On October 15, psychiatrist Allan Tasman, MD, published an article in Psychiatric Times. The title of the article is The Most Exciting Time in the History of Psychiatry.
Psychiatric Times describes itself: “Our Focus: News, special Reports, and clinical content related to psychiatry. Our Audience: Psychiatrists and allied mental health professionals who treat mental disorders.”
According to Wikipedia: “Psychiatric Times is a medical trade publication written for an audience involved in the profession of psychiatry.” It is published by UBM Medica and is distributed to about 50,000 psychiatrists monthly.
Dr. Tasman is their recently appointed editor-in-chief, and this article is his inaugural piece. Dr. Tasman is Chair of the Department of Psychiatry at the University of Louisville, Kentucky. He was President of the APA from 1999 to 2000 and has held various other offices. His research, according to his bio, “…has emphasized the role of brain mapping techniques in the study of the neurophysiology of cognitive processes…” His research has been supported by grants from Upjohn, Pfizer, Forest Laboratories, and Lilly.
The article’s lead-in is interesting:
“Advances in psychiatric research, spanning the entire spectrum of biological, psychological, and social aspects of mental processes and functions, have transformed the field of psychiatry.” (Since publication of the article, this lead-in has been deleted, but an almost identical sentence is retained in the article.)
I was immediately intrigued at the notion that advances in psychological and social research have transformed the field of psychiatry, and I read on expectantly. But, as I suppose I should have known, one can’t judge the article by the opening blurb.
Dr. Tasman begins by telling us that he is honored and excited to be appointed Editor-in-chief of Psychiatric Times. He assures us that he will continue the “visionary approach” of the previous editors, who were committed to ensuring that “Psychiatric Times” provided “an unparalleled source of high-quality information” aimed to assist psychiatrists in their practice.
“We live in what is arguably the most exciting time in the history of psychiatry. At the dawn of the 20th century, though, the themes that would occupy psychiatry in the coming century were already in evidence. One theme has been the emphasis on understanding brain pathology in psychiatric illness, building on the work of the generation of Eugen Bleuler, Emil Kraepelin, and Adolf Meyer.”
Note the phrase: “…brain pathology in psychiatric illness…” This is standard, unadorned bio-psychiatry, i.e. that all significant problems of thinking, feeling, and/or behaving are illnesses, caused by brain damage/malfunction. Dr. Tasman’s identification of Eugen Bleuler, Emil Kraepelin, and Adolf Meyer as early proponents of this position is misleading. Here are some quotes from Drs. Bleuler and Kraepelin that suggest otherwise.
“The conclusion that the development of paranoic delusions is essentially the same as the formation of errors in normal people is therefore warranted.” [p 104]
“Since he [a case study] was sensitive, grounds were not lacking for the feeling that he was being injured by other men and for ascribing to these his failures. And, since the abyss between the wish and its accomplishment always remained, these ideas were continually maintained, and the patient became paranoic.” [p. 97-98]
Emil Kraepelin: Dr. Kraepelin was indeed committed to the general concept of biopsychiatry, but was also honest enough to admit:
“As long as we are unable clinically to group illnesses on the basis of cause, and to separate dissimilar causes, our views about etiology will necessarily remain unclear and contradictory.” [As quoted in The Lancet Editorial of April 5 1997]
Adolf Meyer, according to Wikipedia:
“…is most remembered for reframing mental disease as biopsychosocial ‘reaction types’ rather than as biologically-specifiable natural disease entities. In 1906 he reframed dementia praecox [i.e. schizophrenia] as a ‘reaction type, a discordant bundle of maladaptive habits that arose as a response to biopsychosocial stressors.” [Emphasis added]
Clearly Dr. Meyer was not a supporter of biopsychiatry. It was, in fact, largely through his influence that the various entities listed in DSM-I (1952) were referred to as reactions. This practice was unceremoniously dropped in DSM-II (1968), as psychiatry and its pharma allies embraced the practices, profits, and deceptions of unambiguously biological psychiatry. This decision was deceptively rationalized in the Introduction to DSM-III on the grounds that it “…did not imply a particular theoretical framework for understanding the nonorganic mental disorders.” In fact, its purpose was to clear the way for an entirely biological, and incidentally, fictitious, psychiatry which had to be developed and maintained in order to take advantage of the drugs that were beginning to come on stream. Note in passing the quaint phrase “unorganic mental disorders,” which was also allowed to slip quietly into the black hole of psychiatric revisionism.
It’s possible that Dr. Tasman isn’t aware of these heretical tendencies on the parts of Drs. Bleuler, Kraepelin, and Meyer. Or it’s possible that he is ignoring these troubling deviations from psychiatric orthodoxy in order to convey the impression of a long history of unanimity within his profession. Either way, his statement is inaccurate and misleading.
