Leaving Psychiatry Chap 12; Possibility

Written by Robert against the machine on June 1, 2023. Posted in Current News

We find ourselves in the final chapter. Notice I have not tackled the myth of the chemical imbalance theory of mental illness

Nor have we become lost in the weeds around the mischievous layers of assumptions behind fMRI and genetics studies.

Nor have we wasted time in deconstructing the DSM project. Enough to take it at its Achilles heel in a previous chapter on multiple personality disorder (chap 5).

We have approached psychiatry through deconstructing it down to its basic function in policing the social milieu and having the legal power to incarcerate and chemically modify (chap1). We have opened a window into the culture of the psychiatric apprenticeship (chap 2).

Contra the view of other critics of psychiatry I see the core issues as neither rampant scientism nor as captured by big pharma. Though both are true to a point, rather the problem is philosophical pragmatism (chap 4) and other problems as well.

This is not to deny psychiatry is wedded to mind brain reductionism (it is), though I am comforted in the confidence psychiatry will never prove the unprovable (chap 3).

Within the pragmatic context of truth being whatever works, what works best for now is bending the knee to the trans juggernaut (chap 7), addiction as a brain disease (chap 8) and psychotherapy is whatever makes the customer “feel better” (chap 6).

That the genealogy of psychiatry is as a replacement for the priest or shaman is self-evident. This would have left the clergy with authority only to attend to religious ministrations had Christendom not decided to abandon its faith and its nerve to claim authority over the psyche.

Today the pastoral counsellor is happy castrated itself into a corner, leaving final pronouncements to those better “qualified”. That psychiatry flirted with completely divesting religion of relevance we also explored with the satanic panic (chap 5).

We try and normalise the psychotic alien as an insoluble political problem (chap 9) and suggest property is not truly private unless the owner can destroy it (chap 10). In the penultimate chapter (11) I attempt to climb Mt Szasz.

If I have succeeded in tearing down psychiatry, the onus is probably upon me to offer an alternative. And fair enough. That having been said, some solutions are non-solutions. Or put another way, a problem erected on a fallacy requires no solution, only the removal of confusion.

Logic would dictate that with the bad removed only the good can remain. And yet we live in a culture where it assumed clearing out the weeds is not good enough without adding fertiliser. Sometimes all that is required is to keep the weeds out and treat the plant with 24 hours of time every day.

Taking a leaf out of the book of Szasz, it is not as if we have abandoned medicalized mental illness as myth only to solidify it in another form. No, our project is more radical still. We must take a pause now to think.

We best avoid falling into the “social justice” trap of looking for humane or more logically consistent alternatives to standard diagnosis and treatment in caring for the “mentally ill” and a different kind of expert.

Were we to do so, our fallacious premises remain ensconced in our minds. We would be forever perched atop the patient, a looming shadow of the therapeutic state of which we are one of its organs.

This is the problem of much of the movement critical of psychiatry today. Some Marxists want to liberate the mentally ill from the evils of capitalist big pharma and the stigma of the DSM and the psychiatric power structure.

So far so good? Not quite for it recapitulates victimhood, first to mental illness (an underclass) and second to exploitation (by a pharma overclass and orthodox psychiatry). But the pharma critical psychiatrist usually wishes to liberate the patient from one locus of exploitation into their own.

Any token pretences to toleration of the abnormal or liberation into freedom and responsibility are tepid at best. If the critical psychiatrist really wishes to liberate the patient, first undermine the psychiatric claim to legitimacy to do it and explain who the patient is.

We reach a terminus of incoherent absurdity when the maverick psychiatrist takes aim at their profession, guild, pharma, theoretical schema and all and sundry only to justify authority to critique with….you guessed it…their MD and psychiatric credentials.

The psychiatric tyrant would ask the critical psychiatrist what he/she would do instead if faced with the patient who must be fixed. Szasz answer would be that the psychiatrist probably should not even be in the room. The context and relationship is, a priori, exploitative.

Forcing me to offer alternatives is reminiscent of one of many similar conversations with senior colleagues when I was more junior in psychiatry.

When I asserted that so called antipsychotics were entirely inappropriate for a number of reasons in a particular patient with an emotionally unstable and antisocial personality (tax payer funded medication mind you), the response was that it was then incumbent upon me to arrive at an alternative pharmacological solution as part of a “package of care”.

What was I going to do with, and give to, the person labelled patient, that was the question. What I wanted to recognize in the person was her de-medicalized autonomy, responsibility and the rule of law hanging over her head as it is over my own.

What I wanted to offer her were frequent empathic reminders to grow up and some advice on how this might be achieved. To this I could add all the appurtenances of psychotherapeutic psychobabble, though this jargon is empty and hollow.

Anyone’s wise grandmother could identify the basic fault in her developmental history, her psyche and also recognise the necessary adult behaviour that would be a both a therapeutic exercise and a realization of recovery.

