The problem with Psychiatry
We know what it feels like to suffer. There is suffering associated with visible traumas or wounds on our body, which we call physical suffering, and there is suffering associated with invisible traumas or wounds, which we call mental suffering. The ensemble of practices aimed as alleviating mental suffering is called psychiatry.
People suffering mentally are put under various labels depending on how they describe their suffering and how they behave: 'anxiety', 'bipolar', 'depression', 'schizophrenia', ... . A lot of efforts are invested into psychiatry, yet there seems to be more and more people suffering mentally.
Psychiatry hasn't found precise causes for these sufferings, and as such doesn't have great success in alleviating and preventing mental suffering. I claim that this is because psychiatry today is based on false beliefs.
Contemporary psychiatry assumes that everything we feel stems from our physical brain, from how our brain is wired, from the chemicals present in the brain. Psychiatry assumes that if we suffer mentally, then that's because we have a chemical imbalance in our brain, or wrong wirings in our brain. So psychiatry focuses on finding what chemical imbalances or wrong wirings are responsible for suffering, and how to correct them.
But it is not hard to see that this belief is dubious at best. If you encage a wild animal, and see it suffering from chronic stress and depression and manifesting erratic behaviors as a result, is that because it has a chemical imbalance or a wrong wiring in its brain, or is that because we have put it into a cage it cannot escape? Because it goes against its profound desires to be stripped of its freedom? Then if you numb its mind with chemicals, and it calms down as a result, will you conclude you have successfully cured it of its illness? Or have you just successfully hidden its suffering that fundamentally results from making it endure constraints it doesn't want to endure?
Psychiatry doesn't attempt to solve the root of the problem, it assumes that if an individual suffers then that's because there is something wrong within them, rather than within their environment. Psychiatry essentially says, there is nothing wrong with the constraints that society makes you endure, if you suffer it's because you have a problem and you have to adapt, just like a wild animal has a problem and has to adapt to its cage.
This is reminescent of drapetomania, that 19th century mental illness which was seen as the cause why some slaves attempted to flee captivity. If you suffer and want things to change it's because you have a mental illness, but society is perfectly healthy. And that's the problem with psychiatry.
People suffering mentally are put under various labels depending on how they describe their suffering and how they behave: 'anxiety', 'bipolar', 'depression', 'schizophrenia', ... . A lot of efforts are invested into psychiatry, yet there seems to be more and more people suffering mentally.
Psychiatry hasn't found precise causes for these sufferings, and as such doesn't have great success in alleviating and preventing mental suffering. I claim that this is because psychiatry today is based on false beliefs.
Contemporary psychiatry assumes that everything we feel stems from our physical brain, from how our brain is wired, from the chemicals present in the brain. Psychiatry assumes that if we suffer mentally, then that's because we have a chemical imbalance in our brain, or wrong wirings in our brain. So psychiatry focuses on finding what chemical imbalances or wrong wirings are responsible for suffering, and how to correct them.
But it is not hard to see that this belief is dubious at best. If you encage a wild animal, and see it suffering from chronic stress and depression and manifesting erratic behaviors as a result, is that because it has a chemical imbalance or a wrong wiring in its brain, or is that because we have put it into a cage it cannot escape? Because it goes against its profound desires to be stripped of its freedom? Then if you numb its mind with chemicals, and it calms down as a result, will you conclude you have successfully cured it of its illness? Or have you just successfully hidden its suffering that fundamentally results from making it endure constraints it doesn't want to endure?
Psychiatry doesn't attempt to solve the root of the problem, it assumes that if an individual suffers then that's because there is something wrong within them, rather than within their environment. Psychiatry essentially says, there is nothing wrong with the constraints that society makes you endure, if you suffer it's because you have a problem and you have to adapt, just like a wild animal has a problem and has to adapt to its cage.
This is reminescent of drapetomania, that 19th century mental illness which was seen as the cause why some slaves attempted to flee captivity. If you suffer and want things to change it's because you have a mental illness, but society is perfectly healthy. And that's the problem with psychiatry.
Comments (26)
But the society is made up of individuals. So if it is how we behave with each other and how we interact with each other and what we force each other to do that makes us miserable, then why wouldn't psychiatry address that? If it directed its efforts towards that that would be much more effective.
In the current state psychiatry protects the status quo and ensures that it will remain relevant in the future, as many people will never adapt to what they are forced to endure. But there are many people who don't force others to do anything. It is usually the ones who are forced and constrained who suffer, and those who force others who are seen as the healthy ones. So fundamentally psychiatry protects the few who benefit from the constraints imposed onto the majority.
