A mad world

A diagnosis of mental illness is more common than ever – did psychiatrists create the problem, or just recognise it?

by 2100 2,100 words
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Photo by Constantine Manos/Magnum

Photo by Constantine Manos/Magnum

Joseph Pierre is a health sciences clinical professor of psychiatry at the University of California, Los Angeles, and co-chief of the Schizophrenia Treatment Unit at the West Los Angeles VA Medical Center.

When a psychiatrist meets people at a party and reveals what he or she does for a living, two responses are typical. People either say, ‘I’d better be careful what I say around you,’ and then clam up, or they say, ‘I could talk to you for hours,’ and then launch into a litany of complaints and diagnostic questions, usually about one or another family member, in-law, co-worker, or other acquaintance. It seems that people are quick to acknowledge the ubiquity of those who might benefit from a psychiatrist’s attention, while expressing a deep reluctance ever to seek it out themselves.

That reluctance is understandable. Although most of us crave support, understanding, and human connection, we also worry that if we reveal our true selves, we’ll be judged, criticised, or rejected in some way. And even worse – perhaps calling upon antiquated myths – some worry that, if we were to reveal our inner selves to a psychiatrist, we might be labelled crazy, locked up in an asylum, medicated into oblivion, or put into a straitjacket. Of course, such fears are the accompaniment of the very idiosyncrasies, foibles, and life struggles that keep us from unattainably perfect mental health.

As a psychiatrist, I see this as the biggest challenge facing psychiatry today. A large part of the population – perhaps even the majority – might benefit from some form of mental health care, but too many fear that modern psychiatry is on a mission to pathologise normal individuals with some dystopian plan fuelled by the greed of the pharmaceutical industry, all in order to put the populace on mind-numbing medications. Debates about psychiatric overdiagnosis have amplified in the wake of last year’s release of the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the so-called ‘bible of psychiatry’, with some particularly vocal critics coming from within the profession.

It’s true that the scope of psychiatry has greatly expanded over the past century. A hundred years ago, the profession had a near-exclusive focus on the custodial care of severely ill asylum patients. Now, psychiatric practice includes the office-based management of the ‘worried well’. The advent of psychotherapy, starting with the arrival of Sigmund Freud’s psychoanalysis at the turn of the 20th century, drove the shift. The ability to treat less severe forms of psychopathology – such as anxiety and so-called adjustment disorders related to life stressors – with the talking cure has had profound effects on mental health care in the United States.

Early forms of psychotherapy paved the way for the Mental Hygiene Movement that lasted from about 1910 through the 1950s. This public health model rejected hard boundaries of mental illness in favour of a view that acknowledged the potential for some degree of mental disorder to exist in nearly everyone. Interventions were recommended not just within a psychiatrist’s office, but broadly within society at large; schools and other community settings were all involved in providing support and help.

A new abundance of ‘neurotic’ symptoms stemming from the trauma experienced by veterans of the First and Second World Wars reinforced a view that mental health and illness existed on a continuous spectrum. And by the time DSM was first published in 1952, psychiatrists were treating a much wider swath of the population than ever before. From the first DSM through to the most recent revision, inclusiveness and clinical usefulness have been guiding principles, with the profession erring on the side of capturing all of the conditions that bring people to psychiatric care in order to facilitate evaluation and treatment.

In the modern era, psychotherapy has steered away from traditional psychoanalysis in favour of more practical, shorter-term therapies: for instance, psychodynamic therapy explores unconscious conflicts and underlying distress on a weekly basis for as little as a few months’ duration, and goal-directed cognitive therapy uses behavioural techniques to correct disruptive distortions in thinking. These streamlined psychotherapeutic techniques have widened the potential consumer base for psychiatric intervention; they have also expanded the range of clinicians who can perform therapy to include not only psychiatrists, but primary care doctors, psychologists, social workers, and marriage and family therapists.

In a similar fashion, newer medications with fewer side effects are more likely to be offered to people with less clear-cut psychiatric illnesses. Such medications can be prescribed by a family physician or, in some states, a psychologist or nurse practitioner.

Viewed through the lens of the DSM, it is easy to see how extending psychiatry’s helping hand deeper into the population is often interpreted as evidence that psychiatrists think more and more people are mentally ill. Recent epidemiological studies based upon DSM criteria have suggested that half or more of the US population will meet the threshold for mental disorder at some point in their lives. To many, the idea that it might be normal to have a mental illness sounds oxymoronic at best and conspiratorially threatening at worst. Yet the widening scope of psychiatry has been driven by a belief – on the parts of both mental health consumers and clinicians alike – that psychiatry can help with an increasingly large range of issues.

The diagnostic creep of psychiatry becomes more understandable by conceptualising mental illness, like most things in nature, on a continuum. Many forms of psychiatric disorder, such as schizophrenia or severe dementia, are so severe – that is to say, divergent from normality – that whether they represent illness is rarely debated. Other syndromes, such as generalised anxiety disorder, might more closely resemble what seems, to some, like normal worry. And patients might even complain of isolated symptoms such as insomnia or lack of energy that arise in the absence of any fully formed disorder. In this way, a continuous view of mental illness extends into areas that might actually be normal, but still detract from optimal, day-to-day function.

While a continuous view of mental illness probably reflects underlying reality, it inevitably results in grey areas where ‘caseness’ (whether someone does or does not have a mental disorder) must be decided based on judgment calls made by experienced clinicians. In psychiatry, those calls usually depend on whether a patient’s complaints are associated with significant distress or impaired functioning. Unlike medical disorders where morbidity is often determined by physical limitations or the threat of impending death, the distress and disruption of social functioning associated with mental illness can be fairly subjective. Even those on the softer, less severe end of the mental illness spectrum can experience considerable suffering and impairment. For example, someone with mild depression might not be on the verge of suicide, but could really be struggling with work due to anxiety and poor concentration. Many people might experience sub-clinical conditions that fall short of the threshold for a mental disorder, but still might benefit from intervention.

The truth is that while psychiatric diagnosis is helpful in understanding what ails a patient and formulating a treatment plan, psychiatrists don’t waste a lot of time fretting over whether a patient can be neatly categorised in DSM, or even whether or not that patient truly has a mental disorder at all. A patient comes in with a complaint of suffering, and the clinician tries to relieve that suffering independent of such exacting distinctions. If anything, such details become most important for insurance billing, where clinicians might err on the side of making a diagnosis to obtain reimbursement for a patient who might not otherwise be able to receive care.

Though many object to psychiatry’s perceived encroachment into normality, we rarely hear such complaints about the rest of medicine. Few lament that nearly all of us, at some point in our lives, seek care from a physician and take all manner of medications, most without need of a prescription, for one physical ailment or another. If we can accept that it is completely normal to be medically sick, not only with transient conditions such as coughs and colds, but also chronic disorders such as farsightedness, lower back pain, high blood pressure or diabetes, why can’t we accept that it might also be normal to be psychiatrically ill at various points in our lives?

The answer seems to be that psychiatric disorders carry a much greater degree of stigma compared with medical conditions. People worry that psychiatrists think everyone is crazy because they make the mistake of equating any form of psychiatric illness with being crazy. But that’s like equating a cough with tuberculosis or lung cancer. To be less stigmatising, psychiatry must support a continuous model of mental health instead of maintaining an exclusive focus on the mental disorders that make up the DSM. If general medicine can work within a continuous view of physical health and illness, there is no reason why psychiatry can’t as well.

Criticism of this view comes from concern over the type of intervention offered at the healthier end of the continuum. If the scope of psychiatry widens, will psychiatric medications be vastly overprescribed, as is already claimed with stimulants such as methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD)? This concern is well worth fretting over, given the uncertain effectiveness of medications for patients who don’t quite meet DSM criteria. For example, a 2008 study by the Harvard psychologist Irving Kirsch published in PLOS Medicine found that, for milder forms of depression, antidepressants are often no better than placebos. Likewise, recent research suggests that children at risk of developing psychosis – but not diagnosable just yet – might benefit more from fish oil or psychotherapy than antipsychotic drugs.

In the end, implementing pharmacotherapy for a given condition requires solid evidence from peer-reviewed research studies. Although by definition the benefit of medications decreases at the healthier end of a mental health continuum (if one isn’t as sick, the degree of improvement will be less), we need not reject all pharmacotherapy at the healthier end of the spectrum, provided medications are safe and effective. Of course, medications aren’t candy – most have a long list of potential side effects ranging from trivial to life-threatening. There’s a reason such medications require a prescription from a physician and why many psychiatrists are sceptical of proposals to grant prescribing privileges to health practitioners with far less medical training.

