The Allen Frances – Lucy Johnstone Debate

On October 28, Allen Frances, MD, Chairperson of the DSM-IV task force, published an article on Psychology Today.  It is titled Does It Make Sense To Scrap Psychiatric Diagnosis? and is essentially a response to the British Psychological Society’s Division of Clinical Psychology’s (DCP) call to abandon the medical model in situations where it is not appropriate, and to embrace a psychosocial approach.  You can see a copy of the DCP’s May 13, 2013, statement here.

Dr. Frances identifies Dr. Lucy Johnstone, PhD as the “most articulate and energetic supporter” of the DCP position, and most of his article is directed towards material Dr. Johnstone has recently written on these matters.  For ease of reference, Dr. Frances reproduces Dr. Johnstone’s material in his own article.

Dr. Frances sets the tone in the first sentence:

“I am always sceptical of suggested new ‘paradigm shifts’ and worry that ambitiously striving for them will wind up causing more harm than good.”

Dr. Frances lists three examples of proposed paradigm shifts that, in his view, have caused, or will likely cause, more harm than good.

Firstly:

“DSM 5 failed so badly precisely because it promised a ‘paradigm shift’ in psychiatric diagnosis.”

In support of this position, he suggests that the revised manual:

“…may mislabel as mentally ill millions of normal enough people who would do better left alone.”

This, of course, is an interesting perspective, though in my view DSM-5 is failing, not particularly because it sought a paradigm shift or because it continued the APA’s long-standing expansionist agenda, but because psychiatric concepts and practices generally are being exposed as spurious and destructive.  The publicity surrounding the release of DSM-5 gave impetus to this movement, but the general anti-psychiatry sentiment was already well established when the manual was printed.  It is also arguable that DSM-IV, of which Dr. Frances was the architect, widened the diagnostic net at least as much as DSM-5 is likely to do.

Secondly:

“The National Institute of Mental Health has neglected the current needs of the mentally ill because of its preoccupation with producing a ‘paradigm shift’ in understanding the neural networks that cause psychiatric problems.”

And:

“Dreams of the future potential of a neuroscience ‘paradigm shift’ have blinded NIMH to the crying needs of patients in the present.”

I could quibble with some of Dr. Frances’s terminology here, but at a more substantive level, I think it is inaccurate to describe the NIMH’s RDoC program as a paradigm shift.  It’s actually just an extension of what psychiatry has been promoting for decades:  that human problems are best conceptualized as brain illnesses and are best treated with drugs, ECT, and lately, other biological interventions.  Dr. Insel and the NIMH may like to think of RDoC as a paradigm shift, but it isn’t.

Thirdly:

“… the Division of Clinical Psychology (a sub-section of the British Psychological Society) has issued a statement announcing its own opposite brand of radical ‘paradigm shift.’ While paying superficial lip service to the role of brain in generating mind, the DCP suggests abandoning altogether what it regards as an overly restrictive biomedical model- it would eliminate any role for psychiatric diagnosis and instead focus on the role of external stressors in generating symptoms.”

Somewhat by way of an aside, there is a confusion here that needs to be clarified.  Under the present psychiatric system, the primary objective of the initial interview is the assignment of a “diagnosis.”  This “diagnosis” then becomes the basis of “treatment.”  If the “diagnosis” is, say, depression, then the “treatment” will be an antidepressant; if schizophrenia, the treatment will be a neuroleptic, and so on.  Then as treatment progresses, the drugs are changed, doses adjusted, etc., in response to client feedback.  The presenting problem(s) are conceptualized (spuriously) as caused by the diagnosis, and little or no attention is paid to other matters such as personal history, social supports, lifestyle, economic issues, etc…  This is what’s meant by the medical model.  What’s particularly noteworthy about this model is that in medical matters, it is very effective.  If a person has complete kidney failure, for instance, his likely diagnosis will be end-stage renal disease (ESRD), and this diagnosis gives the nephrologist a great deal of the information he needs to provide excellent care.  The nephrologist will, of course, gather additional data in order to tailor make the treatment to the patient, but an accurate diagnosis constitutes the bulk of what he needs to know in order to design good and effective treatment.

But, and this is a crucial point, problems of thinking, feeling, and/or behaving that are not biologically caused, are so varied and individualized as to their source and presentation, that they simply are not amenable to this kind of approach.  A DSM diagnosis, which is nothing more than a notoriously unreliable label, provides very little of the information that a helping professional needs in order to provide good and effective help, and often presents no useful information at all.  In fact, it is frequently a hindrance.

So when Dr. Frances characterizes the DCP’s position as calling for the elimination of “…any role for psychiatric diagnosis and instead focus on the role of external stressors in generating symptoms…,” he is simplifying the DCP’s position to the point of caricature, as even a cursory reading of the DCP’s paper will attest.

The charge of “paying lip-service to the role of brain in generating mind” reflects a misunderstanding of the DCP paper.  The paper clearly acknowledges the role of the brain in the production of thoughts, feelings, and behaviors, and specifically recognizes the value of the DSM’s system in “conditions with an identified biological aetiology.” [emphasis added]  What the DCP paper challenges is the assignment of “an unevidenced role for biology as a primary cause” [again, emphasis added]  in mental problems generally.

But to get back to the main thread, essentially what Dr. Frances is saying is that what’s needed is a middle way.  Those who see mental problems as purely biological, he tells us, are in error, as are those who see these problems as purely psychosocial.  He advocates a biopsychosocial approach, and he develops this theme for the rest of the article.

Dr. Frances begins this discussion by listing the areas in which he is in agreement with Dr. Johnstone and the DCP.

  • Biomedical reductionism is simplistic and misleading.
  • Mental distress must be understood in its context.
  • There are many ways of dealing with emotional difficulties, and excessive professional competition is unhelpful.
  • Limitations in current knowledge of the brain and behavior call for humility.

Then he turns to areas of disagreement.

“But then there are our areas of continuing disagreement. I fear that you [Dr. Johnstone] would replace biological reductionism with a psychosocial reductionism that is equally incomplete, and potentially harmful to patients. Human nature encompasses the complex interaction of biological, psychological, and social factors and understanding and treating psychiatric symptoms requires adequate recognition of each. The biological model has been greatly oversold and medication has been greatly overused- but both remain essential if kept in their proper place.”

It should be noted that psychosocial reductionism is a kind of contradiction in terms – at least as the term is being used here.  This has already been pointed out by Duncan Double in a recent post.  But I think it is reasonably clear that Dr. Frances means focusing on psychosocial factors to the exclusion of biological factors.

