Paper:Psychiatry As Social Control

Psychiatry has been trying to show this for about 150 years. So far they have lots of rhetoric, and no sound evidence. There is no question that psychological trauma can induce changes in the brain, but the trauma is a trigger, the problem is the brain changes. There is also no doubt some people have "deviant" beliefs, but that is a social matter ... otherwise we medicalise politics, sport, and lifestyle choices. If B, P and S are all connected, then why can't we get rid of P and just treat B and S? Now this does not change the usefulness of some psychological strategies for coping and adapting, but that is not where the psychogenic crowd make their stand.

 

Just cruel:

I think this shows the kernel of psychiatry as an institution.

Wouldn't it be great if this was replaced by understanding, empathy and a certain amount of love, people/therapists who really want to help people with their issues in life (that may have different origins)?

 

I am merely pointing out that the argument you used @James Morris-Lent could just as easily be used against us in our fight for the removal of CBT and GET from the official guidelines.

We do not have the whole argument laid out in the individual article in question, but that doesn't mean the author doesn't have a point and that it shouldn't be raised (& I'm not saying you said either of those things by the way).

I am simply pointing out how easy it is to dismiss complicated questions, where there is a great deal of history and suffering. This highlights the attitudes we are currently up against. (I'm not criticizing you here).

 

The thing is at that point its no longer psychiatry, such issues would automatically fall under the domain of another discipline. You are trying to redefine "good faith belief systems". Science is science and follows the scientific method, religion is religion.

Thats why we still have psychiatry, thats the way the high priests of psychiatry like it.

 

I do have a prediction that psychiatry might go the way of the dodo, it might easily be split into psychology (the psychosocial coping stuff) and neurology (biopharmacy). Not all psychiatry is pseudoscience though, just a lot of it. It might be as much as 90% though.

Some of the biopsychiatry has some foundation, though not perfect.

Freudian psychiatry was like a cult, and so are many specific forms of psychopsychiatry, which are based on the received wisdom of supposed enlightened psychiatrists. Talk to a Jungian, for example. Webster makes a good case as to why this is very much like religion.

There has also been a tendency to have diseases peel off and go into other disciplines, and while I have not kept up with research I suspect schizophrenia might wind up as immunoneurology. Depression is of course from many different causes, including infections and metabolic or dietary issues. Its a cluster of similar symptoms, and not a valid diagnostic category.

Yet there are instances of biopsychiatry such as with depression subgroups, where they respond very well to antidepressants. Where it goes off course is how that is generalised to all depressive symptoms. The theory is mostly bogus, but some science has been successfully applied ... so what do you call that? The serotonin deficiency hypothesis is almost all from marketing push from pharma. That isn't religion. That is capitalism gone amok. The religion of capitalism? I would argue its more an ideology, though I am not sure where ideology ends and religion begins.

I personally want to see most of psychiatry be moved out of medicine into alternative medicine. I would like to see the entire psychiatric evidence based movement, including in Cochrane, put under intense scrutiny.

I would like to say the issues are all in psychopsychiatry, but sadly I don't think that is right either. Most of psychiatry is caught up in category errors.

So where I think psychiatry might have a future, if it does, is as some form of psychoneurology. Sadly I see it hanging on as the Science of the Gaps, for quite a while yet.

 

I don't understand something: Why are negative thoughts linked to "anti-psychiatry"? The organizations I know of don't work for the abolotion of psychiatry, they want the abolition of forced psychiatry that uses means of torture to break people and which functions as a kind of "vassal" for politics.

Where is the problem with the name "bad psychiatry"? Then "in-/humanistic psychiatry" is questionable as well - or any word for it. Somehow things need to be named, and I'd say it's not always practicable to do so in several sentences.

I know the good-bad-dualism is problematic. Still, in my opinion, from a moral-ethical viewpoint, "bad" or "good" could be chosen in this case.

 

What about the patients whose agency has been diminished or withdrawn by psychiatric illness? How is the system going to help somebody without "systematic use of force" who is in a psychotic state? Or manic? Or has delirium? Dementia? I am not talking about misdiagnoses and abuses/excesses of psychiatry; I am talking about the substantial numbers of people who are milling about on the streets with conditions that make them less capable and sometimes totally incapable of exerting moral agency.

Many people go off their meds because of the anti-psychiatry movement. Exactly the sort of people who need meds tend to produce and consume this sort of material.

