biological psychiatry

Neuroscience, Pseudoscience and The Vast Gulf Between

A guest blog and opinion piece at the top of the search pops on the subject of psychiatry at Scientific America is entitled Why Psychiatry Needs Neuroscience. The author is one Daniel Barron. The claim was made in this piece that there was a war between the two fields to which Neuroskeptic blogger at Discovery Magazine replied with a post of his own, The Fake “War Between Neuroscience and Psychiatry”.

Daniel Barron writes:

That the relevance of neuroscience to psychiatry is still questioned is blatantly outlandish: what organ do psychiatrists treat if not the brain? And what framework could possibly be more relevant than neuroscience to understanding brain dysfunction?

Hold on a minute, “what organ do psychiatrists treat if not the brain?” Uh, I’ve got another one for you, what organ do neurologists treat if not the brain?  I suggest we take it to Google and ask for a definition of psychiatry and  then a definition neurology. If we do so, we get this:

Psychiatry: the study and treatment of mental illness, emotional disturbance, and abnormal behavior.

Neurology: the branch of medicine or biology that deals with the anatomy, functions, and organic disorders of nerves and the nervous system.

It is not brains that psychiatrists study, in other words, it is misbehavior. Whether the misbehavior of people can be linked to misbehaving brains, and by extension, nervous systems (misfiring neurons) is another thing altogether.

Psychiatrists, in other words, deal with mental disorders while neurologists deal with brain injury and disease.  Prove you’ve got a bona fide disease affecting the brain, and, as happened with syphilis early in the twentieth century, it is no longer on the turf of psychiatrists, it is then in the territory of neurologists. This is a divide that can’t be breached by wishful thinking.

With the new emphasis on brain research, everything associated with neuro is trendy. Okay, today there are people calling themselves neuropsychiatrists, and that I would characterize as a mystification, pure and simple. Nobody, after all, who has not gotten into trouble with the long arm of the law, is likely to be called a “psycho-neurologist” anymore.

The question becomes, when it comes to behavior, over which people certainly have some measure of control, as conscious decision making must come into play somewhere along the line, should we be placing all the blame for aberrant behaviors on mechanical actions taking place inside the brain, or do they have more to do with other factors–schooling, parenting, etc.–involving a whole constellation of other things.

Again, back to the case of syphilis. Technically speaking, psychiatrists don’t study and treat the brain. Alzheimer’s disease is brain disease. Neurologists handle that. ADHD, distraction among students, is accounted a mental disorder, a matter for psychiatry.  When it comes down to it, we are no closer to reliably attributing distraction in students to dysfunctional brains than we are to attributing it to dull and uninteresting subjects of study.

Although war is an awful strong word to use, I imagine there is plenty of room for disagreement between these two, seemingly similar, disciplines. The present detente worries me much more than any conflict that might arise between them would. I can’t help but imagine bribery, backhanded deals, and suppression of information keeping those lips that should be speaking sealed in the interim..

Anti-Psychiatry Is Dead. Long Live Anti-Psychiatry!

The anti-psychiatry movement has already been consigned to the history of psychiatry (Tantum 1991) despite the relatively recent first use of the term in the literature (Cooper 1967).

So goes the first paragraph in a piece, entitled What Was Anti-Psychiatry, on the website put up by Donald Duncan for a Critical Psychiatry Network.

The paragraph goes on.

A key understanding of “anti-psychiatry” is that mental illness is a myth (Szasz 1972).

Okay, I suppose, and the paragraph ends with…

The argument is that illness is a physical concept and therefore cannot be applied to psychological disorder without any physical pathology. As soon as it is accepted that mental illness can refer to psychological abnormality then the “anti-psychiatry” argument fails (Farrell 1979).

Remembering that Dr. Duncan is a psychiatrist, not a psychologist, the question becomes, What the bleep is a psychological pathology?

I personally don’t see how harboring ideas about thought disease would not in itself be a pretty abstract matter. Organs get diseased, thoughts get jumbled, but however jumbled thoughts might get, there is not a disease present in the thinking of the person with the jumbled thoughts.

