CRITICAL PSYCHIATRY
 
'If A equals success, then the formula is A = X + Y + Z
X is work, Y is play and Z is keep your mouth shut.' 
 
Albert Einstein.

 "Many people who wish to impose their definition of reality would deny that they are involved in gaining power.  They would say that because of their greater knowledge, wisdom, training and experience they know what is best.  The most dangerous people in the world are those who believe that they know what is best for others.

People who believe that they know what is best for other people are denying other people's truths.  Whenever our own truth is denied, ignored or invalidated we experience the greatest fear we can ever know:  the threat of the annihilation of our self.'

Dorothy Rowe - Jeffery Masson, 'Against Therapy' 


 As human beings we would all like to be treated with honesty, integrity, dignity and respect.  As we pass through our childhood years however, we slowly become aware that our society is not always as honest as we would like to believe.  We notice when our parents lecture us about the importance of being honest, then lie to each other, their friends and ourselves without a moments thought.  We also notice when professionals including Teachers, Social Workers, Psychiatrists, Psychologists and Doctors deny the obvious truth to our face rather than acknowledge that they do not have an answer or have made a mistake.  

We are constantly assured that the professional systems we rely on to treat the most vulnerable people in our society uphold those values mentioned above.  All too frequently though we find that dishonesty is rampant, and within the medical system in particular, that treatment of patients is often disrespectful and undignified.  In our Mental Health system the reality becomes even more disturbing.  The biochemical imbalance theory of brain dysfunction has taken hold of Psychiatry, with drug treatments more frequently than not being the first or only choice offered to patients in mental distress. I believe that in the short term, for acute distress psychiatric drugs can be beneficial, and if a person chooses that treatment after being given the full facts, that is entirely their choice.  But let us be honest about what we are doing here in regard to diagnosis and treatment.

  Advice offered by Mental Health Practitioners can often be misleading.  The reliability and validity of psychiatric diagnosis for example is highly questionable.   With new disorders such as ADHD making an appearance, we are seeing many distinguished Psychiatrists and Authors question the profession they belong to.  Drugs are now prescribed too readily to children whose brains have not yet developed fully, and we have yet to find out what the future impact of this will be.  When we consider that homosexuality was both illegal and classified as a mental disorder as recently as 1973, we also have to wonder what the criterion is for appearing in the DSM (Diagnostic and Statistical Manual, the Psychiatrists bible).

It was activism.  But there was not hard science to say that homosexuality was a disorder or an illness, and that was the reason why activists took aim at psychiatry and psychoanalysis and challenged them to come up with the data to support that position.  And they couldn't! 
 
The only data they could come up with were psychoanalytic theories that were not data.  What the gay activists did in the 1970s was pull out the true data, the scientific data that they could find, and presented it to the diagnosis committee of the American Psychiatric Association (APA) and persuaded them that the science that did exist was on the side of homosexuality not being a disease or a disorder.  That is why the diagnosis committee - the Nomenclature Committee, which is what it was called - suggested to the Board for the APA that it be removed, and it was'
 Interview with Psychiatrist, Dr Joseph Merlino - David Shankbone, Wikinews, 5-10-07

Mental health professionals continue to debate whether mental distress is caused by genetic factors such as a chemical imbalance in the brain, or environmental factors such as parent-child relationship issues.  Research supports the conclusion that both contribute to some degree, but there are a number of issues that this debate in itself seems to mask.  The question itself is confusing and misleading.  Asking whether mental distress is caused by genetic factors such as a chemical imbalance, presupposes that a chemical imbalance has a genetic origin, therefore the brain is faulty or damaged in some way.  Mental distress in this context is automatically concluded to be an illness that is permanent or leaves the sufferer at high risk of recurrence, and requires drug treatment to treat the fault or damage.   

Even if we could prove that a chemical imbalance underlies mental distress however, this still leaves us with a chicken and egg dilemma rather than any clear-cut answers as to the origin.  Does a chemical imbalance CAUSE our state of depression or anxiety?  Psychiatrists seem to have made this conclusion despite a lack of any firm evidence to support their position. (This theory has been widely criticised by many distinguished Psychiatrists including Peter Breggin.) The conclusion that a chemical imbalance is a RESULT of us feeling anxious or depressed etc, is though just as viable. 


DOES THE CHEMICAL IMBALANCE OR STATE OF MIND COME FIRST?

 An argument frequently put forward to support the chemical imbalance as causative theory, is that mental distress can be very persistent, with frequent recurrences suggesting a fault in the brain.  This persistence however, may relate simply to how easily the brain repeats a learned pattern.  Our brains are in fact designed to learn through repetition, so the more we practice something the easier it becomes.  This process is no different for learning to ride a bike or drive a car, than it is to learn a state of mind.  If we are brought up in an environment where we learn to be depressed or anxious, we are practicing those negative states of mind over and over again, eventually those states will become habitual and will be easier and easier to activate, hence the frequent recurrences and persistance of depression for example.  If we conclude that these patterns of brain activation suggest an underlying brain malfunction we are forced to turn to drug therapy.  If we conclude that these patterns of brain activation suggest a simple learned behaviour however, we can look at far more effective solutions.