People worry that psychiatrists think everyone is crazy because they make the mistake of equating any form of psychiatric illness with being crazy. But that’s like equating a cough with tuberculosis or lung cancer

Pharmacotherapy for healthier individuals is likely to increase in the future as safer medications are developed, just as happened after selective serotonin re-uptake inhibitors (SSRIs) supplanted tricyclic antidepressants (TCAs) during the 1990s. In turn, the shift to medicating the healthier end of the continuum paves a path towards not only maximising wellness but enhancing normal functioning through ‘cosmetic’ intervention. Ultimately, availability of medications that enhance brain function or make us feel better than normal will be driven by consumer demand, not the Machiavellian plans of psychiatrists. The legal use of drugs to alter our moods is already nearly ubiquitous. We take Ritalin, modafinil (Provigil), or just our daily cup of caffeine to help us focus, stay awake, and make that deadline at work; then we reach for our diazepam (Valium), alcohol, or marijuana to unwind at the end of the day. If a kind of anabolic steroid for the brain were created, say a pill that could increase IQ by an average of 10 points with a minimum of side effects, is there any question that the public would clamour for it? Cosmetic psychiatry is a very real prospect for the future, with myriad moral and ethical implications involved.

In the final analysis, psychiatrists don’t think that everyone is crazy, nor are we necessarily guilty of pathologising normal existence and foisting medications upon the populace as pawns of the drug companies. Instead, we are just doing what we can to relieve the suffering of those coming for help, rather than turning those people away.

The good news for mental health consumers is that clinicians worth their mettle (and you might have to shop around to find one) don’t rely on the DSM as a bible in the way that many imagine, checking off symptoms like a computer might and trying to ‘shrink’ people into the confines of a diagnostic label. A good psychiatrist draws upon clinical experience to gain empathic understanding of each patient’s story, and then offers a tailored range of interventions to ease the suffering, whether it represents a disorder or is part of normal life.

Comments

  • Lynne Stewart

    You are so casual about the harm being done to people by the psychiatric establishment. During my lifetime I have been branded by labels such as: catatonic schizophrenic, paranoid schizophrenic, chronic undifferentiated schizophrenic, post traumatic stress disorder, bipolar II disorder, and major recurring depression among others.

    While these labels are merely a code language for groups of human behaviors and while, in fact, I was seeking relief from suffering, the stigma of these labels persists to mark me forever as an outcast to be shunned and feared by society.

    In fact, now that I revealed this, my response to your article will be less respected, less valued and easily dismissed by you and others as the rantings of a maniac.

    I am the product of a traumatic childhood, and traumatic psychiatric treatment. I am also the result of some sensitive, insightful and loving psychiatric interventions. I owe my life to those professionals and others.

    You speak of psychiatric treatment as benign and compassionate, however for every "good" professional there were five to ten "bad" ones. The bad ones exacerbated and added new trauma to my psyche.

    The short and long term ramifications and repercussions of psychological manipulation, mind altering drugs, and other more physically invasive treatments on society is deep and pervasive. Big Pharma and psychiatrists are changing how we see ourselves.

    Being human is more than a collection of behaviors, feelings and thoughts to be disected, analyzed and "treated".

    The Budha says, "Life is suffering." Psychiatry would better serve humanity if it focused more on the spirit and heart in a loving and compasionate relationship; if it focussed more on respecting, hearing, and intereacting; if it focussed more healing itself of arogance and hubris.

    • Alex

      The author agrees with what you are saying, in fact he argues the same thing in the last paragraph "The good news for mental health consumers is that clinicians worth their mettle (and you might have to shop around to find one) ... draws upon clinical experience to gain empathic understanding of each patient’s story, and then offers a tailored range of interventions to ease the suffering, whether it represents a disorder or is part of normal life."

      • http://endtimechaverim.wordpress.com Princess

        I think Lynne is asking psychiatrists to take on the caring, compassionate role of a religious minister who would view the suffering that is endemic to the human condition differently. Perhaps this is looking for wholeness in all the wrong places.

        • Mike

          That's a valuable comparison - insofar as the medical profession is a secular successor to the church, psychiatrists have become unacknowledged legislators of the human condition.

          Speaking of legislators, however - they also have an important role that the author doesn't discuss: a statutory one, as an adjunct to the law, that gives them the power to confine individuals, treat them without their consent, and offer expert opinion in courts that determines custodial sentences.

          Psychiatry's forensic and legal role can't be ignored. I would like to hear how the author would characterise it, and how he thinks it impacts on the profession.

          • http://endtimechaverim.wordpress.com Princess

            We know from experience that power corrupts. Although they were also imperfect, perhaps the religious community and its leaders did a better job of caring for the suffering than paid, secular authorities. One interesting comment I have heard is that the people who need mental health care the least (think discontented upper middle-class housewives and professionals) use most of the resources, while those who need it the most (delusional persons who roam the streets and can't care for themselves) receive the smallest slice of the healthcare pie.

          • JenJen10

            I have become aware in the last few years that many of the mentally ill end up in prisons, mainly because our society closed down the asylums years ago. Only the rich today can afford mental health care.

          • http://endtimechaverim.wordpress.com Princess

            They end up in prisons, on the street, or dead. And it is not even a matter of money. I know families whose hands are tied because they cannot force a mentally ill member to get help. The only answer is very caring and persistent family members who will do whatever it takes, sometimes destroying their own well-being in the process.

        • Simon

          Agreed. Except care and compassion should be a part of "mental health" practises and are not the exclusive concern of priests.

          But instead of that we get stuff like this about this "study", and that textbook, and some other diagnosis - and no mention of the people who consult Pierre and their kind and why they are unhappy etc. in the first place: social, environmental, family, nutritional reasons etc.

          I think this essentially repeats the old asylum ideas from 100 years but in another form. Its disgraceful, seeing psychiatrists talk like this about real people's real lives.

      • Ed

        The author might have said that in the last paragraph, but the author also downplays any harm the psychiatric community perpetrates with the whole article.

    • SmilingAhab

      "In fact, now that I revealed this, my response to your article will be
      less respected, less valued and easily dismissed by you and others as
      the rantings of a maniac."

      I would have respected and valued your feedback more if your self-pity weren't so transparently on display. The self-deprecation does far more to damage your case than the reveal that - surprise - life cast some of us in the fire.

      • Dan

        I'm genuinely insane, it happens a lot, a lot of people are if you really challenge their assumptions about the world, their place in it and the actions they undertake accordingly. It's a topsy-turvy world, difficult to make sense of for a lot of people, sometime people really do get driven mad, it's not an organic condition or a result of some chemical imbalance, it's just that the world itself is a cruel and unforgiving place and sensitive people can get damaged and don't respond predictably.

        There's a lot of people that really like the sound of their own voices, feel the need to shout louder and louder until they get heard, it's very egocentric and usually unnecessary and counter-productive.

        I thought this article was ok, the response by Lynne Stewart I thought was brave, articulate and considered. I didn't detect any note of self-pity although understandably there was some anger that came through. We're all just trying to make sense of things, that includes psychiatrists, pharmaceutical company corporate pimps, religious fanatics, journalists and humble commentators.

      • Simon

        Thats unnecessary and unkind. Try another interpretation: her remark anticipates the attitudes of Mr Pierre's profession, which she's very familiar with. How does that sit with you?

        • SmilingAhab

          I'd say due to the positive modifiers you used to indicate your interpretation of her argument, both of you are biased against the whole profession based not only on the unsafe apathy of a few outliers, but on your own expectations for that profession to be uniformly Stalinesque in its brutality. Self-fulfilling prophecies are the easiest prophecies.

          I am also familiar with the profession, being both the nephew of a clinical psychologist and the customer of several. The only place that sort of attitude comes from is self-pity and the expectation of pain of lowering self-defenses in the presence of a psychiatrist.

          So I'd say it doesn't sit with me at all, because I dismiss it.

          • Simon

            Say what you want. Its only another tactic, amongst others you've used, to deride the criticism you see here which you don't understand.

            You're getting borderline offensive. I say that, not in relation to me, but in relation to Lynne's remark and what it represented. Part of that is straying into the same "I know better than you" attitude which myself and others here object to. You're repeating the same diagnosis attitude at a public forum, with a complete stranger, who shared some personal details. I don't think its acceptable. it does however illustrate a point about this subject.

