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Reflections On Schizophrenia Etc by Kenneth Wilson

To begin our considerations, I would like to draw your attention to a recent article in New Scientist by Clare Wilson. In the article entitled Out of the Shadows, Wilson discusses aspects of the most recent thinking on schizophrenia. In the course of discussing the case of Peter Bullimore, a recovered schizophrenic, she points out that,

“The downsides [of medication] have always been seen as a necessary price to pay for relief from the condition’s devastating symptoms, but now that idea is being called into question. Not only are the side effects of these drugs worse than we thought; the benefits are also smaller.”[1]

Pills

So the next time you bump into a psychiatric survivor, think twice before you tell them to just keep taking the tablets! I am a psychiatric survivor myself. Until 2005, or thereabouts, I was thought to be bipolar and was prescribed lithium which I rarely took – after which time my diagnosis was changed to schizophrenia.

The main thrust of Clare Wilson’s article is to report recent research results which indicate that in the longer term schizophrenic patients with minimal or no drugs do better. How can this be? It looks as though the medications especially in the longer term are a poisoned chalice and do more harm than good.

According to author of Anatomy of an Epidemic, Robert Whitaker,[2] there has been a huge increase in the incidence of psychiatric conditions which he charts especially over the last 20 to 30 years and as he points out a main cause for this increase in incidence is that the conditions are iatrogenic, ie, caused by psychiatry. If Whitaker’s analysis is true, then the pharmaceutical companies have, with considerable success, turned a niche market into a mass market.

This marketing ploy has taken place with, for the most part, the approval of most governments around the world; and so, it may be said, there is a sense in which there may be said to be an agenda of social control and the medicalization of societies’ ills… Where once unemployment and homelessness were blamed on a bad economy, in part, these social ills have been handed over to biological psychiatry. Could we really be living in an early C21st in which a proportion of Western societies’ populations are being drugged for reasons of social (and financial) control? Do the tendrils of biological psychiatry really stretch into every corner of our society? You could look at it like this: Just about everyone living in the UK has a GP – their first point of contact with the medical profession.

In the UK you can be sectioned on a GP’s authority as long as the GP has one other opinion – not unusually in the form of a Mental Health Officer (MHO). Due to the absence of objective, scientific tests for those allegedly suffering from ‘psychosis’, it is certainly the case that a proportion of those sectioned have been wrongly diagnosed; and, therefore, sectioned without justification. This phenomenon is a time bomb. What is more, the medicalization of society’s ills in the form of homelessness and unemployment is a reality. Try reading the concluding chapter of J. Moncrieff’s book The Myth of the Chemical Cure. She is a consultant psychiatrist and the case she makes has persuaded me that in important respects biological psychiatry is a pseudo-science engaged in duping patients, society and even each other.

Anatomy of an epidemic

For example, as Whitaker points out, the incidence of bipolar disorders has changed dramatically in the last two or three decades; where once bipolarity was a rare condition, now it is almost a commonplace. This arises for several reasons. Firstly, with the help of the various editions of the DSM publications the definition of the condition changed such that its incidence increased. Secondly, the medications bipolar people were prescribed often resulted in an increase of episodes involving hospitalisation. And, thirdly, going back to the 1980s there has been almost a fashion for the condition. The story with schizophrenia is not the same as that for bipolarity but similar. Schizophrenia can, like bipolarity, be episodic.

Clare Wilson reports on a Dutch study of people with schizophrenia published in JAMA Psychiatry, vol 70. My problem with this study lies in its terms of reference, in particular, the diagnosis of schizophrenia. The study Clare Wilson reports on assumes that its research subjects are all schizophrenics – but are they? Going back to the work of David Rosenhan it is known that diagnosing someone with schizophrenia is not a completely objective matter. In other words, there is an important subjective element to such diagnoses, with the consequence that a proportion of patients are misdiagnosed with the condition. In my humble opinion, this is a matter that has to be thoroughly researched as a matter of urgency. In my own case I was thought to be bipolar for many years and as I have already said, the diagnosis was changed to a schizophrenic-type disorder. I have reason to believe that this sort of error of diagnosis is not as unusual as all that. There are all sorts of stringent scientific tests for many medical conditions, this state of affairs does not, as a rule, pertain in psychiatry.

