For generations, the medical profession has been given prime responsibility for mental health care. Governments throughout the world see no need to independently assess the validity of the claims, the practices, of psychiatry. This, I believe, is a serious error on the part of governments worldwide. Are psychiatrists and GPs truly the independent-thinking, objective scientists they portray themselves to be? Lets look for a moment at what doctors say, and compare that to what they do.
The predominant belief within the medical profession regarding mental health problems such as depression, bipolar disorder, and schizophrenia, is that these so-called ‘mental illnesses’ are physical, biological conditions requiring physical, biological treatments. Doctors frequently compare these so-called ‘mental illnesses’ to biochemical conditions such as diabetes.
What doctors do, however, is another matter entirely. Neither GPs nor psychiatrists ever confirm any psychiatric diagnosis with laboratory tests. Why? Because no such tests exist. If such tests did exist, they would immediately become widely publicised and widely available.
Such tests would enormously vindicate the biomedical approach, and those who support the biomedical approach would ensure that they became widely available. Compare this to what doctors do regarding known biochemical conditions such as diabetes. Biochemical tests are an essential part of the diagnosis and ongoing management of diabetes, and of all known biochemical conditions such as hypothyroidism, pernicious anemia, iron deficiency anemia.
How can it be that there is such a vast discrepancy between what doctors say, and what they do? This leads me directly into two related topics; the limitations of psychiatry, and psychiatry’s resistance to change. Doctors are human. While psychiatrists publicly project an air of science and authority, to understand the vast discrepancy between what doctors say and what doctors do, one must look at the human side of the medical profession. Doctors are prone to the same insecurities, vulnerabilities, self-interest, biases, limited vision, external influences, defence mechanisms, and wishful thinking which can and do occur in any area of life.
This point came forcefully home to me five years ago. I had been asked to give a three hour talk with recently qualified doctors. During this talk, I expressed my concerns about mental health care, and about the major inadequacies in the training which these young doctors had experienced. At the end of the talk, most of these young doctors were visibly unsettled. Never before had their faith in the medical system been questioned in such a manner. After the meeting, one doctor wryly commented, "Great! – now we don’t know who we are!"
Those words helped me to see the role played by the human aspects of doctors in maintaining the status quo within mental health. Psychiatrists and to a lesser extent GPs have an enormous investment in the current medical approach to mental health care.
In reality, the biology of mental health problems is a belief system. It is a belief system because doctors have such faith in it, even though their patients never, ever have their supposed biochemical imbalance confirmed by biochemical or other tests.
Three characteristics of belief systems are:
1. an investment in the continuation of the belief system by those who run and believe in the system;
2. a resistance from within the belief system to question the fundamentals of their belief system and to resist such questioning from others;
3. a resistance to the exploration and development of other beliefs, beliefs which might challenge or reduce the power and influence of the said belief system. The preservation of the belief system and of those who propagate it becomes paramount.
It can be said of some belief systems that they are not based on logic, more on desire and wish fulfilment. This is true of psychiatry. Belief systems frequently aspire to a future salvation or redemption. With regard to psychiatry, the future salvation is the hoped-for biochemical and biological proof - at some time in the future - of causation for mental health problems. This hoped-for future salvation would lead to the redemption of psychiatry, allowing psychiatry to finally take its place as the respected medical specialty it desperately seeks to be.
Who has most to lose if the current drug-dominated and biologically-focused psychiatric system were to be expanded to a truly bio-psycho-social model of mental health care? Not service users. Service users want help to overcome the distress they are experiencing, to get their lives back on track. They do not have an enormous vested interest in the type of help provided within the services.
It is the service providers who have most to lose - psychiatrists, GPs, and of course the pharmaceutical industry. Groups or individuals, who have a lot to lose, tend to resist changes which may diminish their power, influence, status, earning power, sense of identity, regardless of whether such changes might benefit the community generally.
The path of psychiatric research over the past 100 years confirms this. Filled with a passionate desire to establish psychiatry as a scientific, respectable branch of medicine, for more than 100 years psychiatrists have made a major error of judgement. They first arrived at their conclusion, the outcome which most excited and validated them, and set up their research to prove that their conclusion was the correct one.
