Leaving Psychiatry. J. R. Ó’Braonáin. M.D.
or disorder groups as natural categories, or deconstructing the successful work of fiction that is the DSM. The attack is “meta” to the DSM, specific psychiatric disorders merely illustrative of a larger argument which is epistemological and political, even moral, in nature. Mine is an attack not simply against the bible of the church of psychiatry whose scripture I cast aside years ago, but against it’s very cannon and creed.
The audience for this book is everyone whose interest or personal experience falls within the orbit of what is called psychiatry or mental health, where mental health is paradoxically in practice a synonym for mental illness. Therefore, the audience includes the orthodox majority psychiatrists I’d like to foil yet who are immune from the voice of reason, the various minority heterodox spanners in the psychiatric wheel who call themselves critical psychiatrists (though curiously not critical enough to leave the profession and the comforts a qualification), junior doctors in psychiatry, nurses and allied health practitioners, and students of all the above. To budding trainees in psychiatry who pilgrim towards the good, the beautiful and the true through a road of free thinking and Socratic or scientific dialectic I’d plant this book as a sign alongside the path, a sincere plea that states “Go back. You will not find what you are looking for in psychiatry, and they are most definitely not looking for you either”. This is the sign I wish someone had given me all those many years ago, or rather the sign I gave myself and failed to read at the time. Finally, this book is also aimed at members of the lay public who might have sat across from this species of secular priest who might in turn have pronounced them sane or insane, of good cheer or bad. To you patients I would simply say some emperors are finely clothed in wisdom, this despite of their apprenticeship and career in psychiatry. Evaluate them as any person would another. I am very blessed to have known and been mentored by a few who have taken their wisdom and placed it in peril of moral and intellectual famine by the profession they have chosen. In refraining from providing personal acknowledgment, I will offer the highest of compliments by dissociation from heresy. Sadly however, the vast majority of psychiatrists are as naked in wisdom as the day they were born.
As if it wasn’t obvious, I’m using a nom de plume. In the fullness of time if the title of the book becomes a matter of past tense, i.e. having left psychiatry, I’ll be tempted use my real name. Apart from the tradition amongst some doctors to write in pseudonym so as to protect the anonymity of patients discussed, anonymity also protects me. For I continue to practice behind enemy lines as it were, and have seen firsthand what happens to the careers of others who dare question too far mainstream psychiatry and the professional guilds from which it draws its power. I should very much like to continue to pay the bills, whilst seeking to quieten a whispering conscience lest it become a scream that will trouble me from sleep. On this point I wish to apologize to the reader for not revealing more of myself, for I would contend that one cannot really cannot understand why a thinker formulates the thought and arguably the quality of the thought itself without understanding the thinker his/herself in all his or her foibles and biases. Every creation carries the stain of its creator. Ergo caveat emptor.
Two of many questions haunt me into writing this book, and haunt me they do as mine is not a captious critique. These are the topics of the final two respective chapters. The first is the degree to which I might find it possible to identify with philosophy of the late psychiatrist Thomas Szasz (some would say anti-psychiatrist, I would say he was neither). I invite the reader to review the works of Szasz first, and also others critical of psychiatry. These include Peter Breggin, Paula Caplan, James Davies, Peter Gøtzsche, David Healy, Niall McLaren, Joanna Moncrief, John Read, Jeffrey Schaler, and Robert Whitaker et al.
The final chapter is more radical still, as if it were conceivably possible to be more radical than Szasz, i.e. what if psychiatry, as opposed to other medical/surgical specialities, simply went away. Would it matter in the same way the maimed would stay maimed if the orthopaedists were to vanish? The answer, cutting to the proverbial chase and making friends and enemies before the first word is read is this; the world does not need psychiatry. Nothing would happen of necessity were it to vanish, nothing bad anyway.
Ontogeny. Entering Seminary.
"Ideally a book would have no order in it, and the reader would have to discover his own."
Raoul Vaneigem
"Education no longer has a humanist end or any value in itself; it only has one goal, to create technicians"
Jacques Ellul
In the beginning, or in this beginning anyway, was the medical student. Only the medical student is far from being without form or void. Quite the contrary. By the time the medical student has their first encounter with psychiatry they are thoroughly encultured in a way of approaching whatever subject matter comes their way, and these cognitive (if not ideological) schemata have gathered such a powerful momentum that it can quite easily launch them into their psychiatric term and spit them out the other side without them having the faintest idea just how alien and even mythical was the species that passed into view for those 10 or so weeks. I include amongst them even the medical student who rejects psychiatry at the outset, for they know not what they reject. They are the ones whom, later as physicians and (especially) surgeons will politely describe their clerkship in mental health as “interesting’ and “valuable but not for me”, this being the most charitable descriptor they will offer to the psychiatrists face. What is said behind the psychiatrists back is, as usual in human nature, another matter entirely.
Broadly speaking, medical students pass through two pedagogical pathways nowadays, both reaching a considerable convergence in the latter phase of studies. The first is a more traditional form, starting with the basic medical sciences of anatomy, physiology, biochemistry and the like. If not stated explicitly, what is certainly taken up implicitly is the notion that one’s vocation is as an applied engineer of a biological machine and, post Virchow, the fundamental patient is the cell, if not some subcellular molecular unit below cellular life or some organ system above it. Granted there will be plenty of lectures from plenty of health sociologists and public health physicians restating endlessly and to the point of tedium various definitions of “health” and “illness” and UN charters of this and that human right (and rite), all the while the student sits there yawning in the most justified assumption that their intuition as a human being informs them when they are well and when they are sick, and when they are making a mess of themselves qua a multicellular ship of Theseus as their soul voyages from birth to death. Granted there will be plenty of lectures and reminders of lectures that we are treating a whole person with whom we must communicate “empathically”. Yet even these lectures on communication are, if to be honest, part of a micro-social engineering strategy. How do I get to the cell and physiological system “through”, as it were, the person? How I might gather the data their body wants to tell me through what might otherwise be a brick wall of personality, should I not first gain “rapport” by uttering some comments here and there “that pain must have been hard for you” as we lean in a little, chair placed adjacent to the patient as we were taught in the class on proxemics (as opposed to on the other side of a desk). How might I charm the patient to take the pills if I don’t empathize with their “lived experience” of side effects and “stigma” whilst pointing out the inevitably (or so it would seem inevitably) higher risks should they flush those very same pills down the toilet. It can be very disconcerting being a physician patient of another physician communicating in taught empathy. It’s just too predictable and quasi-robotic and leaves the doctor who is patient looking in turn to find the person through, as it were, the physician who “cares for” the doctor who is the patient. Thankfully most patients live in blissful ignorance of feigned caring, and many a physician has first deceived themselves that they care. These will be the physicians taking the greatest umbrage at my analysis. No, the patient is the machine that is the body, and more to the point, an abstraction constructed from the machine, for even the body eventually is ignored in the age of information. Psychiatry is no different, though the castle it builds on the body is a castle built on sand.
Returning to the more traditional model of medical education; in learning by rote the almost endless list of facts of the basic medical sciences, which are of their very nature philosophically materialist,