Many of the most prominent psychiatrists in the world disagree with Dr. Duncan about the demise of anti-psychiatry. According to them, disagreeing with the orthodoxy of bio-medical psychiatry IS anti-psychiatry. A heresy some of them might even accuse Dr. Duncan himself of indulging in.

The fact that ‘antipsychiatry’ has existed in one form or the other for some time, and indeed has sometimes been vehement enough to approach psychiatry as a demon to be exorcised, is noteworthy.

Such a statement, authored by Indian psychiatrist Nimesh G. Desai, was published under the title Anti-Psychiatry: Meeting the Challenge in the 2005 Oct-Dec issue of the Indian Journal of Psychiatry.

Even if the anti-psychiatry movement of  psychiatrists has elapsed, for some of us, its victims, in the psychiatric survivor movement, as long as there is a psychiatry, anti-psychiatry never died. We will fight on. We will fight on until psychiatry ceases to exist at which point anti-psychiatry, having served its purpose, itself will cease to exist, for there is no anti-psychiatry without psychiatry.

Of course, just as NAZIism was replaced by neo-NAZIism, keeping alive the anti-fascist vision, the chances of that happening anytime soon are not so great as we would like for them to be.

Anti-Psychiatry however is a phoenix-bird, and it is reborn from the ashes of its previous existences. So long as psychiatry continues to oppress and abuse, it will meet with resistance. Sure, anti-psychiatry was yesterday. Not only was it yesterday, but it is today, and given the abuse and arrogance of psychiatry, it will be tomorrow.

You can bank on it.

Imaginary Disease Awareness Week

I found out subtly, almost by accident, chancing upon an announcement in the local student newspaper. Once again it is Imaginary Disease Awareness Week. Just in time for Halloween I suppose some of you must be thinking. It is as if the 13th hour had struck, and you don’t know what is going to happen next.

The regional Imaginary Disease Coalition has a series of events going on to mark and celebrate the occasion, logically enough. I imagine a few sighkiatrists, doctors who specialize in imaginary diseases, are going to take part in some capacity. It is important that people realize the seriousness of imaginary diseases, otherwise, one sighkiatrist or another might be forced to go to bed without dinner.

Converts to the imaginary disease religion are evangelical about educating people on the tenacity, veracity, and staying power of imaginary diseases. Sighkiatry, the priest caste of the imaginary disease faith, have come up with a BSM (bullshit manual) which is perhaps best described as a field guide to imaginary diseases. Through this field guide, they keep the real world bustling with imaginary afflictions.

The imaginary disease business is booming, which helps explain the importance of Imaginary Disease Awareness Week. More and more people are stepping forward with a claim to having an imaginary disease and, of course, Sighkiatrists, being imaginary disease salesmen first and foremost, are pleased as punch. Actually, sighkiatrists are imaginary disease treatment salesmen, but disease and treatment are rather like love and marriage in myth and song. It is very difficult to sell treatment to people who haven’t first bought the idea of having a disease.

We’re halfway through Imaginary Disease Awareness Week, and I didn’t know it was even going on. What could be wrong with me? I must be afflicted with a serious imaginary malady, huh? You’ve got to be careful. What did I say? Imaginary diseases are everywhere! The imaginary disease closet is being evacuated, the plague is out of the box, and there isn’t much room for people without some compulsive tic or prosthetic begging gimmick in the world anymore.

The good news is, seven days down, and Imaginary Disease Awareness Week is history. As Tony Soprano might add, “Forget about it.” To which one must reply, “If only imaginary diseases thought the same.” One thing you can be sure of, people will be bellyaching until the cows come home given the nature of imaginary diseases. The bad news? Once Imaginary Disease Awareness Week is over, it is only the beginning of Imaginary Disease Awareness Month that has elapsed. You might just consider it a big festival that climaxes with Halloween night, and continues on through Christmas, and beyond.

R. D. Laing, Thomas S. Szasz, and Mental Patients’ Liberation

Maverick psychiatrist Ronald David Laing once defined madness as follows: “Insanity — a perfectly rational adjustment to an insane world.” This speaks to the theoretical divide between R.D. Laing and his contemporary, fellow psychiatrist Thomas Stephen Szasz. His attitude towards Laing, from the beginning, was that of almost a visceral rejection, but on the grounds that Laing was, in his eyes, dissolute or lacking in moral fiber. This sort of symbolizes the distance between these two figures often falsely associated in the public mind.