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Back to the article:
“Also, 1900 marked the publication in Europe of Freud’s Interpretation of Dreams, and the beginnings of the modern understanding of psychological development and our emphasis on psychotherapeutic treatments.”
Ah! Perhaps this is where Dr. Tasman is going to tell us about “the great psychiatric advances in psychological and social research.” [Emphasis added]
Alas, no! For as soon as Dr. Tasman has mentioned Freud’s psychological work, he immediately dismisses it. Watch this:
“Less well known, however, is another work on which Freud was laboring at the same time. In the ‘Project for a Scientific Psychology,’ Freud was attempting to understand the neural basis for psychological processes. While the ‘Project’ was not discovered or published until 1953, this century-old quest has marked one of the most important preoccupations of modern psychiatry.” [Emphasis added]
So we’re back to good, old, thorough-going biological psychiatry. But wait! There’s a glimmer of hope. Dr. Tasman describes the quest for brain pathologies as one of the most important preoccupations of modern psychiatry. What were the other preoccupations? Dr. Tasman poses that very question, and obligingly provides us with an answer:
“Providing humane and effective treatment for psychiatric disorders, developing a meaningful diagnostic classification, and overcoming substantial societal forces working against rational diagnosis and humane treatment were clearly at the forefront.”
Well there’s nothing there to suggest anything other than broken brain psychiatry. And the notion of psychiatry providing humane and effective treatment is a little difficult to reconcile with innovations like lobotomies, insulin comas, rotational chairs, hydrotherapy, and chemically and electrically induced seizures.
Also the notion of psychiatry “…overcoming substantial societal forces working against rational diagnosis and humane treatment” is simply false. The major consequence of psychiatry’s assumption of control of the asylums was the collapse of what was known as “moral therapy”, a model that was based on the view that “insane” people were essentially normal people who had undergone severe psychological and social stressors. James Coleman, in his classic psychology text, Abnormal Psychology and Modern Life, (Fourth Edition, 1972) writes:
“There seems little doubt that moral therapy was remarkably effective, however ‘unscientific’ it may have been.” (p 43)
“Despite these impressive results, moral therapy declined in the latter half of the nineteenth century – in part, paradoxically, because of the acceptance of the view that the insane were ill people.” (p 43)
“In any event, hospital statistics show that recovery and discharge rates declined as moral therapy gave way to the medical approach.” (p 44)
Other writers have made similar comments on this matter.
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Then Dr. Tasman gets into some serious cheerleading:
“Building on the tremendous scientific advances of the late 19th century, the beginning of the past century marked a time of great optimism for what 20th-century science would bring to psychiatry.
We have not been disappointed, and we are all aware of the broad range of amazing advances that have occurred.”
Well, Dr. Kraepelin, as we saw earlier, was honest enough to admit that his classification system, lacking as it did any clear understanding of etiology, would inevitably remain “unclear and contradictory.” And today, 118 years later, psychiatry is in the same position. Apart from those DSM items listed as “due to a general medical condition” or “due to the effects of a substance,” no psychiatric disorder has to date been definitively linked to any specific neural pathology.
So whatever “amazing advances” Dr. Tasman has in mind, it is not in the area of basic causes. Nor is it in the area of abandoning this futile quest, and recognizing what has been common knowledge for thousands of years: that distress is largely the ordinary human response to distressing circumstances.
But in fairness, Dr. Tasman takes a small step towards acknowledging this:
“We are still preoccupied with many of the same issues as our colleagues from a hundred years ago.”
But that precipice looks too scary:
“…but, of course, in ways transformed by over a century of experience and newly discovered knowledge.”
Well, certainly, psychiatry has had over a century of experience, but I’m not aware of much in the way of newly-discovered knowledge – certainly there have been no breakthroughs in the quest for neural explanations of problems of thinking, feeling, and/or behaving. But, “…transformed by over a century of experience and newly discovered knowledge” sounds good. It’s good spin, and when everything one does is flawed and spurious, spin is all one has left, which is why psychiatry is becoming extraordinarily skilled in the use of spin!
Now, emboldened perhaps by his own cheerleading, Dr. Tasman takes another look at the issues that have preoccupied psychiatry for over a century. But his choice of issues is somewhat selective:
“Social ostracism, stigmatization, discriminatory government and corporate policies, and discriminatory limits on access to and reimbursement for optimal care are but a few manifestations of these ongoing concerns.”
So, there it is: all the wicked things that big bad government and big bad insurance companies are perpetrating against psychiatry – the lily-white injured innocent!, the provider of “optimal care.” There’s not one iota of critical self-scrutiny. No mention of invalid basic concepts. No mention of fraudulent research. No mention of ghost-written textbooks. No mention of damage from psychotropic drugs. No mention of corrupt payments to psychiatrists from pharma. No mention of pharma commercial-fests being accepted as continuing education. Nothing but: Oh, my! How everyone hates us!
