Four years ago, I wrote that,"The ultimate security threat is a catastrophic failure of confidence in authority." Now and then my own warning comes back to haunt me.
Today's Chicago Tribune contains an editorial under the headline, "Vaccine ignorance: Deadly and contagious" by Laurie Garrett and Maxine Builder. The authors point out how public misinformation can cause paranoia and derail rational programs when conspiracy theories go viral and the public proves unable to weigh facts accurately.
Think of psychiatry's long and well-financed misinformation about "chemical imbalances in the brain" needing medical cures, for diagnoses of mental illness.
Today's Wall Street Journal featured another opinion piece, "The Last Anti-Fat Crusaders" by Nina Teichols. It turns out that 35 years of official American nutrition advice favoring low-fat diets was simply bad. The balance of science shows that what almost all the authorities were telling us to do has been more likely to make us obese and diabetic.
Think of psychiatry's "treatments" with drugs causing more long-term disability, dramatically reduced life expectancy, suicide and random violence.
When authority has proven untrustworthy and the world seems out of control, individuals, families and small groups of people look for their own solutions and fend for themselves. Surprising movements rise as if from nowhere, wielding utterly unpredicted power. Safe and comfortable centers no longer hold; anarchy is loosed; a blood-dimmed tide flows.
I believe, as did Thomas Szasz, that psychiatry has had the single most destructive influence on human culture since the Middle Ages. It's basic tenets are falsehoods. A human being absolutely is not merely a brain, and his/her thoughts, emotions, beliefs, dreams and goals are not reducible to neurotransmitters and receptors, or circuitry.
Yet psychiatric misinformation has derailed time-tested religious authority, substituting clinicians for spiritual leaders, biochemistry for ethics and genetics for philosophy. It has steadily reduced centuries of jurisprudence in criminal responsibility to cheap evaluations of DSM criteria. It has even wasted the prestige, utility and honor of medical practitioners and scientists, so the public now sees them as little more than another untouchable class of dubious experts with an agenda for profit and power.
There is no more deadly and contagious ignorance than public belief that psychiatry helps people. The last crusaders for medicalization of all human travail, for coercion of all humanity into psychiatric slavery, are way overdue for their reconciliation with reality.
That, or the rough beast comes slouching.
Wednesday, October 29, 2014
Tuesday, October 21, 2014
Sherman is coming and he will burn your city!
Allen Frances is pushing his latest article in Psychology Today all over Twitter now. He calls for an end to civil war among the various advocates for the mentally ill. Very reasonable, very appealing...
I give Dr. Frances some credit for his admissions over the past few years, that psychiatric "diagnosis" as exemplified in APA's DSM is highly problematic at best; and that the medical profession has overprescribed psychiatric drugs almost to the point of criminality. When the chairman of the DSM-IV task force concedes these things, people have to listen, and it has a positive effect.
But Frances is wrong on one central point. He's actually so wrong that his broad appeal and visibility in the mental health world may do more harm than good. Coercion is the only public policy issue in mental health.
Allen Frances says coercion is a "paper tiger" because most of the Twentieth Century snake pit state institutions closed, and half a million mental patients were released for treatment in the community. This is akin to arguing in 1850, that since the African slave trade had been legally prohibited, abolitionists would only shed blood needlessly for a cause already won.
Frances says mental patients have a harder time getting into a hospital than getting out. This is akin to assurances in 1850, that Negroes were much better off under the Southern system of servitude, that they did not want and could never thrive in freedom.
I have worked directly with such "patients" as those with whom Dr. Frances presumes to sympathize, for thirteen years. They are not happy in their slavery.
If psychiatric "treatment" is generally valuable to those who receive it, if the "severely mentally ill" really want to be "treated", then laws which force people into "hospitals" and laws which allow "doctors" to force needles and inject hated, debilitating drugs into the bodies of desperately resisting human beings should be completely unnecessary.
The fact that Allen Frances believes such torture is justified makes his whole argument a dark joke. If he wants to help the mentally ill and society, let him renounce involuntary psychiatry. Let him push publicly for repeal of commitment laws and the insanity defense. Let him become an honest abolitionist or continue to protect his investment in psychiatric slavery, but there is no middle ground.
Dr. Frances, do not cheapen the name or the memory of Thomas Szasz! Let civil war among the various self-proclaimed advocates for the mentally ill continue, as Abraham Lincoln said, "...until every drop of blood drawn with the lash is repaid by another drawn with the sword."
