Ronald Pies In Psychiatryland

One of the biggest clown doctors going at the present moment has got to be Ronald Pies. It would be remiss of me to claim that in his latest post, Nuances, Narratives, and the ‘Chemical Imbalance’ Debate in Psychiatry, he has outdone himself. If there was anyone destined for a pie in the face that anyone has got to be Ronald Pies. I would be honored, in fact, to bestow upon Dr. Pies the moniker Ronald “Pie In The Face” Pies for all posterity. Ronald Pies is a marvel of nonsensical shrink think. In his latest escapade into the theory and practice of shrinkery, Pies, by some disingenuous twist of convoluted illogic, would blame “the chemical imbalance theory” on that bug-a-boo and will-o-the-wisp of modern psychiatry, antipsychiatry. Go figure.

Now, if you were to give credence to a recent online polemic posing as investigative journalism, you would probably choose the first or second statement. In the narrative of the antipsychiatry movement, a monolithic entity called “Psychiatry” has deliberately misled the public as to the causes of mental illness, by failing to debunk the chemical imbalance hypothesis. Indeed, this narrative insists that, by promoting this little white lie, psychiatry betrayed the public trust and made it seem as if psychiatrists had magic bullets for psychiatric disorders. (Lurking in the back-story, of course, is Big Pharma, said to be in cahoots with Psychiatry so as to sell more drugs).

Those first two statements Pies alludes to here would be those that indicate either “mental illnesses” were caused by “chemical imbalances” in the brain, or merely that more “serious mental illnesses” were caused by “chemical imbalances” in the brain. What we don’t get out of this story is precisely who was responsible for promoting and spreading this “chemical imbalance theory” that these people in some antipsychiatry movement would be exposing. Where is psychiatry here? Defending itself from those who would be exposing a discredited theory. Certainly it is not defending itself from the ones who would be promulgating that theory. Curious indeed.

Among his more bizarre notions is the notion that this “chemical imbalance” theory has more to do with some catecholamine hypothesis from many years back than it does with the development, marketing and advertising of those trendy psychiatric drugs still surging strong on the market of today.

To the extent the “chemical imbalance” notion took hold in our popular culture, it was due mainly to distorted or oversimplified versions of the catecholamine hypothesis. These were often depicted in drug company ads; pop psychology magazines; and, in recent years, on misinformed Websites and blogs. In short, the “chemical imbalance theory” was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.

Does Dr. Pies mean that psychiatrists don’t use, or shouldn’t use, those drugs that would be advertised as purporting to correct some kind of postulated and theoretical “chemical imbalance”?  I think not. This leads to another question. To what extent has psychiatry, or the majority of its practitioners, colluded with pharmaceutical companies in producing an atmosphere that now has commercial interests in the media peddling pills, not just to medical professionals, but to the entire buying public perceived and re-envisioned as consumers who will purchase anything at the provocation of the most mesmerizing sound bite?

Psychiatry’s critics also conveniently omit reference to what was arguably the most prevalent paradigm in academic psychiatry, during the 1980s and beyond: the biopsychosocial model (BPSM) of Dr. George Engel. The BPSM has been subjected to much criticism, and some would argue that few psychiatrists nowadays use the BPSM in a systematic, evidence-based manner. And in recent years, several prominent psychiatrists have warned that “…pharmacotherapy and psychotherapy, the major treatment modalities in psychiatry, have become fragmented from one another, creating an artificial separation of the psychosocial and biological domains in psychiatry.”

In the latex gloved mitts of Dr. Pies, our babble here has degenerated into very nuanced babble indeed. If you will notice, despite the nip at bio babble unrefined, bio still has top billing in the theoretical credits. I don’t think this is entirely because of the order of words in the alphabet, or accidental. The mad doctor has shown himself sufficiently proficient in blurring the lines between disciplines to earn himself a rank of major distinction in the therapeutic circus. If criticism equals antipsychiatry, well, there you go. The message is coming in loud and clear. Don’t criticize psychiatry or you must be promoting the discredited “chemical imbalance theory”, too. Clown psychiatry rules!

Is “mental illness” underfunded?

One way to deal with a problem is not to pay for it . In fact, it could be a solution to all sorts of problems. Problems that are subsidized tend to thrive.

The man who probably did the most to end forced psychiatric treatment in the USA in recent history was a Republican politician by the name of Ronald Reagan. I think you’ve probably all heard of him. He helped deinstitutionalize institutions, first in California, and second in the rest of the nation, by defunding them.