The one under pressure slaving away every day suffers and is diagnosed as mentally sick, as if to say why do you suffer? A good slave doesn't suffer. So let's give you some chemicals so you can be a good slave again. While the one putting the pressure enjoys the rewards and the good life, and protects his position in part thanks to psychiatry which justifies the status quo. If you're a slave and you suffer, it's not because you're a slave, it's because there is something wrong with you.
The environment can be the cause of the affected individual's issues. But the environment can't be identical to the affected individual. We still have an affected individual that we need to deal with, and that means addressing how they've been affected, which means addressing what's going on with their brain. That may not solve the problem long-term. If the cause is something environmental, then the environment needs to be changed or you'll never permanently relieve the affects the environment had on the individual. But you can't pretend that there's not an affected individual, as if the issue is ONLY the environment.
Mental issues are going to arise via some combination of genetics/internal causes and environment/external causes, with the balance being different in different situations, with different individuals.
All of this is just the same with non-mental ailments. The cause might be genetic/internal or environmental/external. When we're talking about an environmental cause we still have an affected individual --the guy's arm is still broken because his neighbor hit him with a baseball bat. It's not as if the neighbor is the extent of the problem. We have a broken arm to deal with, too. If we treat the arm and don't take care of the environmental issue then we might wind up with another broken arm, but that doesn't make it the case that there isn't a broken arm, just like focusing on environment doesn't make it the case that there is no issue in someone's brain.
Psychology/psychiatry have always proceeded with an awareness of environmental causal factors, by the way.
Yeah, the old joke is that "Betty majored in psychology in order to try to figure out what's wrong with her."
I think the best solution would be psychology and psychiatry working together to determine as much of the causes of mental suffering as possible and where the environment (external conditioning) cannot be changed, perhaps, the individual (internal conditioning) must.
One of the prevailing symptoms of our primitivity is that, the human collective or society, still demands that we sacrifice individuals for its sake. The society has not yet learnt how to take care of all its members and their distinct proclivities. Thus, we must endure this collective madness a while longer.
Medication does relieve the suffering of many. That said there is a lot we don’t understand, but it is clear enough physiology is not defined by “environment” only. Some people are predispositioned to this or that and the “environment” can trigger innate “disorders.”
Of course the problem is not the environment alone, it is the combination of the individual plus their environment. When I was saying the problem is within the environment, I was taking the point of view of the individual, who is told there is something wrong in in his brain that is the cause of his suffering, while it is often the constraints imposed upon him that make him suffer, constraints that go against his desires.
Faced with such constraints, the individual may come up with intricate strategies to cope with the associated suffering. If he doesn't find a way to cope then that manifests as depression. Maybe he will constantly be on his guards and that will manifest as generalized anxiety. Maybe he will assume others' intentions and that will manifest as paranoia. Maybe he will internally imitate such or such person depending on the situation and that will manifest as schizophrenia.
I'm saying that a lot of mental suffering stems from the constraints imposed by society. And that a lot of psychiatry has to do with trying to adapt the individual to these constraints, rather than finding out why these constraints are there in the first place and how we could remove them.
Some constraints are seemingly unavoidable, we want to survive and we need water and food to survive, so needing water or food and not finding it would be suffering. But many constraints in society are imposed by people onto others, in some direct or indirect way, and those are responsible for immense suffering, but psychiatry doesn't attempt to address them and assumes them to be healthy, and instead attempts to cure the constrained individual who in fact suffers because of how he is constrained.
Of course it is easier for the one who constrains to say that the individual who is constrained suffers because there is something wrong in his brain, rather than because he is constrained, even though if the roles were switched the newly constrained would be the one suffering.
In looking for issues within the brain, psychiatry is legitimizing the way society function, with its rulers and its ruled, and blinding itself to the fact that many are constrained by others in ways that would make pretty much any human being suffer if put into the same situation. Attempting to cure an imagined illness in their brains seems like a hopeless venture.
I see a broken arm as a poor analogy for a "mental illness", I would say a more accurate analogy would be that of breathing poisonous air. Some people are more susceptible to it than others, it is more poisonous in some places than some others, some are more able to find helpful techniques to cope with it than others, some become affected durably by it and we give them sleeping pills so they forget about their suffering, but we never focus on the root cause which is the poisonous air and the root issue which is how to clean it.
What sorts of constraints are you talking about? Could you give some examples?