“Human nature encompasses the complex interaction of biological, psychological, and social factors…”

This part of the sentence is true, but doesn’t say very much.  All it says is that we humans are made up of biological tissue; and that we can think, feel, learn, etc.; and that we interact a good deal with one another.  But Dr. Frances uses this obvious truism as a springboard for the second part of the sentence:

“… and understanding and treating psychiatric symptoms requires adequate recognition of each.”

This assertion is the central issue of the entire debate, but Dr. Frances has just tucked it in under the biopsychosocial platitude as if it followed logically therefrom, which it does not.

Let’s consider the analogy of Mr. Jones, a businessman, who is in financial difficulty.  He goes to his banker to negotiate an extension to his line of credit.  Imagine if the banker said something like this:

“Mr. Jones, you are a biopsychosocial organism, and for that reason, I need to factor all of these perspectives into your loan application.  So let’s start with your childhood illnesses.”

Or take the case of a person who consults a lawyer to sue his employer for false dismissal.  Would it be reasonable for the lawyer to begin the interview by reviewing the individual’s medical and social history, purely on the grounds that the client is a biopsychosocial organism?

Or if a person went to see a surgeon to have a hernia repaired, how appropriate would it seem for the surgeon to perform a detailed survey of the person’s psychosocial history, again on the grounds that the patient is a biopsychosocial organism.

One can readily think of hundreds of similar examples.  The central point is:  yes, we humans are indeed a complex composite of biological, psychological, and social factors.  We can also be conceptualized from political, economic, historical, evolutionary, artistic, ethnic, linguistic, etc., perspectives.  But this doesn’t mean that all of these factors have to be addressed every time a person seeks help.  To the surgeon, I am primarily a biological entity; to the lawyer, I am primarily a citizen with certain statutorily-defined responsibilities and rights; to Wal-Mart, I’m a consumer with money in my wallet; to a teacher, I’m someone seeking knowledge; etc…

The essential point here is that each practitioner focuses on those aspects of my human nature that are appropriate to the situation.  Of course a certain amount of spillover is warranted in certain cases.  For instance, a surgeon working with a frail, elderly person might want to ensure that the person will have adequate post-surgical care at home, but these kinds of matters, though often important, are usually incidental rather than central.

From this perspective, let’s take another look at “…understanding and treating psychiatric symptoms requires adequate recognition of each.”

My position is simple:  if a problem of thinking, feeling, and/or behaving stems from a biological illness or malfunction, then it should be treated biologically.  Some “spillover” into the psychosocial area might be warranted, but it would be incidental and secondary.  The problem is a genuine medical matter, and a medical model is appropriate.

On the other hand, if the problem is a function of psychosocial factors, which, I contend, the vast majority of these problems are, then it is along those lines that the problem should be conceptualized and addressed.  Here again, spillover will occur.  For instance, if a person has been neglecting his health because of a psychosocially-induced problem, then some medical care might be needed.  But the problem itself is not medical in nature.  The medical model is not an appropriate conceptual framework, and medical interventions are not called for.

At the present time (with the exception of the due-to-a-general-medical-condition category and some of the substance abuse categories), no DSM “diagnosis” has been definitively linked to an identifiable biological illness or malfunction.  No psychiatric drug in current use fixes or resolves any biological malfunction, and there is growing evidence that the drugs are doing a great deal of harm.

Dr. Frances mentions other areas of disagreement and discusses them briefly.  He cautions against over-reliance on psychiatric diagnosis, but warns also against abandoning it altogether.  He agrees that psychiatric drugs are over-used, but stresses that sometimes they are needed.

He concludes his piece with a very reasonable-sounding summary:

“The integrated bio/psycho/social model has a long tradition and remains the best guide to clinical practice. It has always been threatened by reductionisms that would privilege one component over the others- but this interacting tripod of bio/psycho/social approaches is unstable and incomplete without the firm support of all three of its legs. In my view, it is equally mistaken to call for a premature ‘paradigm shift’ tilting toward biology (as was suggested by DSM and NIMH) or a ‘paradigm shift’ tilting toward the psychosocial (as was suggested by the DCP). An integrated bio/psycho/social model is essential to understanding each patient and also to unite the mental health professions.

And we certainly need to be united. Mental health care is terribly disorganized and grossly underfunded, especially (but not exclusively) in the US. I think we should find a unified voice to advocate for better care, not be distracted by debates about paradigm supremacy—especially since all three paradigms are absolutely necessary.”

All of this sounds very reasonable, but let’s take a look at the details.  Firstly, the “integrated bio/psycho/social model” does not have a long tradition – at least not here in the US.  In this regard, the only mental health tradition that I am aware of is the inexorable expansion of the diagnostic net through successive revisions of DSM, and the corresponding medicalization of an increasing array of human problems.  Lip service is paid to psychosocial factors, but in practice they are trivialized or ignored.

“An integrated bio/psycho/social model is essential to understanding each patient and also to unite the mental health professions.”

Here again, this sounds very good, but I suggest that it simply isn’t true.  If a person is going “crazy” because of late-stage syphilis, then, I suggest, psychosocial factors have little or no relevance.  On the other hand, if a person is depressed because his wife has left him, his daughter is in jail, and he hates his job, then, I suggest, biological factors are largely irrelevant.  There might, of course, be “spillover” in each case as discussed earlier, but this is incidental to the general position.

“…to unite the mental health professions.”

This is a complex issue, but I don’t think there will be any significant easing of tension between psychiatry and the other mental health professions until psychiatry abandons what has clearly been its mission for the past 50 years:  the medicalization and commandeering of an ever-increasing range of human problems.  Some problems of thinking, feeling, and/or behaving are indeed medical matters.  Others (probably most) are not.  At the present time, psychiatry is giving no indication that they appreciate this distinction.  In fact, I would argue that the very act of putting a problem in the DSM medicalizes the matter.

Dr. Frances himself acknowledges that “…the biological model has been greatly oversold and medication has been greatly over-used…,” but he doesn’t seem to take on board just how damaging and destructive these developments have been and continue to be, both to individuals and to society in general.  Against this background, his notion that an “integrated bio-psycho-social model” will unite the mental health professions strikes me as fanciful, if for no other reason than the fact that psychiatry appears to be moving further and further from such a model with each passing year.  On September 29, Jeffrey Lieberman, MD, President of the APA, was interviewed on 60 Minutes.  The reporter asked him:

“This [schizophrenia] is really a disease of the brain.  Not a disease of the mind?”

To which Dr. Lieberman replied:

“Absolutely.”