    • JenJen10

      You sound like you have had dozens of psychiatrists treating you. I have only had a few, yet I would totally agree that being a caring person is the key without which any doctor is useless, and even dangerous.

      I also think that doctors are too eager to prescribe drugs, especially mind-altering drugs, without adequate followup. I was heavily dismayed to hear general physicians were going to be allowed & even encouraged to prescribe SSRI's. I myself had several very negative experiences with SSRI's, and I became very aware of the lack of oversight & followup from physicians who prescribed them to me.

      Followup is essential. Close followup.

      What happened to me almost killed me. It should not happen to anyone else.

    • Simon

      "The bad ones exacerbated and added new trauma to my psyche."

      Even the best ones will damage you if they treat you on the basis that there's something "wrong" with you. You will subliminally accept that message if you continue in such a relationship.

    • Simon

      He's more than casual - he never acknowledges or refers to the harms of psychiatry.

  • vcragain

    Basically most of us are quite correct in that we really do NOT just trust any medical specialist now that we are aware of the push by big pharma behind the medical world. We all now research everything ourselves and try to make a balanced judgment when something comes up. I just got diagnosed with high BP and now take medication, but I am well aware that I am taking something which will probably give me a different condition in a few years !!
    It becomes a situation of "what would you rather have/die of?" !!!
    Since our healthcare is driven by drug company profits and by doctors who are trained to believe what the drug companies say, until this structure is changed we cannot trust, but will just do the best we can. I personally do not trust the Psych 'experts' either - they are just other humans after all - the best they can do is attempt to make people "no threat to others" as necessary for the health of the rest of us, and God forgive them for the mistakes they WILL make ! The rest of humanity is a variation of normal - we will have a "Big Brother" society if they go further than that.

  • Wang Chung

    Our Brains are not designed for the modern age we live in. It took millions of years for our Brains to evolve in a far less complex environment, but we are expected to adapt in just 100 years.

    • Shirley0401

      Nailed it. I'd go a step further and suggest that maybe instead of treating our increasing levels of depression/anxiety/ADHD/&c with drugs that make what would otherwise be unbearable just bearable enough, we should try, as a society, to "treat" the systems that are making so many of us so confused, miserable, and dissatisfied in the first place.

  • http://endtimechaverim.wordpress.com Princess

    I suspect that with improved imaging, we will see a merging of psychiatry and neurology, and will see improved higher tech treatment, such as DBS, for brain dysfunction that provides documented medical evidence.

    On the other hand, the pseudo-scientific aspects of psychiatry/psychology as well as the DIY self-help entourage is nothing more than a secular form of religion, albeit with a well-ensconced priesthood and DSM or self-diagnostic holy books. There are other forms of religion that provide help, support and comfort, and I surmise that most are far more cost-effect and dignity preserving.

    • Dad w/o Qualities

      I encourage you to read more about imaging, e.g., at the Neuroskeptic blog. That field is also still in its pseudo-science phase.

  • AndyPSV
  • Took Zoxor

    dear joesph pierre (the author of this piece), you say: "If we can accept that it is completely normal to be medically sick, not only with transient conditions such as coughs and colds, but also chronic disorders such as farsightedness, lower back pain, high blood pressure or diabetes, why can’t we accept that it might also be normal to be psychiatrically ill at various points in our lives?

    The answer seems to be that psychiatric disorders carry a much greater degree of stigma compared with medical conditions."

    while you come across as balanced and reasonable in some ways, you are COMPLETELY MISSING the NUMBER 1 OBJECTION to psychiatry, if not from patients' perspective, certainly from a JUSTICE perspective: if i have "coughs and colds [...] farsightedness, lower back pain, high blood pressure or diabetes" and i refuse to take the medicines for that, I AM FREE TO REFUSE THE MEDICATION and I AM FREE TO WALK OUT OF THE HOSPITAL.

    the REAL delusional people are the doctors (and some uninformed/confused folks in the general populace) that DARE THINK it's even conceivably acceptable to LOCK UP and FORCE MEDICATION UPON people who think or act in a way that deviates from the norm.

    if a human being is a danger to society, lock them up IN JAIL, where at least they have some rights. but if some well-meaning "medical professional" LOCKS UP and PHYSICALLY FORCES MEDICATION on a human being who cops have no reason to want to put in jail, that well-meaning "medical professional" is committing one of the most ATROCIOUS ACTS UPON THE LIFE, HEALTH, LIBERTY AND DIGNITY of a human being.

    let me say this again, with my slogan: "even if a doctor says i'm ill, I CAN WALK OUT ON MY OWN FREE WILL."

    alas, that is not the case in our "civilization." our laws currently, atrociously ensure that --since a judge defers to the opinion of the "medical professional"-- a law-abiding non-normal person's freedom is in the hands of a psychiatrist.

  • Ed

    A) If the whole of humanity has mental deviations from what is considered "normal", does that not throw the whole notion of what is "normal" out the window? 2) More problems are caused than solved by forcing people to conform to any such notions of normalcy, especially by altering their brain chemistry. I understand when people need help, but too many people know of a loved one that was put on so many medications and practically lost their mind when complications arose.

    • SmilingAhab

      Note, that the author does not use the word normal, he uses the word optimal.

      • Simon

        And how would you define "optimal"?

        I'm not sure, because you say so little, but it seems you are endorsing his ideas.

        • SmilingAhab

          I am endorsing his ideas. And optimal means able to feed and shelter oneself and experience life with as little psychological suffering interfering as is possible. I read a case wherein a gimp was experiencing a mid-life crisis and left the leather scene. It was hard for him to connect to other women, so my uncle, a clinical psychologist, told him he needed a good woman to beat him and tie him up in a box. It was by no means normal, but it was how his relationships proceeded healthily, and it provided him emotional relief, so it was optimal.

          • Simon

            Thanks for sharing what your view of "optimal" means.

            Does it occur to you it may not be mine, or Pierre's, or anyone else's, and the use of the word is far more complex than your insistent answer?

          • mollybutterfly

            Get a dictionary. Optimial always means the best possible.

    • Serge

      No. Normality can still be defined, as an average, for example, or as an optimal or ideal level.

  • Jesse

    "There’s a reason such medications require a prescription from a physician and why many psychiatrists are sceptical of proposals to grant prescribing privileges to health practitioners with far less medical training."

    This reason being that changes to the current system threaten the monopoly (hard-won through lobbying) that MDs have on many forms of care that could be safely and easily provided by other practitioners at a much lower cost, and the horror of doctors at the prospect of not being able to get rich practicing medicine (a key reason that health care is eating the US economy). There's a reason I am skeptical of sanctimonious claims from people who become millionaires pushing pills.

    • Simon

      "Far less"?

      Or does he actually mean "different" - as you find with holistic health practitioners who help people rather than treat symptoms.

  • Skanik

    If Psychiatry is a Science then it is the most subtle/delicate science

    as the Psychiatrist relies on memories/moods/emotions/irrational/rational thoughts,

    hopes, fears and dreams.

    Wise compassion is what the best Psychiatrist can offer - but that is not found

    in a book or a manual or in a drug.

    Broad experiences and the ability to listen to another heart whispering

    to your heart is what is needed.

  • Ronald Vaughan

    i SUGGEST THAT EVERYBODY READ THE CLASSIC BOOK 'THE MYTH OF MENTAL ILLNESS' BY DR. THOMAS SZASZ (RIP). HE HAD IT RIGHT FIFTY YEARS AGO,AND IT'S STILL CORRECT NOW.

  • seajay23

    Lot Scientology trolling here I suspect, plus the usual Capslock suspects.

    • Samuel Jew

      I don't think Scientologists are as pervasive as people who have been diagnosed with a mental disorder.

    • http://endtimechaverim.wordpress.com Princess

      Yes, I noticed links to pseudo-scientific sounding Scientology front groups. One link exhibited antisemitic vitriol in the comments.

  • Stuart

    I thought this link might be poignant as I read the title and after reading it yes it is.

    http://thebaffler.com/past/rage_against_the_machines

  • CrimeAgainstHumanity

    The mental "health" movement is really about pigeon-holing and attacking people for thought crimes. It's the modern version of witch-hunting, finding out who the "heretics" are, the ones in society are who don't fit in quite right. Then their rights are systematically taken away, they're tortured in "hospitals", and forever labeled for life, even murdered, (quickly, by way of "treatment" in hospitals or abuse by supposed "sane" people outside hospital, or slowly from poisonous medication, all without justice. Those are facts. Reality. Ya know, doc, what you profess to be an authority on?

