as small as a world and as large as alone, madeofpatterns: not anti-psychiatry, but anti...

2:57am September 30, 2014

not anti-psychiatry, but anti some aspects of it

I don’t like how it conflates all these things:

people who have neurological problems that affect cognition or movement

effects of past trauma, current abuse, or unsuitable environments

people who create problems for other people

I’m anti-psychiatry, but I don’t think people know what I mean by that. This is extremely long so it’s under a cut with a TL;DR at the end. But please don’t respond to me if the only line you’ve read is the above one, because you will not grasp what I mean.

I don’t think psychiatry, as constituted now, is a science.
I don’t think any classification system psychiatry has come up with is anywhere near on par with the classification of actual medical diseases.
In fact, having read everything from the Kraepelin era onward, I have a really good look at how mental disorders were invented, and it was done largely by people making wild-ass guesses about the causes and reasons for people’s behavior, and then putting together lots of people who had nothing in common, while keeping apart those who had lots in common. (Both of which are my criteria for “this classification system sucks donkey balls and shouldn’t exist.”)
Psychiatry owes too much to its roots. And its roots stink.
Psychiatry has too often become about how to control people, not how to make people better.
The founders of the American Psychiatric Association were the superintendents of some of the worst mental institutions in history.
The same superintendents who deliberately decided to put the idea out there that patients could not be trusted to describe our own lives, because then we might describe being abused in their institutions and give them bad publicity. Yes, this was calculated and deliberate. It was not an accident and it was not a prejudice that formed out of the blue. It happened when former mental patients started publishing memoirs about insane asylums. Including one where the author drew the superintendent watching on with interest while patients were badly abused. They decided that patients, and our recollections, were the problem – and that’s when their adversarial relationship to our ability to understand our own lives truly began.
Psychiatry is not a science. It is even less a science than medicine is, and I know that even medicine has its problems, but medicine at least tries. To publish a psychiatric theory, it really doesn’t take much credibility. (This is one reason why autism research sucks: It’s not autism-specific, it’s psychiatry-specific.)
I don’t think mental institutions, as currently created, should exist, period. Not acute, not chronic, not public, not private, not wards in main hospitals, not state hospitals. Not as they are now.
If mental institutions do exist, they need to quit calling themselves hospitals and quit pretending to offer anything on par with medical treatment. Because they aren’t hospitals, and they don’t.

However, what I do believe, that most people don’t catch from the above:

Some people need medications in order to survive, function, or live comfortably. They should be able to have it.
They should also be able to have full access to current knowledge of said medications, including the risks, and including the medications where they’re not even sure why they work or if they work. Because there’s a lot of medications out there being pushed as “This works for depression because it raises serotonin and depression is a serotonin imbalance in the brain” when several pieces of that statement are anything but known fact and are being called into question by actual research.
They should understand the history of certain medications. For instance, antipsychotics were not created to make hallucinations go away, they were created to quiet down noisy psych wards by exploiting the fact that neuroleptics break down the link between thought and action, making people much more docile (unless they get akathisia). The fact that sometimes they made people stop hearing voices was an accident of history, not an absolute, and they still don’t stop as many people from hearing voices as you’re led to expect as a patient. There are also varieties of “psychosis” that neuroleptics will turn into a living nightmare – all the aspects of the “psychosis” are amplified, but the person becomes unable to act on them and unable to tell anyone what is going on because of that thought/action disruption.
Which reminds me, neuroleptics should rarely if ever be given to people with catatonia or other conditions that already disrupt the connection between thought and action. We are more prone to extreme and even lethal side-effects.
All of the above is information that should be given to patients before obtaining informed consent. Patients should also be given detailed information about non-drug treatments and alternatives
Psychiatric patients should never, ever be told that the drugs we are given are just like insulin for a diabetic. We should never be told that stopping our meds is like stopping insulin. The whole “chemical imbalance” metaphor should be scrapped until we know whether it’s even true.
I have absolutely nothing against people making use of the psychiatric system if that is what they want to do. I regard it as a fundamentally broken system, but even a stopped clock can be right twice a day, and sometimes a broken system is better than no system.
But people who are trying to get out of the system should have every kind of help available to them to get out of it.