Dr. Frances suggests that we find “…a unified voice to advocate for better care, not be distracted by debates about paradigm supremacy…”

Here again, in my view, he’s missing the point.  This is not some kind of turf war, where we all need to just stop squabbling and sit down and work together.  It is precisely because we “advocate for better care” that we challenge the psychiatric orthodoxy, and call for a paradigm shift.  Decades ago, psychiatry formed a destructive and corrupting relationship with pharma, the results of which persist to this day.  The expansion of the “diagnostic” net was not an accident – it was policy.  The prescribing of drugs for an ever-increasing range of human problems (even to the point of giving neuroleptics to 2-year-olds!) was also policy.  The rift between psychiatry and the other mental health professions is of psychiatry’s making, and it emphatically is not a matter of perceptions, professional rivalry, or turf wars.  It is a real rift.  There is a fundamental incompatibility between the bio-reductionist approach that psychiatry has so avidly embraced, (and shows no sign of relinquishing),  and the approach of most other helping professions.  Most of the non-psychiatric professionals I encountered during my career saw the DSM diagnosis as an inane procedure mandated by psychiatry, for its own self-aggrandizing purposes, to which all must conform if they wish to have a seat at the table.

It is obvious (or at least obvious to me) that the medical paradigm is supreme in medical matters, and the psychosocial paradigm is supreme in psychosocial matters.  The only professional group that disagrees with this position are the psychiatrists, who insist that the medical paradigm is supreme in all matters.

What has changed in recent years is simply this:  psychiatry has pushed its spurious and destructive practices so far that survivors and non-psychiatric mental health workers are no longer willing to just go along.

Sometimes a paradigm shift – meaning a sea-change in concepts and practices – is what’s needed.  When the oxygen theory of combustion supplanted the old phlogiston theory, there was no question of a compromise.  There was no possibility of the two sides sitting down, recognizing the value of each other’s contribution, and agreeing to respect each other’s position.  There was no oxy-phlogistonic approach, nor should there have been.  The simple fact is that some explanatory concepts are better than others.  And psychosocial concepts provide a better framework for understanding and responding to psychosocial matters than do medical concepts.

Psychiatry’s medicalization agenda should have died a natural death (from lack of evidence) decades ago, but has been kept alive through pharma money and psychiatric lobbying and hegemony.  It is truly time for a paradigm shift, and the DCP’s paper is a very good starting point.  Dr. Frances makes the point that the DCP’s approach is untried and unproven, and for that reason should be treated with caution.  I suggest that he talk to social workers, counselors, psychologists, case managers, job coaches, and other non-psychiatric professionals working in the mental health field.  I believe he will find that few if any of them rely on psychiatry’s medical model as a conceptual basis for their work.  They pay lip service to it, of course, because in the end of the day, they need their jobs.  But the concepts and practices that drive their day-to-day interactions with their clients are emphatically psychosocial.  And if Dr. Frances will listen very carefully, I think he will find that these concepts and practices are very similar, though perhaps not as formally stated, as the DCP proposals.

Far from being untried and unproven, the DCP’s paradigm is the unspoken philosophy of the non-psychiatric mental health workers.  These are the dedicated backbone of the mental health system, who for decades have watched with consternation as increasing numbers of their clients have been sucked into the insatiable maw of pharma-psychiatry.

I don’t doubt Dr. Frances’s sincerity.  He appears to believe that the widening rift between psychiatry and the other helping professions can be resolved through dialogue and mutual respect.  Perhaps, in this regard, he sees himself in a mediator role.  But no amount of discussion, however amiable or well-intentioned, will alter the fact that problems that are psychosocial in their origin and in their nature are not amenable to medical intervention.  In fact, medical intervention has proven disastrous for many of psychiatry’s clients, and psychiatric survivors are speaking out with increasing frequency and vigor against the stigmatizing and destructive treatment that they received at the hands of psychiatrists.  To the best of my knowledge, psychiatry is the only medical profession that has a survivor movement.

But again, Dr. Frances doesn’t seem to get it.  In his October 21, 2013, dialogue with Patrick Bracken, an Irish psychiatrist and a founding member of the Critical Psychiatry Network, Dr. Frances expressed the belief:

“Psychiatry is still by far the most human and humane of the medical specialities.”

In response to which I can only shake my  head in disbelief.

 

  • I would also say that conflating ‘psych’ and ‘social’ together can be highly problematic when it comes to thinking about distress in people in particular: especially when psychiatrists fail to examine social structures that affect people’s lives and end up making psychologists’ fallacies in their deeming someone’s response psychopathological. In addition, ‘biopsychosocial’ when applied to physical health is most often (possibly always) informed by Engel’s belief in psychogenic explanations for ill-health, and is not actually synonymous with ‘holistic’. I discuss this problem in my book ‘Authors of our Own Misfortune: The Problems with Psychogenic Explanations for Physical Illnesses’. I think both David Smail’s work and Kutchins and Kirk’s ‘Making us Crazy’ provide useful wider responses to these issues.

  • LucyCJohnstone

    Thanks, Phil, for your usual clear dissection of the issues. In essence, I think you are saying that NOT EVERY HUMAN PROBLEM IS BEST UNDERSTOOD AS A DISEASE PROCESS (sorry, can’t work out how to do italics!) Many professionals and most of the general public do see this in the case of DSM 5’s more ludicrous expansions – eg diagnosing major depression within days of a bereavement – but there is a way to go before it is widely accepted that exactly the same logic applies in the majority of cases of ‘schizophrenia’, ‘bipolar disorder’ and all the rest.
    Some points: To be fair, Allen Frances has publically acknowledged the damage caused by what he describes as the 3 ‘epidemics’ introduced by DSM IV under his chairmanship – ‘ADHD’, autism spectrum, and ‘Childhood bipolar disorder’. He has come out of retirement to try and prevent DSM 5 taking this even further, and I respect him for doing so. However, his agenda is certainly not to abandon psychiatry, but to practise it in a more humane form – which, in his version, means that diagnoses and medication still play a central role in the so-called ‘psychoses.’ The reason I wanted to debate with him was to make this position clearer. Yes, there are some areas of agreement between him and me, him and the Hearing Voices Network, him and Pat Bracken (a founder member of the UK Critical Psychiatry Network) but there are substantial, indeed fundamental, differences of perspective as well. I felt these were in danger of getting lost behind a carefully-staged message of ‘We’re all friends together and all want the same thing.’ Equally, I didn’t want the very real differences to be swept aside with responses such as ‘let’s stop squabbling and focus on actually helping people’ (this argument has been cropping up all over the place.) ‘Stop squabbling’ has the rhetorical effect of making legitimate critiques sound like petty rivalries. The implicit message is ‘We must carry on with psychiatry as usual’. In other words, no more challenges, please! It also, of course, begs all the questions about what is actually the best way of helping people – which is exactly the debate that we need to have.
    I think it is significant that Allen Frances has not actually responded to my ‘compromise’ suggestion – ie that in our present state of knowledge, the only professionally and ethically respectable position is to offer service users a CHOICE about whether they want their difficulties described in medical terms. Instead, he has chosen to attack the bigger target of abandoning diagnosis altogether. And yet, the ‘choice’ option follows absolutely logically from his own arguments. Elsewhere he has made the unusually frank admission that ‘There’s no definition of a mental disorder… you just can’t define it. It’s bullshit.’ So – shouldn’t we, at the very least, be asking service users whether they want this particular kind of bullshit applied to them? But of course, this would be too threatening to the status quo. If diagnosis becomes optional, then the whole biomedical paradigm really is in danger of collapse. The only hope is to hang onto it desperately in the hope that something better emerges very soon. Allen Frances and colleagues are clinging to a precariously narrow ledge on the crumbling edifice of biomedical psychiatry.
    Finally, a quote from Richard Bentall in ‘Doctoring the mind’ 2009: ‘There have never been any anti-oncologists, anti-cardiologists (or) anti-gastroenterologists.’ Precisely!
    Thanks again for your posts.