  • Jeffrey Guterman PhD

    The vast majority of diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) are not objective medical conditions or brain disorders but, rather, are social constructions based on cultural norms.

    • JenJen10

      Can you list the "social constructions based on cultural norms"?

      • Michael Koleoso

        I'll name some, the one that labels you delusional for being ambitious and calls you schizophrenic for being telepathic (or what would you call prayer when you get a direct answer back?). And you get all this diagnosis for something the so-called experts can have no understanding because a lot of it is based on faith, faith that has become a conviction due to a revelation. They say seeing is believing but when you have a vision they dismiss it as hallucination. I attribute unusual things happening in my life as divine intervention towards my destiny what society terms coincidence. Cultural norms are nothing but the illusion that the system burdens us with and we are labelled mentally ill for anything out of these 'societal norms' and science labels anything crazy that they don't have an answer for

        • JenJen10

          Thank you for your seemingly honest reply. I could debate you about prayer & "conviction due to a revelation", but I won't. Whatever is happening in your brain is not happening in mine, so I agree that I can have no understanding of it because it's based on your perception of it, not mine.

          I had a grandmother who fervently believed in everything the Christian bible said, but as far as I know she didn't have "revelations" from god. Even so, she was eccentric enough that most people avoided her. I tend to shy away from anyone who believes they are being talked to by god (or whomever else can't be seen). I hope you understand that most people will do the same as me, they won't understand you, they'll probably be afraid of you.

          People are afraid of the different. I hope your revelations don't lead you to do something harmful. That's what people are afraid of. Our clinical definitions are imperfect, but it's an effort to categorize and explain differences, so as to understand which people are dangerous to us. Most people who are different are not dangerous, but the few that become killers make everyone else justifiably scared. Perhaps if you remember this when you deal with them it will help you.

      • Jeffrey Guterman PhD

        Until any of the DSM diagnoses are verified through objective tests, which none yet have been, all of the DSM diagnoses are social constructions based on cultural norms. All of them.

        • mollybutterfly

          Diagnoses are only (supposed) to be applied when the behaviors being diagnosed cause distress to your life or prevent functioning or if you are a danger to others. Therefore, even if they are social contraints to cultural norms, they are intended to help.

  • Shirley0401

    Where to begin?
    I can't get into all of my reactions to this well-written, thoughtful, and incredibly disheartening article. It would take too long, and it's not how I want to spend this beautiful Friday afternoon. But I couldn't shut my computer down without responding to a couple bits, at the very end, in particular.
    Bit 1: "In the final analysis, psychiatrists don’t think that everyone is crazy, nor are we necessarily guilty of pathologising normal existence...
    Really? It struck me that this whole article is a giant piece of apologia for exactly that. The "final analysis" strikes me as being closer to something like, "The world is complicated, and sometimes people have trouble dealing with it. If we can group symptoms into convenient diagnoses, and find a drug that has something resembling a slight effect on those symptoms, we have a responsibility to do so." (Until I hit this paragraph, I was already wondering if "pathologize" was a real enough word yet for me to use it as a description of what the article seems to support.)
    Bit 2: "Instead, we are just doing what we can to relieve the suffering of those coming for help, rather than turning those people away."
    I can kind of understand this, from the doctor/patient standpoint of trying to ease immediate discomfort/pain/concern. But it seems to me this kind of piecemeal symptom-by-symptom approach to what, to me, is clearly a societal problem is part of the problem. I'm not denying that people benefit from psych meds. I think they can be necessary for folks who otherwise can't function, and I've seen people who've benefitted a great deal from them. But when otherwise healthy, capable, competent people who are struggling with anxiety, or depression, or ADHD, because of external factors that can be addressed, and we rush to make them okay with conditions that are creating natural enough discomfort because they're unacceptable, is that really in the patient's long-term interests?
    If someone is so miserable in their job/relationship/whatever that they feel like they're falling apart, maybe the solution isn't to learn how to "manage," if there are ways they can change the conditions that are creating the discomfort.
    I don't think the author is some kind of drug company shill (and if he is, he does an awfully convincing job of obfuscating it). I think he's probably a well-meaning professional who's bought into the idea that we're all just a walking collection of symptoms to be treated.
    Sometimes I wonder, if we'd had effective anti-anxiety meds (not that I'm convinced we have them now) 1000 years ago, whether we'd have moved beyond feudalism. Since they seem designed primarily to help people find a greater degree of contentment than would naturally arise without pharmaceutical support, they strike me as being, in a weird way, pretty anti-progressive. It's generally been the case, hasn't it, that real progress tends to spring from dissatisfaction, anxiety, and/or anger at injustice? If we see dissatisfaction, anxiety, and anger as symptoms to be treated away, where will that lead us?

    • kenspiker

      I think the article is well-meaning and clear, but still caught up in the 'medical' paradigm. Yes, some people are clearly mentally sick and must be treated as sick. But since Freud people have gone to psychiatry for advice and council about problems which are within normal range but persistent and which have more to do with gaining skill in handling of life's problems than to be diagnosed and treated as a patient. And this, it would seem to me, would require a different kind of training than psychiatry which is designed to deal with illness, not inexperience or lack of social understanding. Not to say that a qualified psychiatrist couldn't help people with these kinds of problems, but psychiatric training prices most shrinks way out of the range of most folks, considering that psychotherapies require long and dedicated involvement with the provider. In my own case, when I found myself out of high school and looking for a career path I was totally at sea. I had no idea what to do, what course in life would be practical for me to pursue and how to develop my talents. If I'd had a lot of money I could have gone to a psychiatrist and spent a year trying to sort out how to proceed. But I couldn't afford that, and certainly the public schools don't provide any help in that area. So without help I was left to flounder around for much of my youth. Obviously, if I'd been mentally ill I would have received help one way or another. But needing wisdom and advice I was left to fend for myself. Not a happy situation.

  • ME Information

    Dear Author,

    Ive been an RN since 1985, I have also been inactive because of disability.

    I worked at a large reknown medical center in NYC.

    While I was active in the field, psychiatry was straight forward, depression, bipolar/manic depression, schizophrenia.

    No one was ever diagnosed with "somatoform" disorder, the word was not even used.

    I will be bold to say there is no such thing as "somatoform" disorder.

    Somatoform disorder has been the biggest deception and quite frankly the biggest
    farce that psychiatrists have learned to outsmart the system with, as they mae a lot of money from the pharmaceutical companies such as the group from an Ivy League school in the north east of this country. (US).

    The psychiatric lobby headed by psychiatrists such as Per Fink in Denmark, Simon Wessely and the "Wessely school" of psychiatrist in London, have spent millions to change the ICD to include ridiculous, false, and deception diagnosis such as Bodily Distress Disorder, and pervasive arousal withdrawal syndrome.

    Those are the most ridiculous things I have ever heard of and and because of that deception, patients have actually been taken out of their homes by force, against their will,

    and put in psychiatric hospitals for a year and more. There is a 24 year old women in Denmark who is going through that right now compliments of Per Fink. That poor 24 year old woman had been diagnosed by multiple doctors previously through the years with the illness she has and the family has not been allowed to get a second opionion, according to Per Fink and his colleagues
    That poor girl in Denmark was given the diagnosis of "pervasive arousal withdrawal syndrome", is being forced to do treatment that is making her medical illness worse,
    and she will may die before the family can get her out of there. The treatment they are forcing upon her is akin to torture.
    No one has symptoms out of "nowhere", I can guarantee you that.
    There is always a cause for a symptom. Sometimes it may take time to find the reason, but there is always a cause.
    Unfortunately, the medical schools are teaching the students this.

    Medical schools are actually teaching practitioners how to get sued as well as how to be incompetent and quite frankly lazy.
    Instead of investigating further, they tell the patients they are depressed.
    This is a very dangerous practice!
    I read an article last week about a professor in England who was told by 3 doctors she was depressed, she finally convinced the 3rd doctor to do a chest xray, she not only had lung cancer, she was terminal and died not long after.

    I was also reading one of the nursing forums and the nurses were talking about how a patient was diagnosed somatoform disorder and 4 days later died of a perforated bowel. These incidents are on the rise.