Psychiatry should be scrapped and be replaced. I am not totally sure what its replacement should look like, and I don’t think it’s my job to come up with what its replacement should look like. But here’s what I suspect it would look like:

Psychiatric categorization schemes of mental disorders would be completely scrapped. They would have to start over from scratch and figure out who really was similar to who, and who really was different from who, using the same scientific rigor that is used to classify physical diseases.
Some parts of psychiatry would become parts of general medicine, as it was discovered that there were obvious physical diseases underlying the “psychiatric” symptoms. Some of these physical diseases are diseases that are already known (but underdiagnosed in psychiatric populations), and others are diseases that are wholly unknown (because nobody bothers to look for new physical diseases to explain psychiatric problems).
Some parts of psychiatry would fall under neurology.
Some parts of psychiatry would fall under an as-yet-unnamed science that dealt with the way we think, the way we feel, and the way these things interact both in the short term and long term to create problems for us. (Yes, I know, there are things that purport to do this already, but we’d be better off starting from scratch from what i’ve seen.)
No single model of how psychiatric conditions come about would prevail. Everything would be on a case-by-case basis or sometimes – sometimes – a condition-by-condition basis. None of this “Everything’s always a chemical imbalance in the brain to be corrected by neurotransmitters” thing that’s really just a way to walk backwards from “we want to give drugs to people” to “how do we convince them it’s the right move?” Every possible cause would be investigated fully.
People’s religion and spirituality would be taken seriously, and not treated merely as symptoms. If someone was dealing with a spiritual crisis, rather than a psychiatric one, professionals should have no problem referring them to the appropriate clergy (or whatever it’s called in a given religion) for the religion in question, or a range of religions if the person isn’t sure what religion they’d want to seek answers from. Nobody would be pushed into religion, mind you. It’s just people would stop being pushed away from it or having it treated like a symptom of psychosis that they are religious or spiritual. Especially if their religion or spirituality was a minority one that was not well-understood by the doctor in question. Even if a doctor is an atheist or agnostic, they have no business pushing their worldview at patients any more than a Christian should push their worldview at patients. And even if their religious problems seem like “clear symptoms of schizophrenia” or whatever, you’d be surprised how much religious or spiritual solutions can help certain people for whom no other solution has helped. When I go to a physical hospital, they always ask my religion and always ask if I want to talk to clergy, because they understand the role religion plays in making patients better. Psychiatry, which has a weirdly high percentage of atheists, does not generally offer such services and in fact frowns on them and may see them as encouraging psychotic thinking. And yet when I’ve been delirious and hallucinating, the chaplain is the person I want to see more than anyone – regardless of what religion they are from.

As for psychiatric “treatment”:

We need places for people to go who are in crisis. Mental institutions as currently constituted, aren’t that, at all. They mostly make things worse. People who go to them and get better tend to be the ones with straightforward problems and very short hospital stays. Anyone who needs to use what we have right now should be able to use it. But what we have right now needs to be replaced by something better. Somewhere people can actually go that is truly safe, that is not run like a prison.
We need real science looking into the causes, treatments, and cures for psychiatric problems. Of course, to have this, we would require real science looking into accurate classification of what are now considered psychiatric problems in the first place.
Treatment would ideallly not fall under some pseudoscientific branch of “medicine” called “psychiatry”. It would fall under general medicine, neurology, or that other branch or branches of medicine (or of something entirely different than medicine) that have not been conceived of and named yet.
When treatment works, we need to be honest about why, and why not. This includes saying “We don’t know why this works. We just know that in 17% of patients, it does, to a certain extent. We’re still looking for why. It could even be the placebo effect, we’re not sure yet.”
People need to stop blaming patients for not getting better.
The viewpoint that patients are manipulative liars incapable of understanding or reporting accurately on our own experiences goes back to the founders of the APA trying to cover their asses. So it has a long history. But it needs to die a quick death and be replaced by the same respect other human beings are accorded.
We need to stop pretending that mental illnesses are just like physical illnesses, only mental. Mental illness is a metaphor that has outlived its usefulness. There are some things classified as mental illness that are, surely, neurological conditions or chronic physical illnesses with mental components. However, there’s lots of things that don’t fit into the illness metaphor and shouldn’t be forced to.