  • Altostrata

    This is the best critique of Allen Frances’s conflicted position I have ever read.

    May I also point out, Dr. Frances dismisses the psychiatric survivor movement. For example, in one of his Psychology Today articles http://www.psychologytoday.com/blog/saving-normal/201308/two-flew-over-the-cuckoos-nest

    The antipsychiatry movement is fueled by those who have suffered
    damage from ill conceived and poorly delivered treatment and are
    understandably angry and eager to protect others from a similar fate.
    But it goes too far in its blanket criticism and misses the value of
    psychiatry done well. ….

    I have known hundreds of patients who were not helped or were directly
    harmed by psychiatry. Thirty years ago, I wrote a paper called ‘No
    Treatment As The Prescription Of Choice’ as a way of warning clinicians
    and patients off treatments that might do more harm than good. But I
    have also known many thousands of patients who have benefited greatly.
    The overall results in psychiatry are quite good and compare favorably
    to other medical specialties.”

    Stung by accusations from his profession that he is anti-psychiatry, Dr. Frances builds a straw man — here are the real anti-psychiatrists! — and dismisses it.

    Moreover, his argument that the number of those injured by psychiatry is inconsequential relative to all the good psychiatry does undermines his own vociferous protest about the DSM-5: That it will cause overdiagnosis and overprescription. The existence of psychiatric survivors PROVES that this is a real medical issue.

    But is Dr. Francis argues that real-world injury from psychiatry is inconsequential now, what’s the problem with more diagnosis and more prescription?

    What we are seeing is someone publicly struggling with his conscience, and all the cognitive dissonance thereof.

  • ssenerch

    ““Psychiatry is still by far the most human and humane of the medical specialities.””

    Seriously? Is he off his meds?? (just kidding) That’s pretty much the most ridiculous and flat-out false thing you could say on the topic. I can’t wait til the entire profession is exposed as completely delusional. Won’t that be rich, being able to fling their stupid “symptom” labels back at them…

  • Phil_Hickey

    Angela,

    Thanks for coming in. You make interesting points. I agree that the term biopsychosocial has become somewhat devoid of content – at least in mental health circles.

    In practice, it’s used to elicit agreement to whatever notion the speaker is promoting at that point in time. “What we need is a biopsychosocial approach,” inevitably draws thoughtful looks and nods of assent, but without any consistency as to exactly what’s involved.

    Again, thanks for coming in. Best wishes.

  • Phil_Hickey

    Altostrata,

    Thanks for your comment. You’ve said a great deal in a few words. Dr. Frances does indeed try to trivialize psychiatry’s critics, including the survivor movement.

    I think he’s trying to be the grand mediator who resolved all these awful conflicts, but he simply hasn’t grasped the enormity of the damage that psychiatry has perpetrated.

    Best wishes.

  • Phil_Hickey

    ssenerch,

    It certainly was quite a statement, and shows, I think, how divorced psychiatrists are from the reality of what they’re doing.

    Best wishes.

  • cannotsay

    Allen Frances is a peculiar individual. He doesn’t believe in choice, he only believes in “he knows best” and everybody else is wrong, whether it’s the APA for clinging to the biological view, or you at the DCP for having a more complex and nuanced view. He advocates for a model in which the balance of what component is biological and what isn’t is dictated by him. By his own admission he wants to keep psychiatry as a tool to label 5% of the population and of course he wants psychiatrists to keep the right of coercive psychiatry.

    The best summary for Frances’ position is this: 1) he knows psychiatry is a scam, 2) he wants the scam to continue because he continues to make a living out of psychiatry -via his pension- and because he doesn’t want to be exposed to legal liability for knowingly promoting a scam 3) he realizes that DSM-5 pushed the envelop too far in a way that might expose his way of life. Solution: come up with a biopsychological “balance” chimera that would affect only 5% of the population so that the number of people who could fight back is small and not enough to threaten his livelihood (as it was prior to DSM-IV).

    Allen Frances is the worst type of critic of psychiatry because his whole criticism is based on deceptive tactics. Somebody like Jeffrey Lieberman or E Fuller Torrey is a believer, you can defeat them with arguments. Allen Frances already concedes that psychiatry is a scam, but he wants a limited version of the scam to continue because he makes a living out of it.

  • Phil_Hickey

    Lucy,

    Thanks for your comment. I agree that the call to “stop squabbling” is a way of
    trivializing and neutralizing the criticisms that are being directed against
    psychiatry. It’s part of the current psychiatric spin. But I don’t think it’s having much success. The dominant trend at present is that more and more people are recognizing the reality: that psychiatry is morally and scientifically bankrupt. The forces that are driving this bankruptcy (the spurious concepts and the marketing of the drugs) are the same forces that propelled pharma-psychiatry to their present levels of commercial success. This, in my view, is why psychiatry is finding it virtually impossible to effect any substantive changes. They only know one tune.

    The choice idea is a good one, though I struggle with how it would work in
    practice. I’m visualizing a mental health center lobby in which the client is confronted with a sign that says: “psychiatry (drugs)” to the left; “other services” to the right. In practice, that’s not all that different from what happens at present – at least here in the US. Of course, there isn’t a sign, but it is well recognized that some clients come to the center for drugs; others come because they want to talk to somebody. At present there is enormous pressure on the latter group to take the drugs, and there is pressure on the non-psychiatric personnel to promote this agenda.

    For me, having psychiatry and the other professions under the same organizational roof will always be a problem, for exactly the same reasons that it is a problem today. I don’t think we will see the kind of progress we would like until there is a complete divorce between psychiatry and the other professions. It’s been an abusive marriage from the start anyway.

    I believe the divorce will come when enough other professionals reach the point where they feel that they can no longer work ethically and responsibly side by side with psychiatrists. We’re already seeing some of this here, as increasing numbers of counselors, social workers, etc., are getting their licenses and going into private practice. Most of the people I’ve encountered who have done this liken it to removing a tight headband that they hadn’t really realized they were wearing; or removing a pair of shoes that were three sizes too small.

    But doing good work is one thing. Making a living is another. Those individuals who decide to break out must either buy into the medical model for purposes of “diagnosis” and reimbursement, or operate their practices on an entirely self-pay basis. Many are choosing the latter, and say that the hassle-reduction, coupled with the sense of intellectual honesty, is worth the drop in income. Others stay with the medical diagnosis model and with private and public reimbursement. There is no general solution to this problem on the horizon at this time. I realize that this is a peculiarly US issue, though I imagine there are analogous organizational issues in the UK.

    However, if (when?) we reach a point where a sufficient number of other professionals simply refuse to work in the mental health centers (i.e. the psychiatric centers), the impetus to address and resolve this matter will become more urgent. At that point there would be real choice. A person could go to the psychiatric center if he wanted drugs, or he could go to the other center (I’m not sure what it should be called) if he wanted a different kind of service. Each center would be free to promote its services, subject to truth-in-advertizing statutes and other regulatory constraints. In particular, the other professions would receive independent legal status in their own right, and their center would be licensed and regulated by government entities as a system parallel to, but in no way subordinate to, the psychiatric centers. There would also be choice for the other professionals. Some could choose to work with the psychiatrists; others (I suspect most) would choose to work at the other centers.

    The urgent point in all this is that if the other professions don’t distance themselves effectively, they will be tarnished with psychiatry’s sins, and will go down with that ship. We need to keep criticizing psychiatric concepts and practices, but we also need to be thinking about and discussing how the alternative will be structured.

    Best wishes.

  • LucyCJohnstone

    Hi again. I agree with your analysis of the situation. I also just want to clarify that, from my own personal position, I do not think we should be using psychiatric diagnosis AT ALL. It is not, in my view, a scientifically, professionally or ethically justifiable thing to do. There may have been a time when some professionals genuinely believed that diagnoses were both valid and helpful, but they have little excuse for continuing this practice now that the very people who invented (I use the verb advisedly) these spurious concepts have admitted that they are nonsense. Do we still tell people that they are suffering from ‘wandering wombs’ or spirit possession, now that we know these early explanatory efforts are simply not true? In continuing to use terms like ‘schizophrenia’ and so on, which have been exposed as non-valid, we are in effect doing exactly that. But, for the purposes of my exchange with Allen Frances, I wanted to see if he would at least be willing to agree on a first step – ie a policy of being honest with service users about the lack of evidence for these terms and a practice of not imposing them without, as it were, their informed consent about both the limitations and the alternatives. I suspected, rightly as it turned out, that he would not be able to agree on this compromise position, despite his own description of the process of psychiatric diagnosis as ‘bullshit.’ I think this is very revealing of the dilemma that he and supporters of the biomedical model now find themselves in. The RDoC project promises to come up with a better system but estimates that it will take anything from 20 years to a century. In the meantime, we are left with a framework that everyone now knows is completely unevidenced – in fact damaging – but supporters of biomedical psychiatry can’t afford to give it up – or even offer a choice about it. It is quite extraordinary. I am sure we will both be keeping a close eye on the desperate attempts to square this circle/shut the gate after the horse has bolted and other British expressions!

  • Nick Stuart

    Phil – great piece. Allen Frances is just the astute politician still trying to keep one foot in each camp – so he can side with the eventual winners. In fact, he is seriously attempting to undermine those that criticise biological psychiatry with his ‘niceness’. See http://www.huffingtonpost.com/allen-frances/psychiatry-and-hearing-vo_b_4003317.html as well as his conversation with Dr. Lucy Johnstone. His attempts to undermine Thomas Szasz’s work with a ‘little dinner conversation anecdote’ is odious. He has now ingrained himself with the moderators at MIA so that his posts are highlighted (and my comments there are now moderated.) He may be attempting to follow a middle way but he ain’t no Buddha. He is a dangerous man and always has been. He should now be a ‘has been’.

  • Nick Stuart

    http://www.huffingtonpost.com/allen-frances/america-is-over-diagnosed_b_1157898.html

    Good grief! He blames everyone else for the mistakes he made with the DSM-IV! Now Pope Frances says to Galileo.. ‘hey let’s not throw the baby Jesus out with the bathwater’. Science does not work that way. Frances has spent a lifetime in error. But of course he will never admit his faults. It is ‘the others’ that are to blame. So it goes…. Sorry for the rant Phil.

  • Nick Stuart

    …and now I have just gone and pulled a hamstring. That will teach me eh?

  • Phil_Hickey

    Lucy,

    We’re in complete agreement.

    You mentioned informed consent, and I think this is a critical point. It is psychiatry’s weak underbelly, because traditionally they tend to be rather cavalier about the duty to inform clients about the negative effects of the drugs. The “reasoning” seems to be that “mental” patients wouldn’t understand these matters, and informing them of adverse effects would only cause confusion. It’s another facet of the “we-know-best” attitude that has been a dominant feature of psychiatry for decades.

    And, of course, they never tell clients that the notion of mental illness is spurious, and that the pills don’t actually treat any illnesses.

  • Phil_Hickey

    Nick,

    I don’t think Dr. Frances is a serious player at the present time. I think he was trying to re-invent himself as the aging moderator who would restore peace to the troubled empire. But we’re way past that.

    We have to keep saying what we’re saying in as many venues as possible: i.e. that psychiatry is based on spurious concepts, and is routinely damaging and disempowering people. I greatly appreciate the energy that you bring to this process.

    I was pleased to see your reference to Gilbert Ryle. His Concept of Mind was one of my very early sources of inspiration.

    Best wishes.

  • Francesca Allan

    That psychiatry is the most “humane” medical specialty will no doubt come as a surprise to those of us who have been tied down and forcibly drugged. Thank you, Phil, for always dissecting the issues rationally while others of us can only froth at the mouth. If it’s okay with you, I’d like to email you an assignment I handed in for my intro psych class. It’s tough to choose between speaking the truth and getting a good grade; I’m trying to strike a balance.

  • Phil_Hickey

    Francesca,

    I’d love to see it.

  • PaulNYC

    Hi, Phil —

    I think that’s a great quote: “… psychiatry is based on spurious concepts, and is routinely damaging and disempowering people.” And i agree it needs to be said in as many venues as possible. I intend to try and start working on the twitter side of things. Engaging @MentalHealthCCS seems like it might be a good place to start.