    It has gotten so bad, we are seeing cases in the news such as the teenager in a hospital with a misunderstood illness, diagnosed at another prestigious institution,
    the emergency room doctors didn't agree with her diagnosis, said her illness "didn't exist," diagnosed her with somatoform disorder in 12 hours and had DCF come in and take custody of the child away from the parents.

    That patient isn't the only one and that hospital isn't the only place this is happening.

    Today. doctors are not taught to say "this is out of my area of expertise" or "I cant tell you what is wrong, they tell the patients "you are depressed" or :"its all in your head" or "you have somatic symptoms" etc...while writing a prescription for some type of antidepressant at the same time.

    Patients get depressed because of a loss such as an illness, it is not usually the other way around.

    Psychiatry and psychiatrists need to stay out and away from medical illnesses, there are plenty of psychiatric patients suffering from schizophrenia, bipolar disorder , etc.. that need psychiatrists, we don't need psychiatrists pushing and forcing
    psychiatry on medically sick patients. This practice is killing patients.

    • Simon

      "Instead of investigating further, they tell the patients they are depressed. "

      Indeed. They have extremely clumsy tools - their textbooks and knowledge of drugs - and nothing more.

      Psychiatrists generally have a medical background, in a field which concerns their humanity and their ability to relate to another human being in distress. They don't see a person - they see symptoms to be treated with drugs. Pierre makes this connection himself and implies its OK.

  • SmilingAhab

    What a wonderful apology for the psychiatric profession! It is a hard science, because the mind is the most subjective and perceptive of all things, requiring structure but fearing assistance with prying open ancient, vestigial defense mechanisms; it's little wonder so many would be afraid of the power of a mind-worker.

    To everyone below - when you bemoan pharmacology in the industry, or how it's all just pigeonholing natural deviancy into little boxes...

    Would you please ACTUALLY read the article?

    • Simon

      We did. And its both appalling and revealing.

      Now will you respect the capacity of people to think differently to you, and criticise Pierre and his kind?

      In short - will you read?

      Your remark 'we fear the mind workers' is so appallingly off target it's impossible to address at a forum like this. However I will try: you substitute fear for criticism.

      - now, why would you do that?

      • SmilingAhab

        I say as much because in the very article above, the author goes on bemoaning those in the profession who use pills like crutches and have given up on the humanity of their profession, only to scroll down and read dozens of comments lashing out at the author for the very problems he bemoans. My problem does not lie in criticism itself, but the knee-jerk reactions I read below. And knee-jerk reactions stem from fear.

    • Simon

      The page isn't loading properly so this reply is to your post below:

      You are deliberately ignoring what people say. Pierre endorses drugs by saying they are better than they used to be. And you are deriding peoples criticisms - some of it concerning personal sharing - with remarks about fear and self pity. It seems you know very little about this subject when you display such attitudes; that you illustrate the very things people object to with psychiatry and you don't realise you're doing it.

      i find that fascinating.

  • notmike64

    I have schizoid affective disorder with depression. I owe my life to my doctor and therapist. I am fortunate to have had only one doctor and one therapist. Could it be that psychiatric care involves really listening and caring by a one team of individuals vs. running around trying to get "fixed." I have a beautiful mind and I am learning through therapy to work with my mind not against it. I found this article to be refreshing in its honesty.

  • Helen

    This is a hugely misleading article, which attempts to portray psychiatry as a well-meaning, benevolent profession. However, that claim is quite simply not true.

    Those of us who recognise that the psychiatric industry (industry as opposed to profession) is in bed with the drug companies, with a strong vested interest in increasing business for both, and has been for quite some time, are not deluded, as is suggested in this article, but are telling the truth. Psychiatrist Loren Mosher recognised this and that is why he resigned from the American Psychiatric Association in 1998. Here is his letter of resignation:

    http://www.moshersoteria.com/articles/resignation-from-apa/

    Since this letter was written, the situation has worsened and corruption worldwide is now even more widespread and rife. Corruption between psychiatry and the drug companies continues, with some of it being reported in the media - here is one link:

    Israeli Drug Company Agrees to Pay $27.6 million for U.S. Psychiatrist's Prescribing of Antipsychotic Drug

    http://www.cchrint.org/2014/03/20/israeli-drug-company-agrees-to-pay-27-6-million-for-u-s-psychiatrists-prescribing-of-antipsychotic-drug/

    It is in the (economic) interests of most psychiatrists and the drug companies to try to continue to con us with their fake diagnoses and fake "cures" - which are not actually cures at all, but which tend to make people more sick than they were in the first place (see the above link). Psychiatric drugs are linked to: heart disease, diabetes, obesity, Parkinsonian movement disorders, suicidal feelings and behaviours, sedation and sudden unexplained death, among others.

    The psychiatrist who wrote this article is unhappy about the fact that people are waking up to the reality of psychiatry and that psychiatry and the drug companies have been found out. We can expect a backlash and continued propaganda from people with a strong vested interest, who refuse to be honest and face the truth. Thankfully, some psychiatrists (albeit few in number) have greater moral fibre and are more honest (see below). They have a conscience, care more about human rights and doing the right thing and wish to base their practice on moral and ethical principles and truth rather than on bio-pharma propaganda.

    Let us continue to educate and inform ourselves about the truth.

    Good documentary - The Marketing of Madness - Are We All Insane?

    http://www.cultureunplugged.com/play/3932

    Center for the Human Rights of Users and Survivors of Psychiatry

    http://chrusp.org/home/index

    Psychiatrist Peter Breggin

    http://breggin.com/index.php?option=com_content&task=view&id=192&Itemid=94

    The Council for Evidence Based Psychiatry (psychiatrists with a conscience)

    http://cepuk.org/

    • elvischannel

      Your criticism could extend to the entire medical profession, not just that of psychiatry.

      • Tom

        Correct, and don't forget dentistry.
        A major problem with psychiatry is that, as medicine does not teach how the body works and how to cure, psychiatry is a mishmash of western rationalizations that do not address who the person is, how they got that way, and how to deal with it. Psychiatrists can rationalize anything, but they cannot prove anything. Like medicine, psychiatry does not recognize that nutrition can cure many issues. Like medicine, psychiatry has turned to the 10 minute and a prescription model to make more money.

        • Simon

          Indeed - nowhere, not once, does Pierre refer to nutrition.

          Why?

          - because it invokes holistic understanding which a) empowers people b) costs little c) doesn't need his psychiatric textbooks.

          And yet "studies have shown" mood, concentration etc are severely impaired if you have a poor diet with a lot sugar, fat etc.

    • Simon

      Precisely - he is encouraging people into psychiatry.

      The rhetoric style is the same as Hitler's or that of a priest: tell people what's wrong, and tell them he has the answers.

      Pierre and his kind encourage a POWER relationship where they have it and you do not.

      That is the heart of this dangerous nonsense which, as posts here indicate, has and continues to cause serious damage.

  • Sonia Best-Koetting

    I see demons and angels on all sides of this discussion. Pills are bad, and yet not so bad when they offer relief that is a stop gap to a sustainable solution. Buddha said life is suffering, but in my view, human compassion and ingenuity will always push us to alleviating suffering. Good and bad therapists, legitimate and unscrupulous uses of pills — It's all an evolution, a tightrope we each must walk, trusting in ourselves or our caretakers to sense what's best for our unique story.

    I hope the evolution will give us a new option... the ability to retreat from modern society for a while to regain balance. A week in silent meditation and wholesome foods in a sanctuary is possibly more affordable, successful and lasting for some "somatic" conditions than pills and talk therapy. Perhaps twice daily massages would do wonders through the power of touch.

    Fast adaptation to physical stressors and invasive communication will wear us down like a marathon. Going back to the cave for a while allows some healing that more noise simply never will.

    But then comes the the problem of money to allow people to go "off grid". In the U.S., a struggling healthcare system is unlikely to support prescriptions for serious R&R or consistent touch therapy for mental diagnosis. Making this happen is a new challenge of compassion for humanity.

    More options than pills, talk therapy, shock treatment and hospitals, PLEASE!

  • elvischannel

    I believe the stigma of mental illness goes back to the time when it wasn't called mental illness. It was called sin or demon possession..

    • JenJen10

      The fact is, being insane means being different, it means thinking different, and acting different. Look at the Sandy Hook killer, the Naval Yard killer, they were acting strange but nobody took appropriate action in time. People have a right to be scared of someone they don't understand & can't control & who might hurt them. We relate to each other using sets of cultural norms, if someone comes up to you, you don't expect them to suddenly kill you, but if they don't act within your cultural norm then you should watch them very carefully because they might. You can't blame people for being scared.