I give Dr. Frances some credit for his admissions over the past few years, that psychiatric "diagnosis" as exemplified in APA's DSM is highly problematic at best; and that the medical profession has overprescribed psychiatric drugs almost to the point of criminality. When the chairman of the DSM-IV task force concedes these things, people have to listen, and it has a positive effect.
But Frances is wrong on one central point. He's actually so wrong that his broad appeal and visibility in the mental health world may do more harm than good. Coercion is the only public policy issue in mental health.
Allen Frances says coercion is a "paper tiger" because most of the Twentieth Century snake pit state institutions closed, and half a million mental patients were released for treatment in the community. This is akin to arguing in 1850, that since the African slave trade had been legally prohibited, abolitionists would only shed blood needlessly for a cause already won.
Frances says mental patients have a harder time getting into a hospital than getting out. This is akin to assurances in 1850, that Negroes were much better off under the Southern system of servitude, that they did not want and could never thrive in freedom.
I have worked directly with such "patients" as those with whom Dr. Frances presumes to sympathize, for thirteen years. They are not happy in their slavery.
If psychiatric "treatment" is generally valuable to those who receive it, if the "severely mentally ill" really want to be "treated", then laws which force people into "hospitals" and laws which allow "doctors" to force needles and inject hated, debilitating drugs into the bodies of desperately resisting human beings should be completely unnecessary.
The fact that Allen Frances believes such torture is justified makes his whole argument a dark joke. If he wants to help the mentally ill and society, let him renounce involuntary psychiatry. Let him push publicly for repeal of commitment laws and the insanity defense. Let him become an honest abolitionist or continue to protect his investment in psychiatric slavery, but there is no middle ground.
Dr. Frances, do not cheapen the name or the memory of Thomas Szasz! Let civil war among the various self-proclaimed advocates for the mentally ill continue, as Abraham Lincoln said, "...until every drop of blood drawn with the lash is repaid by another drawn with the sword."
Wednesday, July 16, 2014
The final propaganda push
American hyper-medical psychiatry is approaching a climactic moment in its desperate struggle for survival. I believe it will fail, and the world will soon change for the better.
We are hearing some high-pitched propaganda these days. One line is typified by cries for more coercion of "treatment" because, it is said, people only refuse psychiatric drugs when their mental illness prevents them from realizing that it's what's best for them. Perhaps the most succinct expression of this comes from Rep. Tim Murphy and his gurus at the Treatment Advocacy Center (T.A.C.).
Another line is heard from the likes of Cook County (Illinois) Sheriff Tom Dart. The real problem according to these guys is, there are a number of violent people who should be treated by doctors rather than restrained/punished/warehoused by the law, and we've made the error of closing down too many treatment facilities, so now our jails and prisons don't work correctly, and that's dangerous.
The public is supposed to put these two points together and conclude: We really need to force more people to be treated by psychiatrists, and we need to spend much more public money to enable psychiatrists to treat them. Otherwise we are cruel, unscientific and deserving of all manner of terrible consequences.
Propaganda is distinct from other forms of advocacy because it intends to change people's minds through deception and confusion rather than persuasion and understanding. Over the past century, propagandists have had to become more and more skilled to achieve the same level of results because human society has learned from being duped and become more cynical about communications from established interests.
We tend to have great faith in anything perceived as medical or scientific. Doctors eliminated smallpox and physicists built the atom bomb after all, so we're impressed. Then again, there was that guy named Mengele, and the uncertainty principle is a little embarrassing. We are suspicious these days, even of the demigods in our expert classes.
The actual scene of coerced "treatment" includes the unfortunate reality that in a non-totalitarian society it's almost impossible to keep people on drugs which they hate, and which disable them for no long-term benefit whatsoever. Forced psych drugging may be a perfectly legitimate emergency measure in some circumstances of immanent threatened violence. Then again, a policeman's baton and handcuffs work just as well for less money. It's also a pitiful degradation of real medicine and the great humanitarian Hippocratic tradition (not to mention our most fundamental human rights principles) to even call chemical restraint (iatrogenic disabling) "treatment".
The T.A.C./Murphy position in favor of "Assisted Outpatient Treatment" (a despicable euphemism) laws pretends that if we just get mental patients on drugs, they'll recover and realize how much it helps them. The anosognosia will go away. This hearkens back with such shrillness to historical episodes of political psychiatric repression, as in the Soviet Union, that the term anosognosia is rarely even offered to the mass media -- it's usually reserved for websites which are frequented more by zealots. Tim Murphy actually did try to lecture about anosognosia in a Congressional hearing once, but he came across as mean and ridiculous, and got slammed by recovery advocates on the web and social media.
