Critical Psychiatry

By Barry Turner

January 17, 2008

The dissemination of information is the hallmark of a free society and is the basis of freedom of speech. This fundamental human right is founded on the concept that information and knowledge are essential to free choice, it is the right of many individuals to hear that is being protected rather than the right of one individual to speak...

 It is a sad fact that even in our mature pluralistic society a good deal of effort is still expended to suppress the rights of individuals to hear views, which may be at variance with current orthodoxy. In medicine this is particularly evident and in psychiatry unhealthily so.

Current orthodoxy in psychiatry has it that all psychiatric disorders are organic in nature and arise form alleged chemical imbalances that may be genetic in origin. This orthodoxy in a branch of medicine is all the more startling when it is subjected to examination. Virtually none of this organic theory has ever been empirically demonstrated and while it is very possible that aberrant genetics plays some part in mental illness there has never been any categorical evidence shown where these defects lie. In short current orthodoxy is based entirely on unproven beliefs.

The pharmaceutical industry provides the most powerful support for this orthodoxy. Since psychopharmacology developed in the 1950’s vast amounts of effort and money have been expended in seeking out chemical cures for mental illness. The logic is simple chemical imbalances need chemical remedies. This is the fundamental orthodoxy of what has come to be known as Biopsychiatry. It has to be said that the use of pharmaceutical interventions has made vast improvements to the lives of very many patients who are happy to express their thanks to and support for pharmaceutical interventions. As with most orthodoxy however overemphasis on the beneficence of the creed has been used to hide the darker side that is to be found in all belief systems. The undoubted benefits conferred to many by psychopharmaceutical treatment has been disingenuously used to suppress the very significant adverse effects suffered by many others.

More disturbing still are the efforts made by current orthodoxy to suppress any view at variance with the chemical-genetic model. The rise of psychopharmacology generated a huge industry of mental illness and changed irrevocably the previous societal models for the treatment of the mentally ill. Prior to the introduction of readily available medications the mentally ill were outcasts from society and in the majority of cases incarcerated to protect the sensibilities of the sane defined by cultural and societal norms of behaviour. Little money was expended on researching the problem in spite of its size and no one would have dreamed that these unfortunates would have ever represented a balance sheet asset.

The invention and establishment of psychopharmacology changed all that[1]. The mass production of medications and the aggressive marketing of these products made very large profits for their manufacturers and the economic pressures created changed the vary definition of psychiatry, let alone its practice. With the development of more and more drugs the diagnosis of mental illness vastly increased often with the drug treatment being in place before the illness was fully described or classified. The definition of mental illness was now controlled not only by societal norms of behaviour but also by the economics of the market.

This is the root of the current orthodoxy. Two of the most powerful agents in human society combine to make the rules. Even in the most rational of societies orthodoxy cannot tolerate alternative approaches and psychiatry, as a branch of modern medicine is no exception. Psychiatrists who adopt a more traditional view, or as some would call it holistic approach are now under threat from the biopsychiatry orthodoxy. Those taking views at variance with the biopsychiatry orthodoxy are finding themselves marginalized, labelled and overtly threatened by that orthodoxy. An alarming use of disciplinary action based on the ‘threat to the patient’ concept has been observed in recent years and it has led to psychiatrists critical of the current orthodoxy being prevented from practising.

As in all of human history the orthodox wish to silence the critics. Where this differs from past ‘persecution of heretics’ or ‘purging of revisionists’ the suppression of criticism is done falsely in the name of the patients. Patients are cynically manipulated in large part not to protect them but to protect the vested economic interests of the biopsychiatry industry. An even more startling element of this attempted suppression of critical views in the name of patients is that patients are very rarely consulted as to their views. A staggering degree of professional arrogance in a branch of medicine that likes to talk about empowering the service users.

Throughout medical history and the concomitant history of medical ethics and essential element in evolution of both science and its humanitarian application has been dissent. It is the differing views of countless thousands of physicians that have over four thousand years brought medical science to where it is today. As in almost all branches of science and philosophy it is doxasticism not orthodoxy that has served mankind best. It was the critical psychiatrists of the eighteenth and nineteenth centuries that changed the treatment of the mentally ill into a caring branch of medicine not the shareholders of Bedlam. We now enshrine criticism and dissent in our political and social systems and elevate them to human rights in our international law. Yet the powerful lobby groups would still suppress the views of the critical not because they threaten patients but because they threaten profits.

In psychiatry as in all branches of medicine it is a categorical imperative that orthodoxy is questioned, scrutinised and held to account. That cannot happen if critical opinions are suppressed out of the profession.

"In Bergens Tidende v. Norway (2001) 31 EHRR 430 it was held that complaints about medical treatment were not private matters but were matters to which the community at large had an interest. Put simply this means that suppressing the dissemination of alternative views is unlawful under Art 10 as an unlawful interference with the right to free expression.

Unjust attacks on the competence and character of psychiatrists who hold views opposite to the current orthodoxy are also violations of the individual's human rights. The suggestion that the holding of differing views to the drug orientated orthodoxy represents incompetence is an unwarranted attack on the doctor’s integrity. Suggesting that doctor is a hazard to patients because they hold views at variance with the current theories about brain chemistry is an alarming breach of principalist ethics. It is well recognised that autonomy as an ethic is not restricted to patient autonomy. The medical professional's autonomy must also be respected. The relationship between a doctor a patient and the professional body is a complex interaction of medical ethics and not a one-way street. The doctor needs to respect the autonomy of the patient, the patient the doctor and above all the profession the autonomy of both. That is the basis of both the second opinion and the legal doctrine found in Bolam."

The suppression of critical views in psychiatry represents the greatest threat to the integrity of the profession and the well being of the patient in over a century and a half of psychiatric practice.

[1] For a detailed history of this see; The Creation of Psychopharmacology. David Healy 2002. Harvard University Press

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The information herein shall not be considered an endorsement of anyone discontinuing psychiatric drugs. If you are stopping taking medication it is advisable to reduce the dose gradually WITH EXTREME CAUTION, as it is difficult to predict who will have problems withdrawing. It is worth getting as much information and support as you can, and involving your doctor wherever possible. You will find withdrawal information here.

FOR MORE INFORMATION ON WITHDRAWAL: Get Peter Lehmann's book, Coming off Psychiatric Drugs: Successful Withdrawal from Neuroleptics, Antidepressants, Lithium, Carbamazepine and Tranquilizers. This valuable resource comes in US, UK, and German editions.