Thursday, January 12, 2012

We Can All Get Along - Can't We?

Last week, I killed off the term, “antipsychiatry.” These days, we only hear the word used as an insult, too often in the context of attempting to discredit even mild critics of psychiatry. 

I may know what I mean when I use the A-word, but others hear it in a different way. They hear it as a weapon to silence skeptical enquiry, to discredit the recovery movement, and - worst of all - to devalue the personal experiences of those who have stories to tell.

So - good riddance to the term. Yes, there is a fringe element out there, but we’re going to have to find a new way to describe them. In the meantime, it is useful to focus on what we all appear to agree on. Forgive me if this all seems obvious, but that is the very point of this little exercise ...

We all believe in recovery.

Not only that, we’re in general agreement on the things we need to be doing to achieve recovery. These may vary widely from individual to individual, but there is a very broad consensus that meds are only a small part of the equation. The real work - which tends to involve accepting brutal realities, making tough decisions, and implementing serious lifestyle changes - is up to us.

It goes without saying that settling for badly compromised existences in the name of stability is wholly unacceptable, but I’ll say it anyway.

We all believe in mental illness.

When we happen to describe the hells we’ve had to endure and the unbearable pain we’ve been through, we’re not just making this up. This is not psychiatry labeling us or pathologizing our behavior. By the time we come to the attention of the psychiatric profession, we have already performed a spectacularly successful job of wrecking our lives beyond recognition. We want the pain to stop - at any cost - and sadly too many of us wind up choosing what we think is the only way out.

We can argue all we want about what to call it and how to define it - much less how to treat it - but when all is said and done, we tend to be fairly relieved when we discover that someone has a name for it. Call it “Fred,” for all I care. 

We all want to know what the hell is really going on.

Brain science is yielding spectacular new insights on the interactions between our genetic makeup and the environments inside and outside of us. This in turn is forcing us to rethink human behavior from every conceivable angle. The one thing we know for sure is that we don’t know very much, which means literally every idea is on the table. No one has an easy answer, which means rigid belief systems no longer cut it with us.

But - oh! - the thrill of discovery. A new piece of evidence, a new insight, a new revelation. We connect our own dots. We draw our own conclusions. We make our own decisions.

We all realize the paradigm is changing.

Psychiatry and its over-reliance on medications is experiencing a current self-inflicted lack of respect. This is occurring at the same time as Big Pharma is pulling out of the business of new psychiatric meds development. A new generation of psychiatrists pushing the same old meds serving up the same old explanations simply defies credibility. 

Thankfully, a new science of the mind is emerging, along with a consumer-driven recovery movement. Psychiatry can choose to be part of both, but when the dust settles it is highly unlikely that as an institution it will be leading either.

We all respect each other.

There may be a general consensus on the same issues, but our own diverse experiences and ways of looking at the facts guarantee that no two people are going to agree with each other on all issues all the time. Thank heaven for that.     

5 comments:

Smitty said...

Amen amen and amen.

But how sad that psychiatry will not be leading. Not the consumer recovery movement nor the new science of the brain.

I bet they wish they had listened to the fringe, the same ones they tried to discredit, as they tried harder and harder to stand on the sands of time.

The sands we'll be making as we grind up all those old meds and landfill them, knowing they never really worked the way the docs kept insisting they did.

Amen, the truth is finally coming to us all.

John McManamy said...

Hey, Smitty. Your comments just prompted this thought: I wonder what psychiatrists talk about when they're in the lunchroom together.

Do they complain that TV producers think they're too boring to do a TV series about, like House or Grey's Anatomy?

Do they complain that they don't make as much as cardiologists?

Do they complain how they get no respect from endocrinologists and those who practice "real" medicine?

Do they complain that the Pharma gravy train ain't what it used to be?

Do they bitch about insurance company paperwork? (Okay, all MDs bitch about this.)

Do they complain about how uncooperative their patients are?

Actually, I wouldn't mind if they complained about all this stuff, so long as they also complained that they wished they could do more for their patients. Then, at least, I would know they cared.

Their biggest crime, alas, may be indifference. So long as they are getting paid - even if it is "only" 2/3 what a cardiologist gets - they are not motivated to press for any kind of change. Whether their patients get better or not, they make the same income. Write the prescription, fill out the insurance forms, pass Go, collect nearly $200,000 a year. Nice work, if you can get it.

I know there are a lot of good docs out there, but take a look at the poll I have going on the right. The responses to date say it all.

So, to get back to your observations. No - psychiatry won't lead and yes this is sad. We really need to hear their voices in this conversation. Their practitioners have pushed forward human knowledge. Their field is a repository of great wisdom. But the pursuit of knowledge is a process of creative destruction, and I don't see much of this happening in psychiatry. The DSM-5, due out in 2013, for instance, won't look much different than the DSM-III of 1980.

To contrast, in the last 10 years, the entire field of genetics has been turned on its head. Imagine - the real action is taking place in the "junk" DNA that scientists used to ignore. Now we know that junk DNA plays a vital role in switching genes on and off and in novel adaptions to the environment. Thus we have the whole new field of epigenetics that overturns the Gospel according to Watson and Crick.

The implications are huge. Bipolar and a lot of other stuff may have a lot to do with epigenetics. But it looks like we're going to find out about it from the geneticists, not psychiatry. On and on it goes.

Anonymous said...

"Actually, I wouldn't mind if they complained about all this stuff, so long as they also complained that they wished they could do more for their patients. Then, at least, I would know they cared.

Their biggest crime, alas, may be indifference. So long as they are getting paid - even if it is "only" 2/3 what a cardiologist gets - they are not motivated to press for any kind of change. Whether their patients get better or not, they make the same income. Write the prescription, fill out the insurance forms, pass Go, collect nearly $200,000 a year. Nice work, if you can get it."


SOOOOO TRUE! Thank you!

Anonymous said...

"Actually, I wouldn't mind if they complained about all this stuff, so long as they also complained that they wished they could do more for their patients. Then, at least, I would know they cared.

Their biggest crime, alas, may be indifference. So long as they are getting paid - even if it is "only" 2/3 what a cardiologist gets - they are not motivated to press for any kind of change. Whether their patients get better or not, they make the same income. Write the prescription, fill out the insurance forms, pass Go, collect nearly $200,000 a year. Nice work, if you can get it."


SOOOOO TRUE! Thank you!

Tony Previte said...

Hey John, been awhile! Great piece, and yes you know "I" think it's possible for ALL of us to get along.

Yeah, I have a dream... the dream of teaching and empowering people to apply critical thinking skills to find their own solutions to their problems and issues.