The current issue of Acta Psychiatrica Scandinavica is devoted to the topic of psychiatry’s poor image, and what steps might be taken to improve it.
Central to the discussion is a study Images of psychiatry and psychiatrists, by H. Stuart et al, – and seven commentaries on this study by various authors. The Stuart et al paper describes a survey of 1057 teaching medical faculty members from 15 sites in Europe and Asia. The overall response rate was 65%, and the results indicate clearly that general medical teaching staff have a poor opinion of psychiatry and psychiatrists. For instance, 90% of respondents endorsed the item “Most psychiatrists are not good role models for medical students.”
“Over a third thought that their colleagues generally did not speak well of psychiatry, and almost a third thought that a bright student would not be encouraged to enter psychiatry by their mentors or teachers. As a career, psychiatry was seen as having low prestige relative to other specialties. Approximately one in five thought that students were attracted to psychiatry because of their own problems or that students chose psychiatry because they could not get in to other specialties.”
The Stuart et al findings are discussed in seven short editorial comments by various psychiatrists and one psychologist (John Read). The primary thrust of the psychiatrists’ comments is that the poor image of psychiatry is essentially unwarranted, and that the situation calls, not for any substantive reforms, but rather for improved communication between psychiatry and other medical specialties, and for “…profession-related self-assertiveness…” One psychiatrist, D. Wasserman, did call for “…changed behavior on our part”, but from his text it is clear that the change he has in mind is improved sharing of the recent advances in psychiatry with other medical practitioners.
“Psychiatry needs to be proactive in providing easily readable and readily accessible scientifically grounded information to medical staff in general hospitals and in General Practitioners’ (GP) offices about modern psychiatric treatments. As we know, education generally requires repetition, and while all physicians in training are exposed to the field of psychiatry, it behoves us as psychiatrists, to continually inform our medical colleagues about the advances in our field.”
This strikes me as condescending to the point of arrogance, and, to the extent that it reflects psychiatric attitudes generally, could, in combination with psychiatry’s spurious foundations and destructive “treatments,” go a long way to explaining the negative perceptions of other medical professions.
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I had planned to write a detailed critique of the seven editorial comments, but yesterday on Mad in America I read Psychiatry’s Poor Image: Reflecting on Psychiatrists’ “Apologias”, by Bonnie Burstow, PhD. The article is a critique of the APS editorials.
Bonnie, in her usual measured but forthright tone, has made all the points that I had wished to make, and many more besides. Here are some quotes:
“Before I proceed further, I would point out that there is a conspicuous void in this collection. While all authors in their own different ways address what might be done to improve psychiatry’s image, significantly, not a single psychiatrist thinks to ask what by humanistic standards would appear to be the compulsory question: Insofar as any of the bad image is deserved, exactly how are the ‘patients’ being ill served and what is owed them?”
“Most of these responses can be divided into several categories, and all entail some level of evasion. Emergent themes or claims in this regard include: 1) The evidence that psychiatry has a bad image is either not credible or is limited and as such, claims based on it are misleading; 2) Insofar as psychiatry and psychiatrists have a bad image, it is not primarily psychiatry’s fault but the fault of others; 3) The bad image is not exactly anyone’s fault—it goes with the territory; 4) While psychiatry is partially to blame, it is only one or two things psychiatry is doing wrong—none of which are substantive.”
“Ironically, what surprises most of us who are aware of psychiatry’s baselessness, is not how critical other doctors are of psychiatrists but how silent they are about the fraudulence of the medical claims—at least as a big a dynamic as the putative unfairness.”
“The primary purpose of the construction of course is to absolve psychiatry by transferring blame onto others. The various people blamed throughout this collection include: other medical teaching faculty; funders (who allegedly are not providing sufficient resources to make psychiatry attractive to enter (see, for example Bhugra, 2015), and, finally, the media. Note in this last regard Bhugra’s curious reference to the “antipsychiatry media coverage.” This of course is ironic given the enormous complicity of the press in furthering psychiatry (see Whitaker, 2002). Moreover, as those of us who organize against psychiatry but receive negligible coverage are well aware, if there is antipsychiatry press out there, it is keeping itself well hidden.”
“Finally comes the very common contention that while psychiatry is wonderful and amazingly successful (and all the psychiatrists more or less concur on this point), it is in fact doing but one or two things wrong, none of which are substantial, albeit they facilitate the “stigma”. Generally, the deficits identified relate to not having a game plan for fighting back and not properly communicating (e.g., what we are being asked to believe is that despite the enormity of the funds spent on promulgating its message—see in this regard Whitaker, 2002—psychiatry is failing to communicate how very scientific and advanced it is—hence the ‘misperceptions.'”
“That these ‘solutions’ will hardly get rid of psychiatry’s fundamental deficits is clear. How can you get rid of shortcomings by putting all your energy into attempting to persuade everyone that they don’t exist? How can you deal with the problem of a faulty paradigm by further entrenching oneself in that paradigm? But, of course, addressing actual deficits is not the point of the exercise.”
Bonnie’s article is characterized by cogency, lucidity, and fearless honesty. It’s a superb critique which I strongly recommend.