At this point I would like to make a few remarks about the term ‘schizophrenia’. The term was coined by Swiss psychiatrist Eugen Bleuler in 1908 and ever since it has caused confusion and frankly panic for all concerned – perhaps most of all for those who suffer from the condition. I do not doubt that schizophrenia-type conditions are real. My concern is that we have a confusing and seriously stigma-laden term to refer to this type of condition.

The term comes with such a weight of stigma that the process of being labelled with it can itself cause suffering. It is almost as though the label is as bad as the condition it aims to describe. Therefore, I would like to advocate a much less stigma-laden term. I don’t know what the new term is to be, but I think we need one. Too often over the years since it was coined has it been used as a term of abuse. The American psychiatrist Peter Breggin has suggested that labelling someone as a schizophrenic is a professional way of describing someone as human garbage – quite wrongly, of course.

Consequently, I would like to liken the situation of schizophrenics as being similar, in terms of terminology, to that that once pertained to homosexuals. Gay men and women have campaigned tirelessly to put a stop to the horrible name calling that was common in society; and, more importantly, to end the illegal status of homosexuality. Obviously, schizophrenia is not a matter of sexual orientation. However, perhaps we can make an effort to destigmatise the condition by modernising the terminology. Efforts have already been made in this direction in some parts of the world and so I merely join those who share this concern.

Up to this point I have introduced examples of literature I have found to be very helpful in trying to put matters in perspective. In addition, in the course of my remarks here, I would like to share with you a little of what I have experienced as a patient at a local hospital going back to the 1980s. So, here I seek to combine a consideration of mental health issues in the abstract, as it were; and also, in terms of my own personal experience. Moreover, although I began by drawing attention to Clare Wilson’s article in New Scientist, I do not address you as a scientist.

This presentation makes no claims whatsoever to scientific status; rather, my aim is to present a set of reflections on schizophrenia and mental health issues which can be seen as being more or less rigorous. As is sometimes said, there is nothing scientific about poetry, but only a fool would not take it seriously.

What is more, I address you not only as a psychiatric survivor but also as an ever so humble philosopher – rather than a poet or scientist. With this in mind then do not be surprised when I begin some brief considerations from the point of view of philosophy of science.

I do not claim to be an expert on the condition from which I suffer other than in the sense that I experience it directly and my psychiatrist, let us say, does not. In other words I am the expert on me and no one else. Of course, this is a very human observation. In the course of my remarks, I would also like to make it clear that in no way am I medically qualified and so am at pains not to act as a quack; my remarks then are those of the diagnosed rather than the diagnoser; in alternative terms my remarks are those of the analys and not of the analyst – they are those of the sufferer rather than the carer.

In the process of being hospitalised, one meets all sorts of professionals who claim in one way or another to be experts on one. Circumstances can vary, but this process of becoming institutionalised often begins with one’s GP. The documents requiring completion to have one detained against one’s will are straight forward – they have become, rather disturbingly, just another tick the box exercise. As a safeguard against people being wrongly sectioned, patients should not only be guaranteed legal representation, they should also have the right to a hearing in court prior to the section being applied. I make this point because of all the sections that are applied for, a minority are wrongly applied for and this small minority of cases amounts to an abuse of medical and legal authority.

A part of the story with the psychiatric services is that they keep written records on one’s status – good, bad or indifferent. For a good many years, for a fee, one can apply to obtain a copy of one’s case notes – and quite right too. If, as a patient, one is not in dispute with the hospital in question OK – there is obviously a proportion of patients who have no complaint with the care and treatment they have received. But, if one is in dispute with the hospital regarding one’s care and treatment, where does one begin? One has to try to keep records for oneself. This sounds easy but psychiatric hospitals can be very disturbing places and keeping cool enough to write up dated and timed reports is far from easy in my experience. In any case, this was my approach to things beginning in the summer of 2004. My tactics that year led to a court decision in my favour and a Section 18 application made by the local psychiatric hospital was successfully rejected.