    Best

    Paul.

  • Great essay of review. I concur with the assessment of big psychiatry’s failed marriage with big pharma. The fundamental problem is that psychology has been usurped by materialistic science under the rubric of neurophysiology and the mind, i.e., the psyche, has been driven out of psychology in favor of the brain. I also concur with Angela Kennedy’s point below about the necessity of distinguishing the psychological from the sociological for the same reason that the psychological must be distinguished from the physiological. However, Ms. Kennedy seems to be biased toward the sociological, while I am biased toward the psychological and keeping the psyche at the center of psychology rather than throwing out the mind for either the physical or the social. A “biopsychosocial approach” could only work if all three of the pods on the tripod are equally balanced and strong. In the current climate, the “bio” and the “social” have overshadowed, usurped or beaten up on the psyche at just about every institution of higher learning and then vie with each other for supremacy of the forum.

  • Anonymous

    Good post. You seem very good.

    “A “biopsychosocial approach” could only work if all three of the pods on the tripod are equally balanced and strong”

    The problem with biopsychosocial, is that the bio, amounts to nothing but garbage speculation. In the absence of hard evidence of a bio problem, why even talk about bio, you can’t fix a bio that you can’t prove is broken.

    Worse still, they put out endless pseudobio propaganda. A shiny picture of a brain scan, not used in “clinical” practice, but merely used in fruitless research, is enough to set the whole public off in support of totalitarian forced drugging laws. It’s terrifying how gullible the human race is. This is exactly how scientific racism worked. Flash a flash card at the public that screams “science”, and bang! You can round up those labeled inferior. And that is what psychiatry does. Allen Frances, is a man responsible for the destruction of countless innocent lives. He is a biological determinist fanatic at heart, and he’s shown he’s willing to use violence to impose his beliefs on others, when he admitted to carrying out forced drugging and supporting forced drugging.

  • Phil_Hickey

    Gregory,

    Thanks for coming in. I agree that there is a lot of confused thinking in this area, part of which, I suppose, derives from the fact that there is no sharp boundary between the disciplines – any more than there is between physics and chemistry. Inevitably, people stress the aspect that seems most important to them, or that interests them the most – or, as in the case of psychiatry – that is most closely aligned with their own interests.

    I very much agree with your point about the need for equal balance. In psychiatry, the term biopsychosocial is spin, designed to make it look like they’re reasonable guys and gals, open to all perspectives, while they avidly promote an exclusively biological agenda in both research and practice.

    I also agree with your point that the individual person should always be the primary focus.

    Best wishes.

  • Thanks for your kind words. We are of like mind here. I have to laugh at myself because I reread that I wrote “big psychiatry’s failed marriage with big pharma” and realized the ostensible “failure” is only if one believes the claim that psychiatry is trying to understand and care for patients However, from the perspective of giving psychiatry practitioners both wealth and hegemonic power in the profession the marriage is going splendidly well.

  • Anonymous, in reference to your issues over the “bio” perspective, that is precisely why I usually preface my comments about science with the adjective “materialistic” when I am pointing out that science treats life, i.e., the bio, as if it were lifeless. The flashcard of materialistic science posing as neurophysiology that we are seeing most frequently these days in the field of psychology is the MRI “brain scan” of colored splotches in a brain photo dissection. These people, whom I call the usurpers, merely have to flash the colorful image and say some mumbo jumbo about what the colors tell us, and magically, some sort of knowledge is supposed to have appeared. The MRI is great for identifying tumors and lesions, but is next to useless for *explaining* functionality.

  • Anonymous

    Yep. It really is chilling how much the public mindlessly goes along with anything painted with a patina of “Science”. It’s chilling, because millions of people have had their right to own their own brain ripped away by government sanctioned psychiatric force, and not a psychiatrist on earth can prove these millions of people have a “brain disease”. And invariably, the banal reposte critics get shoved in their face is just some mindless accusation of “flat earther! do you DENY that human daily life has neurobiological correlates DO YOU!!!, you’re a Scientologist! you’re a denier!”.

    The central message that the public or even psychiatry, doesn’t seem to understand, is that science has NOT unraveled the mystery of consciousness, science has NOT elucidated or explained or produced an objective, replicable, demonstrable, materialistic account of the journey from molecule to complex human behavior.

    For anyone to say that the behaviors, thoughts and feelings of people called a libelous name by psychiatrists, can be explained in any adequate way by a mindless mantra of “look at this picture of a brain”, is just terrifying, dehumanizing, colossally mindless reductionism that explains absolutely JACK about the problem at hand, and offers no way forward, apart from the continued industrialized system of blanket tranquilizer drugging, millions of times by brutal force.

    If putting mind numbing drugs into the bodies of people constitutes practicing medicine, then your local bartender is a doctor. At least the bartender has the decency not to ply innocent children with drink. At least the bartender provides his “treatments” to those who ask for them.

  • Anonymous

    And what equal balance when it comes to bio should mean is, by all means, investigate, using diagnostic medical technology and see if the person does have a brain disease. If no disease is found, don’t just lie to the person and tell them they have a brain disease, don’t erect a global skyscraper dominated mega-city of sandcastles in the sky around a fanatic belief that the “evidence they are brain diseased is just around the corner”. That’s why psychiatry in so many ways represents scientific racism. They started from the assumption 200 years ago that the people they labeled “insane” were biologically defective specimens, and they rolled with it like fanatics, trampling on millions of lives, carrying out the greatest act of worldwide defamation against innocent people possibly in history. Vilifying, maligning, dehumanizing, vast swaths of the population, people who really are going through problems coping with life, and who deserve better from the rest of humanity. We deserve better, than the vast majority of society simply silencing us, in favor of listening to the brain blaming, defect narrative propagating, parasite of a profession, that puts us in the meat grinder, to further their own prestige. To train as a psychiatrist, is to be recruited into a delusional pseudoscience, where brains you never examine, are arbitrarily declared “medically diseased”. This profession is a pure public menace.

  • Phil_Hickey

    Gregory,

    Yes. From a certain perspective, the system is working perfectly!

  • Phil_Hickey

    Anonymous,

    Thanks for coming in. “If no disease is found, don’t just lie to the person and tell them they have a brain disease.” I agree. The great tragedy is that it needs to be said!

  • The Right Hon. Cledwyn B’Stard

    I bet he’s ingratiated himself with the moderators! The truth is, for anyone with eyes for seeing, and brains for thinking, on the pertinent issues, is that Whitaker is more in sympathy with the oppressors than he is with at least many of the victims of this oppression.

    He recently exhorted members of the website not to engage in demonizing the Other, a remark that bears the stamp of the hypocrisy of his thinking on this issue.