      • mollybutterfly

        If you observe people, you will realize that not everybody who is different is a harm to you. In fact, the people who are different are usually also the people who make a difference in the world and are written down in history books.

        • JenJen10

          I agree. I didn't mean to imply that everyone who is "different" is insane. I am different myself from many people I meet.

          When I read this article it reminded me of the killers who suddenly go berserk and do so much harm before they're forceably stopped. All of these people were acting 'different' and could've been stopped before they killed others. The Naval Yard killer was evidently hearing schizophrenic voices in his head, he thought people outside him were trying to control his mind. I talked to a man who was schizophrenic once, he said he thought the voices were "angels". (I think maybe that's where the idea of invisible angels came from.) But he also said all the angels were not good, some of them told him to do harmful things. He was smart enough to not act on what he thought he heard. If the Naval Yard killer had been given suppressants to dampen down the voices in his head, he could've been saved & those 12 people he killed would be alive today, too.

          The fact is, schizophrenia cannot be dealt with by one's own self. And anyone can become schizophrenic at any time in their life. As a society, we need to teach everyone how to recognize schizophrenia & what to do about it. I think if the Naval Yard killer had known he had a disease, he wouldn't have been so scared of what was happening to him.

  • Max

    Interesting article and some interesting comments. What goes unmentioned though, is that - as per pessimist philosophers such as Schopanhauer, Zappfe, Cioran, and in some ways Nietzsche, and as increasingly confirmed by modern neuroscience and evolutionary theory - humans are essentially not built for mental good health. (See Thomas Ligotti's 'The Conspiracy Against the Human Race' for an excellent summary.) In some ways, to be depressed is simply to be paying attention. Psychiatry is in a weird bind, in that it has to act as a science, and yet the maintenance of something like mental balance requires the implicit belief in a host of (un-scientific) illusions - the self, free will, the relevance of a single solitary life etc.

    • Dad w/o Qualities

      I don't know if I agree that free will is 100% illusory, but I agree that if you have any sort of exposure to philosophy and/or statistics, therapists' stock responses to "negative ideation" quickly get tiresome.

    • Ori

      I must say that at this point in life I disagree with this perspective. In my own humble experience, I find that the philosophies one holds are more often caused by one's mood and reflect it, and not the other way around. Either through psychotherapy, meditation, pharmacotherapy or whatever works for you- when you feel better, your ideas about 'the human condition' tend to lighten up..

      • Simon

        I agree. But the point about drugs is they 'nuke' whatever feelings you're having with an astonishingly crude person = chemicals approach that fails to address underlying issues and makes the situation worse with dependency, side effects, and increasing powerlessness when you are treated as "ill" by "experts."

        Psychotherapy and meditation is not in the same category as psychiatry. The first two are holistic and empowering, the second exists in a medical model which traces back, intellectually, to the asylum days.

  • Ian Jay

    "In the past, men created witches: now they create mental patients."

    Thomas Szasz

  • fishyculture

    First, DO NO HARM. You prescribe drugs that say, right on the label, that they can cause suicidal thoughts and behaviors. You are carrying on the work of the Nazis and don't even realize it.

  • Doc Lem

    Now any diagnosis will undermine your right to have gun and this where the FEDS jump in thanks to Obama-care...

  • Afshin Nejat

    It is not merely that some undefined potential for "mental health" is not reachable by anyone, like some amorphous ideal, that is the issue. The ISSUE is that such a condition of a person is not properly defined. How can this be simply and eloquently demonstrated?

    Look online at this link: http://www.mentalhealth.com/dis/p20-ps01.html

    Here you have a discussion about what psychiatrists think and have thought about the "classic" form of mental illness, the famed "schizophrenia" (*echoes repeatedly*)

    Notice that their nosology is based upon deviations from what are presumed to be "normal conditions" of a person in "good mental health". Yet notice how arbitrary these items of description are. Also notice that these traits which are shown as the axes of positive and negative symptoms for this "disorder" are nothing more, basically, than "not fitting in to society well, if at all". Yet this doesn't seem like a proper definition of mental illness in itself. Besides, when one looks at what passes for "normal" in human societies, is one really impressed?

    I've looked at the teeth and gums of these creatures which pass for normal, and I'm not impressed with their "mental health", nor even their mental hygiene (if such a thing surely also exists).

    Clearly, we live in a world of FALSE NORMALITY, enforced by VIOLENT FORCE when its boundaries are not respected. We live in the midst of a violent beast, a mass of human mobs, all beholden to the levers of fear and desire, ever ignorant and doomed "ignavi" of Dante's description. THAT is mental illness, and spiritual illness to boot.

    Enjoy your delusions while they last... for you know what Paul said about the stark possibility that everything you know might be wrong...

    "Eat, drink, and be 'merry' (in whatever form pleases you), for all you know tomorrow you may not be around"

    That was a trick, and joke combined. You must never do such foolish things. Instead you must bother to know reality, and not be bullied or intimidated by either ignorance within yourself or within others. Get to it, then.

  • Ingolf Stern

    Vocal criticisms aren't just "coming from the profession". They are coming from the damn author of the DSM5 itself.
    Maybe we should listen.

    • Simon

      Maybe we shouldn't care one way or the other because to do so gives the nonsense power and recognition.

  • http://batman-news.com Elise

    My concern is less with diagnosis; I sought help for depression in 1985. My dispute is with a “treatment plan”
    which too easily may be, and was, insisted upon by imperfect practitioners of a very inexact science and was given credence and brought to fruition by uninformed, apathetic courts, judges, attorneys, and social workers, as well as by misguided or ostensibly powerless family and friends—all, relative to me, persons allegedly in positions of trust.

    My pastor in the ‘80s remarked, “It’s really unfortunate when someone’s made a decision that will involve everyone lying.” My landlord at the time commented, “Let’s hope they know what they’re doing.” An employer of those earlier days referred to me as a “lab animal.”

    I never was informed of any “peer review,” although I after the fact learned of staunch objections made to “the plan” by others in the profession and by persons especially close to me. Such voices apparently, merely were drowned out, and
    faulty premises were left intact, never revoked by follow-up treatment-providers. I was denied and refused, despite my attempts, participation in, access to, knowledge of my “treatment planning”—no doubt because I certainly would not have agreed or signed on to it.

    The treatment/life plan established for me was set in gear by affordable, but as it turned out, incompetent, unethical, immoral, experimental mental health personnel, without empathy, conscience or compassion, but clearly with their own “issues” and agenda.

    It was a plan based on repeated lies (blatant and those of omission), collusion, and manipulation. Treatment providers were armed only with subjective guesswork and interpretation and apparently found justification in such feeble profferings as, “You don’t have to like us or trust us, for us to be able to help you;” “It may take you awhile to rebuild your trust;” “When you hurt you grow;” “Suffering builds strength;” “Sometimes you have to get worse, before you can get better;” “Sometimes you have to tear something down in order to rebuild.”

    But, like Humpty Dumpty, I had availed to me no feasible plan of just how to put me back together again. A reasonable, thinking person might surmise the deleterious effect on the quality of my life. The upshot is that my condition did indeed worsen within a created Orwellian environment and existence: new symptoms, new labels, new prescriptions. I paid full consequences not just for my own mistaken choices (which I otherwise probably would not have made) and my own reactions, but for the abysmal actions taken by and choices made for me by persons I believe should have been charged with criminal malpractice.

    Practitioners misplaced in the field and within a profession which gave us lobotomies and shock treatment lacking prior consent thought of themselves, were considered, godlike. They espoused opinions and issued decrees as though Biblical. In my case, the cure, indeed, was worse than the disease.

    Nearly 30 years later, without the acknowledgment, clarification and closure I’ve sought through records and myriad sources, I am disabled. Despite the erosion of my trust and confidence; damaged, if not broken relationships and heartbreak; the excruciating and enduring emotional pain; the loss of irretrievable time; the unfathomable loneliness; the intentionally inflicted trauma—all resultant from a poorly conceived, inhumane, treatment team and plan—I survive.