On the basis of this legal result, I have reason to believe that I had been mistakenly sectioned. So what was it about my tactics that led to this successful result? At that time, even although I had been homeless for some months, I kept a pad of A4 paper with me at all times in addition to a supply of carbon paper such that I could make copies of documents. Once I had been sectioned, the first thing I did was to sign up with a solicitor. I was lucky to engage a good solicitor who was very sympathetic. Rather than simply leaving it at that, I started to write to him regularly to explain my position. In addition, I would often furnish staff on duty with copies such that they were informed and that my case notes could be updated. Due to the fact that I was in dispute with NHS psychiatry, I came to the conclusion that one-to-one consultations with psychiatrists were not going to count in my favour – but, nevertheless, extremely difficult to avoid.

 Having been sectioned under the Mental Health Act once too often, I have a sense of the medical profession claiming expertise on me, even although we are barely acquainted. The professional expertise in question is not borne out of a personal relationship of any kind; rather, it is borne of a type of professional expertise – ie medical knowledge – and professional objectivity. Due to the claims to scientific status made by psychiatry one is faced with a paradox.

If my condition were a broken leg or an infection of some kind, then a personal relationship with the patient is quite beside the point and unscientific. Psychiatry tries to emulate the best scientific standards one finds in many other branches of modern medicine; thus, getting to know the patient in any normal sense is eschewed and so, to the extent that this is the case, there is something dehumanising about the approach of the psychiatrist to their patient.

In the world of normal human relationships there are those that one likes and those that one does not. For reasons I am sure you will appreciate, a psychiatrist cannot give in to personal likes and dislikes – they must remain at one removed from a normal, human relationship with their patient. Thus, once again, I would go a little further and suggest that psychiatry qua scientific branch of modern medicine is inhuman as a consequence of the standards of scientific and professional objectivity it attempts to employ.

In summary, the paradox I mentioned resides in this observation: psychiatry claims that its knowledge of a patient’s condition is objectively and scientifically known; while, at the same time, the patient’s condition is fundamentally a condition of their own subjectivity.

In a ‘healthy’ psychiatry, the personal touch would be at a premium, in a way that is simply not required in other branches of medicine not dealing with the brain. If I have a broken bone or appendicitis, who I am, my subjective status, does not much come into it. To some this might sound surprising, but in what is called biological psychiatry based on the medical model and the DSM publications, whatever a patient says can be safely ignored.

Diagnostic_and_Statistical_Manual_of_Mental_Disorders

A word then about the DSM series of publications. DSM stands for Diagnostic and Statistical Manual of Mental Disorders. The most recent version is called DSM-V. The first version of this publication was published in the early 1950s before the first introduction of antipsychotics into the human population. While preparing this talk I had the good fortune to discover a new book by Allen Frances entitled, “Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-V, Big Pharma, and the Medicalization of Ordinary Life”.[3] Frances was the chair of the DSM-IV task force.

So, this book gives a behind-the-scenes look at the nonsense that goes on behind the publication of the DSM series. Unsurprisingly, as a psychiatrist himself he is keen on his own field.

In places the book reads as an apology for all the trouble he and his colleagues have been causing over the years – although it doesn’t go anything like far enough. It is written in a clear and accessible style though I personally don’t like his informal tone in the book. With me the DSM publications had some standing going back to the 1980s when I was an undergraduate psychology student. Having read Francis’s book, the reputation of the DSM series of publications is at an end with me. Francis wants to save normal and save psychiatry. For my money what we need to do is save normal but throw psychiatry in its present form over the side of the aircraft carrier that is modern medicine.

His book is written for a popular audience. However, judging by the, at times, flabby content he really doesn’t think much of his potential readership. That this book has been published at all indicates to me that psychiatry is in deep crisis internationally. I do not wish to be too unkind to Frances – I think he is very brave to publish this book. The work of Joanna Moncrieff and Robert Whitaker call into question the legitimacy and standing of conventional psychiatry. When one takes away the psychiatrist’s diagnostic bible, the DSM series of publications, then psychiatry is in very poor shape indeed.

The aim of the DSM series was to provide psychiatry with clear diagnostic criteria for mental disorders – a classification system. However, from the outset all that DSM represented was a classification system by no more than general agreement. In no sense did it have objective, scientific status. To this day there is hardly a single objective, scientific test for major mental illnesses.

So: no DSM; no objective scientific tests; surprisingly weak evidence for the effectiveness of antipsychotic drugs. When we add this up psychiatry is in a very weak position indeed.