Research is in fact increasingly supporting the conclusion, that our mood and/or behaviour does affect the chemical balance in our minds, and that if we can change our mood or behaviour then the chemicals will rebalance naturally.  For example, brain-imaging equipment demonstrates that clients who have Obsessive Compulsive Disorder (OCD) do indeed show a specifically located increase in brain activity (Schwartz, 2003).  This increase in brain activity informs neurologists that there are changes in brain chemistry, which suggest a chemical imbalance.  Further studies however, have shown that after taking part in a talking and activity based therapy the chemical imbalances or brain activity in those specific areas was greatly reduced.  This research is just one example where changes in brain activity have been clearly demonstrated without the use of any drug therapy, suggesting that mental distress is learned rather than wired in at birth.  

The above questions and answers are critically important because treatment depends on any conclusion we make.  Lets take depression as an example.  If we defer to the medical diagnosis then depression is due to a chemical imbalance that has a genetic origin, the patients brain in this context is considered to be faulty, and drug treatment is a sensible solution, which will in theory rebalance the brain chemicals.  The patient is considered a victim at the mercy of their brain, which could activate depression at any time and will probably be a lifelong problem.  Psychiatric drug therapy however, does not cure any disorder.  The best we can hope for is that the Psychiatric drugs will temporarily alleviate some of the symptoms, but for the most part the drugs merely sedate the sufferer so they are less bothered by (or complain less about) their symptoms.  (Peter Breggin has written prolifically on the treatment basis and side effects of Psychiatric Drugs in his excellent book Toxic Psychiatry). Anti-depressants can be useful for their intended short-term use during an acute period of distress.  However, for those who have a history of mental distress, any depression or anxiety etc, will likely return when the drugs are stopped, if the person has not built up the skills to deal with their distress.  

If we take the position that the chemical imbalance is temporary however, and can be altered by a change in thought or behaviour patterns with some efficient therapy, then we have a different scenario.  The client is no longer viewed as a victim of their circumstance, but instead as someone who can take control of their mental distress and learn skills to combat that distress.  All is required in this situation is that we have effective therapists who themselves have been trained in the skills necessary to assist clients.  The lack of skilled training in this area would currently be our main problem here, and that leads onto a whole new debate about the incredibly low expectations of Psychology, Psychiatry and Counselling in how effective they can be in regard to dealing with mental distress.  In my experience there are plenty of effective methods out there but the most effective seem to have been developed outside of the academic arena.  A distressing but sadly true state of affairs.

One reason that research and treatment has remained so archaic within the Psychiatric profession, is due to the long-standing belief that the brain reduces in plasticity (ability to change, learn, grow and reprogram) after childhood.  Research both in Psychiatry and Psychology in turn has focussed mainly on the problem, cause and management of any mental distress, rather than on a solution or cure.  Thankfully recent research in Neuroscience spurred by the advent of increasingly accurate brain scanning technology, demonstrates that our brains have extraordinary plasticity.  This means that our brains can grow and change right the way through our lives.  We now know that when brain areas are damaged due to a stroke, adult patients can sometimes begin to recover with therapies that encourage their brains to build new areas to control the lost function, or mobility of a body-part (Taub, 1999).  The brain can adapt and learn beyond any of our previous expectations.  We can build new pathways in our brains and that gives us scope to make changes whatever the cause of our distress.

The treatment of mental distress will in my opinion move more and more to those who are skilled in reprogramming the brain through language and behavioural change.  The field that stands out the most in this area is Neuro-Linguistic Programming (NLP) created by Richard Bandler and John Grinder in the 1970s.  NLP is becoming increasingly mainstream and the principles the field is based on are receiving increasing scientific support in the form of neurological findings.  I have witnessed more rapid, effective and long-term change by practitioners who are skilled within this field, than in the areas of Counselling, Psychology and Psychiatry combined.


  PSYCHOSOCIAL ASPECTS

With economic, legal and political factors driving the Psychiatric profession, we are unlikely to witness any major changes anytime soon.  Most disturbing is the fact that Psychiatrists receive research funding from the drug companies, a clear conflict of interests.  Drugs are profitable, quick and easy, and settle the patient enough to satisfy the needs of their community and family.  The wants and needs of the individual human being are being ignored for the most part.  There is no hiding from the fact that research at one time focussed on the effect of the family with concepts such as, High Expressed Emotion (intensity of negative communication including criticism and hostility, and degree of emotional over involvement of parents) providing many answers.  The brilliant work on Double Binds by Greggory Bateson and his colleagues has been all but forgotten, whilst the success of psychosocial initiatives such as Psychiatrist Loren Mosher's Soteria House, or of the Falan Team in Sweden is barely mentioned.

