Sunday, February 24, 2013

Hollywood and psychiatry's demise

I have often referred to Thomas Szasz's theory that absent the facility of state coercion, psychiatry as we know it would rapidly fade away. And I think my own objections to psychiatry would become effectively irrelevant if all forms of the insanity defense and involuntary treatment were simply abolished.

However, if you see psychiatry as a legitimate medical specialty, and believe or hope that brain research will enable more effective treatments and understanding of the causes of mental illness, you might not imagine that it ever could or would fade away, any more than physics, or society itself, or truth.

Culture is the continuing combined attempt of humanity to assign meaning to the experienced world. It is created truth, rather than discovered truth. It may randomly partner or compete with science, and it may be a stronger or a weaker influence than science upon events of all kinds, depending on circumstances. Any prediction of cultural trends is probably arrogant by definition. (Oh, well...)

The high priests of science do research funded by the United States government, and the high priests of culture make Hollywood movies. Right now, from the perspective of us common people who merely market and consume brands, we have apparent competition.

President Obama is calling for breakthrough brain research and "mental health" solutions to endemic human violence. Hollywood is making movies like Silver Linings Playbook and Side Effects.

At first glance, these two films present dramatically different pictures of psychiatry.

Silver Linings shows both psychiatrists and patients as entirely human, tragic and adorable. The mental health system is part of the background, but it's not very relevant because ultimately things can turn out the way good people want them to. In almost total contrast, Side Effects shows both psychiatrists and patients to be criminals, motivated entirely by money and spite. The mental health system is utterly, irredeemably corrupt, and no one ever helps anyone, no matter what they say.

But the contrasts are less interesting, as culture, than the complementary influence these two films might exert toward undermining psychiatry's brand.

Hollywood now seems to completely discard all reference to the 20th Century ideal of beneficent scientific medicine, in these portrayals of bad behavior as a public health issue. The characters in Silver Linings and Side Effects are all equally out of control and unpredictable. The "diagnoses" are random and irrelevant, and the doctors are clearly not Ben Casey or Marcus Welby.

Never mind whether someone on a "therapeutic" dose of Seroquel can ever be a beautiful dancer, dance still cures unhappy and crazy people. And never mind whether a drug can really cause a sleepwalking murder, everyone in the mental health business is a dangerous liar anyway.

These are not ideas which enable psychiatry as we know it. In fact it's pretty safe to say that if most people agreed with the reality of these ideas, they would not come up with a system wherein psychiatric experts get primary jurisdiction over who should be locked up without trial, who should be forcibly drugged, who should be excused from criminal responsibility.

The reason psychiatry has the power it has in Western countries, is that once upon a time a couple of generations ago, people would have found Hollywood's depictions of mental health issues in both Silver Linings Playbook and Side Effects to be completely unrealistic or even offensive.

We live in a different world now, and I think despite President Obama's urgings, psychiatry as we know it is a nearly lost cause.

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