Psychopharmacology: Critical Psychiatry

Psychopharmacology or "pharmacology of the soul" is really a contradiction in terms, but then so is psychiatry itself. It is the art of influencing and controlling behavior that we consider socially unacceptable by means of chemicals, yet psychiatry pretends to be a part of medicine, of an effort to help and heal.

Sometimes psychiatrists have been called shrinks or head shrinkers. Shrinking heads was a traditional practice of some ferocious jungle tribes. Psychiatrists shock and drug their patients, many of whom end up leading a life of mere vegetation, and they may well feel that their head has been shrunk to resemble one of these...

Shrunken heads - image credit: Sony Pictures

I want to thank Vince Boehm for making me aware of the following essay is from medical ethicist Barry Turner. Mr turner is a lecturer in law at Leeds School of Law in the U.K. He teaches mental health, criminal and tort law and he explains, in very erudite terms, why psychiatry and especially psychopharmacology contravene the social values of our society.

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Critical Psychiatry

By Barry Turner

January 17, 2008

The dissemination of information is the hallmark of a free society and is the basis of freedom of speech. This fundamental human right is founded on the concept that information and knowledge are essential to free choice, it is the right of many individuals to hear that is being protected rather than the right of one individual to speak...

It is a sad fact that even in our mature pluralistic society a good deal of effort is still expended to suppress the rights of individuals to hear views, which may be at variance with current orthodoxy. In medicine this is particularly evident and in psychiatry unhealthily so.

Current orthodoxy in psychiatry has it that all psychiatric disorders are organic in nature and arise form alleged chemical imbalances that may be genetic in origin. This orthodoxy in a branch of medicine is all the more startling when it is subjected to examination. Virtually none of this organic theory has ever been empirically demonstrated and while it is very possible that aberrant genetics plays some part in mental illness there has never been any categorical evidence shown where these defects lie. In short current orthodoxy is based entirely on unproven beliefs.

The pharmaceutical industry provides the most powerful support for this orthodoxy. Since psychopharmacology developed in the 1950’s vast amounts of effort and money have been expended in seeking out chemical cures for mental illness. The logic is simple chemical imbalances need chemical remedies. This is the fundamental orthodoxy of what has come to be known as Biopsychiatry. It has to be said that the use of pharmaceutical interventions has made vast improvements to the lives of very many patients who are happy to express their thanks to and support for pharmaceutical interventions. As with most orthodoxy however overemphasis on the beneficence of the creed has been used to hide the darker side that is to be found in all belief systems. The undoubted benefits conferred to many by psychopharmaceutical treatment has been disingenuously used to suppress the very significant adverse effects suffered by many others.

More disturbing still are the efforts made by current orthodoxy to suppress any view at variance with the chemical-genetic model. The rise of psychopharmacology generated an huge industry of mental illness and changed irrevocably the previous societal models for the treatment of the mentally ill. Prior to the introduction of readily available medications the mentally ill were outcasts from society and in the majority of cases incarcerated to protect the sensibilities of the sane defined by cultural and societal norms of behaviour. Little money was expended on researching the problem in spite of its size and no one would have dreamed that these unfortunates would have ever represented a balance sheet asset.

The invention and establishment of psychopharmacology changed all that[1] the mass production of medications and the aggressive marketing of these products made very large profits for their manufacturers and the economic pressures created changed the vary definition of psychiatry, let alone its practice. With the development of more and more drugs the diagnosis of mental illness vastly increased often with the drug treatment being in place before the illness was fully described or classified. The definition of mental illness was now controlled not only by societal norms of behaviour but also by the economics of the market.

This is the root of the current orthodoxy. Two of the most powerful agents in human society combine to make the rules. Even in the most rational of societies orthodoxy cannot tolerate alternative approaches and psychiatry, as a branch of modern medicine is no exception. Psychiatrists who adopt a more traditional view, or as some would call it holistic approach are now under threat from the bio-psychiatry orthodoxy. Those taking views at variance with the biopsychiatry orthodoxy are finding themselves marginalized, labelled and overtly threatened by that orthodoxy. An alarming use of disciplinary action based on the ‘threat to the patient’ concept has been observed in recent years and it has led to psychiatrists critical of the current orthodoxy being prevented from practising.

As in all of human history the orthodox wish to silence the critics. Where this differs from past ‘persecution of heretics’ or ‘purging of revisionists’ the suppression of criticism is done falsely in the name of the patients. Patients are cynically manipulated in large part not to protect them but to protect the vested economic interests of the biopsychiatry industry. An even more startling element of this attempted suppression of critical views in the name of patients is that patients are very rarely consulted as to their views. A staggering degree of professional arrogance in a branch of medicine that likes to talk about empowering the service users.

Throughout medical history and the concomitant history of medical ethics and essential element in evolution of both science and its humanitarian application has been dissent. It is the differing views of countless thousands of physicians that have over four thousand years brought medical science to where it is today. As in almost all branches of science and philosophy it is doxasticism not orthodoxy that has served mankind best. It was the critical psychiatrists of the eighteenth and nineteenth centuries that changed the treatment of the mentally ill into a caring branch of medicine not the shareholders of Bedlam. We now enshrine criticism and dissent in our political and social systems and elevate them to human rights in our international law. Yet the powerful lobby groups would still suppress the views of the critical not because they threaten patients but because they threaten profits.

In psychiatry as in all branches of medicine it is a categorical imperative that orthodoxy is questioned, scrutinised and held to account. That cannot happen if critical opinions are suppressed out of the profession.

"In Bergens Tidende v. Norway (2001) 31 EHRR 430 it was held that complaints about medical treatment were not private matters but were matters to which the community at large had an interest. Put simply this means that suppressing the dissemination of alternative views is unlawful under Art 10 as an unlawful interference with the right to free expression.

Unjust attacks on the competence and character of psychiatrists who hold views opposite to the current orthodoxy are also violations of the individual's human rights. The suggestion that the holding of differing views to the drug orientated orthodoxy represents incompetence is an unwarranted attack on the doctor’s integrity. Suggesting that doctor is a hazard to patients because they hold views at variance with the current theories about brain chemistry is an alarming breach of principalist ethics. It is well recognised that autonomy as an ethic is not restricted to patient autonomy. The medical professional's autonomy must also be respected. The relationship between a doctor a patient and the professional body is a complex interaction of medical ethics and not a one-way street. The doctor needs to respect the autonomy of the patient, the patient the doctor and above all the profession the autonomy of both. That is the basis of both the second opinion and the legal doctrine found in Bolam."

The suppression of critical views in psychiatry represents the greatest threat to the integrity of the profession and the well being of the patient in over a century and a half of psychiatric practice.

[1] For a detailed history of this see; The Creation of Psychopharmacology. David Healy 2002. Harvard University Press

FAIR USE NOTICE: This may contain copyrighted (© ) material the use of which has not always been specifically authorized by the copyright owner. Such material is made available for educational purposes, to advance understanding of human rights, democracy, scientific, moral, ethical, and social justice issues, etc. It is believed that this constitutes a 'fair use' of any such copyrighted material as provided for in Title 17 U.S.C. section 107 of the US Copyright Law. This material is distributed without profit.

The information herein shall not be considered an endorsement of anyone discontinuing psychiatric drugs. If you are stopping taking medication it is advisable to reduce the dose gradually WITH EXTREME CAUTION, as it is difficult to predict who will have problems withdrawing. It is worth getting as much information and support as you can, and involving your doctor wherever possible. You will find withdrawal information here.

FOR MORE INFORMATION ON WITHDRAWAL: Get Peter Lehmann's book, Coming off Psychiatric Drugs: Successful Withdrawal from Neuroleptics, Antidepressants, Lithium, Carbamazepine and Tranquilizers. This valuable resource comes in US, UK, and German editions.

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See also:

Psychiatry's Unapproved Experiment on Children
Medicines' precautionary ethical principle, "First, do no harm" is largely violated by psychiatrists who expose patients to serious harm caused by faith-based, invasive biological interventions--be they pharmacologic, magnetic, electric, or surgical. In the absence of scientific evidence to support them, such prescribing practices are unethical.

Homeopathy for Psychological Problems (PDF) - by Louise Zeus
Psychiatry is not the only field to deal with problems of the psyche. One of the alternatives is homeopathy, with its similar-cures-similar remedies. A substance that could provoke the symptoms of distress is diluted several times, turning the extract into a potent antidote...

ECT - "Penicillin of Psychiatry" - Review of Shorter and Healy
The history of psychiatry is a story of megalomania. A confounding problem for psychiatry is the profession's failure to examine its therapeutics from patients' perspectives or to put psychiatry's therapeutics to a valid scientific test to determine whether the benefit outweighs the risks from patients' perspective.

Also relevant to this article is another one on the same site, of Professor Peter Sterling discussing the side effects of ECS or electroconvulsive shock.

 

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posted by Sepp Hasslberger on Friday January 18 2008
updated on Monday February 4 2008

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Readers' Comments

A mental Health Consumer Provider's experience working on two Programs of Assertive Community Treatment

After an accident I was disabled for five years. During this time I received Social Security Disability Income and counseling. I joined a club house in Newton Massachusetts for vocational counseling. After volunteering there I got a temporary employment placement. I did janitorial work on two days each week for two hour shifts at some group homes. On one night each week I attended a vocational support group to discuss issues related to the job. After this I found a part time telemarketing job. This independent employment was a step in the right direction. I had an excellent college education and had difficulty getting hired. I thought this could be related to having been disabled. Employers are careful in hireling people and this can exclude people who can do the job but have been unemployed. I was grateful that a program was available in my community to help disabled people get jobs. Being excluded from the work force creates a unique poverty of the soul. I vowed that someday I would help disabled people with finding jobs.
A year and six months into my recovery I got a residential counselor job working with individuals called mentally retarded. I slept overnight three nights. This was an excellent situation for someone with depression. I got off public assistance and was self supporting, productive and responsible member of society. After you worked for a year at the agency you were eligible for tuition reimbursement. I took advantage of this and enrolled in the U Mass Boston's Rehabilitation Counseling program.

After taking one course a semester for a few years I moved into a therapeutic community where I worked as a counselor with mental health clients. Working in a supportive environment as a counselor and learning about mental health counseling helped me grow as a person and nurture the growth of people I worked with. I worked in this position and studied rehabilitation counseling for five years. After I earned a Masters in Counseling I got certified as a rehabilitation counselor.

Then I took a job with a Program of Assertive Community Treatment (PACT) in central Massachusetts. I was able to advocate for clients and help them with a lot of problems. I liked the fact that we did outreach and helped clients where ever they were. This type of work brought me to homeless shelters, schools, work places, hospitals, jails and client's homes. The psychiatrist and staff were supportive. Because the program was associated with a University teaching and learning were emphasized. I received good performance reviews over my four years of employment. I handled numerous crisis situations effectively. I helped clients to find jobs.

After four years I was offered a better paying position at another PACT. I had twelve years experience and not one complaint on my record. I moved near to Malden take a position as a Vocational Counselor with a PACT in Malden at Tri-City Mental Health Center (TCMHC). The company was merging with Eliot Community Mental Health (ECMH). This was because TCMHC had committed fraud in billing Medicaid and the director of rehabilitation stole from clients. I understood that the company was in transition. I was confident in my ability to help clients and I knew I had a good work ethic and thought that would be enough to succeed. No one new I had a disability when I took the job. I had the experience of being on an effectively operated PACT. This experience was needed because the program had problems.

After taking the job I saw that clients were not getting services they needed with housing and employment. Clients needed help. Staff would say that clients were to "symptomatic" to benefit from help with these important issues. Staff treated clients in a condescending manner. I raised my concerns about client treatment with Aaron Katz the new program director. A Katz did not have the required credentials or experience to manage the program. This program was designed to serve the most disabled and vulnerable mental health consumers in the area. The response I got was "mind your own place and business". I could see his approach to management was to bully subordinates, use intimidation and push people around. For example he and another manager would co supervise a counselor while A Katz sat at a computer taking notes like it was a disposition. You never knew what was being written. I asked if I could take notes during a meeting but was told this was not allowed. I do not respond well to this approach by a manager.

In my first month of employment I was asked to take a client to get a toxicology screen. The test results could get the client in legal trouble. I thought that this task was a bad idea for our first meeting. I found out latter this client had been charged with attempted murder. I was not told about his background but just to take him to get tested. I refused to do this. This is just one example of a number of problems where clients and staff were put at odds because of poor management. (Reports to DMH never told what was going on.) In a PACT program clients are often under court order to get treatment and have the program manage their money. The only way to be sure clients are not coerced and staff is acting ethically is for there to be effective communication between all staff and management. However this was not possible at the ECHS PACT all communication was one way. Aaron Katz gave orders and expected staff to obey his orders without question. It was as if the clients weren't people but animals to be feed anti-psychotic medications. A Katz the program director would say "I have to micromanage everything". If a team meeting was going on counselors were expected to raise there hand and ask permission to go to the bathroom. We were in team meetings ten hours a week.

The work place became hostile. I think it was because other staff saw that I advocated for clients in meetings and management felt threatened. I got the "you aren't fitting in talk" from the manager. Then I got a written warning that threatened termination. This was for late paper work. Some of the paper work was the program directors (A Katz) responsibility. I explained that I had dyslexia and I asked for some extra time to complete the paper works. I advocated for my self and asked for the accommodations that I am entitled to under the American's with Disabilities Act. Other than this minor issue I had demonstrated leadership in important matters. I helped client's find jobs and housing. I managed crisis situations. My request for more time to do paper work was denied by A Katz.

Then after a client in crisis did not get help from management in a timely manner a blame game started. I had brought the client in crisis to meet the manager. I got blamed because this client who needed to be hospitalized ended up driving in Malden. This happened after I warned the manager that he needed help. A staff person from the day program was in his car. He could have crashed his car into someone. But I was blamed for this management neglect. I filed two grievances with the SEUI union. Management ignored them. I developed health problems as a result of the stress I was under. The management created a hostile work place. I even got treatment for job related stress. I let A Katz and M Mathews a senior manager know I was being treated for job related stress. The work place got more hostile. I requested time off but this was denied. Even though I had a doctors note as evidence that I had job related stress and both vacation and personal time.

Basically I was thrown out like the trash. The reason was because I advocated for clients, workers rights and would not accept unethical behavior by management. ECHS management contested my unemployment claim. At hearings M Mathews and Aaron Katz committed perjury. After four hearings the Massachusetts Department of Employment and Training found I had an urgent and compelling reason for ending the job. I was paid unemployment compensation. ECHS management also refused to pay me for my last two weeks work. I went to small claims court and named Pam Burns the Human Resources Director in my complaint. I had an excellent case but the hearing officer was a Malden court clerk named Paul Burns. Without considering the facts I lost my case.

Because of all this I lost my health insurance and couldn't continue treatment. Now, I can not get a good job because I do not have a reference from my last employer. My health problems have not been treated. I am applying for Social Security Disability. I found management's main interest was in misleading the Massachusetts Department of Mental Health about how the PACT was operated. Ethical issues were not to be discussed. Dishonesty and hostility were the foundations of management's practice. They treat counselors like dogs and laugh at the SEUI union.

Signed,
Dog Meat

Posted by: dog meat on April 7, 2009 07:39 PM

 

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