Being forced to do a mind-numbing repetitive task for 8 hours a day every day, being treated more or less badly by some superior who tells you what to do, feeling constrained to submit for fear of losing that job, having to do that for 20 or 30 or 40 years before you can have a house that you can call your own, being unable to go settle anywhere without some landowner telling you that you can't settle there and forcing you to leave unless you have enough numbers on an account to give him in exchange, thus being forced to take part in society which often involves doing a mind-numbing repetitive task for 8 hours a day every day...
Okay, but for something like that, presumably we would (or at least could) be talking about a job where there are a lot of employees, right? So if we're going to claim that the mental issues are caused by the environment there, is the environment causing the same mental issues for everyone? If not, why not? Wouldn't the only room for difference be something about the individual's mind?
What "psychiatry says" needs to be heard together with other forms of psychology, including clinicians who are not doctors in the way psychiatrists are trained to be. The very terms of diagnosis found in the DSM are not "physical" in the way other problems of the body are described. At the very least, evidence in regard to what is wrong involves engagement with the person and what they say. It is not an MRI.
There are lively disputes in the profession how to establish good models. I linked to the most far flung global example to suggest how steamy it gets when you get close to actual cases. But that background lets me point out that most institutions use teams where different kinds of evidence are considered before deciding upon treatment.
It is right to find ways to quell the internal conditions of a disturbed person. It does not mean that it's the ultimate solution but it's a good standby option. For the moment, mental problems are harder to diagnose and so there's a lot of dependence on a trial and error basis of progression.
You seem to have misunderstood me. I'm only trying to say what I think is better than a drug based approach to mental health. In my statement, both psychologists and psychiatrists can analyse the psyche, therefore, they both cover the psychoanalysis part. However, psychologists are often more inclined to solve mental issues via cognitive behavioral therapy (cbt) and are therefore complementary to psychiatrists who seem more inclined to pharmacotherapy. This is especially so in modern times when the distinction between a psychologist and psychiatrist has been exceedingly contrasted, unlike in the past.
What I'm saying is that both drug therapy coupled with an understanding of one's mental situation (via cbt) is a better approach to solving problems than one solely based on drug therapy.
I think the key is discovering what the patient needs and when. If cbt alone can work then, the better. But, if drugs are needed, as is sometimes the case, then it should as well be coupled with cbt. The personal participation in one's recovery or therapy is of paramount import.
So what I'm saying is, when people think about sad things, like their own inevitable death for instance, it results in some depression. Instead of then going to a doctor or psychiatrist in the belief something is wrong we should all be educated about mental health from an early age so that we know that most depression is a normal condition for a thinking imaginative and intelligent human being. In other words if somone is never disordered then they are abnormal.
The trick is to understand that everyone is in the same disordered boat and that it's OK to be disordered and to gradually put your cupboard in order as you grow older.
Awareness of mental health should be at the forefront of education, after all everything is based on it.
Show me an example of where "psychiatry" says "there is nothing wrong with the constraints that society makes you endure". Psychiatrists live in the same fucking world as everybody else, and they too have to endure various constraints they would prefer to avoid--there is no avoidance. What a psychiatrist might say to a client is "You neither qualify for disability, nor are you independently wealthy, so one way or another you will have to earn a living." Most psychiatrists know that work sucks -- that's why they pay people to work -- no one would do it for free. Psychiatrists don't work for free either. If they stop working, they don't get paid anymore.
Quoting leo
You probably know (or you should know) why social constraints exist (social control, a ruthless profit-based economy, severe traffic congestion, high rent, etc.). You are quite right that society drives many people crazy, but there are also endogenous causes like genetics or exposure to toxic chemicals. Families can replicate mental illness in their children.
Psychiatrists are not community mental health engineers. No single profession is in a position to reorganize society. Psychiatrists are also not social workers.
Quoting leo
You have named the problem:
[i]being forced to do a mind-numbing repetitive task for 8 hours a day
being treated more or less badly by some superior who tells you what to do
feeling constrained to submit for fear of losing that job
having to do that for 20 or 30 or 40 years before you can have a house that you can call your own
being unable to go settle anywhere without a landowner telling you that you can't settle there.[/i]
The solution is both obvious and simple: Carry out a revolution; overthrow the existing property relationships; release man from mindless labor for rich people's profits; expropriate the expropriators.... That will take care of many of the social constraints that afflict us. Other social constraints will appear, however, because many people can not exist in close proximity without rules. Even in utopia, people will still need to work in order to produce the necessities of life -- work much less, work under much better circumstances, but work nonetheless. Even in utopia you will not be able to make noise all night and keep everybody awake.
Education should at least not drive students crazier than they already are.
Good points.