The other propaganda line, the Tom Dart pitch, seems inconsistent. T.A.C./Murphy insist we need to force more people onto drugs, and the traditional institutions where you force people to do things are prisons and jails. It's a quintessential function of the law, not of health care, to coerce people.
Maybe the real bottom line is, we don't even remember the difference between criminal punishment and medicine anymore, it has all become a giant confusion. The expert classes simply demand that we cough up more money, to be spent for whatever they think is best. The state is our only hope and paying for it is our only duty. That's what they tell us.
I think we should stop paying them and stop giving them coercive authority. Meanwhile, we should learn to quickly recognize the two lines of this big push. Whenever somebody implies that more people need to be forced onto psych drugs and/or that more taxes must go to pay for "treatment", they are working for the same establishment experts who brought us more disability from mental illness and more random, unexplained violence.
Future generations will laugh about how anyone was ever expected to believe this propaganda.
We are hearing some high-pitched propaganda these days. One line is typified by cries for more coercion of "treatment" because, it is said, people only refuse psychiatric drugs when their mental illness prevents them from realizing that it's what's best for them. Perhaps the most succinct expression of this comes from Rep. Tim Murphy and his gurus at the Treatment Advocacy Center (T.A.C.).
Another line is heard from the likes of Cook County (Illinois) Sheriff Tom Dart. The real problem according to these guys is, there are a number of violent people who should be treated by doctors rather than restrained/punished/warehoused by the law, and we've made the error of closing down too many treatment facilities, so now our jails and prisons don't work correctly, and that's dangerous.
The public is supposed to put these two points together and conclude: We really need to force more people to be treated by psychiatrists, and we need to spend much more public money to enable psychiatrists to treat them. Otherwise we are cruel, unscientific and deserving of all manner of terrible consequences.
Propaganda is distinct from other forms of advocacy because it intends to change people's minds through deception and confusion rather than persuasion and understanding. Over the past century, propagandists have had to become more and more skilled to achieve the same level of results because human society has learned from being duped and become more cynical about communications from established interests.
We tend to have great faith in anything perceived as medical or scientific. Doctors eliminated smallpox and physicists built the atom bomb after all, so we're impressed. Then again, there was that guy named Mengele, and the uncertainty principle is a little embarrassing. We are suspicious these days, even of the demigods in our expert classes.
The actual scene of coerced "treatment" includes the unfortunate reality that in a non-totalitarian society it's almost impossible to keep people on drugs which they hate, and which disable them for no long-term benefit whatsoever. Forced psych drugging may be a perfectly legitimate emergency measure in some circumstances of immanent threatened violence. Then again, a policeman's baton and handcuffs work just as well for less money. It's also a pitiful degradation of real medicine and the great humanitarian Hippocratic tradition (not to mention our most fundamental human rights principles) to even call chemical restraint (iatrogenic disabling) "treatment".
The T.A.C./Murphy position in favor of "Assisted Outpatient Treatment" (a despicable euphemism) laws pretends that if we just get mental patients on drugs, they'll recover and realize how much it helps them. The anosognosia will go away. This hearkens back with such shrillness to historical episodes of political psychiatric repression, as in the Soviet Union, that the term anosognosia is rarely even offered to the mass media -- it's usually reserved for websites which are frequented more by zealots. Tim Murphy actually did try to lecture about anosognosia in a Congressional hearing once, but he came across as mean and ridiculous, and got slammed by recovery advocates on the web and social media.
The other propaganda line, the Tom Dart pitch, seems inconsistent. T.A.C./Murphy insist we need to force more people onto drugs, and the traditional institutions where you force people to do things are prisons and jails. It's a quintessential function of the law, not of health care, to coerce people.
Maybe the real bottom line is, we don't even remember the difference between criminal punishment and medicine anymore, it has all become a giant confusion. The expert classes simply demand that we cough up more money, to be spent for whatever they think is best. The state is our only hope and paying for it is our only duty. That's what they tell us.
I think we should stop paying them and stop giving them coercive authority. Meanwhile, we should learn to quickly recognize the two lines of this big push. Whenever somebody implies that more people need to be forced onto psych drugs and/or that more taxes must go to pay for "treatment", they are working for the same establishment experts who brought us more disability from mental illness and more random, unexplained violence.
Future generations will laugh about how anyone was ever expected to believe this propaganda.
Sunday, June 29, 2014
Marva says I'm a bully!
I have a client at Elgin Mental Health Center who drives me nuts. I like that, because it means the person is smart enough to get under my skin a little.
One of the staff on this client's "treatment" team is a nurse or security person (I don't even recall her exact title or role and it doesn't seem to matter) and a union boss (which probably does matter a lot). Her name is Marva. Perhaps that's a nickname for Marvelous, but I don't know.
My client gets under Marva's skin, too. And even though I really don't know Marva, haven't worked with her in the decade-plus that I've been advocating for people at EMHC, only met her once as far as I can recall (and in that instance I was actually impressed -- she seemed marvelous enough to me), it seems that somehow I must be getting under Marva's skin now, too.
Anyway, my client says Marva calls me a bully. Fascinating! Marva is the one who can have people forcibly held down to be shot up with psych drugs on her whim (and has done so recently in fact)!
All I can do is talk and write. If my words carry any intimidating force, whether they are spoken to a judge in court, to a passerby on a sidewalk, to a public official in a letter, or in this blog; whether they are polite, or clever, or obnoxious, it's only because someone might agree with them.
I have no idea how I can "bully" anyone, unless they are afraid of me because I might find out something they are trying to hide. But anybody like that is "bullying" him or her self really, by his or her own guilty conscience.
I recently suggested that Marva may have been the one who attempted that stupid, anonymous "complaint" about me to the ARDC. She seemed like a long shot as a suspect, at the time. But so far, I've had no denials from anybody I named, so I can't rule any of them out.
I've gone back and forth. I thought Dan Hardy, Medical Director at Elgin, was the best suspect for awhile, because he is trained as a lawyer but hasn't practiced law for a very long time. He'd know the legal term, "defamation per se" but he might fail to realize that the ARDC never takes anonymous complaints about lawyers defaming psychs (the thought of that is just hilarious, really).
I also figured Dr. Malis or Dr. Hussain (two unit psychs at Elgin) might have pulled this goofy prank. But I've seen all three of these guys (Malis, Hussain and Hardy) since I wrote that last blog, and although none of them took any trouble to deny... they just didn't come across to me as very suspicious.
When people are afraid you'll find something out about them, they start being critical of you. It's an instinctive thing, they just can't help it.
So there's Marva, telling my client I'm a bully. Marvelous Marva!
One of the staff on this client's "treatment" team is a nurse or security person (I don't even recall her exact title or role and it doesn't seem to matter) and a union boss (which probably does matter a lot). Her name is Marva. Perhaps that's a nickname for Marvelous, but I don't know.
My client gets under Marva's skin, too. And even though I really don't know Marva, haven't worked with her in the decade-plus that I've been advocating for people at EMHC, only met her once as far as I can recall (and in that instance I was actually impressed -- she seemed marvelous enough to me), it seems that somehow I must be getting under Marva's skin now, too.
Anyway, my client says Marva calls me a bully. Fascinating! Marva is the one who can have people forcibly held down to be shot up with psych drugs on her whim (and has done so recently in fact)!
All I can do is talk and write. If my words carry any intimidating force, whether they are spoken to a judge in court, to a passerby on a sidewalk, to a public official in a letter, or in this blog; whether they are polite, or clever, or obnoxious, it's only because someone might agree with them.
I have no idea how I can "bully" anyone, unless they are afraid of me because I might find out something they are trying to hide. But anybody like that is "bullying" him or her self really, by his or her own guilty conscience.
I recently suggested that Marva may have been the one who attempted that stupid, anonymous "complaint" about me to the ARDC. She seemed like a long shot as a suspect, at the time. But so far, I've had no denials from anybody I named, so I can't rule any of them out.
I've gone back and forth. I thought Dan Hardy, Medical Director at Elgin, was the best suspect for awhile, because he is trained as a lawyer but hasn't practiced law for a very long time. He'd know the legal term, "defamation per se" but he might fail to realize that the ARDC never takes anonymous complaints about lawyers defaming psychs (the thought of that is just hilarious, really).
I also figured Dr. Malis or Dr. Hussain (two unit psychs at Elgin) might have pulled this goofy prank. But I've seen all three of these guys (Malis, Hussain and Hardy) since I wrote that last blog, and although none of them took any trouble to deny... they just didn't come across to me as very suspicious.
When people are afraid you'll find something out about them, they start being critical of you. It's an instinctive thing, they just can't help it.
So there's Marva, telling my client I'm a bully. Marvelous Marva!
Thursday, June 5, 2014
Abused by a COWARDLY psychiatrist
This afternoon I received a letter dated June 3, from the Illinois Supreme Court's Attorney Registration and Disciplinary Commission (ARDC), informing me that on May 30 they had received an anonymous complaint regarding my conduct. The ARDC enclosed a copy of the complaint and stated, "We have reviewed the communication and have determined that further action by this Commission is unwarranted."