Laing was a seminal thinker for the decade that came to be known as “the turbulent sixties”. Thoms Szasz was an emigre from a Hungary that fell under the soviet orbit following WWII, and thus reflected an older and more established world view, although similar claims could be made there, too. Szasz disputed the idea of mental illness, and approved, when it came to treatment, only of a therapist client sort of arrangement, an arrangement that jived with free trade. Laing wanted to throw off the divisions between patient and therapist in his unstructured and freer environment, the experimental therapeutic community, or residence.

What Szasz saw in Laing’s therapeutic setting, in his social experiment, was collectivism, of which, regardless of whether you are looking at communism or monasticism, he violently disapproved. Laing, on the other hand, recognized some of his clients “issues” as situational and social rather than imaginary and isolated. The theory is simple, you put some plants in one environment, and they are going to shrivel and die, however, if you transfer the same plants to another environment, they thrive. Animals, specifically the human animal, must be pretty much the same way.

There were other differences between the two, the stance of Szasz was moral. He was against forced treatment, and being against forced psychiatric treatment, he opposed the insanity defense as well. Laing, despite his social experiment, would never go so far as to oppose psychiatric force across the board. Power was something, for him, a psychiatrist might ruminate about, melodramatically, without relinquishing. He also was not beyond using the insanity defense, of which Szasz disapproved, in testimony before a court of law. Laing was operating under a mandate to live one’s life completely, and in so being, he would not be restricted by such moral constraints.

Another issue Szasz attacked Laing over was his use of psychiatric terminology, disease language, which he rejected. If “mental illness” was a myth, we shouldn’t speak of “problems in living”, as Szasz saw them, as “diseases”. Laing thought the disease theory, merely a theory, and not one that he necessarily subscribed to, but one he was not beyond utilizing in the interests of research and treatment. Basically it boils down to this. Laing served as an inspiration to those in favor of alternatives to forced and conventionally harmful treatments while Szasz served as an inspiration to those who would abolish forced treatment. Szasz’s approach to treatment focused more on accepting personal responsibility for one’s actions rather than evading that responsibility.

Thomas Szasz’s most famous book, in which he first expounded his views, The Myth of Mental Illness, was published in 1961, a year after he had published a landmark essay by the same title. R. D. Laing’s entrance into the published world began with The Divided Self, arguably his most famous book, in 1960. Kingley Hall, the first Laingian experiment, operated in London from 1965 – 1970. The mental patients’ liberation, or psychiatric survivor, movement began in 1969/1970 with the launch of the Lunatic Liberation Front in Portland, Oregon. The mental patients’ liberation movement, in so far as it existed, before becoming almost totally co-opted by federal financing, was against force and for “alternatives”, and thus, could be said to have been influenced and inspired by both figures.

Combating “Stigma” As A Selling Point

If you want more people claiming to be “mentally ill” in the world, there is a sure fired way to get them, and that way is to fight “stigma”, the “stigma” attached, by the way, to making that claim. This, at a time when currently the USA “mental illness” rate is estimated to range from somewhere just under 20 % to 25 % of the US population. We need, in other words, more mental patients like we need more Lyme’s disease to make Swiss cheese of more people’s brains.

What is the highest health care cost in the USA? The cost of mental health care. Why is this so? Because of campaigns to end “stigma”. “Mental illness” is a very popular “illness”. The state is paying for it to be so. What the state is not doing is getting people out of the mental health system (i.e. “mentally well”). This is because it is, in point of fact, not a mental health system at all, it is a “mental illness” system. You don’t push approaching a 1/4 of the population of the USA into treatment, for their “illnesses”, however illusory, if you want people to leave that system. “Mental illness” represents a cash cow to all sorts of people.