 A little refresher 101 might come in handy at this point. We have had a mental health movement for some time in this country. This movement is actually a “mental illness” movement. (Review the first paragraph.)

First you have moral management with the introduction of asylums, then here comes Dorothea Dix contributing her part to the asylum building boom that immediately followed. At the beginning of the 20th century, there’s Clifford Beers doing his part for mental hygiene, supporting treatment, bashing illness, if entirely theoretical illness at that.

 The mental health movement wants the government to pay for mental health treatment. The mental health movement hit pay dirt with the Kennedy administration. The Kennedy administration came up with the community mental health system idea, and passed an act to get it started.

Depopulate state mental hospitals, and what do you do with all the inhabitants then? No Clue? Well, one thing you could do is create little mini-hospitals in communities throughout the country. Another thing you could do is treat the prodigal son or daughter returning from one of these institutions like everybody else. The Kennedy admin legislation decided on the first option.

I read once that a person is “mentally ill” until the insurance runs out, and I think this statement is relatively true. If necessity is the mother of invention, as the saying goes, when one is subsidized by the tax payer, working ceases to become a necessity.

 Today there is a movement directed towards hiring patients in the mental health system as para-professional mental health workers. I have a few issues with this approach. Namely, what is the difference between a disabled person and a non-disabled person in the mental health field? Stumped. Well, I will tell you then. Employment.

Employing people in mental health is not getting them jobs in other fields, nor is it getting them very far from the problem, that problem being the mental health system. If a person enters the system against his or her will and wishes, does working for that system really represent a significant improvement?

Unfortunately, mental health insurance parity is on the horizon for which I suggest holding your nose. What was I saying about necessity? I know, There are those people with jobs in mental health care. Maybe some of them might be able to do a little bit of good.  All I can say to  them is, “When are you going to get a real job?”

Sacred Cow Mental Health Mental Illness Dogma

A great sacred cow of our times is the idea of “mental illness”.  Expose the sacred cow for the myth that it is, and you are, according to some of its most fervent adherents, converts, and devotees, “stimatizing” people who are convinced they have it, hampering people who would treat it, and dismaying people who use it as a convenient excuse to get annoying people out of the way.

The dogma is just that, dogma. You’ve heard the dogma before, “Mental illness is real, it is biological, it is brain disease”.  Given these premises, and they’re only premises, nothing has been established here. People with it, that is, “mental illness”, are thought to be beyond self-control. They are, as it has been put, thought to be “controlled by their illnesses”.

The executive function of the brain has been short circuited by an idea. We’ve replaced the demons of religion and sin with the no less far fetched demons of “mental illness”. You can’t find it on a microscope slide, you can’t test for it, you can only ascertain its existence through the services of certain professionals trained to diagnose it. This diagnosis, according to some of these professionals, is more of an art than a science.

Given that we are dealing with what purports to be medical science, exposing this fraud for the fraud that it actually is can bring you accusations of raising the suicide rate. People don’t kill themselves for reasons. They kill themselves because they are ‘sick’, according to theory. Negative emotions, unhappiness, sadness, moodiness, are all “sicknesses”, according to theory. Cause is “disease”, the opposite of good fortune. Effect is a label and treatment.

Excuse me, excessive negative emotions are “diseases”, and they are excessive if they are enough to bring you before one of these imposters trained in picking them out. In other words, everyday ordinary emotions are not excessive until they send one into the presence of a “disease” detector, and if one crosses the thresholds of one of these “disease” detectors, one’s negative emotions must have been excessive.

 As far as Catch 21s go, you’ve hardly scratched the surface of the number of ways a person might get caught up in this process. The new heretics, disbelievers in those initial premises, must be dealt with, and they are dealt with in a number of ways.  Dismissal for the employee, treatment for the patient, silence and persecution for the critic, ostracism and discrimination among them.

The panacea of this new religion is the pharmaceutically achieved chemical lobotomy, the chemical strait-jacket, the chemical coffin.  People can now live in the community rather than be segregated from it because they are on these wonderful new anti-mental illness drugs goes the story. Suppression is cure. Suppression of the self. Self-expression here seen as an assemblage of unwanted ‘symptoms” equaling “disease”.

What you’ve got to realize is that before these drugs are even used you’ve got a diminishment of the human being into something less than a human being in the dogma. Anybody who doesn’t make the cookie cutter fit for a 9 to 5 dismally gray existence is by default “mentally ill”. Mental health treatment isn’t about healing “sick” people, it is about eliminating maladaptive behavior.

