From: arodgers@dcs.qmw.ac.uk (Angus H Rodgers)
Newsgroups: sci.med
Subject: Re: Peter Breggin, _Toxic Psychiatry_ (Q)
Date: 9 Jan 93 23:03:39 GMT
Organization: Computer Science Dept, QMW, University of London

[I've only seen the most recent postings in this thread. I apologise if 
I am only repeating things that have already been said. I also apologise
for the length of this posting. I've kept it as brief as possible. I 
could write a book on the subject -- if I weren't so depressed. :-) ]

In <1993Jan4.183308.14646@news.eng.convex.com>
cash@convex.com (Peter Cash) writes:

>One thing that has mystified me throughout the debate has been this: what,
>precisely, is at stake? That is, why is it important whether or not
>schizophrenia and depression are "diseases"? Specifically, why do you
>attach such importance to insisting that they are _not_ (or, in your more
>cautious moments, that they _may_ not be) diseases? What mistake are you
>trying to correct? What are the consequences of this mistake?

I don't know much about schizophrenia (although I've known a couple of
diagnosed schizophrenics quite well), so I'll confine myself to the topic
of depression.

Depression is a sort of spiritual "poverty trap".

If your mood is typically above a tolerable level, you fend for
yourself, taking responsibility for how you feel; and when you feel
unhappy for no obvious reason, you try to work out why; and more
generally, you just try to improve your low moods in whatever ways 
make sense to you as an individual.

Anything goes.

If you feel that you need someone to help to cheer you up, you may turn
to friends, lovers, work, recreation, family, priests, gurus, prostitutes,
agony aunts, alcohol ... anyone whom (or anything which) you happen to 
trust to give you something you want, even if it's only understanding of
your pain. At this stage, still, anything goes.

Sometimes things are so bad that nothing seems to work; or you can't
even work up the energy and faith needed to try anything, or you seem
to lack some basic skills to make things work when you do try them.
Or -- most fundamentally of all -- you just don't feel that you have
any rights, to any kind of happiness or relief of suffering, at all.

Then you have to turn to whatever social services your society provides
for unhappy people whose unhappiness is not manifestly caused by any
problem for which some specialised service already exists. (There doesn't
seem to be any simpler way to put this!)

In our society (i.e. UK and US, at least), this means that you are almost
certain to find yourself in the hands of a medical doctor: at least for
an initial referral, but probably for more specialised attention as well.

A mighty strange thing now happens: as Ronald Laing (blessed be his memory)
might have said, your "praxis" becomes suddenly and magically transmuted
into "process". And once that has happened, nothing will ever quite make 
sense any more.

Without any actual malfunctioning of your nervous system having been
demonstrated (and perhaps without any intensive medical examination
having been carried out), you find yourself labelled as suffering from
a "disease" called "depression"; and this "disease" is treated with
real drugs (which my well make you really ill -- but no doubt this
aspect of things has already been discussed at length here).

Or else you aren't; and then you are left with the medical verdict that
there is "nothing really wrong with you". (Or maybe even that you're
just a bad person. -- True moral masochists will revel in the sadistic
delights of conservative psychiatrist Garth Wood's sublimely nasty
little book entitled "Moral Therapy"!) It seems to be a lottery
which determines the outcome -- what kind of "treatment" you receive, or
whether you receive any kind of "treatment" at all. But certainly if
your mood is bad enough, for long enough, then you will receive some
kind of medical treatment (unless you refuse it, *and* are allowed the
liberty to refuse it).

Perhaps (in rare cases) the "treatment" will assume the form of a
practice known as psychotherapy, which is, for convoluted historical
and political reasons, classed sometimes as a medical procedure, 
sometimes not. (To anyone who thinks clearly about it for a moment,
it is not a medical procedure at all. But clear thinking on the
topic of "mental illness", and all that surrounds it, is vanishingly
rare.) As a medical procedure, I believe it has the same success rate
as benign neglect.

Whetever happens -- treatment or no treatment, physical or psychological
treatment -- you have now entered a labyrinth.

Although there is a revolving door between the health care system and the
rest of society [oh, of course, I forgot, there is no longer any such
thing as "society", only "community care" -- how silly of me], going out
through this door does not even begin to take you out of the labyrinth.

Here is one thread which helps to make some sense of what is going on.

Medical psychiatrists have first undergone a full medical training,
which teaches them to regard people as malfunctioning slabs of meat --
all the better to be able to operate on them with knives and drugs
when necessary, without simple squeamishness interfering with their
ability to do what is ultimately best for the patient.

This attitude to health and sickness in general can be, and has been,
heavily criticised, of course; but it is not the issue here, and the
case against medical psychiatry does not depend on a rejection of 
scientific medicine, per se. For present purposes, I am quite happy
to imagine every doctor as a human saint and scientific genius, played
by Alan Alda.

Part of the problem is that (for very complex reasons, which I won't
even attempt to diagnose here) doctors don't really want to treat 
"mental illness", but they don't want anyone else to treat it either.

Medical psychiatry is in a pretty poor position from the start. Its
status as a medical speciality is very low, a fact which forms a
vicious circle with the tendency of the least medically competent
doctors to want to practice it. After all, it offers little scope
for all their most highly developed skills.

This can lead to amusing situations, such as three doctors in a
psychiatric hospital being unable to diagnose a simple everyday
complaint which the patient in question was finally only able to
get recognised and treated by her own GP, after she'd made enough
fuss about it to be allowed out of the hospital to see him. (Just
one anecdote, from a close friend, which has stuck in my mind as 
representative of the whole ridiculous mess of psychiatry.)

So you have these guys, trained intensively and expensively for
years to set their empathetic feelings aside, like good scientists
and technicians should; and then trained for several more years
in the specialised used of drugs and other devices for affecting
the human nervous system. They are now let loose as "psychiatrists"
-- literally, "doctors of the mind". -- Whoa! When, in all that
expensive training, did they learn things about the human mind, which
the rest of us don't know? Well, unless they spent several more years
becoming psychoanalysts (unlikely), they didn't. (And if they did
study psychoanalysis, it's not exactly clear that they learned
anything which is true, still less "scientific".) In fact they've
been trained precisely to unlearn the kind of knowledge which
depends on emotional empathy (as all psychological knowledge
relevant to mental illness must do).

And you have youself, the sufferer (now become patient), who needs,
as a bare minimum, some sympathy and understanding; perhaps nothing
more; or perhaps some specific help, once the source of your 
difficulties has become apparent; or perhaps some specialised form
of human understanding, e.g. if you have been sexually abused (to
take a relevant and topical example). Or perhaps, indeed, you are ill,
and the your need is for whatever is wrong with your central nervous
system to be diagnosed and treated.

By and large, you can forget it.

Even if your depression has some biological cause, there is little or
no chance of anyone knowing what it is. There are many amusing twists
in the story here. For instance, every time some new class of actual
lesions of brain tissue is identified, the report in the newspaper will
stress that the syndrome which typically results from it is *therefore 
not a mental illness*! (I have read two such reports in recent months.)
This is beautiful, because the whole ideology of medical psychiatry is
based upon the dogma that mental illnesses are diseases of the central 
nervous system, exactly like diseases of other parts of the huamn body.
But it seems to depend, in practice, upon said "diseases" never actually
being identified, because psychiatrists would then have to start behaving
like real doctors, making differential diagnoses, etc., and most of them
would be hoplessly out of their depth.

You may be lucky, and meet a medical psychiatrist who is genuinely 
helpful -- *in spite of* his training -- just as a good human being.
I've met one or two psychiatrists who seem to be good people (and
who are therefore, I expect, acutely aware of the shortcomings of
their profession in general).

Usually you won't; you are still a slab of meat. And here is one of
the juiciest ironies: for to believe that one's every thought and
emotion is nothing but the meaningless side-effect of some chemical
process is the very acme of depressive thinking. (Psychoanalytic
ideology has a similarly reductive effect, but that's not at issue
here.)

And here, I think, lies one of the roots of the instinctive distrust of
psychiatry which is felt by the proverbial Man in the Street. He
obscurely feels that psychiatrists are all quacks, and that no good
can come of their ministrations; but he feels magically protected, by his
own presumed normality, from having to worry about the possibility on his
own behalf, because *he* certainly isn't just a mess of chemically-
caused emotions and delusions (or psychoanalytical complexes, for that
matter). The Mentally Ill, however, are a different matter.  What is 
obviously not good enough for an ordinary bloke like *him* is presumably
good enough for *Them*; after all, psychiatrists are doctors, and they
know what they are doing, and it's not for the ordinary bloke in the
street to question their judgement.

Thus the Mentally Ill are offered up as human sacrifices to the god
of Science, that it might not render *all* our lives meaningless. Amen.

And this is the "spiritual poverty trap" that I wrote about (so
long ago). If you can stay above the spiritual poverty line, you
have the responsibility and the freedom to find your own salvation
in your own way. But if you fall below the line, to the point of
desperation, you become subjected to an entirely different moral order.
A double standard applies. There is a catastrophic discontinuity between
being (apparently) a free human subject in society, and being (apparently)
a passive material object to be operated on by scientific means. The two 
imperatives pull in opposite directions, and negotiating your perilous way
between them is an exquisite belancing act, for which a desperate state of
emotional depression is the very worst preparation.