As more and more behaviours are pathologised and classified as mental illness we find ourselves continuing on a dangerous path.  Now rather than take the opportunity to find out why a child may be causing a fuss, or see their inability to pay attention or sit still as a sign of distress in other life areas, or a reflection of our tedious school system, we diagnose them with ADHD (Attention Deficit Hyperactivity Disorder) and give them a pill to prevent them bothering us any more than necessary.  Our children are being medicated like no time before and Ritalin has become teacher's little helper.

The Mother of the child being drugged for their ADHD meanwhile, reaches for Prozac to treat her depression. She lives in a tower block on a notoriously dangerous estate, and her ability to deal with the loud music pumping through the walls at 2am is diminishing.  She also finds it difficult because her daughter causes such as fuss when she has to get up in the morning.  There is little money for food let alone a school uniform and her daughter is bullied because her old skirt is stitched and her jumper is two sizes too small.  Are the drugs working do you think? 

Having been abused physically and sexually by her parents for most of her childhood, a teenager begins acting out and telling people that her parents are being controlled by the devil.  Her parents bring her to see the Psychiatrist, as she is obviously delusional.  Will she be forcibly drugged and sedated until she shuts up, or taken to a place of refuge where she can work through this crisis with an understanding team of empathic human beings highly skilled in communication?

'A human being receives neuroleptic drugs. One who loves her sees that she has been deprived of her Life. The beauty, the aliveness, the creativity, the passion that made her lovable and gave her life meaning has been effaced. Something – something as momentous as it is intolerable – has happened. But the psychiatrist sees nothing. The psychiatrist records "improvement," "reduction of symptoms," "insight," "therapeutic effect," etc. His language makes him blind.'

Lars Martensson, The Meaning of Life Effaced - Article in the leading Swedish newspaper Dagens Nyheter

Every time a person swallows a pill to make themselves feel better they accept the message that they are broken, and can't fix themselves without external intervention.  The system as it currently stands often takes away those very elements that empower a person to enable them to deal with any mental distress.  We are fed incorrect information as we are told that, because our 'illness' is caused by a biochemical imbalance we will have, or certainly will be at risk from this disorder for our entire lifetime.  We are told we are helpless, and the feeling of helplessness keeps us a victim of our circumstance.

This message takes away from us the hope and encouragement to find ways that assist us in reaching new ways of living that feed our mental health and general well-being.  We are informed blindly that the system has knowledge, expertise and evidence to support its assumptions, but it simply does not exist.  Psychiatry feeds us the information that they have the answers and solutions to our problems, but do they, really?  We deny consumers of the mental health service the right to open and honest information, and fail to give them an informed choice as to how they can see their distress, or provide options for how they can be treated. Despite evidence of the healing power of working through a period of distress, the system is set up so that people are coerced and pressurised to take madications rather than to explore their emotions in a way that they themselves want to.

 EDUCATION

 Currently those with mental distress are frightened into complying with treatment because the mental health professionals they deal with claim to know what is best for them.  These professionals currently have the right to restrain, drug and lock people up against their will, and it is far too easy to dismiss the beliefs and concerns of those diagnosed as mentally ill.  As a society we fail to educate people individually, and we rely instead on handing over our free will to a profession that falls far short of providing the best they can for the people they serve.

If a system is secure in its knowledge and practice it will have no issue with providing honest information and freedom of choice to its consumers.  So lets ask loudly why we are not given these basic rights in our Mental Health Services?

MOVING FORWARD

Rather than needing to be right and to prove others wrong, lets focus on seeking the truth.   

Rather than relying on flawed Scientific ‘proof’ or theory, lets look for what works.   

Rather than applying treatment knowledge to the mass population based on studies done on a selection of people and generalised, lets start treating people as individuals.   

Rather than relying on professionals to tell you how to run your brain, treat your body and what expectations you must have, lets educate ourselves and learn the reality behind the mask of professionalism.

 

"Peter Breggin has challenged the powerful and prestigious profession of psychiatry, the immensely wealthy and influential drug industry, and that vast number of people who prefer to believe that there are such things as mental illnesses rather than to take responsibility for their own lives and for the influence that they have on their children."

Dorothy Rowe, Peter Breggin - Toxic Psychiatry. 

Bibliography

Breggin, P. Rowe, D. 1993. Toxic Psychiatry: Why Therapy, Empathy and Love Must Replace the Drugs, Electroshock and Biochemical Theories of the New Psychiatry.

 

Carter. R. 2000. Mapping the Mind. University of California Press.

Schwartz, J.M, Begley, S. 2003. The Mind & The Brain: Neuroplasticity and the Power of Mental Force. HarperCollins.

Taub, E., Uswatte, G., & Pidikiti, R. 1999. Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation – a clinical review.  Journal of Rehabilitation Research and Development. 36. pp 237-251.





Peter's books cover a wide array of mental health subjects and his work is very human and empathic.  

His site has lots of information relating to the toxic effects of Psychiatric medication.

A site that gives advice about how to withdraw safely:

Rufus May

Coming Off


This page is dedicated to  Rebecca Hill 1981 - 2001 Neglected to death by  Mental Health Services at  St David's Hospital - Pembrokeshire and Derwen NHS Trust: