The Psychiatry Problem
Resistance to a scientific paradigm of mental health
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The devaluation of subjective experience when it comes to mental health is laughable and ironic, but history has shown that no matter how many people report being mistreated, abused, misdiagnosed, and overmedicated, systemic change will not take place on account of patient testimonials.
Aside from subjective descriptions, the two key factors we consider when it comes to the diagnosis and treatment of psychological suffering are mechanism and clinical evidence. By studying the physiological mechanisms of perception and consciousness (i.e. the brain and nervous system) we gain a better understanding of how the mind works. By observing how patients respond to different treatments, we gain a better understanding of how to treat psychological suffering.
Perhaps in the future, we will be able to measure and quantify consciousness with a precision similar to our current capabilities with physic and chemistry, but for now, this combination of subjective descriptions, mechanism, and clinical evidence is the closest we can get to a scientific understanding of the human mind.
By these metrics, the Diagnostic and Statistical Manual of Mental Disorders (DSM) can no longer be considered scientific.
Psychiatry and Anti-Psychiatry
The word Psychiatry comes from ancient Greek, and combines psyche (soul or mind) with iatros (healer). If we think of psychiatry as healing the mind or maybe the medical healing of the mind, it’s hard to imagine that anybody would have a problem with psychiatry, yet there is an Anti-Psychiatry movement nearly as old as psychiatry itself.
Being pro- or anti-psychiatry is unproductive and philosophical. To address the issue productively, we must identify concrete problems and solutions.
Here are some issues I see:
The DSM, which is written and published by the American Psychiatric Association (APA), is more or less the official playbook of governmentally endorsed mental-health care institutions. Despite a mottled history of human rights abuses and questionable ties to the pharmaceutical industry, the APA still presents itself as the authority on consciousness-gone-wrong.
The APA and DSM continue to tout chemical imbalances as the root cause of mental illnesses and pharmaceutical medicine as the best solution. They exhibit a grandiose lack of meta-cognition of their position in the greater landscape of healthcare and the human experience and downplay or ignore an increasingly irrefutable body of scientific (i.e. mechanistic and clinical) evidence that indicates chemical imbalances to be just one small piece of the human experience.
Some examples of what the APA and DSM downplay and ignore are nutrition, meditation, epigenetics, gut health, somatic therapy, EMDR, psychedelics/plant medicine/entheogens, environment, polyvagal theory, cold exposure, flow states, peak experiences, numinous/non-dual experiences, the placebo effect, and cognitive and affective neuroscience.
Sometimes this new sort of understanding of how the mind works is called being “trauma-informed”. A few of the pioneers and big names in this general territory are Gabor Mate, Peter Levine, Stephen Porges, and Bessel Van Der Kolk. All of them hold PhDs, the last two are psychiatrists, and all of them are extremely critical of the scientific validity and clinical efficacy of the current institutional expression of psychiatry and the DSM.
The gap between what we know about the biomechanics of human consciousness and the model put forth in the DSM is widening, but the mainstream psychiatric paradigm continues to operate with a sort of doublethink that views the mind as separate from the body and environment, yet endorses pharmaceutical intervention as the first and best method of treatment.
The American Psychiatric Association and the DSM
The APA and DSM function on a tautological loop that goes something like this:
The DSM was written by psychiatrists, who are the most scientific and medically competent thinkers in the field of human consciousness. We know that psychiatrists are the most scientific and medically competent thinkers in the field of human consciousness because that’s what it says in the DSM.
It’s almost as if they believe their book is the official source on how a person should feel, think, and behave because they’ve written it and say they know best.
I can’t quite pinpoint what that reminds me of, but it definitely reminds me of something.
In their own words
Authors like Ethan Watters and the organization Mad in America do an excellent job of detailing the many branches of the psychiatry problem, but one of the best resources for a clear view of how it all works is the official website of the APA, psychiatry.org.
The organization identifies itself as “the voice and conscience of modern psychiatry. Its vision is a society that has available, accessible quality psychiatric diagnosis and treatment.”
Some of their mission statements and goals are focused on patient care:
Promote the highest quality care for individuals with mental illness, including substance use disorders, and their families
To improve access to and quality of psychiatric services.
To improve research into all aspects of mental illness, including causes, prevention, and treatment of psychiatric disorders.
But more are focused on protecting psychiatrists:
Promote psychiatric education and research
Advance and represent the profession of psychiatry
Serve the professional needs of its membership
To improve psychiatric education and training.
To promote optimal conditions for practice and career satisfaction.
To foster collaboration among all who are concerned with medical, psychological, socio-cultural and legal aspects of mental health and illness.
To improve the functioning of the APA in the service of its mission.
In an article from January 2021, entitled Is the term ‘Psychiatric’ becoming extinct, APA president Jeffrey Geller worries about how the loss of the term psychiatric in favor of terms like mental health, mental illness, and mental disorder will impact the future of his profession.
“Maybe the “psychiatric” versus “mental” disorder distinction didn’t matter so much 70 years ago when psychiatrists dominated the treatment of psychiatric disorders. And maybe we don’t care that “mental” is heard loud and clear these days and “psychiatric” is becoming a whisper…Our profession will be ill served if “psychiatric” becomes an archaic word, if DSM-6 slides into being the Diagnostic and Statistical Manual of Mental Health Issues, and the name of the publication you are reading becomes Mental News…But of course the issue is more than about how we use words. It’s about our identification and role as psychiatrists…And it’s about what we want the profession of psychiatry to be.”
Geller’s nervous article is typical of modern psychiatric rhetoric, which prioritizes the continued existence of the institution of psychiatry more highly than the treatment of patients.
The Psychiatric Solution
I dream of a scientifically literate global jury that could preside over the hypothetical case of “The APA vs. Common Sense and Science”. The DSM’s biochemical model would be proven intellectually indefensible, conflicts of interest with pharmaceutical corporations would be exposed, and the APA would be forced to dissolve or adapt to a more up-to-date understanding of how consciousness works.
This isn’t how it will go, of course. Institutional change is slow. The industry is too profitable and powerful to disappear overnight, and as we see on the APA’s website, the old guard is dedicated to their survival, regardless of whether psychiatric treatment is healthy for patients.
The first steps are admitting there is a problem, getting educated, and changing the conversation.
As with issues like systemic racial and gender inequality and the prison industrial complex, we must become conscious of the psychiatry problem before meaningful change can occur. We need to stop pretending that the American Psychiatric Association is the medical authority it claims to be and start talking about it as the self-interested, sinking ship that it is.
We need to normalize skepticism towards psychiatry in conversations surrounding mental health.
When we start seeing them for what they are — lamplighters protesting electricity, farriers resistant to automobiles, taxi drivers protesting Uber — they will be forced to adapt or go away.
