Leaving Psychiatry. J. R. Ó’Braonáin. M.D.
child and providing an easy answer is, well, easy. Effecting cure by treating the child alone is difficult. Effecting cure in the child by having to “treat” the parents also is extremely difficult. Effecting cure in the child by treating the child, parent, school and society is nigh on impossible. Sooner, rather than later there is something or someone out of the psychiatrist’s hands. How does the child get well then? By the psychiatrist’s gentle hand of course. Or so they will say, though I’m reminded of the old adage that medicine is the art of amusing the patient whilst nature (or time) effects the cure.
The above examples of Amburr and Jaxxson are but tiny drops in the ocean of the same heterogenous muddle of snake oil. My point is not to say that there won’t also be vast chunks of homogenous agreement within psychiatry. There certainly will be in cases of what passes under the banner of chronic schizophrenia for example, and the DSM is intended to be an aid towards increased interrater reliability (i.e. enabling different psychiatrists to diagnose the same person with the same thing, though the empirical evidence and my experience has failed to show it increases reliability, and this says nothing on the subject of construct validity, i.e. if the disorder exists as they say it exists in the first place). Nor is my point that any of the above psychiatrists are more correct than any other. Though I could argue that those who believe in type II bipolar disorder are delusional, and though I have some sympathies with psychiatrist number 5 above in Jaxxsons case, I have seen some patients lives turned around for the better under the care of the ADHD guru who prescribes them legally sanctioned and otherwise illegal amphetamines (or a life turned around for a while anyway). No. My point is saying that psychiatry is a church so broad as to be stretched beyond the breaking strain of its own credibility, inhabited by persons blindly fumbling around in the dark with a Rumi’s elephant of person in the midst of the human condition in a fallen world. The same deconstructive critique could be levelled at any of the diagnoses, and future chapters will cover some of these. My point is that psychiatry does not have any epistemological foundation for any of psychiatrists one through five to lay claim to being correct. We might as well include in the example above a psychiatrist number 6 who formulates the case as a boy with Sagittarius disorder. A star sign is also a physical referent as much as a gene, and as equally convincing as a determinant to those who do not approach the topic of genes (or celestial bodies) critically so far as determining the psychology of the individual patient who sits across from us. With regard to the first patient example (i.e. the young emotionally unstable woman), my point is not simply to argue the non existence of type II bipolar disorder as to argue the non-existence of it and the cluster B personality disorders as anything more than convenient descriptors that all fail to adequately capture the person. And so they do more harm than good, or at least no better than the obvious fact of emotional dysregulation, a fact for all to see who have eyes to see. If the core problem can be almost whatever I argue it to be, then what really do we grasp in our intellectual hands? And if, as narcissism implies, the real “pathology” is, at least in our example, a “me, myself and I”-ism, might we have sailed so far from the shore of science and medicine that we are more in the misty lands of the humanities, of moral philosophy and even theology as ultimate formulations as to what maketh the man (or woman) in good cheer and bad? Yet another example might drive home the point. Following the suicide of the nu-metal rocker Chester Bennington of Linkin Park, I overheard some learned psychiatrists talking of his “depressive disorder” killing him via suicide, as if he succumbed to recurrent infections with some foreign agent. This was certainly the theme of all the many articles written in the wake of his passing, the infection of depression that he caught, the disease of depression he carried. I never once read or heard it pondered if the lyrics were not entirely the outward reflection of some mental illness as claimed. Deeper still were these lyrics to hold oneself in a constant choice of becoming not simply depressed, but were the lyrics within the world the beingness of depression itself, a constant meditation uttered over countless concerts, the aural dark cloud spreading out into the world again and again and reflecting back upon him. To quote only one of the songs,
“I tried so hard and got so far. But in the end It doesn't even matter I had to fall, to lose it all. But in the end It doesn't even matter”.
If so, where is depression? In some simple causal medical model? In the voiced expression of depression? That is to say, the tautology of one suffering from depression because one says they are depressed. How banal. Is it in some deranged neurochemical system? I can assure you no such “chemical imbalance” or serotonin or bio-amine deficiency has been found, and I doubt it ever will. Is the depression in the lyrics themselves? No. These can be interpreted as depressive nihilism or a beautiful poetic and liberating retelling of the book of Ecclesiastes. Rather I think that in the appetite for the potential nihilistic interpretation of the lyrics, is attached the mood that speaks to a sickness in mood of the world, an ever present proclivity in man to something destructive that the collective mind of psychiatry is hopelessly ill equipped to apprehend.
Psychiatrists are neither scientists and God forbid they be considered philosophers with the will to truth. They are narrators, story tellers, salespeople, engineers with medical degrees and medicinal tools and, to the degree they are bound together at all, a kind of secular clergy of a materialist faith. I’m amazed at how some patients wait months for an appointment with an in demand psychiatrist and walk away actually believing they were just diagnosed with something as solid and true as lung cancer or the Rock of Gibraltar, when the psychiatrist is more like an epistemological Wizard of Oz, all puffed up beyond the optics of the real image. Psychiatric stories are like the proverbial turtles, it’s convenient pragmatic stories all the way down. We are back to where we started. The ties that bind the definition of what a psychiatrist is, is the power itself to tie and bind, and the fallacy of authority makes the bondage stay tight.
Now the reader may wonder how such potential for (and often real) heterogeneity of opinion does not implode into infighting, psychiatrists cannibalizing each other’s credibility to mutual death. How do they stay strong and appear so coherent for so long? Guilds have evolved several mechanisms to counter this, and perfected these practices over decades. Some examples are included or implied within the text above. I will give three additional examples here…
Firstly, the Guilds control the publications and the conferences. True science and true philosophy are intellectually brutal endeavours, something akin to Spartan midwifery. The strong infant lives. The weak infant is cast out to die. In a similar vein, one knows in advance that an idea or hypothesis will be tested against either a dialectical process or an experiment. And that idea might too have to be cast out and die. The very statistical methods employed in data analysis in what passes for scientific method nowadays place the cherished idea as guilty until proven innocent. By way of a different analogy, the scientist must adjust their thinking and take on the role of an attorney for the prosecution against their own cherished hypothesis. Only in attempting to prosecute against their idea and failing does the idea have the right to walk out free into the sun. In philosophy the idea placed in peril might be philosophy itself. Several philosophers have laid claiming to ending the whole philosophical enterprise and been given their chance to do so. Some might argue otherwise, yet I would historically connect the scientific method as above described as in turn connected to that Christian drive to dying to oneself so that theosis, like scientific verisimilitude towards the truth, might take the place of self instead. One will never find the same glorious attitude in psychiatry. In the church or corporate body of psychiatry, what passes for robust debate always passes first through a filtration or screening process of guild and professional self interest. If critique is presented in a way that threatens the psychiatric church doctrine and its power, it will not even be declared anathema. It will simply not be published and will disappear in silence. They will probably allow the DSM to die in time and mock it in generations to come, but only when they safely have something else.
Secondly, renegade psychiatrists are like heretic priests, only worse in a sense. For if one studies the true history of the early church from which I make my numerous analogies, the patristic fathers who advanced what was called heresy were by and large left to their own devices. Even Galileo was not imprisoned in a tower as opposed to the family vineyard, and story of him being tortured was a myth. Renegade psychiatrists who criticize psychiatry in a substantial sense will not be tortured of course. They will be alienated and find it impossible to gain employment except in private practice or where they