Some people don’t learn the ropes, and for those people we have a psychiatric label and treatment. The ropes I’m speaking of are conventional steps to conventional success. Problem: conventional success often means unconventional failure. One answer to a misstep here or there is the motivational specialist in the self-help field. as a career option. Another answer is the sky, about which I hold my tongue.

Overcoming Namby Pamby Disorder And, With It, The Psychiatric Nanny State

Iranian born Dr. Nassir Ghaemi in a MedScape piece, Fallacies of Psychiatry, actually only succeeds in revealing his own bias.

His first conjectured fallacy, the psychological fallacy, he would answer with a fallacy of his own. Namely, the flat earth fallacy. If enough people think a person “needs” psychiatric “help”, in other words, it must be so, and this makes the difference between a biological basis and a psychological, social, or psycho-social origin for “mental disorder”. If the person makes his way into the doctors office, at his friends and associates bequest, his or her “illness” must be biological.

These psychological judgments are essentially made on the basis of common sense. But if common sense were enough to explain things, then our patients would have convinced themselves, or been convinced by their friends and family. If a patient crosses the threshold of a clinician’s door, then common sense has failed — no need to keep using it. What is needed is scientific sense, which is quite different than common sense.

Suddenly because a doctor has entered the picture, we’ve got science. Really? Conventional wisdom may not apply here, but reason doesn’t cease to apply. I wouldn’t be beyond suggesting that our mad doctor’s uncommon sense was a little tainted with an unreason of his own.  If a pseudo-scientific credentialed elite says it is true, it must be true. Right? I’d say, reasonably, that it isn’t true until it is proven true. Here we have one theory in competition with others. The winner is only a poser. The scientific method is about disproving, not proving.

Dr. Nassir would then debunk such a biological reductivist view for certain “mental illnesses” that, in his view, have a psycho-social basis. This creates an even more serious dilemma for our doctor because now we have two entirely distinct species of “mental illnesses”, those with a primarily biological basis, and those with a primarily psycho-social and environmental basis. I would suggest that if “mental illness” is not actually “brain disease”, but erroneous ways of thinking, you don’t need two species of “illness” at all to explain it. Simply put, removing consciousness from the equation does not, at the same time, remove consciousness from the organism.

The doctor’s view is a pretty conventional one, but it asks many serious questions about the profession of psychiatry today. He establishes the psychiatric divide. His examples of biologically based disorders is pretty orthodox, as are his examples of more psycho-socially based disorders. On one side we’ve got schizophrenia, bipolar disorder and major depression, the holy trinity of the “mental illness” belief system, and on the other side, we’ve got PTSD, adult ADHD, and borderline personality disorder. I’ve seen this divide presented before. Recently I encountered a person attributing minor disorders to stress factors and major disorders to heredity and biology. In psychoanalytic theory, what has become the divide between major and minor “mental illness”, constituted the division between psychosis and neurosis. If these “disorders” existed on a continuum–big if, but they could–you’ve still got the psyche in psychosomatic. I don’t think it has, by any stretch of the imagination, been proven that they don’t exist on a continuum.

Big problem, little problem. Major “disease”, minor. The big secret is that diagnosis doesn’t represent the eternal biological curse that some professionals would have it represent for people given serious diagnostic tags. Some people manage to get out of the system, and to cope, and even to flourish, despite the cynicism of professionals. The devastating statistics actually represent a systemic challenge. When you’ve got a system based on unequal power relationships, that’s what happens. The success and independence of professionals is based on the failure and dependence of patients. Step back a little bit, and consider, the success of the professional actually depends on failing his patients. You’ve got more job security when your job is keeping a junkie supplied with dope (and this dope could be methadone, heroin, haldol or clozapine) than you would have if your job was getting him or her off drugs entirely.

Initially asylums were set up to segregate and imprison lunatics, i.e. people believed afflicted with any earlier version of the holy trinity in the psychiatric belief system. The advent of psychoanalysis expanded that field a great deal to include people suffering from more minor afflictions and offenses. General anxiety disorder, for instance, is in many ways the mental health equivalent of a skinned knee. Recently, psychiatry has been accused, due to the absolutely absurd number of “diseases” proliferating in the DSM, of pathologizing “normal”. Since the genesis of psychoanalysis, utilizing professional services has been put forward as a way of life. I’d suggest that there are other roads to take besides that of treatment, and maybe we’d better look to them. Take the case of what used to be called hysteria, or the case of what used to be called hypochondria, when a crutch is imaginary, perhaps a person would do better to get along without it.