Supposing you do somehow manage to extricate youself from the clutches
of the psychiatric apparatus. You are now back where you were before,
but probably feeling somewhat worse -- partly because one more possible
source of help has proved illusory -- partly because you now have an
additional stigma to carry (no-one is fooled by the rhetoric about
"mental illness" being just like any other) -- partly, perhaps, because
of the (side-)effects of any actual medical (mis)treatment you may hav
received -- partly because time has moved on, and your social situation
is likely to have worsened.

Perhaps you will turn to non-medical psychotherapy. [That's a whole other
thread, which properly belongs in another newsgroup -- only, there doesn't
seem to be any group which is appropriate for the discussion which the
topic needs. There ought to be something like "soc.therapy", not part of
the sci.* hierarchy.]

If not, you are simply left to cope, using those same resources which
you already knew at the start were not enough. There is still something
wrong with you; and for all you know, it may really be a medical illness;
but no illness has been diagnosed, or treated, still less cured. At best,
you will have had some symptomatic relief -- as if you had cancer, and
had been prescribed pain killers, and been told to go away. (This is no
exaggeration. I have heard someone who had "had" both depression and
cancer say that they'd rather have cancer again, given a choice between
the two. And I have known a schizophrenic woman, even more depressed
than myself, who was *glad* when she got cancer, because of the care and
attention she was at last receiving. ... We had both, incidentally, just
had some very bad experiences with some *anti*-psychiatrists, who worked
for the Philadelphia Association, founded by Laing, although by then he 
had left after a row with the very same ignorant bastards whom we were
unlucky enough to encounter.)

Whether you are truly ill or not, you are certainly suffering what has
been called "the worst pain known to human beings" (Catholic priest,
on UK television last Sunday); and you are genuinely *disabled* by
it; and something should be done for you -- only not necessarily by
doctors.

I do see some hope on the horizon: and this is the increasing status,
and numerical presence, of clinical psychologists in the health service.

Not that they are likely to know anything more about the problems of
life than the rest of us (I picture them as weedy, bespectacled, earnest
university graduates, still wet behind the ears, just like myself); but
at least they don't have to unlearn the positivistic and authoritarian
bias of a medical training; and they are in a position to call upon the
specialised assistance of medically qualified personnel *when such
assistance is needed*.

The medical profession should have a strictly ancillary role in this
field. It has overextended itself, and should give up most of its 
dangerous power and uncomfortable responsibility in this field of
emotional, intellectual, sexual, and moral disturbances, with which it 
is so singularly ill-equipped to deal. 

I am sure that, once they had got used to the idea, and had stopped
harrumphing about the indignity of it all, doctors would find it a great
relief to be no longer expected to act like gods, but just to be able
to get on with practising *medicine*.

I think that trained psychologists ought to be put in the position of
overall responsibility for the management of cases of mental illness.
I can remove the scare quotes from the latter phrase now, because we
are talking about people who -- to some extent at least -- do study 
the human *mind*, and aren't disposed to take the word "illness" *too*
literally. Of course the scientistic bias is still there; but I suppose
we'll just have to wait 400 years or so for the emergence of a form of
systematic psychology, or a new religion, which really can assist in
the understanding and help of people in extreme emotional distress.

[Obviously I'm begging the whole question here -- just as the medical
model itself does. What *does* the oxymoronic phrase "mental illness"
mean? But I've written enough for now -- and undoubtedly more than
enough, from the specialised perspective of sci.med.]

There is a real and serious problem of "differential diagnosis" --
not *within* the field of medicine, but *between* medical conditions
and other human conditions whose description and amelioration belongs
more (if not completely) to the field of social psychology. Doctors,
by definition, are not trained to make such "diagnoses". In fact,
no-one seems to be. Psychiatrists have been lumbered, or have lumbered
themselves, with the job. I don't think clinical psychologists are
particularly well-qualified to do it, either, but at least they wouldn't
be pre-empting any possible honest solution, by describing every problem
that comes to them as either a disease or no real problem at all.

[I've gone on far too long, and I must stop, Thanks for bearing with
me, if you have. It helps me to feel a bit less depressed ... :-) ]
--
Gus Rodgers,  Dept. of Computer Science, | Cinema's worst romantic dialogue? --
Queen Mary & Westfield College, Mile End | "Mechagodzilla's brain is  installed
Road, London, England.   +44 71 975 5241 | in my stomach!" "I don't care if you
E-mail (JANET):   arodgers@dcs.qmw.ac.uk | are a cyborg  --  I still love you!"