Rethinking Psychiatry/Medical Model

I do not understand how we can continue to avoid the conversation about psychiatric medications and their role in the violence that is affecting far too many of our children, whether Seung-Hui Cho, Eric Harris, Kip Kinkel, or Jeff Weise (all of whom were either taking or withdrawing from psychotropic medications) or the scores of children and adults they have killed and harmed. It is not clear what role medications played in the Newtown tragedy, though news reports are now suggesting there is one.

We have long been told that “low levels” of serotonin in the brain equal bad and sad, and we have been educated by the Pharmaceutical industry about the opportunity we have, through the use of antidepressants, to retrain our wayward neurons: by making the proverbial holes in the strainer that much smaller. But even if you accept the conventional wisdom regarding the role of serotonin in the narrative of mind, merriness, and misery, from where do we think that this magical neurochemical arises?

When plans for the DSM-5 were first announced about ten years ago, most folks’ reaction was “Why?”. Many of us asked that same question several times as the publication date for the new tome kept on getting pushed back. Finally, the curtain enshrouding the DSM-5 Task Force and its several committees began to part and proposed revisions/additions began to appear on its website. To our dismay, we found our question answered.

Recently, two more waves of criticism have broken onto the beach of opinion concerning mental health services and practice. Allen Frances has mourned approval of DSM-5 in his Psychology Today blog and the British Journal of Psychiatry has published a paper by members of the UK Critical Psychiatry Network. What is notable about both of these is that they give further voice to criticism of conventional mental health services by those who have spent years providing and researching them.

Yes, a psychiatric diagnosis can be a dangerous thing to have. But, these days, so is having any medical diagnosis. The names and words of the diagnoses themselves are not so much to blame for the harm. Rather, the harm comes through the ways the diagnoses are created and how they are used.

In my recent Alternatives keynote I talked about mental health issues and our unjust prisons, including the shameful racism of the criminal justice system...

In "The Order of Things", Michel Foucault, the great French philosopher cites a ‘certain Chinese encyclopedia’ that notes ‘animals are divided into: (a) belonging to the Emperor, (b) embalmed, (c) tame, (d) suckling pigs, (e) sirens, (f) fabulous, (g) stray dogs, (h) included in the present classification, (i) frenzied, (j) innumerable, (k) drawn with a very fine camelhair brush, (l) et cetera, (m) having just broken the water pitcher, (n) that from a long way off look like flies’.

There's a widespread belief in psychiatric and mental health circles that human experience can be reduced to the biology of brain chemistry -- the "medical model." But this is just the tip of the iceberg: our whole society is in the grips of a faddish pseudo-science of "neuromarketing," "neuropolitics" "neurotheology," and 'neuroeconomics."

My sabattical of last winter has spun off a second one. I remain uncertain of my role as a physician in a society which values pills over personal growth and change. Last summer, unplugging my life from the “American dream” seemed in order. It’s not easy to make changes with chains and weights in place. It’s not easy to think, decide and move with the financial shackles that are the bones of everyday life.

The practice of medicine in our country is being swallowed whole by a snake. The snake started with the poor, the black, the brown; the already disenfranchised of the deep south and inner cities many years ago. It was an easy sell to the better-off taxpayers. Who wants to give up money to take care of poor people?

How did the APA talk go? Overall a success-- the audio went viral on the internet, and the talk itself was so crowded we had to move to a larger room -- more than 70 psychiatrists and behavioral healthcare professionals attended. Afterwards many stepped up to shake my hand and congratulate me: I was told by two people I was a gift to the conference, asked to present at a Grand Rounds, encouraged to do a TED talk, thanked for my compassionate response to a question about forced treatment, and invited to do more trainings in the future. I even met several psychiatrists who are Madness Radio listeners. Psychiatry is clearly not a monolithic profession and many in it are beginning to think differently.

How does a straightforward, common-sense idea - guaranteeing the elemental pleasures of fresh air and access to nature to those in inpatient and residential psychiatric/mental health facilities – repeatedly fail on a policy level?

An opinion article by a survivor of forced hospitalization writes in The Irish Times argues that the 30% reduction in involuntary detentions in Ireland...

Psychiatrist Pat Bracken speaks on the current "crisis of legitimacy in psychiatry," and the growth of the international "service user" movement at the Forum...

by Chaya Grossberg July 25, 2012 He also told me the shrinks were changing around his drugs and adding more.  They added an antidepressant or two to the Lithium and increased doses and eventually he seemed to have very little life left in him.  Our phone calls became trying for he was so down, practically dead sounding a lot of the time, and I felt unable to do anything or say anything to make a difference.  To even try felt futile and I wondered if talking to me at all was becoming the burden of yet another person he couldn't connect with. In the early years, he liked to think of us as being in the same boat, both mentally ill, since I'd also had a meltdown and I also am extremely sensitive and go through extreme states.  But as the years went by, especially towards the end, I seemed to be in the ever growing “other” camp in his eyes, which meant I was yet another person who didn't get what it was like to be him. And at that point I can confirm I did not, and perhaps did not want to.

The July issue of Nursing Ethics takes on the myths of psychiatric drugs, saying that "psychiatric drugs are used only to control ‘patient’ behaviour...

I was invited to give a Keynote Address at the 2012 Alternatives Conference in Portland Oregon, and I'm collecting your input on what I should...

“What do you think caused your problems?,” I asked. “I have a chemical imbalance, a chemical imbalance, an imbalance in the brain that makes me ill.”

‘I’m severely depressed.’ These were the words that Donesha*, a 35 year-old African American woman repeatedly uttered to me.

A review of the literature on behavioral genetics, published online today by Developmental Psychobiology, finds "powerful new methods have failed to reveal even one bona...

Psychiatrist Pat Bracken, "a friend of Mad Pride Ireland," writes about the current state of psychiatry in the Irish Journal of Psychological Medicine. As...

What if it were the sun that could cure you; would you have the courage to go and find it? Would you wear sunscreen? If...

In a continuing series, Scientific American analyzes the "Trouble at the Heart of Psychiatry's Revised Rule Book." Article →  Part 1: Psychiatrists Are About to Shift...

Each time I see the initials for Mad In America, MIA, I think of the Vietnam war and lost young men. I remember engraved...

A reader in the commentary here asked me if I think “psychiatry is salvageable.” This is a timely question that requires careful consideration. First, I’ll...