Breaking Up The Shrink Crime Syndicate

My virtue was that I never made a good little “mental patient”. Compliance with a treatment plan, such as adhering to an irritating brain-numbing drug taking regimen, in other words, was never my forte’. When “mental patient’ isn’t your goal in life, it’s hard to become a conscientious “consumer of mental health services”.  “Consumer of mental health services” in today’s parlance translates “chronic mental patient”. The person who refuses to “consume mental health services” isn’t a “mental patient”.

Not being a conscientious “consumer of mental health services”, from the beginning I was looking for an escape clause. Prognosis, you will notice, here would be a matter of living down to expectations. “Mental illness”, after all, is all a matter of applying the odd man, odd woman, out school of philosophy in practice. This means that there are no good prognoses in the mental health field, only calculated curses of a sort. “Mental illness”, then, by definition, is a matter of being launched on a failure track.

I don’t like losing any more than the next person, and so I found this loser track to be somewhat distressing, to say the least, and what’s more, I didn’t think it was the right track for me. What could I do? First you’ve got the diagnostic tag, “mental illness”.  Then you’ve got the role, “mental patient” or “consumer of mental health services”. The tag and the role have been supplemented by the recovery approach to treatment. The recovery approach to mental health treatment sees recovery as a journey without a destination.  In other words, the patient is expected to recover in the sense that he or she is not expected to recover.

Okay. If you don’t want to be a “chronic mental patient”, you’ve got to stop “consuming mental health services”. This was a little easier for me than it has been for some other people. This is because the better part of “mental health services” is something called “medication management”. That’s right. “Mental health treatment” in today’s world is all about treatment with psychiatric drugs. Those drugs are the primary ingredient in the services that “consumers of mental health services” consume. Stop taking psychiatric drugs, and you’ve ultimately slipped the butterfly net. There is nothing left to mental health services but endless talk.

I have to backtrack a little bit here. Outpatient services are a blast in the most ridiculous way. In fact, everything about outpatient services is ridiculous. Take vocational rehabilitation. You’ve got people pretending to be working for no pay. People expected to never hold down a real job do this thing where they go through the motions day after day. They do everything, in fact, but go to the employment agency and fill out a form. This is the difference between a patient and a non-patient. Non-patients are a little less serious about the matter, and they have  managed to become the masters of filling out employment applications.

Given pervasive discrimination, don’t let me bash networking. The clown takes his or her costume off, and he or she still desires something of the human touch. The network is full of imposters, double agents, and swindlers, but to say so would be to hazard a diagnostic label and, frankly, I’ve had enough of that racket. Which brings me to the point. Psychiatry and prescription dope peddling are organized criminal activities as far as I’m concerned. I’ve heard of one instance where the Rico Statute was used against a pharmaceutical company. I hope to see more such realistic moves and appraisals being made in the future.

R. D. Laing and the Politics of Liberation

I am not a Laingian psychotherapist. The spirit of the Pasha of Kingsley Hall can guide other disciples on a lifetime regimen of therapy to its wispy heart’s content, not me. I don’t see losing one’s way as a lifetime endeavor I would wish to pursue. I’m not an apologist for R.D. Laing excesses. Leave that to those of his associates who have survived him and their associates.

I have no aversion to being called Szaszian. Thomas S. Szasz was, from beginning to end, against psychiatric oppression. Dr. Szasz, in fact, supported the abolition of coercive psychiatric practices. R.D. Laing’s position on the same subject was much more circumspect, except where specifically stated, and then rarely. I think it important for doctors to take sides as advocates on this matter, and Dr. Laing, when he wasn’t practicing non-coercive psychiatry, seems to have, wrongly in my view, taken the other side.

I don’t want to bash Dr. Laing entirely. Credit must be given where credit is due. He did much good. He humanized the face of madness, he discerned that there was often a hidden reason to it, and he put it in a social–mainly familial–context. He also inspired the initial Philadelphia Association experiments that have in turn spawned whole generations of successors, most impressively the Soteria Project, still with us today.

When the BBC would discredit R.D. Laing, that is one thing, when Thomas S. Szasz would do so, that’s another. The BBC just wants to finish the reactionary establishment job of making this Maverick psychiatrist mud that his heart attack on a tennis court along the French Riviera started. Thomas Szasz, on the other hand, wanted to show that this Maverick psychiatrist was actually not so much a Maverick psychiatrist after all, and certainly not the Maverick psychiatrist he was taken for.