There’s a slogan out there that goes, ‘It’s okay not to be okay’, which is kind of like saying, ‘It’s cool not to be cool’. Suddenly all these tinted shades have gone completely transparent. A contradiction is no longer a contradiction. A horse is a goose, a snake is a cow, a duck is a bear, your enemy is your friend, etc., etc., etc. Illogic is no longer illogic. Got it. You get these slogans because there’s money to be made in mental health treatment, and somebody is out to make it. When we talk about mental health treatment here, it is important to note, we are talking about treating people claiming to “have a mental illness”. There is no money to be made in treating people who claim to “have mental health”.

There is also, to provide a corollary, no known “stigma” attached to “mental health”, except in so far as there is a “stigma” attached to “mental illness”, giving the person who makes the claim of having a “mental illness” access to a steady funding stream denied to the person claiming to “have mental health”. We can’t manufacture “disability” payments without at the same time manufacturing “disabled” people to receive them. Manufacturing “able” people, enabling them, would be working in the opposite direction, that is, on getting more people back into the work force, and on lessening the numbers of people claiming to have a “mental illness”. This, unfortunately, is not the direction in which we are headed.

The World Health Organization has, if alarmingly, announced more than warned that depression is rapidly overtaking heart disease as the number one cause of disability throughout the world. A heck of a lot of people are unhappy. If we pay people to be unhappy, of course, that is not going to mean you’ve got less unhappy people in the world. If you keep people from being employed because of their unhappiness that is not going to make for less unhappy people in the world at large either. If you build a business around people’s unhappiness that is not going to make for any fewer unhappy people in the world as well.

Obviously, we are waiting on some kind sea change here that may be a long time indeed in arriving. Could we make a business out of facilitating happiness and contentment, in a material as well as spiritual sense, we might be getting somewhere. “Mental illness”, or rather it’s treatment, may be selling like hotcakes, all the same, were that it could be “mental health”, or non-treatment, that was selling instead; then the little pandemic of “mental disorder” that we are stuck in the middle of at present might show signs of letting up.

Food for thought then, for the decades ahead: how do we get people out of the mental health system and back into their communities rather than expand that system, and, thereby, manufacture more people who see themselves as being “in need” of treatment. I certainly don’t think we are going to get there by pretending to be combating a “stigma” attached to receiving treatment.

Anti-Psychiatry In The 21st Century

I just finished reading David Cooper’s The Language of Madness (1978), his last book. I’d been been talking to some folks about the views of various psychiatrists who had some issues with their own profession. I don’t think Anti-psychiatry: Quackery Squared (2009) was a very wise maneuver on the part of Thomas Szasz. Szasz, in his book, attacks the psychiatric left wing, anti-psychiatry. This puts Szasz in the very uncomfortable position of providing a defense to the very people he opposes, proponents of forced psychiatry. It also alienates him from potential allies, regarding psychiatry and force, because of political differences. The result of this publication was to provide even more fodder for opponents of abolition of forced treatment, and to weaken the position of proponents of abolition, that is to say, now you’ve got establishment psychiatrists claiming Szasz as one of their own at the very moment they are bashing him.

R.D. Laing and David Cooper I would call anti-establishment psychiatrists. Thomas Szasz was an anti-psychiatric-establishment, considering that the psychiatric establishment is all about force, psychiatrist. Thomas Szasz was not otherwise anti-establishment. He was no friend of the new left, nor of what was then known as the counter-culture, both of which both Laing and Cooper could claim to have a stake in. Laing eventually saw in madness religious experiences. For Cooper madness embodied political action. I would fault Laing, Cooper, and associates (especially Laing) for not going all the way, and clearly opposing coercive psychiatry. I don’t think everybody was necessarily on the same page about this matter. I would have thought that the guru of Kingsley Hall would have “got it”, to a greater degree anyway, but apparently he stopped short. Laing, to a certain extent, is being “rehabilitated”, “resuscitated” perhaps, by the media. David Cooper, unfortunately, in the process becomes more or less a footnote on stories regarding Laing.

I love the clarity found in the thought of Thomas Szasz. David Cooper’s thought is more fuzzy, but there is some, perhaps much, good to be found in it as well. The problem is how do you separate the sense from, if you will pardon the pun, the anti-sense in Cooper. One thing he does is quote Karl Marx, in relation to his followers, saying he was not a Marxist. He then makes a similar claim about anti-psychiatry, that nobody can be one. I might have agreed if he’d said he wasn’t Cooperian or a Cooperist, and especially as that means little more than a footnote anymore. Cooper eventually talks about a non-psychiatry movement as if it were the successor to his anti-psychiatry movement. My conception though of anti-psychiatry is as a promoter of non-psychiatry. He titled the final chapter, The Invention of Non-Psychiatry.