On a personal note, I am prescribed a drug called Abilify. It’s generic name is aripiprazole. On p.96 of his book Frances shares a chart with us. His chart lists 13 court actions in which Big Pharma was found guilty and fined large sums of money in the US courts. The American arm of the company that manufactures Abilify was fined $515 million in a legal result in 2007. For reasons you will understand, this information has come to me as deeply disappointing and perhaps you can better understand my critical view of psychiatry. In the UK I am not aware of Big Pharma appearing in court. Is it really above and beyond reproach in this country? Judging by the unnecessary zeal with which I have been involuntarily drugged, their sales team could only have been a phone call away…

Returning to my theme, it is not what the patient says that matters, it is their brain biochemistry. And since the introduction of antipsychotic drugs in the 1950s this paradigm of the medical model has been used to downgrade virtually all other attempts at treatment. In order for psychiatry to join with the rest of the medical fraternity it had to establish scientific credentials to become respectable. From the first introduction of chlorpromazine in the 1950s psychiatry has, to put it politely, over-egged the efficacy of now two generations of antipsychotic drugs.

The-Bitterest-Pills-joanna-moncrieff

From the outset the scientific basis for the action for both generations of antipsychotics is clearly deeply suspect. Robert Whitaker in  Anatomy of an Epidemic and Joanna Moncrieff in The Bitterest Pills make this point crystal clear. Please allow me to quote Moncrieff, who is herself a consultant psychiatrist,

“Prominent psychiatrists, including David Cunningham Owens (whose research had been used to argue that tardive dyskinesia was part of schizophrenia, but who, in later years, has become more critical of drug treatment), have started to suggest that the story of atypical antipsychotics as a group of compounds with unique therapeutic properties is a myth, largely constructed by the pharmaceutical industry, and swallowed hook, line and sinker by the psychiatric profession….”[4]

I would go further and suggest that what is being said here can also be said not only of the atypical antipsychotics but also of the first generation of antipsychotics. For now, I shall return to issues more connected with philosophical concerns.

          If biological psychiatry is accurate, then the patient’s subjective, phenomenological[5] world matters not a jot – all that matters is their brain biochemistry. Once their brain biochemistry has been adjusted then one can talk to the patient again. In significant respects, psychiatry has set itself up, allied with Big Pharma, in an Orwellian, Clockwork Orange type of role and claims to have a complete account of human behaviour and of thought itself. Ultimately, the account of brain biochemistry with which biological psychiatry operates is self-defeating.

The psychiatrist qua brain biochemist can say nothing about the actual environmental stressors which often cause illness; it says nothing of the importance of relationships with others – these profound weaknesses in the psychiatrist’s position lead him (and her) to, as Foucault pointed out, reveal themselves as power before knowledge. Biological psychiatry believes that the root causes of illness is to be found in the microscopic world of neurotransmitters such as dopamine and serotonin. To the extent that biological psychiatry believes this to be true, it strips the patient of the ability to say or do anything meaningful. In my experience, only once the antipsychotic drug has been administered will they begin to listen. The problem then is that one is on drugs.

According to both Whitaker and Moncrieff and many other researchers, there is no doubt that antipsychotics affect brain biochemistry: what is absent though is conclusive evidence that the job done by antipsychotics is the one required. There is no doubt that the brain is a very complex tissue. In my opinion, at this time, research into its functioning has hardly begun.

In the 1950s far less was known than today and so there is a strong sense in which the pharmaceutical companies sold chemical compounds based on a highly imperfect and incomplete account not only of how the brain functions but also as to how their compounds worked.

The situation with the antipsychotics then is that in spite of the hard sell they have been proven to cause brain damage; they are neurotoxic. It is for these reasons, and others, that as Clare Wilson notes, “…subjecting people to a lifetime of compulsory antipsychotics seems to be on the way out.”[6] Due to my own experiences in this regard I sincerely hope that she is right.

At this point in our deliberations, I would like to put on my philosopher’s hat. Having done so, I am going to share with you some thoughts on two publications. The first of these is a famous work by R. D. Laing entitled The Divided Self.[7] For the purposes of brevity I shall confine my remarks on his great book to Part I alone. My edition of this work has a preface written in London and dated 1964 – almost exactly as old as myself! The second work that I shall refer to was published in the Schizophrenia Bulletin in 2013.