First of all let me just say, HAHAHAHAHAHAHA!!!
But perhaps I should elaborate.
This anonymous "complaint" was (supposedly) from a co-worker of Alicia S. Martin, M.D., the Elgin Mental Health Center psychiatrist whom I excoriated as an abuser, in my blog article of February 3, 2014. I accused Dr. Martin of abusing her patients, her employers and many other people for money, or for status, or possibly for other motives, none honorable.
Just to make sure I'm not misunderstood, I hereby reiterate, for the record, those precise accusations.
The next issue might be, who filed this anonymous "complaint" with the ARDC? What were his/her motives for doing so, and what did he/she expect to accomplish?
There are several people at Elgin Mental Health Center, I'm fairly sure, who don't like me. On one hand, I was once called a valuable member of a clinical treatment team, by a psychiatrist! On the other hand, my natural instinct is honestly to defeat treatment teams rather than to collaborate with them. I resist this instinct when a team is willing to follow the law, and I have considerable respect for many clinicians at Elgin. Almost all are well-intentioned, and many are capable of clever effects in helping. But they do not habitually follow the law, they cheat.
They cheat because they have to. It's impossible to do what the law, and the taxpayers, expect: routinely improve the behavior of bad guys with medicine. So the "forensic mental health" enterprise becomes (as I said in the offending blog about Dr. Martin) a racket.
Right now I am defending another forced drugging petition. The psychiatrist who filed that petition might be one of the best suspects for having authored this recent ARDC "complaint". His name is Dr. Richard W. Malis, M.D. So far, I have nothing quite so bad to say about Dr. Malis, as what I said before about Dr. Martin. However, he and I apparently do not get along. We'll just see.... If he tells me he did not write the anonymous "complaint", I will believe him, and I'll apologize for the accusation here. If he did write the complaint, I'll simply laugh at him, because it was a stupid waste of his time. But I don't think he's very stupid, so maybe he didn't write it.
Other possible anonymous complainants might include the psychiatrist Dr. Syed Hussain, M.D., one particular social worker on the White Cottage Unit named Mario, and another staff on White named Marva. There's also a psychiatrist on L Unit (name escapes me at the moment) who may feel that I've recently been too critical or insulting toward her. I would encourage any or all of these guys to let me know if the complaint was not filed/written by them. I will believe them, and apologize. But if they don't deny, I will probably continue to mention them, by name, as suspected idiots (for wasting their taxpayer-financed time) and cowards (for being afraid to put their name on the complaint).
The ARDC complaint ends with the statement, "This complaint is being filed Anonymously..." (the capitalization strikes me as a bit weird, by the way) "...as Mr. Kretchmar engages in intimidating behaviors towards the staff at Elgin Mental Health Center." Needless to say, this is my favorite part!
If writing and publishing this, new article is intimidation, well... expect much more of the same, and worse!
However, I'll also keep in mind the possibility, however remote, that somebody was honestly offended by my accusations against Dr. Martin, and that I am seen as a real threat to something that is thought to be good and that needs defense. I would actually love to believe that's the case. If this ARDC complaint was made by a good, well-intended person, I am no threat to that person, and I would consider it a most valuable opportunity if I could somehow engage in a discussion with them.
First of all let me just say, HAHAHAHAHAHAHA!!!
But perhaps I should elaborate.
This anonymous "complaint" was (supposedly) from a co-worker of Alicia S. Martin, M.D., the Elgin Mental Health Center psychiatrist whom I excoriated as an abuser, in my blog article of February 3, 2014. I accused Dr. Martin of abusing her patients, her employers and many other people for money, or for status, or possibly for other motives, none honorable.
Just to make sure I'm not misunderstood, I hereby reiterate, for the record, those precise accusations.
The next issue might be, who filed this anonymous "complaint" with the ARDC? What were his/her motives for doing so, and what did he/she expect to accomplish?
There are several people at Elgin Mental Health Center, I'm fairly sure, who don't like me. On one hand, I was once called a valuable member of a clinical treatment team, by a psychiatrist! On the other hand, my natural instinct is honestly to defeat treatment teams rather than to collaborate with them. I resist this instinct when a team is willing to follow the law, and I have considerable respect for many clinicians at Elgin. Almost all are well-intentioned, and many are capable of clever effects in helping. But they do not habitually follow the law, they cheat.
They cheat because they have to. It's impossible to do what the law, and the taxpayers, expect: routinely improve the behavior of bad guys with medicine. So the "forensic mental health" enterprise becomes (as I said in the offending blog about Dr. Martin) a racket.