 

i don't disagree with you @Sid, but I think both view points are valid. What about people whose agency is incorrectly removed by psychiatry? What about people forced to take medication whose side effects are worse than the symptoms of their condition?

The fact that there are some good psychs out there, that there are patients who may well need to be sectioned or have enforced medication should not prevent those who have suffered abuses at the hands of the system speak out.

A friend was diagnosed with bipolar and ME a decade or so ago. While an inpatient in a psych hospital he was given medication that wasn't helping and one side effect was that he had to keep moving - he was exhausted and it was making his ME worse. He politely asked if his meds could be reviewed as he felt they were making him worse. He was told he could either take them or refuse them, but if he refused to take them he would be sectioned and given ECT. This was a compliant, voluntary patient who knew he needed help.

Needless to say he just went along with everything to get away and you can guarantee he won't ever go back voluntarily.

 

To people who think that psychiatric diagnoses are not political, how can the changes in the diagnosis of Schizophrenia in Chicago be explained?

There was a sudden outbreak of contagious Schizophrenia in black male civil rights protesters?

What if there was a perfectly rational reason for what doctors cited as "Paranoid against his doctors and the police"? The rational reason would be the FBI's COINTELPRO program. https://en.wikipedia.org/wiki/COINTELPRO

I would urge anyone with the slightest interest to read this article about the primary source research in this area https://www.psychologytoday.com/us/...became-black-disease-interview-jonathan-metzl

What are the odds that contagious Schizophrenia also happened at the same time as state repression and assassination, the changes in DSM-II , the political rise of Fred Hampton with a focus on the "rainbow coalition", and the turbulence around the assassination of Martin Luther King?

Who benefited from being able to incarcerate (without trial) and discredit activists and people rebelling at this time? Who had a motive? The powerful or the powerless? Which groups are still diagnosed disproportionately? What do the primary sources tell us?

 

I am sorry to hear about your friend's akathisia, a truly horrible and common side effect. I completely agree that the current medical establishment is unaccountable and doctors are permitted to basically terrorise patients. But there is genuine mental illness and there are many instances where patients with no insight whatsoever are a danger to themselves and others. Many people in the anti-psychiatry movement claim that mental illness isn't real and is just a social construct. That's false.

 

I do agree that there is a need for good psychiatric treatment. However it is also true (as far as I know) that while many psych conditions are later attributed to some other cause, there are no examples of other conditions being later proven to be psychiatric.

Psychiatry has done a lot of harm in the past and lends itself very readily to political convenience as in the article @Luther Blissett 's linked to in his post. Also all of the women over the years incarcerated for not conforming etc. If it has a poor reputation then it's own practitioners are to blame.

There is no excuse for treating vulnerable people badly or unfairly.

 

There are good reasons for it being a social construct. What are the good reasons that mental illness is real, in the sense as it is defined by psychiatry?

There is no question about the existence of odd or strange people, of people that have physical illnesses that lead to mental behavior, etc. Some people are fearsome and I probably would change the side of the street. But does this justify to lock them away, practically indefinitely, without rights, and force upon them "treatments"?

There are people with schizophrenia who commit criminal actions; there are those who don't. There are paediphiliacs who misuse children; there are those who don't. There are "mentally" ill who commit crimes and those who don't. What's the difference between "strange/odd" people who do criminal actions and those who don't? Maybe it's the same difference as the one between people who get criminal and those who don't?

Maybe we just want to believe that strange/odd people are dangerous. Like the ugly ones in movies are always the monsters...

Again, no one wants to take away psychiatric help from people who want it, e.g. people who think about suicide but actually don't want to do it; because, maybe, they are very desperate or very ill. But why? Couldn't they be helped by understanding and empathy and giving real solutions? And by the way, why shouldn't people be allowed to leave if their suffering is unbearable for them and if they decide for themselves to put an end to it? We with ME know a certain amount of suffering.

(Forensic) psychiatry must be regulated, e.g. under criminal law. E.g. prisoners cannot be forced to agree to a treatment they don't want. In (forensic) psychiatry they can.

Edited to replace queer by strange/odd.

 

I have not discussed governance. Theory of governance includes the idea of balance of powers, which require that agencies/powers be transparent to their counterparts. So we have the concept of different houses in government, with the judiciary and media as compensating forces. Presidents/governers/prime ministers are another aspect. So is the public, at least in democracies.