    Hmm, that’s exactly what he did with his purge of undesirables and with the justifications (our limitless capacity for self-justification is one of the the most impressive achievements of the human mind, no doubt about it, and some of Whitaker’s writings on the issue of moderation on his website afford a perfect example of the extent of this capacity) advanced in support of this policy, albeit through the mouths of his moderators, to whom he delegates the responsibility of saying the things he doesn’t have the courage to utter himself, lest it sully an image that has taken on a messianic aspect, or tarnish his exalted status as the tutelary spirit of the survivor movement, the guardian and protector of their welfare and interests of the victims, to whom reverence is unconditionally due from all who have fallen victim to psychiatry, a man of such unimpeachably, superhumanly noble character, that no criticism will be brooked.

    As I say, the fact that he is quite comfortable with demonizing many of the people who have commented on his site testifies more eloquently to his compromised stance on this issue than any of his self-justifications, mistaken for fruits born of rational, detached deliberation as they are by his votaries..

    He even said recently that psychiatrists are the victims of Big Pharma propaganda, as if they were little irresponsible children living in an informational vacuum and incapable of exercising the mental endowments evolution has bequeathed to us.

    As if they were philosophical wayfarers who in their ceaseless search for truth have become entangled in a web of misinformation, lies and deception cunningly woven by the sinister agents of the pharmaceutical industry (an example of demonizing the Other perhaps? Although I think the use of the word “demonizing” would be a little strong, as it is when applied as if it were semantically interchangeable with the term “criticism”, albeit criticism of the blunter kind, by Whitaker against those whose voices he banishes without a scruple or without a trace of compunction in evidence from one of the few places where they have the opportunity to be heard).

    On the contrary, it is people like myself who are REHUMANIZING the psychiatrists, by acknowledging their personal responsibility, the contradictory currents which converge in their natures (unlike the people who simply say, “most psychiatrists simply mean well..”), the mechanisms they rely upon to shield themselves against the criticism of the field in its theoretical and practical guises, criticism that often has a firm ethical and scientific base.

  • T.A. Anderson

    Ya, his posting rules ruled me out. As you no doubt know language (even the best Queen’s English) is not a perfect medium for communicating thoughts and ideas. Creativity and things like sarcasm, hyperbole, etc., help us to better communicate.

    As for personal attacks, those who promote themselves are fair game. That is our English tradition.

  • Francesca Allan

    Your criticism of Whitaker surprises me. Bob’s certainly done more for the cause then those who rant and rave about “crimes against humanity” but actually accomplish nothing. Whitaker’s credentials are impeccable and his work is taken seriously. I think he’s doing a really good job.

  • Nick Stuart

    Yeh well… The moderators banned me from MiA cos they wanted to attract people like Allen Frances…I was told that they did not want to encourage those deemed ‘anti-psychiatrist. (I can send you the emails) And that my posts were too critical. Power corrupts. So I do not engage anymore. . (this appeared in my email so I wanted to respond… but this is a one off.) Cheers!

  • Francesca Allan

    Nick, did you know they have new moderators at MiA?

  • The Right Hon. Cledwyn B’Stard

    Ha, fair game indeed. I love slagging off psychiatrists. From my experience, psychiatrists are like celebrities; their self-esteem is so high, they react with righteous hostility to any criticism, kind of like happens when movie stars are told their movies are shit and they were shit in it by some brave journalist.

    (Self-esteem, rather than being the unqualified good as modern culture would have it, might just be at the root of much violence. Woe betide the man who incurs through his criticism the wrath of one who harbours grandiose ideas about himself)

    Nothing gives me greater pleasure than puncturing the pretensions of these self-entitled egostists using their careers as a salaried ego-trip, reminding them of the transience of power and prestige, of how much pleasure fate takes in knocking people off their Olympian perches from whence they play god with the rest of us, as happened with Stalin.

    Anything that denies me this pleasure will get no support from me.

  • The Right Hon. Cledwyn B’Stard

    Fair enough, we’ll have to agree to disagree. I hope though that you aren’t insinuating that I just rant and rave.

    I would say in my defence that I think there is very little in my writing that supports such a view. In fact, the emotional indulgence that such a phrase suggests is often to be found in abundant quantity in some of your effusions of anger, usually in response to something I or anonymous have written.

    Instead I as much as anyone, I would say, who comments regularly on this website (and I would say much more than yourself) have worked to discredit the fundamental presuppositions of this secular religion that has usurped the authority of science for rhetorical and propagandistic purposes; offering alternative ways of looking at what we call “madness” that I put out there in order to offer a new way of seeing things that restores people like myself to their proper place in humanity, whilst demystifying the splintering apart of the human race, in modern psychiatrized societies, into unequal categories of mental worth, used to justify the inequitable distribution of rights and responsibilities and which in these respects corresponds to recognized ideologies of supremacism, which is what psychiatric theory is to me; largely another dialect of the language of supremacism.

    Apropos the comment about “his views being taken seriously”, the views of abolitionists of chattel slavery weren’t taken seriously for centuries, yet under the aspect of remote posterity, they are deemed the correct views. In my opinion, Whitaker’s opinions are taken seriously in many circles because they can for the most part be absorbed into the fabric of the current ideology whilst leaving in tact the most important parts. Not that, from my perspective, he’s changing much. The psychiatric empire is expanding by the day, but I very much doubt you’ll be telling him he’s accomplishing nothing with his pointless attempts to create an environment for a dialogue which can only take place if it takes place at all within the parameters strictly defined by the oppressors.

    Nor do I think he’s achieving much with his intellectually lazy talk about psychiatrists being the victims of ignorance, at least not for the victims. You render a disservice to the victim when you seek to exonerate his tormentors, as Whitaker does, and become an accomplice in his crimes!

    This reminds me of the time when people actually bought into the idea that the people of Nazi Germany were ignorant of the death and concentration camps, and the work of the police battalions and the einzatzgruppen. In the film, “Judgement at Nuremberg”, Burt Lancaster’s character, Ernst Jannings, said, to paraphrase, it is not that they did not know, but that they did not want to know. Most mental health professionals do not want to know, which is why they do not expose themselves to the full spectrum of views and evidence on this issue; which is why they attack the critics and impugn our motives, and which is why they distort the evidence in accordance with their interests etc etc etc..

    I’m surprised that so many people who are pro-psychiatry are hostile to Whitaker. Maybe this is some sort of example of the narcissism of small differences.

    Whitaker does not question the foundational suppositions of modern psychiatry or institutional psychiatry itself. For that reason and many others I am in disagreement with him and which is why I am at least one visitor to the shrine who refuses to make obeisance.