    I’m putting together for hoped for publication a narrative account/expose’ of my experiences, complete with lessons and caveats for those seeking help and support from mental health agencies and providers—i.e., educate yourself on provider’s education, experience, practiced therapies and goals; be advised that not all mental health providers are competent, trustworthy, necessarily healthy or stable;. . .When seeking/getting help for yourself or for another, be thoroughly informed re treatment plan, goals, anticipated duration; be well aware and advised of and have full possession of legal rights, protection, and recourse.

  • Surviving ADs

    This psychiatrist is utterly deluded about the safety of psychiatric drugs. No one should be taking a drug chronically unless it is absolutely needed to treat a real condition. There is no drug that is not a two-edged sword. Prescription of psychiatric drugs by an MD is no guarantee against adverse effects. Many MDs, even psychiatrists, would not know an adverse effect from a psychiatric drug if it bit them on the tender parts. It's Dr. Pierre who's lost perspective about psychiatric treatment.

  • Simon

    This is like propaganda. The message is

    1) We are the experts
    2) We judge your life and tell you what we think
    3) There's nothing to worry about and we're much better at it than we were in the asylum days
    4) Our drugs are a bit better
    5) You don't complain about penicillin when you have influenza and you can trust us in the same way.

    Pierre refers to the following:

    1) The asylum days of 100 years ago
    2) The damaging effects of drugs
    3) The medical model we don't complain about if we have a broken bone

    Thats a reasonable starting point. He suggests every one of those objections is unfounded while providing contrary evidence:

    1) The asylum days were a power relationship embedded in social conditions which Pierre maintains

    2) There is enormous evidence documenting the damage of drugs irrespective of fatuous remarks saying they're now better

    3) Someone going to a doctor feeling unhappy is not the same as having a broken bone. Pierre himself makes this connection and thinks its OK. His psychiatry sits inside a medical model which traces back, as he admits, to asylum days and medieval diagnoses.

    What he expresses here is no different. It is a POWER relationship which causes enormous damage accordingly. It says there's something wrong with you, and we are the experts not you.

    "must be decided based on judgment calls made by experienced clinicians."

    No Pierre, what people "must" do is avoid, at all costs, getting into a consulting room with you and your kind, maybe paying for it, losing all sense of personal power, autonomy and wholeness. In short - getting trapped in a system where the very basics are wrong, where you are subjected to quasi medical diagnoses, told you and your kind are the experts on other people's lives, and simultaneously given drugs which perpetuate symptom based nonsense rather than heal.

    "Recent epidemiological studies based upon DSM criteria have suggested that half or more of the US population will meet the threshold for mental disorder at some point in their lives."

    And priests say I have to believe their stories too.

    "To many, the idea that it might be normal to have a mental illness sounds oxymoronic at best and conspiratorially threatening at worst. Yet the widening scope of psychiatry has been driven by a belief – on the parts of both mental health consumers and clinicians alike – that psychiatry can help with an increasingly large range of issues."

    And politicians speak the same way. Its an entirely fatuous remark.

    "might benefit from intervention"

    Sure. The "intervention" of exercise, friends, a good movie, better nutrition etc - not
    being labelled by an "expert" on way or another and given drugs, we're told, which are not quite as damaging as they used to be.

    "A diagnosis of mental illness is more common than ever – did psychiatrists create the problem, or just recognise it?"

    - the question is: why should we care one way or the other?

    The dynamics here are similar to religion: tell people they're wrong (sinners) according to a model we control (the bible stories) and we will make you better with drugs (ensure you get to heaven).

  • Simon

    Throughout, the sub text to this piece is the following:

    1) We are the experts
    2) We judge your life and tell you what we think
    3) There's nothing to worry about and we're much better at it than we were in the asylum days
    4) Our drugs are a bit better
    5) You don't complain about penicillin when you have influenza and you can trust us in the same way.

    Pierre refers to the following:

    1) The asylum days of 100 years ago
    2) The damaging effects of drugs
    3) The medical model we don't complain about if we have a broken bone

    Thats a reasonable starting point. He suggests every one of those objections is unfounded while providing contrary evidence:

    1) The asylum days were a power relationship embedded in social conditions which Pierre maintains (we are the experts)

    2) There is enormous evidence documenting the damage of drugs irrespective of fatuous remarks saying they're now better

    3) Someone going to a doctor feeling unhappy is not the same as having a broken bone. Pierre himself makes this connection and thinks its OK. His psychiatry sits inside a medical model which traces back, as he admits, to asylum days and medieval diagnoses.

    What he expresses here is no different. It is a POWER relationship which causes damage accordingly. It says there's something wrong with you, and we are the experts not you.

    "Recent epidemiological studies based upon DSM criteria have suggested that half or more of the US population will meet the threshold for mental disorder at some point in their lives."

    And priests say I have to believe their stories too. Psychiatry works in a similar way by controlling the story and fitting people into it.

  • Bulkey

    So one may ask why psychiatric services have failed to integrate with primary care, despite theoretical aspirations proclaiming it; Could we assume that doctors of other specialties hijack at least some psychiatric disorders, in order to protect their chronic patients' social status? Or could it be that medical rationality at large stands against patients with clinically important psychopathology, since they are considered non-compliant or even a failure-story? Of course one should not be surprised neither for stigma by association to mental health workers, nor for the lack of funding to research in this domain: After all, these questionable professionals have created the aforementioned exclusion with their preaching!

  • Cllr Chris Cooke

    I often think the pyschiatric profession won't rest until they make everybody crazy! Pellagra, for instance, was a disease initially and for very many years misdiagnosed and mistreated (often with some very nasty "treatments"!) as "insanity". Yet it is now well understood that the cause of Pellegra was inadequate diet - particularly of niacin (Vit. B3). It seems to me that most if not all "behavioral" conditions would also be linked to diet, especially where that diet involves heavy intakes of chemical toxins deliberately put into our foods for the purposes of taste enhancement, preservative or, as in the case of fluoride, even to medicate us!! It's small wonder that one's natural body reaction to such things is to create neural stress, resulting in inappropriate behavioral patterns. Treating such things with more poisons (ie - a wide range of pyschiatric "medicines") is absurd and dangerous.

  • Simon

    "As a psychiatrist, I see this as the biggest challenge facing psychiatry today"

    - referring to negative perceptions of psychiatry, not the reality of the negative practices.

    You illustrate the problem Mr Pierre. In your own words, you connect medical matters and "mind" matters saying we accept the first but not the second as part of the same field, and as if they should be regarded as such.

    "Mind" matters, Mr Pierre, concern "whole persons in their social contexts" and not "patients’ neurotransmitters" -

    http://www.moshersoteria.com/articles/resignation-from-apa/

  • Simon

    Dear Aeon Mod: its hard for me to talk to you nicely after you treat me with such dismissive contempt for posting reasonable stuff which you deleted twice. You will no doubt delete this again but perhaps people will see if for a short time, and condemn you too. If you post articles you should allow critical dialogue against them. Its adult and sensible to do so, not to delete the following - for example - like a baby.

    ----------------------------------

    Throughout, the sub text to this piece is the following:

    1) We are the experts

    2) We judge your life and tell you what we think

    3) There's nothing to worry about and we're much better at it than we were in the asylum days

    4) Our drugs are a bit better

    5) You don't complain about penicillin when you have influenza and you can trust us in the same way.

    Pierre refers to the following:

    1) The asylum days of 100 years ago

    2) The damaging effects of drugs

    3) The medical model we don't complain about if we have a broken bone

    Thats a resonable starting point. He suggests every one of those objections is unfounded while providing contrary evidence:

    1) The asylum days were a power relationship embedded in social conditions which Pierre maintains (we are the experts)

    2) There is enormous evidence documenting the damage of drugs irrespective of fatuous remarks saying they're now better

    3) Someone going to a doctor feeling unhappy is not the same as having a broken bone. Pierre himself makes this connection and thinks its OK. His psychiatry sits inside a medical model which traces back, as he admits, to asylum days and medieval diagnoses.

    What he expresses here is no different. It is a POWER relationship which causes enormous damage accordingly. It says there's something wrong with you, and we are the experts not you.

    - perfectly reasonable, Aeon. Not abusive or anything similar, just radically disagreeing.

  • Simon

    "psychiatrists don’t think that everyone is crazy, nor are we necessarily guilty of pathologising normal existence and foisting medications upon the populace as pawns of the drug companies."

    So? Why are you talking here like you are experts, needed, and people should come to see you -why is that?

    Why don't you talk about facts and methods people can use for themselves so you are NOT needed which is supposedly the basis for your work? How about diet and exercise to start with and the "studies" proving their importance for mood etc??

