The troubled history of psychiatry

Interesting, long piece in the New Yorker

Challenges to the legitimacy of the profession have forced it to examine itself, including the fundamental question of what constitutes a mental disorder.

https://www.newyorker.com/magazine/2019/05/27/the-troubled-history-of-psychiatry

 

Mental disorder seems to often be informally defined as any behaviour or opinions that are sufficiently distant from what is considered normal. This means that in one culture, a behaviour could be mental illness while in another it could be normal.

 

20 years ago wandering down the street talking to people that weren't there would have been considered, at best, as eccentric. If it happened enough or at the wrong time, it could easily have prompted an 'investigation'.

Now it just means you may have a bluetooth headset for your mobile phone.

I am still firmly of the view that such people should at least be be locked up as a danger to society, or set fire to as is the traditional method for dealing with those who speak to people who aren't there, obviously facilitated by satan, or if that's too expensive or too environmentally unfriendly, pointed at and laughed at, until they stop.

I once saw a man attempting to climb a ladder outside a police station, he was at it for several minutes, until someone came out and arrested him, when he refused to go away or stop, for causing a nuisance, on the somewhat flimsy basis that whilst he was attempting to climb a ladder there wasn't a ladder present. His behaviour was perfectly acceptable, apparently, if there had been a ladder, but as there wasn't, it was considered abnormal, worrying.

My point is that's what's considered 'normal' changes, and is contextual.

Without knowing everything no judgement can be made. There is no way to know everything, so I assume that psyche type people simply declare what they personally find a nuisance as evidence of mental illness.

If I was to do this then there would be several billion people commited immediately, only to starve, freeze etc. a short time after.

Possibly that's what happened, and I've simply forgotten, this being the asylum would explain a lot of how people behave.

 

As usual mothers are generally to blame...

"overprotective mothers stunted their children’s maturation and were, according to a leading American psychiatrist, “our gravest menace” in the fight against communism; excessively permissive mothers produced children who would become juvenile delinquents; a mother who smothered a son with affection risked making him homosexual, while the undemonstrative “refrigerator mother” was blamed for what is now diagnosed as autism."

Seems Crawley and UCLH are just continuing with the flawed idea, until proven otherwise.

 

There would have been a fair number of people in the China of the Cultural Revolution, perhaps even the China of today, in Soviet Russia, and many other countries and timed where a diagnosis of mental illness was a means of suppressing political dissent.

 

The counterpoint being that some prominent world figures seem borderline insane, yet accepted as normal by many. I suppose sanity is in the eye of the beholder.

 

I think all the blind people in the world should get together and section all the sighted people who are seeing things that are not there.

Everyone with hyperacusis should report people who think there is silence when there is not.

Deaf people should report hearing people for having voices in their heads.

People with no sense of smell should round up everyone who thinks the air can be differentiated around them by breathing in through the nose.

 

I didn't read the whole thing but scanned. Sadly, the writer has this to say:

It’s too early to say whether any of these hypotheses could hold the key to mental illness. More important, we’d do better not to set so much store by the idea of a single key. It’s more useful to think in terms of cumulative advances in the field. Many people have been helped, and the stigma both of severe mental illness and of fleeting depressive episodes has been vastly reduced. Practitioners and potential patients are more knowledgeable than ever about the range of treatments available. In addition to medication and talk therapy, there have been other approaches, such as cognitive-behavioral therapy, which was propounded in the seventies by the psychiatrist Aaron Beck. He posited that depressed individuals habitually felt unworthy and helpless, and that their beliefs could be “unlearned” with training. An experiment in 1977 showed that cognitive-behavioral therapy outperformed one of the leading antidepressants of the time. Thanks to neuroscience, we can demonstrate that cognitive-behavioral therapy causes neuronal changes in the brain. (This is also true of learning a new language or a musical instrument.) It may be that the more we discover about the brain the easier it will be to disregard the apparent divide between mind and body.

What I want to know then is where is the CBT for those individuals who instead of being depressed because they feel unworthy and helpless feel overly entitled, seek power to lord it over others as if by royal decree and view others suffering as their just desserts.

Then maybe I might take CBT seriously.