Right now I am defending another forced drugging petition. The psychiatrist who filed that petition might be one of the best suspects for having authored this recent ARDC "complaint". His name is Dr. Richard W. Malis, M.D. So far, I have nothing quite so bad to say about Dr. Malis, as what I said before about Dr. Martin. However, he and I apparently do not get along. We'll just see.... If he tells me he did not write the anonymous "complaint", I will believe him, and I'll apologize for the accusation here. If he did write the complaint, I'll simply laugh at him, because it was a stupid waste of his time. But I don't think he's very stupid, so maybe he didn't write it.
Other possible anonymous complainants might include the psychiatrist Dr. Syed Hussain, M.D., one particular social worker on the White Cottage Unit named Mario, and another staff on White named Marva. There's also a psychiatrist on L Unit (name escapes me at the moment) who may feel that I've recently been too critical or insulting toward her. I would encourage any or all of these guys to let me know if the complaint was not filed/written by them. I will believe them, and apologize. But if they don't deny, I will probably continue to mention them, by name, as suspected idiots (for wasting their taxpayer-financed time) and cowards (for being afraid to put their name on the complaint).
The ARDC complaint ends with the statement, "This complaint is being filed Anonymously..." (the capitalization strikes me as a bit weird, by the way) "...as Mr. Kretchmar engages in intimidating behaviors towards the staff at Elgin Mental Health Center." Needless to say, this is my favorite part!
If writing and publishing this, new article is intimidation, well... expect much more of the same, and worse!
However, I'll also keep in mind the possibility, however remote, that somebody was honestly offended by my accusations against Dr. Martin, and that I am seen as a real threat to something that is thought to be good and that needs defense. I would actually love to believe that's the case. If this ARDC complaint was made by a good, well-intended person, I am no threat to that person, and I would consider it a most valuable opportunity if I could somehow engage in a discussion with them.
Friday, May 9, 2014
APA Annual Conference 2014: The Future of Psychiatry
At 3:30 pm on Tuesday, May 6th, APA President Jeffrey Lieberman opened his talk on "The Future of Psychiatry" by asking how many people in his audience were not psychiatrists. Along with only two others, I raised my hand.
Lieberman then asked each of us what we were doing there. I said that I was a lawyer working with psychiatrists. He queried, "What side are you on?" I shrugged from the back of the room and smiled, and after a moment he asked, "Are you on the side of truth?" I answered, "Absolutely! And justice, and the American way."
He then suggested that someone in the crowd should probably take my picture, just in case....
Lieberman is a politician and a PR man, but his viewpoint is a little incoherent, and he just never quite wins.
After a brief, fairly competent lesson on the history of psychiatry (he omitted a few chapters, of course, like the key role psychs played in the holocaust and the highly embarrassing "satanic abuse/multiple personality disorder" craze in the 1990's), the President of the APA offered his key predictions for the future:
1. Psychiatrists will work more and more for large organizations. They will not be hands-on, direct care clinicians as much as they are now. This is due to simple economics, i.e., no one wants to pay psychiatrists for direct care, because they're not worth what they charge. But ideally in the future they can become the elite advisors or "captains" of treatment teams, mostly removed from human patients.
2. Breakthrough technologies from scientific research into the brain, and the position of psychiatrists as first implementers of these new technologies, will be the single source of value and power to command public resources for the profession, going forward. Modern culture has not caught up with the overriding significance of the brain, but when it does psychiatrists will be able to assert their role as the real experts on all of life.
Whether these prognostications seem glorious or darkly threatening, there is a major countervailing factor. BRAIN was one of two key words in Lieberman's dissertation. The other word was STIGMA.
Stigma is purportedly the basic reason why psychiatrists don't have the power they should, and why they can't get paid enough. People don't like to talk about mental illness or admit having it, and they don't want their friends to know if they're seeing a psychiatrist.
Ironically, psychiatrists themselves may stigmatize psychiatry as much as the lay public does. An interesting poster in the exhibition hall described a recent research study in Belgium which concluded, "It could be useful to explicitly start with anti-stigma campaigns during medical training in order to avoid a continuing decrease in the number of candidate psychiatrists." One of the authors of the study told me that as little as ten years ago, there were on average seventy candidate psychiatrists per year in Belgium; now there are only ten or fifteen. She said the trends are the same throughout Europe. It's just too socially embarrassing to be a psychiatrist.
So, on one hand Jeffrey Lieberman sees great and increasing power for the psychiatric elite as captains of a medical-industrial complex ruled by those who know the secrets of the brain. But on the other hand, he and the APA are now hiring crack PR firms to fight stigma, because after decades of public campaigning nothing has worked, and psychiatrists around the world can't even admit their profession to ordinary people in social circumstances.