Naturally such good sense falls on both the deaf ears of the patient who does not wish to grow up, and the psychiatrist whose affirmations to mental illness obstruct her from the same.

The psychiatrist’s ego wants the patient to pass through a process of confession of being sinful (insight into mental illness), acts of contrition (medication etc) and only in passing through this ritual is absolution (recovery) and partial freedom to be found (partial, as freedom is always conditional in the therapeutic state).

I imagine abolitionists of slavery free the captive from chains only to ask “but what do we do with them now?”. If the master slave relationship is broken, the answer is there is no “we”, no “them” and no “doing with”.

When the one who sits across from me is a free autonomous citizen under the rule of law and assumption of adult personal responsibility, they are none of my business and I am none of theirs save for whatever free transactions we voluntarily choose to make amongst ourselves.

After the twilight and just before the passing away of the slave/slave master dyad, “we” may go so far as to “give” our erstwhile slaves the plantation upon which they have laboured. Should free citizens choose to make it into a productive endeavour the profit is theirs.

Should they choose to raise it to the ground they face the consequences of their own ruin and famine. In the latter eventuality, the slave master cannot a posteriori claim licence to re-enslave the free citizen and the citizen cannot blame their former masters for failing in “duty of care”.

Same with imagining a death of psychiatry and any transitional alternative objects we may employ en route to its end. The point is not to argue whose “model/system of care” results in greater performance outcomes re suicide, “morbidity” from depression and anxiety, untreated psychosis etcetera using existing psychiatric metrics and observational studies.

The people who would argue such things are, to quote Wilde, those who know the price or everything and the value of nothing. I could easily argue in favour of some monstrous Huxleyan brave new world where autonomy is effectively abolished altogether, everyone wrapped in proverbial bubble wrap, drugged into blissful oblivion and suicide as rare as a blue moon.

But how would it profit the world if the psychiatrist engineers this utopia at the expense of the person’s soul? Freedom and responsibility are the only metrics worth measuring.

If psychiatry to vanish overnight the next day would not be smooth sailing. Every major change is a revolution of a kind. And every revolutionary or abolitionist, for lack of better terms, must be careful what they wish for.

They must ask themselves what is to happen the day after they seize the barracks and the post office, or the psychiatric clinic. The immediate upheaval would be enormous and not without some quantum of tragedy, though not the catastrophe that the professions narcissism would want us to believe.

Besides, tragedy is the stuff of life. Tragedy lived before psychiatry as it lives during the current era. The medicalization of tragedy is the greater sickness. Psychiatry’s narcissistic delusion is that a society without this class of expert manager is destined to failure and unnecessary suffering.

Problems arising in the wake of psychiatry’s sudden death would be more the clash between the inertia of iatrogenic fostered expectation against the vacuum created in psychiatry’s absence, as opposed to revealing the indispensability of psychiatry in principle or in the mid to longer term.

Such would be the birth pains of society growing up. If we are to reject utilitarianism, philosophical pragmatism, the myth of mental illness, the specialist class of the psychiatrist as the minister to souls, the involuntary therapeutic state, the whole menagerie of these hideous little creatures, the consequent inauguration of greater principles within which we may come to live is its own reward.

Nonetheless and notwithstanding there is no excuse for failing to move swiftly towards a complete abolition of coercive and forced psychiatric practice and the market expansion of alternatives, one needn’t be rushed and reckless to do what is best.

Apart from a calling to a different principle, or principle as such (vs sophistic mischief from the pragmatic void), it occurs to me that the task is harder still. For even a salutary suggestion of what is possible might be seen as something of a fantasy, if not my own delusion.

Just as many a youth today could not imagine a possible world without social media and smart phones, these being places within which their identity dwells and is diffused, many a psychiatrist is indoctrinated to believe it is impossible have a functioning world without SSRI’s, let alone involuntary hospitalization, civil commitment, ECT, lifetime administered neuroleptics and the psychiatrist themselves.

They have swallowed the idea that without psychiatry there would be hordes of unwell people suffering, taking their own lives, or chained in the attic by the family or dying in the gutter. What I offer is a collage of suggestions, impressions, and proposals.

I don’t offer solutions so much as an invitation to believe in possibility. Possibility must come first.

Trieste

Most in psychiatry and I’ll wager everyone under 50 years of age knows nothing of the Italian project. It is impossible to discuss the psychiatric history of 1960’s-1980’s Italy without running the risk of historiography.

One can find whatever answer one wishes to find if to ignore the accounts and arguments one wishes to ignore. That is the prism which one is handed when looking back at Professor Franco Basaglia, the “Psichiatria Democrata” (democratic psychiatry) and the alleged secular miracle in Trieste at the San Giovanni hospital.

Consequently, I shall restrict myself to what is undeniable in what mainstream psychiatry thought impossible before the fact of the miracle, this to be compared with the miracle itself.

This is taken from a long document. Read the rest here substack.com

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