Anti-Psychiatry

By Marvin Ross

I really don’t get it – anti-psychiatry that is. I can understand that if someone has had a bad experience with a psychiatrist, they might be wary and hostile. After all, not all doctors are good and I have no doubt that most of us have run into a bad one over the course of our lives. I certainly have seen my share of rude, arrogant and stupid doctors from family practitioners to cardiologists but I do not condemn them all. I do not devote my energy to attacking emergency medicine because of a bad ER doc I’ve encountered.

A lot of the anti-psychiatrists I’ve encountered fall into this category. They’ve had a bad experience and generalize to all. But a lot of the others aren’t in this group. They are people who have decided that their time should be devoted to attacking psychiatry as their contribution to freedom of the individual or to the good of mankind. And, for the most part, they know very little of neuroscience, medicine or mental illness. If they truly want to make a difference, they should devote their time to advocating for better care and treatment for the seriously mentally ill or to help with the growing problem of refugees, world peace, homelessness, child poverty, and the list goes on.

For the most part, they are mistaken in their views of psychiatry as Mark Roseman pointed out so brilliantly in his review Deconstructing Psychiatry. I highly recommend that people read that. His analysis is far more detailed than mine but I would like to comment on a few of the common myths that he covers in more detail.

The one complaint that is common among the anti-psychiatry mob is that psychiatrists are controlling people who give an instant diagnosis and then force their patients to take toxic drugs.

People do not go to see psychiatrists by calling one up or walking into their offices. They need to be referred by a general practitioner or via a hospital like an emergency room. And they would only be referred to a psychiatrist if they had psychiatric problems that were beyond the expertise of the general practitioner. That referral would only be made after the general practitioner had ruled out non-psychiatric causes of the symptoms and behaviour.

Like all doctors, the psychiatrist will take a detailed history from the patient, consider possible diagnoses and recommend appropriate treatment. The treatment recommended is based on the professional guidelines outlining evidence based strategies. These are the practice guidelines used by the American Psychiatric Association. Similar guidelines are used in different countries. The cornerstones of any medical practice are to do no harm and to relieve suffering.

I often hear comments and criticisms that a psychiatrist put someone on toxic drugs that they were then forced to take for eternity. A comment to my blog on the anti-psychiatry scholarship at the University of Toronto stated “based on the results of a positive diagnosis (from a 15 minute questionnaire score) a patient (including young children) may receive powerful psychoactive drugs for years, the long term effects of which are not yet known.”

As I said above, the diagnosis is not based on a 15 minute questionnaire but on an extensive evaluation. And, regardless of the medical area, drugs are always (or should be) prescribed in the lowest dose for a short period of time and the patient brought back in for evaluation of efficacy and side effects. The goal is to find the lowest dose that is effective with minimal side effects. This is a process called drug titration.

If the drug is not effective or if it causes too many unwanted side effects, it will be changed. No one is forced to take a drug that does them little good in any discipline of medicine. Surely, the patient does have choice to continue with that doctor or not and to take the advice that is offered. People who see psychiatrists are not held captive.

When it comes to children, they are not seen in isolation as the anti-psych criticism I quoted above implied. They are seen with their families who, understandably, do not want their kids on powerful drugs. There are long discussions with the psychiatrist where all less invasive means are explored. When pharmaceuticals are prescribed, the parents are at complete liberty to stop them if they do not work or if they cause troublesome side effects. The children are not held captive by the psychiatrist and force fed pills against the wishes of the parents.

When a child does continue to take the medication it is because it is having a benefit and there are no troublesome side effects. I remember a mother who resisted Ritalin for her hyperactive child for years telling me how well it worked once she decided to give it a try. “I wish I had tried it much earlier”, she told me. “It would have saved so much grief.”

The anti-psychiatry bunch also assert that mental illnesses do not exist and cite the lack of any one definitive test to prove bipolar disorder, schizophrenia or other afflictions. Quite true but the same can be said for many other maladies. How about Parkinson’s as but one example. Doctors cannot measure the amount of dopamine in the brain (which is depleted in Parkinson’s) to definitively say that the person has the condition. They determine the presence of this condition based upon observing the person and his or her movements.

Alzheimer’s is another. Like with schizophrenia, it is diagnosed by eliminating all possible other reasons for the observed dementia and when none can be found, the diagnosis of Alzheimer’s is made. On autopsy, there will be found specific markers but no one ever gets an autopsy to prove that the doctor was correct. And rarely is anyone with schizophrenia autopsied on death but this is a lengthy list of the abnormalities that demonstrate that it is a disorder of the brain.

The anti-psychiatry group should be looked upon with the same disdain that sensible people look upon the anti-vax faction.

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2 thoughts on “Anti-Psychiatry

  1. The big stumbling block for the anti-psychiatry folks it that they will not accept that some people suffer from medical conditions that physically impair the brain e.g Schizophrenia and Manic Depression. to name a couple. Treatment is usually somewhat restorative. It is my belief that many of the anti-psychaitry people are not only bigoted but criminal in that they step between a patient and needed treatment. Imagine if they called insulin injections a toxic substance . Of course an overdoes would be.

    Over the years i have been on committees where anti-psychaitry people have described a life saving injection an assault. One even said “but diabetic patients agree to have insulin” to which I replied . They can’t if they are in a diabetic or insulin coma.

    Liked by 2 people

  2. As usual I enjoyed your comments today. This Antipsychiatry force is a phenomenon I’ve given much thought over my decades of experience. I’ve also wondered why psychiatry and not others. My good friend is an experienced oncologist who talks about his frustrations with antitreatment people promoting alternative treatment and conspiracy fanatics who claim that a cure for cancer exists but big Pharma keeps it secret. My son is a pediatric cranial/facial surgeon who complains about rampant misinformation campaigns and threats of litigation. I’ve come to believe there are two basic reasons antipsychiatry gets so much more notoriety.
    First, psychiatry has been forced to address the intersection of mind and body. Or better still, the soul and body. No other medical specialty has to struggle with existential and spiritual issues tha can be seen as threatening to self identity and the meaning of life. To many people, Psychiatrists are the only medical specialists who have the potential of capturing the soul.
    Another fuel for Antipsychiatry fervor is the fact that psychiatrists are the most difficult to sue. Simply put, other unhappy patients are more like to get their pound of flesh revenge against perceived wrongs by any other medical specialty. Catharsis can only be experienced through Antipsychiatry vitriol.
    Having said all that, Marvin, I must disagree with your comments about the 15 minute evaluation. I don’t know about Canadian psychiatrists, but my experience in the US is that you’re lucky if you find a psychiatrist that spens more than 15 minutes, especially in an institutional or crisis setting where they many be required to see 30-60 patients in one work day. Even psychiatrists in private practice have learned that an assembly line practice is the most profitable. Even in institutional settings with a mental health team approach, some psychiatrists may disregard input from other clinicians. That’s why one person may receive numerous diagnoses and widely varying prescriptions over time.
    I agree that mental health treatment needs to be improved, not abandoned.
    Thanks again for your insightful analysis.

    Liked by 1 person

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