And then, just to cement himself firmly into place as a psychiatric leader:
“And, we are still working to develop more effective treatments based on a growing understanding of brain structure and function and an etiologically based system of diagnosis.”
An etiologically based system of diagnosis! The most fundamental issue in the entire debate tossed in like an after-thought – after social ostracism and reimbursement limits! Proof of neural pathology underlying every conceivable problem of thinking, feeling, and/or behaving is just around the corner where, incidentally, it’s been for the past forty years.
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At this point, Dr. Tasman restates the optimistic assurances of his lead-in:
“Advances in psychiatric research, spanning the entire spectrum of biological, psychological, and social aspects of mental processes and functions, have transformed our field and our clinical work.”
Ah, the hopeful reader thinks, now we’re going to hear about psychiatry’s embracing of psychological and social concepts. This is what we’ve been waiting for. But again our hopes are dashed by the very next sentence:
“We are, though, only in the early years of studying underlying mechanisms of both normal and abnormal brain function and structure via direct functional imaging and sophisticated lab techniques. More exciting findings lie ahead.”
More exciting findings lie ahead from functional imaging and sophisticated lab techniques. But don’t expect too much. We’re still in the “early years.” And don’t expect anything from psychiatry in the psychological or social areas. Those references were window dressing, designed to create the impression that psychiatry is taking these kinds of issues seriously, even though they aren’t. And in case there’s any doubt:
“We will undoubtedly, at some point, learn to influence these [neural] processes with more precision than is now possible.”
New drugs? Different voltages on the shock machines? More exciting findings lie ahead! It reminds me of the old serialized movies from my childhood. Can Captain Marvel escape the molten lava? More exciting adventures next week!
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And then the ultimate dismissal of any kind of psychosocial interventions:
“It is also true, however, that interpersonal experiences, such as in psychotherapy, can alter brain function in the same way as medications, as we have seen in studies of OCD and depression.”
There’s no need to talk to anybody; no need to acquire new skills or coping strategies. Pills have exactly the same effect in the brain as these old-fashioned folk remedies. Pills are modern. Who has time for all that old-fashioned stuff anyway? Life shouldn’t be difficult. There’s a pill for every problem.
Dr. Tasman then directs his attention towards the biopsychosocial model. This is an interesting notion. A biopsychosocial approach to problems of thinking, feeling, and/or behaving means that one acknowledges the obvious reality that these kinds of problems can arise from biological, psychological, and/or social factors, and that interventions should be based on a realistic assessment of the relative weight of each of these factors in individual cases. It is emphatically not what is found in psychiatry today, where all significant problems of thinking, feeling, and/or behaving are conceptualized as biological illnesses, best “treated” by drugs and/or electric shocks to the brain. Under the present psychiatrically-managed mental health system, the biopsychosocial approach means, at best, the development of a “good bedside manner” and at worst, the use of non-psychiatric personnel to persuade clients to take their pills, keep their appointments, and be generally compliant.
But watch Dr. Tasman at work. He describes the biopsychosocial model as “…an integrative approach to understanding not only what the illness is, but also who the person with the illness is – both areas providing essential information for optimal clinical understanding and intervention.” Note the term “illness,” with its clear implications of biological etiology. The notion of needing to know “who the person with the illness is…”, is a caricature of the biopsychosocial model, designed to create the impression of an integrative approach while requiring no deviation from the status quo. A genuinely biopsychosocial approach in this field would entail, as a fundamental prerequisite, the recognition that most of the clients don’t have an illness at all, and don’t need medical care.
Psychiatry clings to the broken brain theory, because without it, there is no justification for the employment of medical techniques in this area. Without the broken brain theory, psychiatrists are unnecessary, and even counterproductive. In their hearts, all psychiatrists know this, which is why they never address the fundamental question: why should all significant problems of thinking, feeling, and/or behaving be considered illnesses? Instead, they rely on simplistic, unsubstantiated assertions, and dismissive sidestepping of anything that challenges these assertions. They also make extensive use of spin, cheerleading, and outright deception. Self-congratulatory rhetoric has become the hallmark of psychiatric writing.
Psychiatry’s edifice is crumbling. It’s crumbling because it was founded on spurious premises, and has shamelessly embraced destructive and disempowering “treatments”. But it will not address these issues. Instead, it conceptualizes the problem as PR. They believe that they need to become better at “educating” the media and the public. They feel the need to maintain a constant flow of spin, both internally – to convince themselves that they are a benign institution, and externally – to convince the world that the cries of their detractors are baseless.
But there’s only so much mileage in spin and PR. And for psychiatry, time is running out.