Also, regarding psychiatric ex-patients and survivors especially, and even some consumers:

Former mental patients should be able to organize for our rights without having psychiatry try to shut us down because they don’t like what we have to say about our experiences with them.
People who have been abused by therapists shouldn’t be treated like the exceptions who got the bad apples, especially when therapists are explicitly taught how to abuse power.
People who have been abused in the system should not be forced into the system to receive treatment for the PTSD and CPTSD we have from that abuse. As a friend put it, this is like sending former prisoners of war back to the prison camps for treatment.
Nobody should ever be blamed covertly or overtly for having “picked a bad therapist” or “picked a bad apple” among psychiatrists, same goes for choosing mental institutions.
Former mental patients who organize against psychiatry should never, ever, ever, ever, ever be described as (these are near-direct quotes from psychiatric professionals quoted in major publications) “people with borderline personality disorder who love the attention they get from being victims” and “very psychotic people whose paranoid process has not died down yet as much as we had hoped”. (I can’t describe the rage when I first started reading those descriptions, and then as I learned this kind of talk goes back to the founders of the APA.)
People who want to form alternatives to psychiatry should be able to do so.
“Consumers” who basically re-create psychiatric institutions but “consumer-run” instead of “staff-run” should be exposed for what they are: Staff under another name, who think they are kinder and gentler because they’ve been in the system, but can be just as horribly cruel. Nobody should think that having been a mental patient makes them immune to abusing power.
Psychotherapists who are upset that biological psychiatry has taken over psychiatry, need to be kicked out of the leadership of the psychiatric survivor/ex-patient movement and the anti-psychiatry movement, stat. These people abuse power just as badly as biological psychiatrists. And their ideas are just as pseudoscientific (they still believe refrigerator mothers cause autism and schizophrenia, and that autism is not a neurological variation). I’m lookin’ at you, R. D. Laing, Peter Breggin, et al.
People in these movements need to stop being afraid of the idea that people can differ from each other neurologically. The fear is that if we admit neurological difference we will open the way to forced drugging. But I know my brain is different than normal. It responds to both prescription and street drugs massively differently than normal, something that is important to know about a person before you go prescribing anything to them anyway. And it is never a good thing to think backwards like that “If we believed X, then we’d have to do Y, and we don’t want to do Y, so we can’t believe X.” Generally you’ll find the if/then statement isn’t accurate in the first place. And you’ll also find that thinking backwards is sloppy thinking and won’t help you find the truth if you even care about the truth.
Some anti-psychiatry activists need to quit banding together with Scientology. They say Scientology’s done less damage than psychiatry, but I’d say that’s because they haven’t looked at it very closely, and because Scientology is smaller and less widespread than psychiatry. If Scientology became the norm, it would result in so many deaths I don’t even want to think about it. I used to work with an ex-patient group where the leader, while not a Scientologist, was always using Scientology’s anti-psychiatry posters in her protests, and didn’t seem to understand why I wouldn’t go to protests with her.
This is one area where “the enemy of my enemy is my friend" does not apply. It gets especially rankling when the only anti-psychiatry movement anyone has heard of is Scientology, so when they hear I don’t believe in psychiatry, they automatically assume I’m a Scientologist until proven otherwise. When in fact there’s a huge movement of survivors and ex-patients who want nothing to do with Scientology, nothing to do with psychotherapeutic psychiatrists who have lost their jobs to biological psychiatrists, and just want to create something that works for us and our friends who are still in the system.

So I would say I’m anti-psychiatry, as in, against psychiatry. But that does not mean I think people should all stop seeing their therapists and psychiatrists if those therapists and psychiatrists are truly doing them good. It just means that I think psychiatry is a pseudo-science that mostly does good by accident and needs to be scrapped and replaced all the way from the ground up in order to make true progress. Right now it’s like sitting on top of a scrap heap trying to put together the pieces of brains that have been torn to shreds in the name of understanding and helping them, without proper labeling systems or anything. We really need to start from scratch – new name, new classifications, new everything. While meanwhile slowly phasing out the existing system, so that nobody gets harmed in the meantime. I’ve put a lot of thought into this over the years, I’m not a knee-jerk anti-psychiatry activist and I’m not a $cientologist.

TL;DR: I’m probably anti-psychiatry, but I’m probably not anything you would normally think of under that term. I hate Scientology. I despise the work of R. D. Laing and Peter Breggin and other so-called "dissident psychiatrists” who are really just psychotherapeutic psychiatrists pissed off that biological psychiatrists have stolen their jobs, and who have taken over the anti-psychiatry movement from its rightful leaders, ex-patients. I believe that psychiatry needs to be completely scrapped, started over from scratch, and replaced by general medicine, neurology, and something or things that doesn’t exist yet. This would be phased in gradually so that people getting use out of the existing system wouldn’t get hurt. And I would never, ever tell someone getting benefits out of psychiatry to stop seeing their psychiatrist just because I don’t agree with psychiatry. I think it’s possible to benefit from parts of a broken system. I’ve done it myself.