Discussion in 'Other health news and research' started by Allele, May 20, 2018.
Mental illness exists as a useful category. Some 'psychiatric' therapies prevent deaths and make lives worth living.
Let's not throw the baby out with the bathwater.
There's nothing worse than mentally ill people writing long essays to convince themselves and other mentally ill people that mental illness isn't real and they can all stop taking their meds.
I'm not anti-psychiatry, and very wary of anyone who claims to be. It's what the BSP crew what have us labelled as, just as they try to broad-brush-label us as anti-science ... when we are in fact anti-crap-science. I am however very anti-crap-psychiatry, like the rest of us. There are some very good and dedicated psychiatrists. Unfortunately the truly crap ones seem to be in the ascendancy at the moment ... but I suspect and hope they see the writing on the wall.
I agree that there is a place for mental health treatments and that there are cases where mental health professionals can be compassionate and do a world of good.
However,the fields of psychiatry have a questionable past - many people being incarcerated for post natal depression and a range of other illnesses. MS patients being a fairly recent case in point. A mental health diagnosis automatically changes your status within the community in a way few other conditions will.
Does having a mental illness mean that you are no longer a reliable witness to your own experience? It may in some cases, but not all. If mental health patients are being treated poorly should they not speak out? Don't forget, there are still many out there who don't believe that we are reliable witnesses to our own experience and that we should just obediently follow the advice of Wessely, White, Sharpe et al. Sadly, in the UK, this attitude is the norm among health professionals.
I don't disagree but I am very aware that is exactly how CBT (PACE style) and GET are currently seen in the UK. Okay PACE has been discredited, but their attitude is it helps some people (even though that's questionable to our eyes) and it's better than nothing so why upset the status quo?
"Wessely, who qualified at Oxford and trained at the Maudsley
Hospital in London, where he is still a consultant, knew he
wanted to go into psychiatry early on. But he remembers
countless times when colleagues spoke with derision about the
specialty and suggested that he was too good a doctor to go into
mental health. Some believed there was nothing wrong with
mental health patients, some believed they were all “sabre
wielding” and dangerous, and others believed anyone who is
interested in psychiatry must be mad themselves.
“I vividly remember neurologists at Queen Square [the National
Hospital for Neurology and Neurosurgery in London] would
always say, ‘You seem a decent enough chap. I can’t understand
why you want to do psychiatry.’"
Although it turned out that Wessely is not a a decent chap at all(and there may be some truth in the "must be mad themselves" idea), you get the idea.
It seems like psychiatry is not very respected among doctors themselves and we see the results now...
I have read reports that psychiatry as a specialty was getting fewer and fewer young doctors signing up, it was regarded so poorly. The BPS story is what changed that. Sadly its just a story.
As a society we NEED good psychiatry, just as we need to get rid of bad psychiatry.
The author, as I read it, is talking about the system, not the category. If you read the article he is explaining about the use of force and control by psychiatry as a means for social control.
It is a serious issue, on the rise now with MUPS etc, and we don't have to drink the bathwater to care for the baby.
Thomas Szasz was a psychiatrist himself who wrote at the beginning excellent works about "his field". He himself, as I understood correctly, didn't view himself as an anti-psychiatrist. He "only" pointed out what psychiatry is - its history and its present. He, as others of his profession, like Thomas Insel, Argeo Bämayr and Prof. Mausfeld, have very clearly pointed out what psychiatry today is: a power complex that is used to control people and to help politics.
Anti-psychiatry movement fights for a kind of "humanistic psychiatry" where people who want help can find it, and people who don't want it aren't forced to be "helped". And honestly - isn't that something we all would welcome?
What psychiatry is - a normative science, pseudoscience and real harm - should be obvious today, especially for people who already had contact with it, like most people with ME. Topics like PACE, BDD, MUS, BPS model, psychosomatism etc. are widely discussed in this forum; the problems are clearly presented. The aims behind these constructs are very obvious. @Jonathan Edwards put one aspect very good:
Prof. Mausfeld, a German psychologist and mathematician (edit: and philosopher):
I'm not sure how you got to this from the article. He's talking about how the system has been gamed via psychiatry.
Most people in the "anti psychiatry" movement are against the systematic use of force and withdrawal of agency.
Nowhere do they say don't take your meds, don't get help.
He's also speaking from personal experience, having being tortured in by psychiatrists with a psuedo scientific theory. In his case, insulin shock therapy.