Non-psychiatry is coming into being. Its birth has been a difficult affair. Modern psychiatry, as the pseudo-medical action of detecting faulty ways of living lives and the technique of their categorization and their correction, began in the eighteenth century and developed through the nineteenth to its consummation in the twentieth century.

Etc., etc., etc.

The thing is, you don’t have to invent non-psychiatry as it existed long before psychiatry was ever ‘invented’. It exists, even with what Cooper calls psycho-technology, in the same world that psychiatry exists in. The government control and surveillance aspect of psychiatry may be a big thing, but it certainly isn’t everything. There is also the matter of what we mean when we say psychiatry. Psychiatry wasn’t even a word until the nineteenth century.

I see a lot of good in Cooper. He and Szasz might have even agreed about force. We will never know. Szasz thought of anti-communist as a “good” word. Cooper was laying his cards on world revolution. Cooper was a supporter of worker co-operatives and social experimentation. Szasz thought the only way to go with counseling/therapy was as a contractual matter between professional and client. The issue I have with David Cooper is that if he had looked maybe he could have seen that anti-psychiatry doesn’t have to exist within psychiatry (or the mental health system). I see him talking about anti-psychiatry changing psychiatry from within. I don’t think there is a big likelihood of its doing so. I think there is a much greater potential for anti-psychiatry to overtake psychiatry from outside of psychiatry. When the taxpayer becomes anti-psychiatry, well, there you go. Why would anybody be paying for something they don’t have to pay for, and especially when that something is torture, slavery, physical harm, and imprisonment?

Enough is enough when it comes to the anti-psychiatry of psychiatrists. If we’re going to have an anti-psychiatry movement, let it be dominated by people who aren’t psychiatrists. In other words, a few more survivors, a few more blacks, a few more women, etc. We will even consider a psychologist here or there. As people never tire of saying in the disability rights movement, “Nothing about us without us!” The monopoly by psychiatrists on the development of the theory and practice of anti-psychiatry is something pretty easy to remedy. I think, in fact, we are getting there, if we are not already there. Nobody needs a degree in psychiatry to oppose psychiatry. There is something to be said for non-psychiatrists, in fact, there is something to be said for non-Ivy League professionals, or even non-Wall Street speculators, opposing psychiatry. There is something to be said for people taking charge of their own lives, and with those lives, their bodies, and the health of those bodies.

Psychiatry, Critical Psychiatry, and AntiPsychiatry

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I don’t know that I had ever encountered two words critical and psychiatry coupled together until I encountered it in book form with a copy of Critical Psychiatry: The Politics of Mental Health, edited by David Ingleby. This Critical Psychiatry was published in 1980, almost two decades before the network and website of the same name were established in 1990s UK. Critical Psychiatry, curiously enough, is also referenced in Anti-psychiatry: Quackery Squared (2009) by Thomas Szasz. Critical Psychiatry, as it is delineated in the book here, sets out to distance itself from the anti-psychiatry it associates with the 1960s.

The idea that psychiatry is a political issue is, of course, one which was first brought into public view by the ‘anti-psychiatrists’ who gained prominence during the late 1960s — Laing, Cooper, Basaglia, Szasz and others. Each of these figures stood for a different approach, and all have therefore disowned the umbrella label of ‘anti-psychiatry; Laing’s work led him into a therapeutic concern with fundamental existential issues, while for Cooper ‘anti-psychiatry’ was replaced by ‘non-psychiatry’, as the questions resolved themselves into more purely political ones. Basaglia sent his staff out of the hospital into the community at large; while Szasz denounced all these varieties of ‘creeping socialism’, and insisted that psychiatrists should return to a contractual relationship with the patient, aimed simply at promoting individual liberty. Yet despite their differences, all these figures were united in seeing the scientific image of psychiatry as a smokescreen; the real questions were: whose side is the psychiatrist on? what kind of society does he serve, and do we want it?

