imaginary magnitude

I’ve been wondering whether to respond to an essay that was posted on VICE Magazine a couple of weeks ago, and so this is my meagre attempt. The hesitation you are picking up is based upon the fact that it’s an almost impossible essay for anyone to attempt to write; impossible because its subject matter contains so many perspectives — ground level, professional, clinical; historical, academic, unacknowledged — that one would need to write a thick book in order to begin to encompass just a notion of the territory that is being covered. The fact that I’m blogging about it means it’s stirred up some feelings (some conflicted) that need to be put on paper. Mostly this reflects well on the piece, despite the fact I’m not exactly a fan of VICE in general.

The essay, The Movement Against Psychiatry, by Shayla Love, lays itself out from the beginning with a profile of two people with two very different mental health challenges: one of whom, it’s argued, might have been helped by being institutionalized (even if against her will) in order to prevent her downward spiral; the other sought psychiatric assistance but found herself over-prescribed with various medications, without a sense of there being an overarching logic or consideration for the underlying causes of her situation, or the side effects of what she was prescribed. In this comparison we are presented with an outline of the challenges facing mental health in general and modern psychiatry specifically.

We are then presented with three groups: the psychiatric orthodoxy, those who belong to what is known as the anti-psychiatry movement, and those who belong (or fall into) what is referred as “critical psychiatry.” The first glimpse of the impossibility the author faces — if using those two persons’ examples off the top didn’t do it — is that, if you stop and consider it, there are inevitably going to be many voices within each of these three groups, ranging from the open-minded to the downright neglectful. For my purposes, it is specifically with how those who belong to the last two groups are separated from each other that I think the piece finds its greatest challenge. A key problem is that there are those who are self-declaratively anti-psychiatric — ranging from wanting to abolish psychiatry altogether to those wanting to revolutionize the foundations upon which patients’ conditions are considered — and those whose philosophy might be considered by the establishment as anti-psychiatric, in a pejorative sense, but who for all intents fall into the “critical psychiatry” group.

To her credit, the author touches early upon the detractive nature of the term anti-psychiatric, however my criticism is that the essay misses an opportunity to convey the power those in the psychiatric establishment have who wield this term, compared to those who are not medical doctors (perhaps researchers, perhaps academics, or clinicians) but who nonetheless have pointed questions about the prevailing logic of certain psychiatric interventions (whether it be about overprescription of drugs, or the use of ECT). That term and its connotations, in other words, can be weaponized, whether or not it is used accurately or as an attempt to discredit or dismiss the person in question entirely.

But I want to be fair where fair is relevant: the author also correctly exposes the fact that the waters of the anti-psychiatry movement are muddied by the more than passive involvement of the Church of Scientology. They have a stake, albeit a selfish one, which is fitting for a cult. This does no one any favours in this debate, and only makes it easier (see last paragraph) to punch down from the psychiatric establishment with only the briefest mention that a critic may have ties to Scientology.

And I will admit that there are a host of well-respected voices who, if pressed, I might put in the “critical psychiatry” camp, who do themselves no favours by using only the most self-serving, one-sided Mad in America articles to labour their (otherwise respectable) arguments. I find by contrast that my professional perspective ends up being more nuanced (which gives me pause given my comparative lack of academic credentials). I believe in a biopsychosocial approach to mental health (whereby causation might be one, or a mix of all). I can tell you anecdotally that, yes, there are people who are temporarily helped by medication, who are able to use that stabilization to pursue non-biomedical interventions like talk therapy. It’s good to question the underlying chemical imbalance hypothesis of depression, but if someone achieves stability enough to be able to advocate for themselves (and to make choices such as tapering off said medication) then so be it.

I think what gets lost in the debate, which can often pit two highly qualified individuals speaking in terms that are highly specialized and often theoretical — and again, I think the author does their best to come back to this point — is that, at ground level, regular people who need help are harmed. Harmed, because their GP likens depression to something like diabetes, insisting that their patient will need to be on drugs for the remainder of their life, or puts their patient on a high dosage of a toxic anti-anxiety med like clonazepam without mandating regular check-ups in order to potentially lessen the dosage. Or they are harmed because community organizations are often ill-equipped to provide consistent space for people who suffer from psychotic episodes. Or they are harmed by an untrained psychotherapist who operates in a province or state where the profession is unregulated, thus allowing practically anyone, regardless of credentials, to see clients.

I keep hearing the word “patchwork” when the mental health support system is mentioned. That is what the average person faces: a patchwork of often disconnected resources with no sense of guidance about what is best for them and their situation. Moving closer to a system that has the capability to provide continuity for each individual within a public health system should be the priority. While there is a need for debate, the largely sectarian nature of it only seems to put that possibility further away.