Perhaps, as has been indicated, R.D. Laing’s position hardened over the years. Dissident psychologist Seth Farber in his recently published book, The Spiritual Gift of Madness, makes a great deal out of Laing’s The Politics of Experience. Laing himself, near the end of his life, in a series of interviews with Bob Mullan, published as Mad To Be Normal, refers to this same book, The Politics of Experience, as a mistake. R.D. Laing, also in Mad To Be Normal, speaks about how disturbed the people he dealt with were, something he might not have done way back when The Politics of Experience was published quite so explicitly.

The thing I’m trying to stress here is that you don’t equalize the field merely by donning informal attire. At Kingsley Hall, behind the illusion that there was no illusion, all residents weren’t on an equal footing. They played at being on an equal plane, but without the assent of the psychiatrist residents, there was no equality. When R.D. Laing in his memoir, Wisdom, Madness, and Folly, rationalized forced institutional psychiatry as necessary, he turned poser and hypocrite. There is something hypocritical, after all, in reattaching the chains Sunday that you had removed on Monday.

Historically there are parallels. Take the much lauded casting off of chains at the beginning of the movement for moral management in mental health treatment. Restraints may have been removed in some cases, but these restraints were being removed from people who were quite literally prisoners. If any problems ensued, they could be quelled simply by throwing the prisoner into solitary confinement. The moral management movement created an asylum building boom, and thus raised the rate of people being held captive by the state for alleged “mental illness” substantially.

Given that R.D. Laing, by his own admission, considered psychiatric hospitals necessary, I wouldn’t rank him up there with the great liberators, and if he was not a liberator, he was a collaborator with the psychiatric plantation system. Perhaps there were two faces to him as far as R.D. Laing was concerned; if so, I guess you can choose the face that most pleases you. I much prefer honesty and integrity myself. It is, quite frankly, less deceitful.

The Language Wars

The language wars are old and have a long history. Take psychiatry, for instance, where “sickness” starts with an insult applied to a human being. The human being thus insulted becomes a patient, and at the same time, is rendered “less” of a human being. Once this insult has been applied, in some cases, the application can lead, in a straightway and thorough-going fashion, directly to the ruination of the patient.  There is, in a concrete sense, no protection from ruination given psychiatric intervention. Psychiatric theory, being negative in general, supports ruination.

A few years back arose what were termed mental patient liberation groups. These mental patient liberation groups were part of a growing movement. It was a mental patients liberation movement that came to be called the psychiatric survivor movement. Eventually, something went haywire. These people who had been justifiably suspicious of the government decided to make a peace pact with the government. They let that government take the reins of their movement. The result goes by many names, but most pointedly, or disappointingly, perhaps, the c/s/x or consumer/survivor/ex-patient movement.

Psychiatry is notorious for its failure to integrate people–damned, divided and conquered by psychiatry–back into society at large. Psychiatry has an expression for its failures. That expression encompasses a set of people psychiatry dubs people, using the currently most political correct expression, with “chronic serious mental illness”. Looked at from another perspective, psychiatry’s failures are actually the secret of its success. People who fail to recover from the mishaps encountered in life keep psychiatrists in business. Once upon a time, psychiatry was a profession made up solely of the superintendents of lunatic asylums in this country. No more. Now there are 48,000 psychiatrists in the USA alone, and they claim that number is way too few to serve the numbers of people who would utilize their services, or disservices, depending on your perspective.

If psychiatrists, and other mental health workers, could be termed the ‘functionaries’ in this field, the patients, or “consumers” as some of them now prefer to be called, could be termed the ‘dysfunctionaries’. Their role in life is primarily to give the mental health worker a purpose through their own lack of a purpose. So-called “chronic mental illness” is defined by psychiatry, with all of its medical pretensions, as ‘dysfunction’. Alright. Now ‘dysfunction’ is a matter of degree, just as jobs can be part time or full time, and so you have a situation developing where ‘dysfunctionaries’ are moonlighting as ‘functionaries’. Because nobody else will hire them, the mental health system has taken the lead in hiring mental patients.

Sometime while you are slogging through a quagmire of gray areas, do you ever feel nostalgic about more basic black and white issues? I mean to say by this that there is a point at which complexity reaches a ridiculous level because the forgotten virtue of simplicity was always more black and white. We are experiencing an epidemic of so-called “mental illness” today and, ironically, mental patients have started working with professionals to escalate this epidemic to even more incredible proportions. I would suggest that if this situation is ever going to change, another role needs to be found for them beyond that of tending to ‘dysfunctionaries’. Just think, taxpayer money is going for the ‘functionaries’ who tend to the ‘dysfunctionaries’, and more and more, both categories are tending towards the synonymously interchangeable. What a savings we would have if we could find a more fruitful position for some of these people, both professional and patient.