My view of psychiatrists is coloured by my experience....mostly ghastly. I’m also lucky never to have had a mental health condition, although I have had experience of a number of family members that have suffered with poor mental health.
I do think that behavioural science is a fascinating and valid subject and that counselling can be useful to a point for some conditions. I also appreciate that it’s difficult to test behaviour and judge what’s a destructive pattern vs a person just being a bit different. (Different is generally a good thing in my book)
However, I still don’t know how you can get from theoretical observational studies to practical treatments for human beings without something tangible to measure or a reference as to what good looks like.
I kind of hope that we will understand the brain and it’s chemistry a lot better in the future so that the treatments will end up being more medical and based on science and not a form of theoretical armchair concocted illusions that feel more like a circus act or a slight of hand.
It would be great to be able to measure why people are more prone to depression or anxiety or other psychiatric conditions with a bit more science being applied as to treatments and a measure of when people are deemed to have improved.
The problem is though, even if we do have the technology, who gets to decide what normal looks like?
The problem is what we have now is just a jumbled up mess of political nonsense. When psychiatry ever comes up with a real definition of what it is trying to be then I might decide if we need the "good psychiatry".
It appears to me the problem for psychiatry is that if they really try to define what it is they do they might just define themselves out of existence if people see that they are currently just a dumping ground for misunderstood issues, crap practice and medicalising of situations that may not need to be medicalised.
Personally that is why I think there is a push by people like White et al to claim everything is Biopsychosocial.
It certainly has a very poor track record in terms of:
Diagnosis - vague. Seemingly no tests can be done. this has left it open to abuse historically by people trying to get non compliant family members, especially women, locked away. This has allowed serious mission creep as they try to muscle their way in to piggyback onto other specialities.
Treatments - because of no biomarkers it has been acceptable in the past for some of these guys to basically do what they like to patients. Essentially, experiment on them. There is no way some of the treatments used have undergone the same scrutiny that would be expected in mainstream medicine. This allows the widespread introduction of treatments that provide no real benefit to anyone such as GET.
The combination of the above mean that this field is open to those who might be inclined to put money, power and prestige above the good of their patients. This allows the speciality to be used and abused by those with political and commercial interests. Invariably to the detriment of patients.
I do believe there is a need for good empathetic psychiatry. I do believe that there are some good psychiatrists out there. However, overall the speciality has far too much power and independence and too often the best interest of the patient is not served.
I have no idea what can be done about it though.
Historically its because psychiatry, and especially psychosomatic psychiatry, was severely dwindling. The BPS thing gives them a framework to claim legitimacy.
By good psychiatry I mean scientific, rational, based on evidence, and compassionate. There is a guesstimate I have read, and it might not be accurate, that half of all medical findings are wrong. However I think in psychiatry its more like ninety percent are wrong. How can a discipline be so without sound basis?
Even depression is not a stable diagnostic entity. With cancer medicine isolated things and divided it down into types, and subtypes, and is looking at individualised treatments. We do not even have diagnostic tests for depression.
Its the universality claim from BPS that is part of its strength, but also its weakness. Its so broad its meaningless. Its also typically hypocritical in its practice. It seems that the mind can cause biological symptoms, but Freud help you if you claim that biomedical issues cause psych issues.
Once upon a time everything psych was about Freud. Then Freudian theory became so discredited they needed a new mantra. BPS is what we got. What will they do when that becomes discredited? History suggests they will make something else up, and wrap it in seemingly plausible statements without sound evidence.
There is a disconnect between theory and practice. Basic BPS theory is so simple, and so obvious, it cannot be discredited. This then serves as cover for things that are totally without sound basis.
The problem with the opening document linked to here is not that it is wrong, its mostly right, its that the focus is very narrow and ignores the good psychiatry does by highlighting the harm. To me it seems the real issue is that the protections offered to scientific medicine extend to unscientific medicine. Medicine in general has to decide if its scientific or not. Until it does this then its subject to politicized abuse of patients.
I have read about much, much, much worse things in the history of psychiatry than in that opening document. The heinous practices of psychiatry are horrifying. There is a saying, lest we forget, but we have forgotten how bad psychiatry can be if its not held up to close scrutiny. Psychiatry does not deserve a free pass, it needs to be modernised. It needs to be held to modern scientific standards.
As I am fond of saying much of psych is not scientific. If they claim its scientific its pseudoscience. If they practice pseudoscience its ...
Yes, this argument they are anti-psychiatry is too broad, its a strawman argument by overgeneralisation. There are some who are against all psychiatry, but in general they are mostly just against bad psychiatry ... which is far too common.
I wanted to discuss the politicisation of medicine to show how broad the issue with psychiatry is. In many parts of the world doctors are becoming, or are already, agents of the government or large corporations. They operate to those rules. We see that in the UK with the medical issues surrounding disability, DWP politics, denial of tests that would prove disability, and so on. Until the medical profession gets political itself these issues will not go away. Its actually much more complex than that, I have discussed some of the other issues, but they would be outside the topic of thread.
Feel free, @alex3619 , to elaborate, as this issue is crucial to all people, in an ever more urgent way.
This is my current interpretation of what is happening, but its far from complete and there will be lots of things I have not taken into account.
There is a congruence of factors, mostly originating in the 70s. The first is a political ideology, that meshes with an economic ideology, and sometimes called Thatcherism or Reagonism. Its basically that government has to be efficient as a priority over other concerns. Bureaucratic "evidence based" agencies follow from this idea, such as NICE, as do economic rationalist cutbacks to government services. Here money is the key thing, and actually providing the services government have a mandate to provide seem secondary.
Now normally the investigative media would expose these kinds of things. In the UK however the government can suppress stories. At the same time the rise of the internet damaged the economic model for news media, and in a true economic rationalist fashion they responded by firing the reporters they need for quality news. This was compensated for by a rise in churnalism, or repeating stories others investigated. Reporters not only had to cover more stories as a result of this, they had to do it on smaller budgets and with less time. Its no wonder the temptation to use stories investigated by others is so rife. Yet the more this happened the worse the coverage got, and the less people bothered to pay for news. Its a vicious cycle, and has seen many news media companies, especially newspapers, fail.
Large corporations have come to be more influential in recent times, and push for economic agendas that suit them, not the general public. This is compounded by the rise in public relations companies, and their covert posting on social media, which I see really started in the 60s with campaigns to counter antibusiness and environmental activism. In medical research and other areas this led to a rise in zombie science, which I blogged about a few years back. That is science supported by money (and for government by political support) rather than good results. This science is often bad, but it wont die so long as funding is maintained.
Now while part of this is ideological, and has failed to produced promised results (economic rationalism) the rise of the internet has led to grass roots politics being organised on a larger scale. This means individuals can be engaged in politics in numbers that were never available before. It also led to the rise of crowdfunding. Corporations have the right to engage in activity I would call political, but so does the average person. Democracy will fail without good information and lots of people getting involved.
What I was expecting is the rise of independent journalism groups with subscription and crowdfunding as a way to fund deep investigations. What I currently see, and I have not been looking, is one example, in David Tuller, except he managed to do this within academic auspices. I had never considered that likely, but I guess its very viable now, for at least some journalists. It wont cover everyone as such positions are not great in number, and journalism needs to keep and develop seasoned investigators, who specialise in specific areas. Leave the food critics reporting on medical science to the cash strapped papers.
We also have organisations like the Science Media Centre which operates a lot like a public relations company, though via donors rather than fees. My counter to that was going to be public and charity funded information distribution sources, with fast and easy access to information to the media. When my health crashed five years ago all my blogging on this and biochemistry issues slowed to a crawl.
In medicine doctors have long held a view they should not be political. That has not stopped other forces meddling in medical politics. Hence we have the rise of doctors as agents of the state, and doctors who cannot practice medicine in the best interest of themselves and patients, but within government, agency or corporation guidelines. The issue here is that there are many things in which such guidelines are justified, but many more are about delivering cheaper services, not better services. If doctors start to get more political, though perhaps only in medical matters, they might be able to counter those trends. I think many of the public would support them.
That's all right but it requires a totally different criticism than what this author wrote.
But in a sense it is sad that they've worked so hard to 'mainstream' their garbage that it sullies the field generally and the people who do good work within it. Well, if we end up throwing some good out with a lot of bad that's on them in my opinion. I guess I just want to record it in this illustrious venue for posterity that I want to separate the good and the bad; I think 'they' don't.
My impression was that he was basically asserting that schizophrenia, bipolar, etc. are purely political artifacts rather than bona fide diseases. I take your point if you interpreted it to mean that these categories are abused but not necessarily totally illegitimate.
MUS and all that are all bathwater. The baby would hypothetically be the people who actually have psychogenic neurological symptoms - but if you can positively show this (I think you can in some instances) then it's not medically unexplained. I have no problem summarily discarding that blither.
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