    But no, you say we accept doctors if we have a broken bone and say we should accept you people in the same way.

  • Simon

    "That reluctance is understandable. Although most of us crave support, understanding, and human connection, we also worry that if we reveal our true selves, we’ll be judged, criticised, or rejected in some way. And even worse – perhaps calling upon antiquated myths – some worry that, if we were to reveal our inner selves to a psychiatrist, we might be labelled crazy, locked up in an asylum, medicated into oblivion, or put into a straitjacket. Of course, such fears are the accompaniment of the very idiosyncrasies, foibles, and life struggles that keep us from unattainably perfect mental health."

    Possibly so. And such "fears" are also legitimate when psychiatrists, as you imply yourself with reference to doctors who heal broken bones, address such people in much the same way: as if they "ill" and need to be "fixed" by "experts" about their lives where drugs are the overwhelmingly prevalent "intervention".

  • Warren

    This essay reminds me of Michael Moorcock's story THE DEEP FIX (1975-ish) which describes a society where people's minds are controlled and kept in line by drugs, which are later superseded by electronic manipulation via microwave transmitter stations.

  • Eve

    Where is the social perspective in all of this? It seems to me that psychiatric or psychological diagnoses are mostly about helping people get the insurance coverage they need in order to pay for specific kinds of pharmaceutical products or pay the money that it costs to speak to a professional about their "problems of the spirit and/or mind" or ... those of relationship.

    How do these diagnoses compare internationally, and with countries that have any assortment of "real" universal health care systems (using "real," since the overall we have, at present, is nothing of the sort).

    It seems that, one, a single payer system would redress many inadequacies in the present American system.

    Secondly, you can't get away from the mental distress that our current economic system is plaguing upon individuals and families. With a multiplicity of psychological issues, as a result.

    IMO, the movement towards basic income guarantees at liveable levels would go a long way towards alleviating people's suffering in today's America, and coupled with a single payer Medicare for all health care system.

    I know that there are persons who would have very serious "mental health ailments," regardless, but I am sure that life would be a lot easier for them as well with these two signifcant, and what would be "revolutionary" reforms in the United States.

    • Eve

      Allow me to add that I think there should be some new psychiatric diagnoses for the sociopathy or psychopathy (whichever) that is rampant on Wall Street.

  • Jeff N.

    A number of posters have shared that they've had diagnoses related to schizophrenia or "schizoid" disorders. This is veering off the topic, a bit, but I have noticed that the diagnoses is more and more common these days and I'm wondering what that is about. Isn't schizophrenia a "multiple personality" disorder? With some personalities "knowing" the others, who may or may not know another personality? With the individual in question literally blacking out periods of time?

    If someone who knows could clarify for some of us less knowledgeable readers, and whether the nature of the diagnoses has changed over time.

    • mollybutterfly

      Schizophrenia and multiple personality disorder are absolutely not the same thing. Schizophrenia involves hallucinations. Multiple personality disorder is what you described above, though it has been called into question whether there is any solid evidence of it's exsists ce, particularly since there are so few documented cases. Schizophrenia is much more common, and the afflicted are often able to recover with medication to a "normal" state of being where they would be able to describe exactly what they went through. There is a lot of variation in individual suffering, but the general consensus is hallucinations and paranoia.

  • Nick

    I'd submit that our society really is just terribly "sick" in ways people embedded in it cannot understand. Divorce, the breakdown of the family, smartphone addiction, the sheer loneliness and lack of love that is utterly commonplace in our everyday lives. It's no wonder such a huge percentage of people are doped up. They are mentally unsound because we live in an upside down society where that which truly makes us happy is diminished.

    We avoid our family, can't build our own families, have fewer and fewer friends, spend more and more time working for someone who doesn't care about us, and we wonder why we feel depressed, anxious, etc.

  • Nick

    Our lifestyles are so atrocious as well, adding to that which I wrote below. We eat complete junk made in laboratories which really doesn't qualify as food. 2/3 of us our overweight. We don't exercise. Of course we have chemical imbalances because the chemicals we ingest are disgusting to begin with. Garbage in, garbage out.

  • dfwmom

    Have you read about the case of Justina Pelletier, and do you still stand by your comments, in light of the behavior of BCH psychiatrists. Are you aware of the apparent obsessions by BCH psychiatrists with the diagnosis of "somatoform disorder"? Look at the number who advertise somatoform as one of their specialties. Are you aware of Per Fink, in Denmark, who is trying to get his "bodily distress disorder" diagnosis into the ICD-11, and declared a young woman mentally incompetent, and sectioned her into his own hospital, where he is presumably doing research on her to further his ambitions? The somatoform trend is an incredibly dangerous erosion of human rights, worldwide. In this context, the current trends in psychiatry are a danger to civil and human rights.

    • mollybutterfly

      he didn't say that everyone in his field acted appropriately. I think you should reread the article. He's talking about the optimal results of psychiatry.

  • Vinay Kolhatkar

    Why does this article ignore the role of psychologists, social workers, clinical hypnotists, and counsellors? For other than the psychotic and the criminally insane, the non-medicating professionals should be the first stop for such ailments as anxiety attacks, grief, insomnia, the blues, procrastination, even the so-called ADD. "Find what you love, in terms of productive activity, and love what you do", will relieve, even cure, many of these things. Reach for medication when you must, but only when you must.

  • Karl Haebler

    I thought this was a fantastic article. I have had anxiety and depression for many years now, been to quite a few psychologists and psychiatrists for help, and the question of whether or not this is just a result of modern medicine or something that should be addressed is a very pertinent topic. I fully agree that although these conditions don't represent psychosis, they definitely need to be addressed since they affect all manners of life and livelihood

  • Only Me

    I think Aeon deserve some kudos for not closing the thread given that the overwhelming majority of feed-back is highly negative (and I agree with it!) For my part, I will try not to be polemical but my experience of psychiatry is not good. I happen to have O.C.D. which started when I was about seven years old. Given that it is/can be a very debilitating condition, I entirely understand that 'help' was sought on my behalf. It's just a shame that no-one I have ever spoken to in connection with the disorder has had any real insight into the condition at all. Above all, what is disheartening is that you are almost never listened to with any real care and there is a very strong sense that you are disbelieved in many regards: oddly, since most people who have written about the condition agree that Obsessive-Compulsives are not impaired in terms of insight or judgement and that their symptoms, in that respect, stand apart from their overall personality. (I.e. we are neither backward nor delusional and might be expected to 'help them help us' - again, if we were listened to). Yet invariably, I have found that whilst I am permitted to speak, and heard out relatively politely, little or nothing I say is allowed to influence the treatment prescribed. It's something of a puzzle, also, that there is general agreement that neither therapy nor medication ever cures the condition - all known cases of cure are remission, i.e. self-cure. My own symptoms were alleviated dramatically when - entirely unconnected to any treatment - I was belatedly able to effect the course of action I had repeatedly recommended to my therapist and my parents. Namely, that since I was being viciously bullied at school, my condition would never improve under those circumstances. I needed 'the geographical cure'. This was dismissed out of hand, and my condition deteriorated year on year (medication - administered against my will - did absolutely nothing) until I completed secondary school, moved away to attend college and about ninety per cent of my symptoms ceased almost immediately. Previously, on one occasion, family members were encouraged to - and did - attempt to physically beat my OCD out of me (in the course of breaking down "safe areas", which manifest in certain cases, in which Obsessive-Compulsives separate their living space from areas they associate with negative emotions - in my case, areas containing objects which my class-mates had ritually defiled in various ways, knowing this to be extremely upsetting to me)... This was all recommended by an 'expert' in the field, whom I have occasionally wondered since if I should have sued for criminal negligence and/or abuse of a minor. On balance, I took the view that the compensation culture is beneath me, however gross the stupidity of this supposed expert. With 'help' like this, the main problem is that having survived and substantially recovered from OCD, you are still left with lasting feelings of disbelief, occasionally despair and nightmares (literally) about the abuse suffered at the hands of your contemporaries, ignored by your teachers, and aggravated by incompetent therapists. The fact that you were totally betrayed and at times further traumatised by such people leaves some residual trust issues and depression - which in itself is then taken as an indication that you are still not 'making progress'. With this kind of circular logic, you have to wonder 'just how is anyone supposed to win'? On balance, talk to your friends, or even a sympathetic stranger. It will help at least a little. All the experts ever seem to do is make it worse.