Leaving Psychiatry. J. R. Ó’Braonáin. M.D.
especially when it was in his hand. Having mastered the psychiatric projection onto the world, the psychiatric trainee is too far from the great works of literature and the humanities they likely never read at all or at least not deeply, literature that might have provided a different more illuminating view of the human condition. They have given themselves over to the grace of a special kind of human indoctrination towards a special kind of secular priesthood. Welcome to seminary.
But I wish not to mix my metaphors too much here, and certainly not to the point of contradiction. To be sure I see the psychiatrist as a secular priest of a kind. To the end of convincing you of this fact I will provide evidence aplenty in the chapters to follow. Yet all the above talk of algorithm in medicine and psychiatry leads one to something perhaps more sinister, that being the mechanization of humanity. You see when the patient is situated upon the algorithm the patient ascends to the realm of abstraction and ceases to be as a human being. This is not to imply the malady in psychiatry is the misplaced primacy of the biological over the psychological, or a lack of kindness or apprehension of the pathos in the heart and mind of the psychiatrist. Heaven forbid I suggest anything so banal. What I am suggesting is that looking upon the patient as an object situated upon an algorithm or a bookmark to be placed in the appropriate page of the DSM is a red herring for the concerns of the humanities in psychiatry (or medicine in general for that matter). For what is assumed not to be lost, this assumption being entirely false, is that the psychiatrist has themselves retained their humanity. You see when the psychiatrist sees you as an object of a flow chart they must first have taken into themselves the being of “flowchartedness”, of “differential diagnosis”, of DSM and all that makes for the method. Having identified on too deep a level with their method, they are like Heidegger’s carpenter where the hammer is ready at hand, and indeed the hammer is an extension of himself, and he of it. And the method of squashing humanity out of psychiatry is an essential part of psychiatry itself, for how can it be otherwise. The method being what it is, without it psychiatry would cease to be. Even the psychiatrist cannot escape the technocratic method of approaching the person, for the method sits “meta” to he (or she), in the body of knowledge and the bureaucratic imperative for how the patient is processed through their own mind just as their body is processed through the hospital. These metastructures, like Adam Smith’s unseen hand of capitalism, take on a life of their own that in turn reflexively sets to mould both the psychiatrist and patient alike. The imperatives are efficiency, comprehensive “mental health assessment” and documentation, “risk assessment” and risk minimization, accurate diagnosis according to the accepted nosology and so on. Each one of these is a place upon which the patient is situated. And then the psychiatrist feeds the method and bureaucracy in its insatiable need to consolidate and expand itself, to sustain its own lifeless being. And in each and every psychiatric transaction there is nothing but method as far as the eye can see. Unless one is inoculated by a congenital hatred of it, one fails to see technocratic slavery save in such examples where the method approaches absurdity. Take for example the adolescent in state care. He is wilful and violent, this in some way related to adverse events of early childhood, chiefly being witness to violence from adult others. It does not take a genius to recognize the developmental connection which is its own explanation. And his supposedly psychologically trained residential care workers follow their method when he is violent, the method as directed by their own cognitive schemata and the directive of their hierarchy. They call the police or paramedics, for he requires a mental health assessment, or so says their method. And the police or paramedics dutifully respond, bringing him against his will to the hospital with the powers invested in them by the state and its mental health legislation. Their motive and orders too are the same. And all look to the psychiatrist to “assess”. What is the diagnosis, this is one question? What is the risk is another question? What might the treatment be for this condition is yet another question as the adolescent is placed upon the assessment machine? The answer, alien as it may seem to some readers, is no answer at all. The child is badly behaving. There is nothing to explain that has not been already. There might be corrective action in order, likely not to be successful in his march towards criminality yet not to be considered “treatment” in any sane world inhabited by those who have retained their humanity and good sense. Yet these simple answers simply do not compute. All involved, from the emergency physicians to the police to the care workers look doe eyed and baffled when I say there is nothing to be explained that is not known to any competent adult, and no recipe to a remedy that is medical and not the analogue of good parenting. But what is the “diagnosis” and how might we treat it? What psychological therapy will “change him”? Let’s talk medication another says. Good sense falls on deaf ears. The child settles. Most hot heads do. And he returns back to their care. And later that week he returns again under similar circumstances, the action activated by the method, and returns twice more the following week, and three time more the next. The humans who behave like stupid robots act reflexively. The questions are the same. The assessment is demanded by the method. My (non) answers are the same, as I refuse answer as an agent of the psychiatric machine. The failure to compute is thoroughly recalcitrant to good sense, for the person has given themselves, their mind, their individuality, their good sense, all given over to method. And on goes the circus. Even to negate the method by appeal to personal psychiatric authority as opposed to good sense of an adult human being is itself to fall victim of the subtly of the technocratic machine. There is no escaping it save to escape psychiatry. So yes welcome to seminary. Yet welcome also to the machine of what a technocratic psychiatry has wrought on the world. Only the joke is on you, for if you enter into psychiatry the machine is you.
Ontology. The Keeper of the Keys.
“When we cannot be delivered from ourselves, we delight in devouring ourselves. In vain we call upon the Lord of Shades, the bestower of a precise curse: we are invalids without disease, and reprobates without vices”
E. M. Cioran
What is a psychiatrist?
The UK Royal College of Psychiatrists website “What is psychiatry?” offers a rather laconic description, prompting the question of the boundary between what is a mental health condition and what isn’t. Whatever they say it is I guess.
“Psychiatry is a branch of medicine dealing with people with a huge range of mental health conditions. As a psychiatrist you’ll help people to manage, treat or recover from these.”
The United States American Psychiatric Association, “What is psychiatry?” provides a longer, yet altogether equally prosaic definition. They say…
“Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioural disorders. A psychiatrist is a medical doctor (an M.D. or D.O.) who specializes in mental health, including substance use disorders. Psychiatrists are qualified to assess both the mental and physical aspects of psychological problems. People seek psychiatric help for many reasons. The problems can be sudden, such as a panic attack, frightening hallucinations, thoughts of suicide, or hearing "voices." Or they may be more long-term, such as feelings of sadness, hopelessness, or anxiousness that never seem to lift or problems functioning, causing everyday life to feel distorted or out of control.”
The US guilds definition is equally provocative of questions. An emotion is not a behaviour granted. Yet is an emotion not something “mental”? Are substance use disorders a matter of mental health, or the product of choice? And in what sense is substance use a “disorder”? Is disorder “a thing” in the sense that cancer is a thing? And when I was going to school “anxiousness” was not a real word. My how things change when psychiatry is the lexicographer.
In Oceania the Royal Australian and New Zealand College of Psychiatrists define the psychiatrist thus
“Psychiatrists are medical doctors who are experts in mental health. They specialise in diagnosing and treating people with mental illness. Psychiatrists have a deep understanding of physical and mental health – and how they affect each other. They help people with mental health conditions such as schizophrenia, depression, bipolar disorder, eating disorders and addiction.”
The Royal Australian and New Zealand College of Psychiatrists at least makes an attempt at something more, succeeding at defining