This article is somewhat dauntingly entitled, Rediscovering Psychopathology: The Epistemology and Phenomenology of the Psychiatric Object and I shall henceforth refer to it simply as Rediscovering Psychopathology.[8] It was written by a triumvirate of authors, Parnas, Sass and Zahavi. What is the connection between these works and what are they about? Both works are by psychiatrists who take a serious interest in philosophy. Given that I completed a research degree in philosophy, I thought you might share my fascination for these works.

The Divided Self is heavily influenced by C20th philosophy, in particular in the guise of phenomenology and its post-War offshoot existentialism. When The Divided Self was written Sartre was still alive and his work enormously influential internationally. The Divided Self and Rediscovering Psychopathology share an intellectual ancestor in the form of Karl Jaspers. Though perhaps less well-known than Sartre, Jaspers was a psychiatrist who went on to train as a philosopher and was himself an exponent of phenomenology and existentialism. We can begin the chain of philosophical influence with Husserl leading onto Heidegger, Jaspers, Laing and Sartre and most recently Parnas et al. So what was the interest, what was the subject that these authors shared? In a word ‘subjectivity’.

A note on the ‘anti-psychiatry’ movement. Figures such as Laing were part of a loose association of people who were anti-psychiatry going back to the 1960s. However, Laing didn’t see himself as being anti-psychiatry, he was critical of it and wanted to move psychiatry forward in new directions. Laing was heavily influenced by continental philosophy and the French existentialism popular at the time. In addition, Freud was very important to Laing as he himself acknowledges in the opening pages of The Divided Self.

the divided self

The fact that Laing thought Freud to be important in addition to figures such as Sartre meant that his work was not going far in the face of the newly powerful biological psychiatry of the time. As a Freudian, and someone with serious philosophical influences in how he saw psychiatry, he was destined to become unorthodox. The introduction of the new antipsychotic drugs beginning in 1954 was a development that saw the increasing marginalization of psychotherapy in its various forms.

As Laing notes in the Preface to the 1964 edition of The Divided Self, “Psychiatry could be, and some psychiatrists are, on the side of transcendence, of genuine freedom, and of true human growth. But psychiatry can so easily be a technique of brainwashing, of introducing behaviour that is adjusted, by (preferably) non-injurious torture. In the best places, where straightjackets are abolished, doors are unlocked, leucotomies largely forgone, these can be replaced by more subtle lobotomies and tranquillizers that place the bars of Bedlam and the locked doors inside the patient.” (p.12)

It is a rightly famous passage written almost exactly 50 years ago. Here Laing points to psychiatry as having the potential to be a sinister form of mind and behaviour control. For Laing and others then psychiatry has to, almost by moral imperative, go in a quite different direction – in that of genuine freedom and true human growth.

In my opinion, from the perspective of psychiatry there are powerful tensions between the patient seen as a diseased specimen, a mere conglomeration of complex biochemistry – the organism; and, the patient seen as an experiencing subject who must be listened to. If the patient’s condition is to be explained by biochemical dysfunction, then what they say (or do) is of little import. On the other hand, if we see the patient as an irreducible Gestalt whose experiences can, if with great difficulty, be interpreted and understood then a different paradigm awaits us; one in which antipsychotic drugs have a minimal role to play rather than a putative sole form of treatment.

When the first antipsychotic drug was first introduced into psychiatry in 1954, it (chlorpromazine) was hailed as a wonder drug aided and abetted by the company that made the stuff. Since then the idea that antipsychotic drugs are wonder cures or magic bullets has gradually worn thinner and thinner as the list of serious side-effects gets longer and longer.  Substances such as chlorpromazine went on to be widely used in the tranquilization of animals. If it is good enough for a lion, tiger, rat or monkey – it is good enough for me – but is it?

It has been routine to test newly synthesised drugs on non-human mammals before inflicting them on humans. The long-dead mice, rats and monkeys on whom these compounds were first tested deserve to be remembered. So, the usual logic is this: If animal testing of antipsychotic drugs go well, i.e., the animals show responses which would be desirable in humans, then it is OK to introduce them to the psychiatric patient population. One of the major problems with this type of drug testing is that animals don’t talk – humans do. If you have ever wondered why your psychiatrist is not all that keen on listening to what you have to say, it is because they regard you as an animal, an object, a diseased specimen.