With his forlorn hope that scientific miracles and arbitrary assertion of authority can save the psychs from the black stigma magic in the nick of time, there is an obvious schism between Jeffrey Lieberman and reality. Funny how that reminds one of a once-postulated "disease", schizophrenia.
There is no unity of view, or authority, in psychiatry. It's a profession falling apart.
As I left the hall after the President of the APA had given his speech on the future of psychiatry, I was approached by a doctor who asked me where I practice law. I told him Chicago, and he responded that he had family there, including six siblings who were all lawyers. He said that despite what Lieberman had implied earlier, as far as he was concerned I was welcome at the APA.
Lieberman then asked each of us what we were doing there. I said that I was a lawyer working with psychiatrists. He queried, "What side are you on?" I shrugged from the back of the room and smiled, and after a moment he asked, "Are you on the side of truth?" I answered, "Absolutely! And justice, and the American way."
He then suggested that someone in the crowd should probably take my picture, just in case....
Lieberman is a politician and a PR man, but his viewpoint is a little incoherent, and he just never quite wins.
After a brief, fairly competent lesson on the history of psychiatry (he omitted a few chapters, of course, like the key role psychs played in the holocaust and the highly embarrassing "satanic abuse/multiple personality disorder" craze in the 1990's), the President of the APA offered his key predictions for the future:
1. Psychiatrists will work more and more for large organizations. They will not be hands-on, direct care clinicians as much as they are now. This is due to simple economics, i.e., no one wants to pay psychiatrists for direct care, because they're not worth what they charge. But ideally in the future they can become the elite advisors or "captains" of treatment teams, mostly removed from human patients.
2. Breakthrough technologies from scientific research into the brain, and the position of psychiatrists as first implementers of these new technologies, will be the single source of value and power to command public resources for the profession, going forward. Modern culture has not caught up with the overriding significance of the brain, but when it does psychiatrists will be able to assert their role as the real experts on all of life.
Whether these prognostications seem glorious or darkly threatening, there is a major countervailing factor. BRAIN was one of two key words in Lieberman's dissertation. The other word was STIGMA.
Stigma is purportedly the basic reason why psychiatrists don't have the power they should, and why they can't get paid enough. People don't like to talk about mental illness or admit having it, and they don't want their friends to know if they're seeing a psychiatrist.
Ironically, psychiatrists themselves may stigmatize psychiatry as much as the lay public does. An interesting poster in the exhibition hall described a recent research study in Belgium which concluded, "It could be useful to explicitly start with anti-stigma campaigns during medical training in order to avoid a continuing decrease in the number of candidate psychiatrists." One of the authors of the study told me that as little as ten years ago, there were on average seventy candidate psychiatrists per year in Belgium; now there are only ten or fifteen. She said the trends are the same throughout Europe. It's just too socially embarrassing to be a psychiatrist.
So, on one hand Jeffrey Lieberman sees great and increasing power for the psychiatric elite as captains of a medical-industrial complex ruled by those who know the secrets of the brain. But on the other hand, he and the APA are now hiring crack PR firms to fight stigma, because after decades of public campaigning nothing has worked, and psychiatrists around the world can't even admit their profession to ordinary people in social circumstances.
With his forlorn hope that scientific miracles and arbitrary assertion of authority can save the psychs from the black stigma magic in the nick of time, there is an obvious schism between Jeffrey Lieberman and reality. Funny how that reminds one of a once-postulated "disease", schizophrenia.
There is no unity of view, or authority, in psychiatry. It's a profession falling apart.
As I left the hall after the President of the APA had given his speech on the future of psychiatry, I was approached by a doctor who asked me where I practice law. I told him Chicago, and he responded that he had family there, including six siblings who were all lawyers. He said that despite what Lieberman had implied earlier, as far as he was concerned I was welcome at the APA.
Thursday, March 13, 2014
Allen Frances & Samuel Sewell (an Update)
Several years ago, I read one or two articles by Allen Frances and suggested that he might be a constructive force for reforming the cruel, corrupt and inhuman field of "mental health". Little did I know at the time I wrote that blog article that he would soon be considered a leading critic of American-style, "label-'em-&-drug-'em" psychiatry.
Dr. Frances recently published a curious little book: Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (NY: The Guilford Press, 2013). I just got a copy from Amazon of the revised edition (published only four months after the original -- no idea why such a quick revision was necessary & I am curious about that).