    You say we are accomplishing nothing. Au contraire, I have worked indefatigably to get alternative views out there, to demystify the so-called “dangerousness” of mental patients, to comfort the afflicted, doing all within my power and using whatever avenues are open to me, with the limited resources at my disposal, whilst being the occupant of a status that militates against the possibility of my being heard.

    I may not have won over people like yourself, and the people you admire, but that was never my intention, instead I have tried to offer whatever support I can to my fellow outsiders by availing myself of every opportunity to afflict the comfortable, and in that matter I have accomplished a lot, and your comment that “actually” (an opinion does not cease to be an opinion because the person who expresses it is given to using adverbs designed to give an appearance of apodeictic certainty to one view amongst many, as if your view is so baked in certainty, it’s susceptible of iron clad proofs) I have accomplished nothing does nothing to rob me of that belief.

    You seem like something of an argument junkie to me, and for this reason I will refrain commenting any further under this one.

  • Francesca Allan

    Cledwyn, I most certainly did not mean to imply that I believe you rant and rave and I’m sorry if I gave you that impression. I enjoy your thoughtful comments and how you express them so well. All I meant to say was that Bob Whitaker has done an awful lot for the cause and it pains me to see him criticized so harshly.

  • The Right Hon. Cledwyn B’Stard

    Oh, right. Bugger. My sincerest apologies. Sorry for the misunderstanding, and thanks for the courtesy. I reciprocate the sentiments. I would remove that post but such privileges only extend to members, and I can’t be bothered to become one!

  • The Right Hon. Cledwyn B’Stard

    Yeah, it’s all right to “Otherize” people like us.

  • Surviving ADs

    Dr. Frances has been stung by accusations from his colleagues in psychiatry that he is anti-psychiatry and a traitor to his profession. This has led him to take what he might think are conciliatory positions that ultimately contain internal logical contradictions.

  • Phil_Hickey

    Surviving ADs,

    Thanks for coming in. Yes, he’s’ got himself caught in a difficult position, trying to critique DSM-5’s excesses, without acknowledging that his own baby –
    DSM-IV – was not essentially different.

    I think you’re correct in stating that he’s attempting to cast himself as the mediator/conciliator in this business, but in fact he’s not having much effect in either camp. The only honorable course left to him is to repudiate DSM-IV – but that seems unlikely.

    Best wishes.

  • Anon

    It’s been sickening to watch Frances paint himself as the voice of DSM reason these last couple years. The man most singularly responsible for millions of children and adults being labeled, libeled and smeared from 1994 to 2013, 19 years of unmitigated quackery damaging the lives of millions of innocent human beings, and this man feathered his nest by claiming to be the big critic of DSM 5, it was pathetic to watch. Even more depressing was the fawning press, and public, that lapped it all up, “saving normal” was his worthless book if I recall, no living man in the late 20th/ early 21st century did more to destroy normal than Frances. But all you need to get psychiatry critique-LITE in the press, are some psychiatry credentials and some soft criticism of the status-quo and they lapped it all up like kittens, the public, the press, Huffington Post, a real shame. The only saving grace is that it will be another 20 years before we have to go through the whole charade again for DSM 6. All indicators point to a rebranding, a name change, of the same thing. They’ll call their book of quackery something else, no doubt. Or try something really brazen in desperation. We live in pathetic times.

  • Surviving ADs

    What we’re seeing is cognitive dissonance in action, as Dr. Frances tries to reconcile two logically conflicting positions. Not at all uncommon in psychiatry, where denial is a river in Egypt!

  • cledwyn b’stard

    Johnstone is one of the people who believes in the preponderance of good intentions in psychiatry and the mental health system.

    In her work, she postulates that the majority are literally desperate to help. For an honest account of the motives and intentions of a profession, you cannot rely upon the practitioners of that profession. Nor can you rely upon people close to them. Johnstone works in the mental health system. Her colleagues are psychiatrists and nurses.

    The average mental health worker worries no more about his/her patients than the average patient worries about his/her mental health workers. Do we patients lose sleep over psychiatrists, and social workers? Of course we bloody don’t, anymore than they do over us, which is why it is so easy for them to harm us.

    Why is it always the most powerful people, and people who exercise control over others, with whom the the pious incantation, “We only want to help!”, is most readily associated?

    You never hear bus-drivers claiming “I only want to help my passengers!”.

    Do postmen give a shit about the people they post letters to?

    Politicians, doctors, psychiatrists, why is it always these people who insist that they want to help? Maybe the lady is insisting too much; just like denial is often an admission of guilt, this insistence of noble intentions is perhaps the defense of the guilty.

    You’ll never hear, “don’t thank me, it’s just my job”, amongst these people.

    Sadly, you can’t express such secular heresies without offending the sensitivities of people like Johnstone and Whitaker, on the basis of which they accuse you of dehumanizing the opponent (although Johnstone doesn’t use those words, that’s the gist of it). Whitaker even censors people on this basis (you see, that’s the problem with intolerance; it presupposes an ability to defend our opinions with logic and reason, in the absence of which, people appeal to force and use it. I mean, look at the history of religion).

    I am rehumanizing the oppressors, because no-one is as saintly as some of the critics make people who work in the mental health system seem.

    Contrary to popular perception, intentions are not things we can know, but are deduced from a person’s behaviour on the basis of our view of human nature.

    A lot of what we call good intentions, I would surmise, are actually self-interest.

    A lot of what we call compassion for victims on this issue, I would surmise, is an advanced case of bad conscience.

    This is easily remedied. Just go on MIA and write some pointless articles that change nothing (not that this is aimed at everyone who writes on there, just those for whom a much stronger proof of their supposed compassion and desperation to help would be to remove their cooperation from this evil institution), whilst maintaining the pretense, both for your own deception and others, that you are taking part in a dialogue portending a seismic change in the mental health system, when the truth is, nothing is happening, and the people who comment on such websites don’t have the power to make any proper changes anyway (the only way such people can make a change is to get another job, psychiatrists and nurses I mean).

    Talking about an advanced case of bad conscience, I see Allen Frances has been writing a lot of crap recently.

    Compassion, empathy, the desire to help others, these usually emerge in relations of reciprocal warmth and care between people close to each other, the kind of closeness that doesn’t exist between patients and “carers”. On top of this, we are living in an age of such widespread solipsism and alienation, that compassion and concern for anything other than those who are a part of our circle of intimates is extremely rare, although the training of medical professionals and nurses does nevertheless impart the requisite theatrical skills to simulate compassion and concern, though in all the times I’ve been in hospital its true example was rarely encountered. It’s mostly a performance.

  • Anonymous

    Of course one can lose a lot of sleep when one considers the violence these “professionals” are free to unleash on us.