A question arises: Do non-human mammals experience ‘mental illness’. If non-human mammals such as mice and rats do experience mental illness then testing antipsychotic drugs on them could be an idea. In terms of the medical model, the testing of antipsychotic drugs on non-human mammals is justified on the claim that mammals such as rats, mice and monkeys are sufficiently similar to ourselves as to draw strong comparisons. However, one of the main weaknesses in the claim to these similarities is that humans are the only language users. We are unique; we aren’t just like the lab rats.

The limitations of animal testing are serious in regard to the claimed insights they provide to the effectiveness of new antipsychotic drugs. This type of application of the medical model by biological psychiatry is an affront to the key concept of the patient treated as an irreducible whole. The success or otherwise of drug trials on animals says nothing about the subjective me, the experiencing I. It is in the light of such considerations that we should see Laing’s The Divided Self. The subjective reality of the patient comes first – not the alleged biological basis for their condition. As Laing goes on to note,

“There is a common illusion that one somehow increases one’s understanding of a person if one can translate a personal understanding of him into the impersonal terms of a sequence or system of it-processes.” (p. 22) This common illusion, a key element of biological psychiatry, in reality, dehumanizes the patient.

 

The Divided Self was written many years ago. The notion that his ideas are somehow irrelevant to us here and now is quite wrong. Laing’s agenda is still alive and well, if nowhere else than Copenhagen, the address given of the authors of Rediscovering Psychopathology. In this article, published on the 100th anniversary of the publication of Jaspers’ book General Psychopathology, the authors examine the philosophical foundations of psychiatry, particularly in its orthodox Anglo-American form.

The agenda of Parnas et al is one that Laing would immediately identify with, as I did myself. Parnas and co-authors point out that the philosophical basis for orthodox biological Anglo-American psychiatry lies with logical positivism as a philosophy of science.

In other words orthodox Anglo-American psychiatry sees itself as being tied in with the natural sciences. It would certainly like to be tied in in this way but on closer examination this is much more fiction than reality. In my opinion, psychiatry needs genuine scientific credentials. A part of it needs to be tied into the natural sciences. This by itself won’t be enough, it also needs input from the arts end of the epistemological spectrum. In the two works that I am briefly discussing here, The Divided Self and Rediscovering Psychopathology, that is the aim of the authors, that is to say, to inject a healthy component of philosophical considerations to, as it were, save the subject-patient from the dehumanising effects of being treated as what Laing called it-processes.

For my own part, I have an open mind as to whether phenomenological and existential approaches can be applied to individual subject-patients. I also feel strongly that psychiatry needs to look much more closely at its philosophical underpinnings before it can move forward such that to paraphrase Foucault, it does not reveal itself as power before it reveals itself as knowledge.

I have been involuntarily drugged on many occasions going back to the 1980s. I interpret these experiences as psychiatry revealing itself to me as power before it reveals itself as knowledge. I object in the strongest possible terms to my being involuntarily drugged and my objection to being treated in this way arises from the following considerations.

Antipsychotic drugs are routinely used to tranquillize wild animals. For reasons you will appreciate, I rightly object to being treated as a wild animal would. Secondly, I strongly object to the use of ECT. In the case of this type of treatment one is within one’s rights to refuse point blank. My position is that I also ought to be within my rights to refuse antipsychotic drugs – however they may be administered. In contrast, I have, in this last year accepted the assistance of a clinical psychologist – an instance of what is known as the talking cure. Even in the most severe cases I strongly believe that the talking cure has a key role to play in the care and treatment of patients.

Prescribing and administering antipsychotic drugs is easy when compared with good quality talking cure. One of the reasons as to why the talking cure is difficult is because personalities do come into it – one’s subjectivity is entered into as a communicating being, as a language user. One’s feelings and emotions and ideas are taken much more seriously. Although Big Pharma makes huge sums of money from selling antipsychotic drugs around the world, per head per diem they are far cheaper than the time, for example, of a properly qualified, trained and experienced clinical psychologist.

The frightening zeal with which antipsychotics are imposed on the unwilling, can be seen as a function of a mental health system that is not only in chronic failure but one that is inured to little better than primitive crisis management in the form of tablets and injections that are as cheap as chips per diem per head. The growth of psychiatric diagnosis over the last twenty to thirty years, the enfranchisement of increasing proportions of Western societies’ populations is an enormous medical disaster – a disaster on a truly grand scale. For centuries humankind lived well enough without psychiatry, why are so many deemed to need it within a twinkling of an eye by comparison?