On one hand, the book is replete with cautionary statements about various DSM-5 "diagnoses", and Frances does consistently suggest that labeling people with psychiatric disorders is a dicey business.
But on the other hand this is a clear, opportunistic attempt by the erstwhile most-powerful-psychiatrist-in-America to maintain some vestige of his remunerative franchise as a famous diagnostician despite replacement of his very own DSM-IV last May.
I initially found it disappointing and ironic that Dr. Frances is now making money by ostentatiously piggy-backing on the sale of the APA's new DSM-5. His book even looks exactly like the DSM (albeit smaller), with the same typefaces and formatting. With the exception of a 16-page introductory chapter, it follows the DSM outline chapter-by-chapter and diagnostic-code-by-diagnostic-code. It is, effectively, a DSM-5 supplement. Minor omissions of individual diagnoses and an altered sequence of disorders are insignificant changes. If I were the APA, I might consider some sort of intellectual property claim...
Under a very thin guise of criticism, it sure seems that Allen Frances is actually supporting the psych status quo. He just wants to continue making money from it like he used to when DSM-IV was king of the hill. Frances has never repudiated the central idea, that unwanted human emotion and bad behavior must be essentially brain disease, treatable according to the medical model. He merely hopes psychs will be more conservative in asserting their philosophy and a bit more careful about damaging people, so the profession can avoid calamitous bad PR.
But there is another interpretation and a more optimistic view. We probably don't need dramatic, road-to-Damascus conversions, or even Judge Sewell apologies, to end specific psychiatric evils in the world and bring a new, freer day of human dignity. Little by little, the culture is changing. It might get much better pretty soon, and in future decades history might credit Allen Frances for some sort of personal mea culpa leading to positive changes, even if he himself never intended any such thing.
The real changes will never come from correcting such middling problems as Frances sees with DSM-5. They will come from total elimination of the one thing which Frances never addresses directly, although his arguments all hint around about it and point toward it: legal coercion of "treatment".
In fact, psychiatric "diagnosis" is not done for any purpose of finding useful treatment, it's done to justify "treatment" which is useful mainly to people other than the patient. The patient arrives, directly or indirectly, because the police bring him in.
And for the moment at least, Dr. Frances is still in the business.
Dr. Frances recently published a curious little book: Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (NY: The Guilford Press, 2013). I just got a copy from Amazon of the revised edition (published only four months after the original -- no idea why such a quick revision was necessary & I am curious about that).
On one hand, the book is replete with cautionary statements about various DSM-5 "diagnoses", and Frances does consistently suggest that labeling people with psychiatric disorders is a dicey business.
But on the other hand this is a clear, opportunistic attempt by the erstwhile most-powerful-psychiatrist-in-America to maintain some vestige of his remunerative franchise as a famous diagnostician despite replacement of his very own DSM-IV last May.
I initially found it disappointing and ironic that Dr. Frances is now making money by ostentatiously piggy-backing on the sale of the APA's new DSM-5. His book even looks exactly like the DSM (albeit smaller), with the same typefaces and formatting. With the exception of a 16-page introductory chapter, it follows the DSM outline chapter-by-chapter and diagnostic-code-by-diagnostic-code. It is, effectively, a DSM-5 supplement. Minor omissions of individual diagnoses and an altered sequence of disorders are insignificant changes. If I were the APA, I might consider some sort of intellectual property claim...
Under a very thin guise of criticism, it sure seems that Allen Frances is actually supporting the psych status quo. He just wants to continue making money from it like he used to when DSM-IV was king of the hill. Frances has never repudiated the central idea, that unwanted human emotion and bad behavior must be essentially brain disease, treatable according to the medical model. He merely hopes psychs will be more conservative in asserting their philosophy and a bit more careful about damaging people, so the profession can avoid calamitous bad PR.
But there is another interpretation and a more optimistic view. We probably don't need dramatic, road-to-Damascus conversions, or even Judge Sewell apologies, to end specific psychiatric evils in the world and bring a new, freer day of human dignity. Little by little, the culture is changing. It might get much better pretty soon, and in future decades history might credit Allen Frances for some sort of personal mea culpa leading to positive changes, even if he himself never intended any such thing.
The real changes will never come from correcting such middling problems as Frances sees with DSM-5. They will come from total elimination of the one thing which Frances never addresses directly, although his arguments all hint around about it and point toward it: legal coercion of "treatment".
In fact, psychiatric "diagnosis" is not done for any purpose of finding useful treatment, it's done to justify "treatment" which is useful mainly to people other than the patient. The patient arrives, directly or indirectly, because the police bring him in.
And for the moment at least, Dr. Frances is still in the business.
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