And if neuronal changes happen as a result of CBT then what does this say with regard to all our various experiences and how this should be reflected in social policy toward those who suffer ill especially children. Why is there not even a whisper of this among psychiatrists. If this is what they believe then they should be a the forefront of social change to relieve people (again especially children) of malign influences in their lives.
That would seem the most reasonable thing and more preventative rather than curative.

 

One reason I think society has to be wary of psychiatry is because they keep expanding the definition of what constitutes a mental disorder, and have stretched it way beyond breaking point. In recent years I've read about toddlers going through the "terrible twos" being diagnosed with Oppositional Defiant Disorder. I've also read that grief is now considered "treatment-worthy" just two weeks after a person is bereaved. Would any non-psychiatrist (i.e. a normal person) ever think these are reasonable?

Edit : I think the ever-expanding definition of "mental disorder" must be largely for financial and reputational reasons. I simply can't accept that they are all for the benefit of the patient.

 

Their accountants probably would.

I've set that one up. I dare not continue.

 

If a physical cause for a mental disorder is found doesn't that immediately move the condition out of the hands of the psychiatrists and into the hands of the doctors who deal with tangible health problems? A psychiatrist can do nothing useful to cure or help a patient with syphilis.

 

deleted. sorry tired brain gave way to childish impulse

 

I grew up learning that illnesses had a single treatment e.g. antibiotics for tonsillitis or cough medicine for a cough, and once I'd had that treatment I would be better. It has taken me years to unlearn that.

 

Because they make money instead of needing it...

 

a lot of waffle pretty much what you would expect how the writer glosses over the horrors inflicted by these narcissistic know nothings is probably why no one ever goes to prison for the crimes and misinformation spread by these worthless and hateful individuals. whose sense of importance far outweighs their actual intelligence .

 

Yep. We are medicalising life.

 

Psychiatry can be just weird.

On one hand psychiatrists want to claim as many disorders/illnesses as possible for themselves. Presumably so they can be paid to “treat” them.

Then on the other hand they try to dismiss as many of these disorders/illnesses as possible as psychosomatic, or as the patient just mis-reading normal body symptoms.

Then they “treat” these conditions with Catch 22 style treatments (ie ones they say will cure, but more likely cause harm) and when their patients don’t come running back for more, they claim their treatments a success!

It’s amazing how effective this formula has been. Claim, “treat”, “cure”, rinse and repeat.

Okay - maybe that’s a bit harsh, as I’ve no doubt there ARE mental disorders that psychiatry can genuinely help. But, I’m becoming increasingly cynical these days.

 

We desperately need effective treatments for mental health problems. Watching someone you love struggle with severe depression is awful.

My grandson has mental problems which prevent him living. They frustrate every thing he wants to do. CBT helped him up to a point but he knows perfectly well what he wants to do but his body won't let him.

 

I have previously commented on cultural interpretations of insanity. Barracking for the wrong sports team, the wrong political party, the wrong singer or actor ... signs of psychosis? There is a long history of the nature of mental illness being questioned, from both within and outside of psychiatry. Its not been long since there was essentially a homophobia promoted diagnosis, and there was serious efforts to make more than normal PMS a psychiatric condition.

In history people were incarcerated in insane asylums for diabetes and multiple sclerosis. MS was considered a mental disorder in my lifetime ... and some psychs still make that claim, as recently as last year.

If you read contemporary (last several decades) accounts of how psych disorders are created and defended, its horrifying. Like two psychs on a boat on a fishing trip coming up with a new diagnosis. How these diagnoses are validated also has not much to do with the existence of the proposed disorder.

Theories that mental diseases were due to germs, early last century, led to surgical removal of all teeth or colons. Other atrocities abound, and most were probably not recorded in a way we can easily find out about.

We like to think times have changed, medical professionals like to claim times have changed, yet still people with ME and other complex diseases get held against their will, for unproven treatments for unprovable conditions, and some of these are children.

One of the big issues that needs addressing is how the global medical profession tends to remain silent when these things are happening. Some do speak out, but its a rare exception and not the norm.

One of the factors pushing this seems to be the promise of cheap and easy solutions. To those politicians and bureaucrats, please come forward and we can tell you about the miraculous properties of snake oil.

Psychiatry does need to create a sound scientific basis. To do so the standards of quality science cannot be relaxed. I wish the authors of the PACE study knew that.