Thursday, May 27, 2010

The Vanishing Oath and the APA

Immediately upon returning from the American Psychiatric Association's annual meeting in New Orleans, I saw an excellent film entitled, "The Vanishing Oath" - all about the intensely discouraging conditions and changes in the profession of medicine, from the point of view of its very noble and hard-working (if you suspect irony just because I'm a lawyer, forget it - I honestly mean this) practitioners.

I hope I can do justice to the connection here.

Back in January, I wrote that the economics of our love affair with modern psychiatry are inexorable. The broad context of that thought was actually national security. As I watched "The Vanishing Oath" I was filled with apprehension that my instincts in this regard are not paranoid at all; they might even come too late to warn.

Western Civilization, or American Civilization (whatever one wants to name this first cultural superpower since the Roman Empire), has incorporated a fundamental and potentially fatal error: the utter invalidation of individual intuition, free will, responsibility, original creativity and spirituality as the motive force for human improvement, in favor of acquired materialistic data and perfected technical process.

This is obvious in the sad complaints by doctors about the recent ruination of the medical profession. I could be quite unsympathetic, because these same people were perfectly willing to allow the psychiatric charlatans to claim status as healers, when they were never anything but enforcers and punishers.

The degradation of medicine into commoditized "health care" is just one outcome of our conviction that applying rationality and science to human biology is the obvious way to solve the whole human condition and make everybody happy forever.

The ultimate expression of that same conviction may be mandatory psychopharmacology. But the psychiatrists in New Orleans this week were all about collaboration and "Fostering Adherence (N.B., not compliance) to Psychotropic Medications". This was in fact the title of course 36 on Sunday, directed by Luis Ramirez, M.D. and Richard A. McCormick, Ph.D. Dr. Ramirez gave a telling indication of how toxic the prospect of forcibly medicating anyone is these days, with a grinning, almost devilish statement: "I personally LOVE long-acting injections and implants!" When you only have to dose a patient once a month or so, this issue of adherence - or compliance or coercion - needs to be confronted only rarely.

The broad demoralization of doctors is a canary in a coal mine. The increasing complexity and skyrocketing need for great subtlety and ever more creative euphemisms with regard to forcing people into treatment with psychotropics is another one. Maybe something is about to blow up ... "Things fall apart, the centre cannot hold, mere anarchy is loosed upon the world."


  1. Psychiatrists had better be careful about those depo injections. When the patient does something untoward, the psychiatrist can't say he did it because he "was off his medications." Indeed, the psychiatrist could possibly be held liable and be forced to take responsibility for his drug dependency.

  2. Interesting point. I've always presumed, perhaps like most people, that the unpredicted violence occurs when patients are changing meds or dosages, rather than when they are stably continuing them. Of course, patients do change meds or dosages relatively often (compared, e.g., to baby aspirin for colesterol). They just don't stably continue them, because psychotropics are ineffective and very debilitating over the long term.

  3. Shrinks call people psychotic sometimes simply because they don't like a person's attitude towards them. Some of these people, particularly ones with personality disorders, show absolutely no response to anti-psychotics or anything for that matter. Withdrawal problems also tend to be non-existent. You're believing the lies of the shrinks when you think these drugs induce a response for everybody. These people who show no response can be quite nasty, whether they're drugged or not. However, they certainly can learn to pay lip service to current exigencies.

    So what's stopping some one who's been quietly diagnosed with, say, anti-social personality disorder from going out and committing a crime and then raising the defense of involuntary intoxication due to depo injections? The sociopath could quite easily say that the drugs caused memory lapses for which he wasn't responsible or they otherwise occluded his thinking. Last time I looked sociopaths and that mens rea requirement were inseparable companions. However, with shrinks getting involved in these people's lives with something so intrusive as depo injections, ultimate responsibility could lie with them, particularly in a civil trial brought by the patient's victims.

    And I don't think that I have to remind you, shrinks want to involve themselves more and more in these sorts of people's lives.

  4. These kinds of involvement are indeed a liability, and not just for individual psychiatrists. As recent events in the financial world have demonstrated, presumed "experts" (and even whole classes of them) who get bad results which overflow into "civilian" space are not always treated with kid gloves by society. There was a New York Times book reviewer who actually wrote that Americans' love affair with modern psychiatry is a sub-prime crisis waiting to happen. We have not transcended the potential for mob action.