifesto, but it does cover a great deal of the mainstream.

We could argue a few points over some of the empirical claims, but it’s a surprisingly good snapshot in the round.

Probably the most important thing it underlines is that most psychiatrists are less obsessed with diagnosis than people who are are obsessed about the fact that psychiatrists make diagnoses.

Most psychiatrists typically don’t think that ‘every diagnosis is a disease’ and recognise the fuzziness of the boundaries – as indeed, do most medical professionals.

The article also highlights the fact that the medicalisation of emotional distress is driven as much by public demand as it is by drug company profiteering. People like pill-shaped convenience and drug companies make it their business to take advantage of this.

I would also say that the piece reflects mainstream psychiatric thinking by what it leaves out: a sufficient discussion of the psychiatric deprivation of liberty and autonomy – and its emotional impact on individuals.

Considering that this is the thing most likely to be experienced as traumatic, it is still greatly under-emphasised in internal debates and it remains conspicuous by its absence.
 

Link to ‘A Mad World’ on Aeon magazine.

3 Comments

  1. Posted March 20, 2014 at 4:32 am | Permalink

    On reading the opening paragraphs of the Aeon piece the role of psychiatrist in the US seems far different from psychiatrists I’ve had personally or known through being a carer in Scotland. I don’t remember much if any analysing, rather it was more about labelling/diagnosing and prescribing/drugging.

    I agree that psychiatrists apply a diagnosis so as to treat a patient, rather than to label and stigmatise, however the fact remains that psychiatric labels remain in medical notes whether accurate or not, especially if a person has experienced a psychosis or altered mind state. This is the bogey man and requires identification, making it very difficult to escape from.

    The mention of schizophrenia “divergent from normality” sums up the major problem with psychiatry, its power to name, shame and blame. Whether they intend to do so or not, the fact remains that people get the label and it can result in lifelong compulsory treatment, being subject to domination. Unfortunately in the UK we can’t “shop around” for another psychiatrist unless we are well off and have private healthcare.

  2. Posted March 21, 2014 at 10:22 am | Permalink

    Reblogged this on chrys muirhead and commented:
    my comment on Mind Hacks blog:
    “On reading the opening paragraphs of the Aeon piece the role of psychiatrist in the US seems far different from psychiatrists I’ve had personally or known through being a carer in Scotland. I don’t remember much if any analysing, rather it was more about labelling/diagnosing and prescribing/drugging.

    I agree that psychiatrists apply a diagnosis so as to treat a patient, rather than to label and stigmatise, however the fact remains that psychiatric labels remain in medical notes whether accurate or not, especially if a person has experienced a psychosis or altered mind state. This is the bogey man and requires identification, making it very difficult to escape from.

    The mention of schizophrenia “divergent from normality” sums up the major problem with psychiatry, its power to name, shame and blame. Whether they intend to do so or not, the fact remains that people get the label and it can result in lifelong compulsory treatment, being subject to domination. Unfortunately in the UK we can’t “shop around” for another psychiatrist unless we are well off and have private healthcare.”

  3. Posted March 23, 2014 at 9:59 pm | Permalink

    My concern is less with diagnosis; I sought help for depression in 1985. My dispute is with a “treatment plan”
    which too easily may be, and was, insisted upon by imperfect practitioners of a very inexact science and was given credence and brought to fruition by uninformed, apathetic courts, judges, attorneys, and social workers, as well as by misguided or ostensibly powerless family and friends—all, relative to me, persons allegedly in positions of trust.

    My pastor in the ‘80s remarked, “It’s really unfortunate when someone’s made a decision that will involve everyone lying.” My landlord at the time commented, “Let’s hope they know what they’re doing.” An employer of those earlier days referred to me as a “lab animal.”

    I never was informed of any “peer review,” although I after the fact learned of staunch objections made to “the plan” by others in the profession and by persons especially close to me. Such voices apparently, merely were drowned out, and
    faulty premises were left intact, never revoked by follow-up treatment-providers.

    The treatment/life plan established for me was set in gear by affordable, but as it turned out, incompetent, unethical, immoral, experimental mental health personnel, without empathy, conscience or compassion, but clearly with their own “issues” and agenda.

    It was a plan based on repeated lies (blatant and those of omission), collusion, and manipulation. Treatment providers were armed only with subjective guesswork and interpretation and apparently found justification in such feeble profferings as, “You don’t have to like us or trust us, for us to be able to help you;” “It may take you awhile to rebuild your trust;” “When you hurt you grow;” “Suffering builds strength;” “Sometimes you have to get worse, before you can get better;” “Sometimes you have to tear something down in order to rebuild.”

    But, like Humpty Dumpty, I had availed to me no feasible plan of just how to put me back together again. A reasonable, thinking person might surmise the deleterious effect on the quality of my life. The upshot is that my condition did indeed worsen within a created Orwellian environment and existence: new symptoms, new labels, new prescriptions. I paid full consequences not just for my own mistaken choices (which I otherwise probably would not have made) and my own reactions, but for the abysmal actions taken by and choices made for me by persons I believe should have been charged with criminal malpractice.

    Practitioners misplaced in the field and within a profession which gave us lobotomies and shock treatment lacking prior consent thought of themselves, were considered, godlike. They espoused opinions and issued decrees as though Biblical. In my case, the cure, indeed, was worse than the disease.

    Nearly 30 years later, without the acknowledgment, clarification and closure I’ve sought through records and myriad sources, I am disabled. Despite the erosion of my trust and confidence; damaged, if not broken relationships and heartbreak; the excruciating and enduring emotional pain; the loss of irretrievable time; the unfathomable loneliness; the intentionally inflicted trauma—all resultant from a poorly conceived, inhumane, treatment team and plan—I survive.

    I’m putting together for hoped for publication a narrative account/expose’ of my experiences, complete with caveats for those seeking help and support from mental health agencies and providers—i.e., educate yourself on provider’s education, experience, practiced therapies and goals; be advised that not all mental health providers are competent, trustworthy, necessarily healthy or stable;. . .When seeking help for yourself or for another, be well aware and advised of and have full possession of legal rights, protection, and recourse.


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