An Impossible Essay: “The Movement Against Psychiatry”

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.



Book Review: Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness, by Anne Harrington

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For the longest time I’ve been looking for an impossible book: an historic exploration of psychiatry and psychology over the last 150+ years that lays the groundwork of how we got to where we are (with the infighting, the arrogant spectacles, the tentacles of private interests), that also isn’t painfully academic or with too little (or too much) of the author’s own perspective of such a unwieldy topic. Well, as I said, it doesn’t exist, but Anne Harrington’s Mind Fixers comes very close.

As the subtitle states, Harrington (a science historian and the Franklin L. Ford Professor of the History of Science at Harvard University) has her lens steadied on the search for the (real, perceived, and ultimately elusive) biological underpinnings of mental health conditions. This is a terribly important topic and if this book has not ignited the debate it might have, it’s no reflection on the scholarship or insights gleaned from Mind Fixers, but perhaps a victim of timing and not being the loudest possible controversy to be found on Twitter. Even then, if you follow psychologists, psychiatrists, and those who specialize in related research on Twitter you’ll soon find yourself inundated with accusations of anti-psychiatry levelled at those who criticize prevailing notions of mental illness being caused by chemical imbalances in the brain, while the replication crisis undermines many of the foundations of Psychology 101.

If there’s a story here, it’s one of shifting hegemonies: from those who were concerned of their patient’s physical wellbeing, to those concerned with their brains, from those concerned about subconscious maternal conflict to those convinced the answer was in our brains, but only chemically. And with each shift in search of a possible answer to mental suffering there are reciprocal shifts in public investment and, eventually, interest from pharmaceutical companies. And at the end of the day what shifts the most are some of the most vulnerable people in our society: from sanitariums to hospitals; from wartime battlefields to community centres…only to be dumped onto the streets. It’s all here in Mind Fixers, and it’s a timely read considering the vested interests currently luring large investments in brain science, or in such promised but potentially dangerous remedies as ketamine, or those convinced of a genetic pathology. And if it sounds as if this book is strictly for history/psychiatry wonks you are dead-wrong.

What Harrington does very well is take reams of historical information and distill it into a narrative that ultimately maps out how those with what is generally called (though I hold some hesitations at times) mental illness were treated and what those in their charge felt was at play inside their bodies. Along the way we see ethical lapses in the form of wholesale human experimentation (i.e. injecting unknowing patients with blood infected with malaria), as well as the overreaching ideal of Freudian psychoanalysis as a Rosetta stone. Along the way we are introduced to ideas and theories which seemed to make sense at the time — narcosynthesis, insulin coma therapy — along with travesties such as deinstitutionalization, basically the dumping of people with mental health issues on the streets as a result of overambitious government policy that was out of sync with the realities of state coffers. Mind Fixers is also blunt about the influence of pharmaceutical companies, who increasingly figure in the narrative; the last quarter of the book is an admonishment of the profiteering that took place from the mid-1980s to the mid-00s as companies such as Eli Lilly were able to advertise directly to Americans and, with the help of an increasingly subjective DSM that allowed two people with completely different symptoms to be diagnosed with the same disease, exponentially increase their profits through prescriptions.

There are some issues. Repeatedly, Harrington refers to the “neo-Freudians” who, in their day (mid-20th century), held the reins of power with respect to diagnosis and how psychiatric trends were approved. There is a lot of confusion (just look at the definition provided on this U of C Berkeley page) about what a neo-Freudian is: those who studied but ultimately disagreed with Freud (however kept his strictly psychodynamic approach) or those who held Freudian views but refused to downgrade the role of biological processes? It may sound semantic, but in lieu of a definition the term’s repeated use without context begs for clarity. In the process it also makes it sound as if all psychoanalysts were in some way Freudian adherents. What about Melanie Klein and the rest of the object-relations movement? How did they differ? Indeed, the role of plain ol’ talk therapy — explicitly Freudian or not — is given short shrift, which might sound understandable in a book looking at biological underpinnings, but as a tool in the arsenal against so-called mental illness its absence feels odd, especially in light of the author’s emphasis on the misdirections of neo-Freudians. I get that Harrington could easily have written a book three times its size on her chosen topic. But if you’re going to talk about the influence of Freud and psychoanalysis in general then I feel you have to unpack and contextualize a bit more than what is on display here.

For the most part, however, Harrington is surprisingly fair-minded, not only unveiling the naked greed (and capricious biological arguments) of psychopharmaceutical manufacturers, but highlighting the testimony of those patients who were — placebo effect or not — helped by their medications, even if it came at a cost of other aspects of their health. She is by no means on a mission to dispel the notion of a biological source of mental illness, as I’m sure some vested interests might think looking at her book from a distance, but rather to show how partisanism, arrogance, and greed have wasted decades of valuable mental health research as we swing from trend to trend.

Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness, is available at an independent bookseller near you, or online.


Book Review: Casting Light on the Dark Side of Brain Imaging

Whenever a mental health authority is interviewed in the media it’s nearly inevitable that this person is a medical doctor, usually a psychiatrist. This individual typically isn’t a practicing therapist; they may only be able to speak of clinical diagnoses and/or the prescription of psychopharmaceuticals. I mention this because when this authoritative psychiatrist is interviewed in the media I end up listening to a depiction of the massively complex human interrelational landscape I see around me every day, as both a writer and psychotherapist, reduced to a chemical imbalance in someone’s brain. It’s like ascribing a boxer’s loss of a title match solely to the width of their biceps.

book coverThe gold standard for looking at mental health is through what’s called a biopsychosocial lens, a flexible model that allows professionals to consider the biomedical (for example, thyroid issues, dementia), the psychological (traumatic experiences, abusive relationships), and socio-economic factors (unemployment, impoverished environment) that might be at play in the mental health profile of any given individual, even if it ends up a combination of one or more parts. In North America there is unfortunately a sacred primacy around the biomedical approach to mental health, with the psychological and socio-economic as (at best) secondary considerations at the table of funding and education. At this moment there are medical doctors losing sleep wondering how to beat the shame of knowing there is a patient in their care whose condition might be psychogenic (meaning, whose pathology is not, strictly speaking, a biomedical end product). Continue reading “Book Review: Casting Light on the Dark Side of Brain Imaging”