As discussed earlier, Allen Frances wants to ‘save normal’. To do this, if my analysis is correct, then psychiatry has to shrink (perhaps you can see the irony in this term at this time!). Please allow me to offer you a summary of my criticisms of psychiatry:

Suppose mental illness to be real, does psychiatry have the resources to deal with it? No, and here’s why:

  1. There are no objective, scientific tests for the major mental illnesses
  2. The leading classification system, the DSM series, is now largely discredited
  3. The list of negative consequences of taking antipsychotic drugs grows longer almost by the year (I hesitate to use the usual term side effects)
  4. When it comes to housing and employment for sufferers psychiatry is noticeably silent
  5. The iatrogenic mushrooming of psychiatric diagnosis in Western societies, described by Whitaker, clearly shows how prone psychiatry is to socio-economic forces, rather than being a natural science governed by the medical model.

In conclusion, I’d like to make a few comments on Thomas Szasz. Psychiatry aims to deal with ‘mental illness’. Yet the late departed Thomas Szasz argued that ‘mental illness’ is a myth. If biological psychiatry and its medical model are correct, then mental phenomena are mythical; all forms of illness are physical in origin, or are they?

I believe that biological psychiatry is a gross over-simplification of mental illness. My comments are based on a reading of two documents: First, by Szasz, The Myth of Mental Illness second edition published in 1974. The first edition of this work was published in 1961.

the-myth-of-mental-illness-thomas-szasz-1961ad-revised-19741

The second document in question is an article published in 2010 entitled The Myth of Mental Illness: 50 years after publication: What does it mean today? This fascinating update is to be found in the Irish Journal of Psychological Medicine.[9] One of the reasons as to why this article is so interesting is that at its end Szasz himself responds to commentary on his work – this is shortly before his death in 2012. In the time remaining I can only highlight a very few of the points of interest that Szasz and his commentators raise.

Firstly, Szasz draws a clear distinction between mental and physical illness. Many would then ask the question: Is he a Cartesian dualist? No he isn’t. Szasz in his own words in the article I have cited, says that “Methodological dualism is part of my method. It is not my conclusion.” (p. 41) So what then is methodological dualism? Being brief, Szasz quoting Bracken, one of the commentators in the article, remarks, “… I agree with Szasz and those philosophers who argue that the meaningful world of human reality cannot be grasped in the causal logic of the sciences of nature…” (p. 41) I myself advocate a form of methodological dualism. The natural sciences have a key role to play in our understanding of the world in which we live – this includes biology and the science of the human brain. However, at the same time, as indicated above, we are language users and as such there is a vitally important sense in which meaning for us cannot be reduced to physics, chemistry and mathematics.

Consciousness is itself a kind of Gestalt. Whatever biological psychiatry has to offer us in understanding the major mental illnesses such as manic depression and schizophrenia, it will only ever be a part of the story. We must also include an account that begins with the me, the I, the subjective experiencing self.

 


[1] Wilson, Clare: Out of the Shadows, NewScientist, 8 February 2014, pp. 32-35

[2] Whitaker, Robert (2010): Anatomy of an Epidemic, Broadway.

[3] Frances, Allen (2013): Saving Normal: An Insider’s Revolt Against Out-of-Control Diagnosis, DSM-V, Big Pharma, and the Medicalization of Ordinary Life, HarperCollins, New York.

[4] Moncrieff, Joanna (2013): The Bitterest Pills: The Troubling Story of Antipsychotic Drugs, p.90.

[5] Here I use the term ‘phenomenological’ in the philosophical sense of the term.

[6] Clare Wilson, Ibid, p. 35.

[7] Laing, R. D. (1964): The Divided Self, Penguin

[8] Parnas, J. et al (2013): Rediscovering Psychopathology: The Epistemology and Phenomenology of the Psychiatric Object, Schizophrenia Bulletin, Vol. 39(2), pp 270-277.

[9] Szasz, T. (1974): The Myth of Mental Illness, Second Edition, Harper, New York. Kelly, B. D. et al (2010): The Myth of Mental Illness: 50 years after publication: What does it mean today?, Irish Journal of Psychological Medicine, Vol. 27(1), 35-43.

 

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