Critical Psychiatry (1980), Introduction, Ingleby, pg. 8

Nonsense to a degree, but baring a residue of truth.

Later, in this same introduction, Ingleby channels us into the real distinction between their antipsychiatry and his critical psychiatry.

A word about the title: why ‘Critical Psychiatry’?
‘Psychiatry’ because, unlike David Cooper’s ‘non-psychiatrists’, the contributors to this volume all feel that mental illnesses — whatever their correct interpretation and their political significance may be — do exist, and furthermore call for specialized understanding and help…

Critical Psychiatry (1980), Introduction, Ingleby, pg. 18

The contributors to Ingleby’s book felt such to be true because they couldn’t know such to be true. That “mental illnesses” exist isn’t knowledge, really, so much as it is supposition. and, in the case of most people so diagnosed, presumption. Minds aren’t subject to disease, and diseased brains are the proper sphere of study for neurologists, not psychiatrists.

Critical Psychiatry versus Psychiatry

  • The predominate mode in psychiatry today is bio-medical psychiatry.
  • Bio-medical psychiatry sees mental disorder as largely biological.
  • Critical psychiatry questions, if not the biological basis for mental disorder, the extent of that basis.
  • Critical psychiatry then sees social, psychological, and environmental factors as no less important to the formation of mental disorder than biology.

The Bio In Biological Psychiatry

  • While some mainstream psychiatrists have cautioned against a bio-bio-bio approach to psychiatry,
  • Calling it extreme and claiming to be bio-psycho-social in approach.
  • The difference is in how much emphasis is placed on the biological.
  • It is much more permissible for a critical psychiatrist to envision a mental disorder without a basis in biology while it is practically considered heresy for a biological psychiatrist to do so.

Antipsychiatry versus Critical Psychiatry

  •  At the heart of the matter is the validity of psychiatric diagnosis.
  •  Critical psychiatry supports the notion of mental disorder.
  • Antipsychiatry dismisses the notion of mental disorder as a popular fiction.

Abolition versus Reform

  • Reformism = more or less forced treatment.
  • Reformism when it comes to force is a matter of degree: law and order reformers want more, socially progressive reformers want less.
  • Abolition = NO non-consensual coercive psychiatric treatment.
  • It is only through mental health law that you get non-consensual coercive treatment.
  • Repeal mental health law, and non-consensual coercive treatment is what it is everywhere else, that is, criminal assault.

The issue of abolition of forced treatment is pivotal. I find it very hard to consider anybody who doesn’t support the abolition of forced treatment antipsychiatry. Critical psychiatry, in the main, remains reformist, that is, critical psychiatry would opt for less force. More mainstream psychiatrists, also reformist, could go either way, for more or for less, on the force issue. Abolitionists would have mental health law repealed, or the UN CRPD, which could potentially outlaw forced treatment through international law, endorsed. Should psychiatry itself be abolished? First things first. Some might not think so, but as for myself, I’m not setting myself up to be the psychiatrist’s friend on this matter.

Antipsychiatry Redux

  • Antipsychiatry is not a throw-back to the sixties and seventies.
  • Antipsychiatry has not disappeared. If antipsychiatry has gone underground, due to the success of the failure of psychiatry, antipsychiatry has also managed to remain above ground. Antipsychiatry can’t entirely be forced underground until all the governments in the world have been replaced by a world psychiatric institution. Just because such hasn’t happened yet doesn’t mean that it is outside of the realm of possibility.
  • Antipsychiatry has merely progressed beyond the antipsychiatry of psychiatrists, and even the antipsychiatry of the mental health profession.
  • Psychiatrists are hardly the only people in the world capable of promoting non-psychiatry.
  • Psychiatry being bigger than ever before, and also being a bigger failure at recovering people to non-psychiatry from its diagnoses and treatments than ever before, justifies the existence of its nemesis, that is, antipsychiatry.
  • The problem, in other words, is not that people have “mind sicknesses”, the real problem is the profession of psychiatry that identifies, and lives off of, its postulated “mind sickness”. The solution to this problem is more tolerance for human difference (i.e. an end to the profession of psychiatry).