Medicine has been granted special privileges under law. In some cases this includes limitations on legal repercussions. Psychiatry does NOT have a counter-balance under political governance theory. Its self regulated. When anyone needs to enquire about things, its psychiatrists who supply the answers. When ME patients die after treatment during sectioning, there has not been one case where they have been accountable. There is little transparency, and little independent counter to bad practice. In governance theory this is specifically what allows things to go out of control ... not that it has to, but there is a strong tendency especially when there are other influences.

I have argued elsewhere that for the most part most doctors, and even government agencies, are not to blame. They are however responsible. (@Samuel) Collective failure to act is a big issue. The medical profession has failed to contain bad psychiatry and has permitted unscientific medical practice. I would also like to add that the public, media and patients have some collective responsibility too. Its just the medical profession has the largest share of responsibility, and individuals within the profession sometimes are to blame, not just responsible.

 

Good point

 

@Sid I do appreciate your point, that some people need meds and psych help. I think everyone here agrees with that.
However when you make statements like this

...have you considered if this is really true, or simply a point of view you have adopted? I understand it is a strong point of view, and we all have our own sets of those, but are these assertions based on reality? How do you know what "types of people" , and how many of them, consume and produce this material? Which people claim mental illness isn't real? Do those people represent the entire base that questions the ethical framework of psychiatry?

My perception of the "anti-psychiatry" movement is that the vast majority are against the abuse of power within the psychiatric system, not against psychiatry or mental illness as a diagnosis per se.
They ought to have a better name, that much is true.

 

There is very strong evidence that mental illness as defined by psychiatry is real (i.e. caused by organic brain fail) and no evidence at all that it's a social construct. It is possible to induce and/or reproduce symptoms of various well-defined psychiatric syndromes using drugs and other experimental procedures. Examples include:

- carbon dioxide (CO2) inhalation in a controlled laboratory setting reliably reproduces panic attacks in a large percentage of patients with panic disorder, some close relatives of patients with panic disorder, and very few normal controls
- dopaminergic drugs like phencyclidine (PCP) induce positive symptoms of schizophrenia (hallucinations, delusions)
- ketamine (NMDA receptor antagonist) challenge induces a wider array of symptoms of schizophrenia (positive, negative and cognitive) in healthy individuals and in small doses that have minimal effects on healthy individuals triggers symptoms in patients with schizophrenia
- interferon alpha, antimalarial drugs, steroids and many other drugs often induce symptoms of major depression
- dopaminergic agents used to treat Parkinson's cause addictive, gambling behaviours in the predisposed
- etc. etc. etc.

 

There is also a difference between isn't real, is a social construct, and is a failed construct. There are real problems. Most psych diagnoses were made up by small teams of psychs deciding their diagnostic criteria work ... DSM is a social construct. Name the objective diagnostic tests! Its also a failed construct. This does not mean there are not real problems requiring real solutions. The nature of these kinds of problems has simply eluded everyone, the science is still trying to work out the most basic ones, and the rest is medical mythology. Further research will get good answers in time, but in the meantime we have the DSM in which not one single diagnosis has any objective validation.

When I kept reading about DSM diagnosis validation procedures I grew more and more horrified. Much of it, maybe nearly all of it, is not remotely scientific.

Schizophrenia, last I looked, seems to be an immune disorder, not a psych disorder, in which abnormal damage was being done to the brain.

People currently classified with psych disorders probably need help for the most part, but huge numbers have normal human experience psychologized and medicalized, drugs are over-prescribed, and a lot of treatments are not properly validated, despite papers claiming otherwise. Psychiatry is mostly living in scientific paradigms that the rest of science gave up on a half century ago. The only other major discipline that is even close is economics ... which is not a science anyway.

 

@Sid, you give examples of biochemical alterations that lead to changes in the human, amongst others behavioral changes. All these are not examples of "mental illness" as defined by psychiatry (or areas of psychology). It's only that psychiatry adopted them in the first place (as so many unknown diseases), and it took time to understand there are physical processes. It's as @alex3619 says:

Thomas Insel, director of NIMH until 2015, said this himself, too: DSM is not objective and not reliable.

We understand slowly that (some) behavioral changes can be due to biochemical alterations in the body, not due to an "ill psyche". Still, the concepts to "heal the psyche" remain the same, only today pain and torture and submission aren't widely used to enforce "normal behavior" ("only" in psychiatric clinics), but CBT for instance.

Somewhere someone linked to a book with a list of known physical illnesses that can present with behavioral changes, amongst others. The list was very long.