Having decided that mental illness was caused by a physical brain defect, psychiatry has in the main designed research to establish that this is the case. Thus, the cart was put before the horse. Wishful thinking becomes presented as scientific thinking. This approach is grossly unscientific. Science demands, of those who purport to be scientists, an open and enquiring mind; rigorous, regular self-examination to ensure that one’s own biases are not influencing one’s conclusions; and sufficient honesty and humility to acknowledge the possible validity of views contrary to one’s own. Science does require us to be open to the possibility that at some future time, perhaps biochemical and/or genetic imbalances may be identified for mental health problems. Science also requires that we do not come to premature conclusions; that is precisely what the medical profession has done for decades, unfortunately.
It is no coincidence that what psychiatrists value – medication, for example – is widely available to patients, while what psychiatry does not value – counselling, self-esteem, self-confidence, empowerment-building programmes, step-by-step programmes to help people get their life back on track, for example – are thin on the ground within the mainstream mental health services.
Regarding what is called schizophrenia, psychiatry has preoccupied itself with certain aspects, such as hearing voices, so-called delusions, and paranoia, seeing these as meaningless and purposeless evidence of psychosis. Hence, psychiatrists rarely explore or validate these experiences. However, I and others have come to see so-called hallucinations, delusions, paranoia and many other such experiences in a very different light.
These experiences frequently reveal something very important about the person, about their life. I have found that exploring these experiences can be extremely worthwhile. Talking about them is frequently very important to the person, since it is not everywhere that they can talk candidly about these experiences.
I have also learned that through exploring these experiences, both I and the person experiencing them can come to an understanding of them, can see the sense in them, so to speak. This can be quite beneficial for a person who up to now has been told that these experiences are meaningless, symptoms of their illness.
But I won't be holding my breath waiting for mainstream psychiatry to enthusiastically develop this possibility further. Because to do so might threaten the belief system, might produce results which question the fixation with biology and which might suggest that approaches other than medication may have real potential. This is directly against the beliefs of the psychiatric belief system. Such ideas will not be fully developed as long as biopsychiatry dominates mental health care, regardless of any potential benefit for the user of the mental health services.
Schizophrenia Ireland, a major service user group in Ireland, carried out a survey of service users in 2002. Many interesting findings emerged from that survey. The survey asked respondents about a range of non-medical interventions. The most commonly experienced non-medical interventions included employment training, counselling/psychotherapy, peer group support, and Art/Music/other creative therapy. In each of these areas, an average of over 75% found the intervention to be very helpful, or helpful. Yet, the vast majority of psychiatrists insist that counselling and psychotherapy are a waste of time in the treatment of schizophrenia, bipolar disorder, and, to a considerable degree, depression.
Service users are saying they want these services and find them helpful. Psychiatry, however, is telling service users - and governments - that doctor knows best, that service users own experiences regarding what helps them cannot be relied upon. Hardly a democratic way to provide services. Psychiatry continues to insist that counselling and psychotherapy and other psycho-social interventions have little role in the management of enduring mental health problems.
Its not as if drug treatment of schizophrenia is so successful that we can be complacent about the possible value of other treatment options. According to a London psychiatrist, quoted in the Summer 1998 edition of Community Mental Health, "Sedation, rather than any genuine anti-psychotic effect, is often the main role of standard anti-psychotics". Recovery rates from schizophrenia have not improved over the past 70 years.
World Health organisation studies suggest that recovery rates from schizophrenia are significantly higher in underdeveloped countries than in developed countries. In order to maintain the belief system, psychiatry needs to remain blind to the possibility that psychosocial approaches have real potential. This situation is hardly in the interests of the users of the mental health services.
The medical approach focuses on maintenance, on symptom control rather than on recovery. Far more attention and research should be devoted to those who have recovered, to identify what factors were important in their recovery.
Such research would contribute to a far more proactive mental health care policy than currently exists, but isn’t happening to any great extent because it is fundamentally challenging to the biomedical belief system.
Any theory which might potentially enhance our understanding and our approaches to the condition should receive appropriate attention. Because of medical tunnel vision in favour of biological theories and against psycho/socio/emotional aspects of mental health, such exploration is currently not happening. Even in the top psychiatric hospitals, patients regularly report that there is little for them to do during the day. The day revolves around the drugs trolley.
Steps need to be taken towards the creation of preventative policies within mental health care, something which is currently virtually nonexistent, due in no small part to psychiatry’s focus on biology at the expense of psychosocial issues.
Thus, the limitations of psychiatry permeate all aspects of mental health. I urge you to do all you can to bring this to an end. Only then can we create a truly bio-psycho-social model of mental health care.
Thank you very much.
Source: Understanding Psychiatry's Resistance to Change
Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers