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DISABILITY-RESEARCH  August 2002

DISABILITY-RESEARCH August 2002

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Subject:

A CRITIQUE OF PSYCHIATRY AND AN INVITATION TO DIALOGUE

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Sat, 31 Aug 2002 04:04:28 EDT

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7. COERCIVE-MEDICAL PSYCHIATRY COLLUDES WITH DRUG COMPANIES AND THE INSURANCE
INDUSTRY TO BOLSTER THE MEDICAL MODEL.

The medical model serves the interests of the pharmaceutical industry by
proclaiming that mental illnesses are brain diseases which can be treated
with drugs the pharmaceutical industry makes, markets, and sells. The
pharmaceutical industry, in turn, subsidizes research, training, education
and professional journals which support the medical model. Psychiatric
theories are drug driven. Psychiatric therapies are drug driven. The
pharmaceutical industry grants millions of dollars to psychiatrists for
research on psychiatric drugs from which the industry profits. It's
advertising supports psychiatric journals which publish the positive findings
of this research. It contributes money for the training of psychiatric
residents and the continuing education of psychiatrists at conferences and
seminars which support the use of psychiatric drugs. Pharmaceutical companies
spend between eight to thirteen thousand dollars per physician in this
country on gifts, meals, speaking honoraria, consulting fees, luxurious
travel to conferences, and free samples of their products. In most other
circumstances, the default presumption would be that money buys influence.
But psychiatrists deny that money from the pharmaceutical industry influences
their thought and practices.

Managed care companies also support the use of the medical model in
psychiatric practice and contribute to the medicalization of human problems.
The mission of managed care is to manage payment for psychiatric services.
This means that every patient seen by a psychiatrist who belongs to a managed
care plan must have a psychiatric diagnosis. This encourages viewing the
patient's life problems as medical illnesses. Often, managed care companies
will pressure the practitioner to use psychiatric drugs which they believe
save time and money. Psychotherapists who avoid the medical model and who
avoid psychiatric drugs in favor of encouraging the patient to experience and
learn from their life problems are penalized by being excluded from insurance
reimbursement.

The pharmaceutical industry and the managed care industry are powerfully
linked in support of the medical model. The state, which supports the use of
the medical model because it justifies covert social control is also a
partner in this meeting of minds. The NIMH, which supports the medical model,
is the research arm of the state. The state maintains public psychiatric
hospitals which hold involuntary patients. The medicare and medicaid systems
follow the official DSM of psychiatric diagnoses. It is bad enough that
psychiatry, the state, and private industry are working together to patronize
the medical model. It is far worse for the future of our society that this
complex relationship has not been fully examined.

8. THE MEDICAL MODEL CONTRIBUTES TO THE EROSION OF PERSONAL RESPONSIBILITY.

The medical model views certain human thinking, moods, and behavior as
caused. If an act is caused then it cannot also be chosen or intended. In law
and ethics, intention is the key to responsibility. If an act is intentional
the actor is responsible. In law, if an act is not chosen or intended, the
actor cannot be held responsible and is excused, except in cases of
negligence which is the failure to form proper intent. Does it not follow,
then, that the increasing tendency to view human behavior through the lenses
of the medical model as caused results in a erosion of the public sense of
personal responsibility?

If a person who commits violence has a history of psychiatric treatment, the
act is often explained as a product of mental illness. If the act is claimed
to be the product of mental illness the perpetrator may not be held
responsible and can plead insanity in a criminal trial. This often results in
excusing the obviously guilty, as in the case of John Hinckley who was found
not guilty by reason of insanity for shooting President Reagan in front of
millions of witnesses on national television. Ironically, the medical model
is used not only to incarcerate the innocent but to excuse the guilty.

When someone commits suicide, the most common explanation is that he or she
suffered from a clinical depression caused by a biochemical imbalance.
Suicide is thus, reduced from a moral problem to a medical problem. The list
of caused (and excused) thoughts, moods and behaviors is long and growing
rapidly. It now includes anxiety, depression, suicide, homicide, anger and
aggression, phobias, obsessions, compulsions, binge eating, anorexia, sexual
deviance, sexual abstinence, addictions, and various forms of withdrawal,
intrusiveness, garrulousness, shyness, excitement, sloth, insomnia,
somnolence, hedonism, anhedonia, egotism, self hatred, rebellion and
conformity. The more we explain the spectrum of thoughts, emotions and
behavior with the medical model the greater the erosion of the public sense
of personal responsibility. Ironically, the more the ethic of personal
responsibility is eroded, the stronger the state must be to control deviant
behavior. The erosion of the sense of responsibility, thus, leads inevitably
to totalitarianism.

It this age of political absurdities, it is considered politically incorrect
to suggest that people are responsible for their thoughts, feelings, and
actions. Nevertheless, we are responsible for our states of mind and our
moods as much as for our actions. If one observes human behavior with a
degree of self reflection it will be perfectly obvious that it is always
possible to exert a greater degree of control over one's thoughts, feelings
and actions if only one makes an effort and persists with patience. Contrary
to the implications of the medical model, our intentions, choices, and deeds
can make a difference. This leads to the heretical suggestion that we are
responsible for our anxiety, depression, and anger, as much as for our
conduct. Were this not so psychotherapy would not be possible,
self-improvement would not be possible, maturity and spiritual growth could
never happen.

The medical model is contrary to the concept of human agency. It does not
permit of choice and responsibility. If depression is a disease, as the
medical model asserts, it must viewed as caused in spite of the contradictory
fact that to heal it the person must take responsibility for his or her
attitudes and life choices. To suggest that depression may be better viewed
as an existential or a spiritual problem rather than as a biochemical
imbalance, exposes the critic to vicious attacks by medical psychiatrists and
their supporters, notably, NAMI. The fact that the antidote to hopelessness,
the main mark of depression, is hope, a spiritual quality, is ignored, much
to the detriment of those suffering from depression who are told they need
prozac rather than courage and hope.

The ideology of the medical model also serves the social function of
diverting our attention away from serious social and political problems which
society does not want to confront. To regard anger, aggression, and violence
as symptoms of brain disease distracts us from a criticism of the social
conditions and values of our anomic, consumer society in which desires run
rampant and violence is recreational. By diagnosing children who disturb the
classroom or do not absorb its lessons as ADD, caused by a brain defect, we
do not have to examine the culture of schools which cannot capture the
imagination or attention of its students. In these ways and others, the
medical model serves the status quo of prevailing social interests. It is a
form of social neurosis, analogous to the neurotic symptoms of the
individual, which avoid, repress, and deny the awareness of conflict while
constructing convenient, self serving compromises. The repressed wish is for
a greater degree of social control than provided by rule of law. The
super-ego, which represents the social value of individual freedom under law,
opposes. Clever ego finds the neurotic solution. Social control disguised as
psychiatric diagnosis, involuntary hospitalization, and forced drugging.

9. MEDICAL PSYCHIATRY CONTRIBUTES TO THE REPRESSION AND CONSTRICTION OF HUMAN
CONSCIOUSNESS

Psychiatry is a house divided against itself. On the one side, represented by
the medical model and the state hospital, is the function of covert social
control of individual behavior and the repression of dissent. On the other
side, represented by the moral model and voluntary, humanistic psychotherapy
is the function of liberating the individual from self-imposed suffering and
raising consciousness.

By repressing its critics, medical-coercive psychiatry deceives the nation.
Knowingly or unknowingly psychiatry practices social control under the rubric
of medical diagnosis and treatment. Some psychiatrists know it but won't
admit it. Others refuse to even consider the idea. Santayana is famously
quoted for reminding us that those who forget the past are doomed to repeat
it. It may be equally pertinent that those who become fixated on the past are
doomed to miss the present. Historically, every new tyranny has taken an
unprecedented form that those fixated on tyrannies past failed to recognize.
From the historical lessons of Hitler, Stalin, Mao and the like, we expect
tyranny to emanate from the head of state. The new tyranny, however, is more
subtle, disguised, and diffused. It is disguised in the garb of the
psychiatric helper, and it is diffused through every community, institution,
organization, and industry in this country. Psychiatry contributes to the
confusion and constriction of public consciousness by disguising its social
functions. The American public represents its political self to itself and to
the rest of the world as the defender of individual freedom under law. At the
same time, it gives silent assent to the coercion, confinement, and abuse of
individuals in violation of rule of law.

Psychiatry contributes to the repression and constriction of consciousness by
interpreting human behavior as caused by the brain thus blinding us to the
world of mind and meaning. If human thoughts, feelings, and behavior can be
reduced to brain and bodily functions then what happens to the person? What
happens to choice and purpose? To ambition and hope? To tragedy and comedy?
To clarity and love? To law and ethics? If our thoughts, feelings and actions
are no more than neurochemical eruptions, then we have lost our humanity. Our
narratives are meaningless. We have forsaken the possibility of knowing
ourselves. And we have lost the capacity to heal ourselves.

10. FOR ALL THE ABOVE REASONS MEDICAL COERCIVE PSYCHIATRY CONTRIBUTES TO THE
DECLINE OF CIVILIZATION AND THE INCREASE OF HUMAN SUFFERING.

How shall we evaluate the contributions of medical-coercive psychiatry to the
development of civilization? To answer this question we must distinguish
between the persons and the acts, the people who work in the "mental health
field"who follow the medical model and the social functions and practices of
medical psychiatry.

We should not fail to note and pay homage to those honest and decent
practitioners who follow the medical model, but eschew coercion, and display
wisdom, warmth, respect, and kindness to those who come to them for help.
These personal qualities are precious, vital contributions to the development
of civilization. Those who suffer mental, emotional, and spiritual pain the
pain of life often suffer from frustrated yearnings to be loved and
respected. The maturity, wisdom, warmth, respectfulness, and kindness of a
helper can be therapeutic, not in a medical sense, but in a spiritual sense
it can work miracles.

We should not hesitate to add, however, that working with the medical model
is a handicap in developing the virtues vital to healing and social progress.
It depersonalizes and dehumanizes both the therapist and the patient. In
addition, we must remember that therapists and other workers in mental health
have egos too. They can be selfish and self centered, defensive and
aggressive, callous and disrespectful. When the dehumanizing medical model is
used by insensitive, egotistical workers the result can be, and often is, the
infliction of great suffering at the hands of medical-coercive psychiatry on
people who are already suffering from the difficulties of life.

The practice of coercion through involuntary hospitalization and forced
drugging is a serious issue which begs for debate. On the one hand,
involuntary, coercive psychiatry serves society by providing a supplemental
form of social control which, because it is covert or disguised, preserves
our national pride by giving us the appearance of being a nation of free
individuals under law. On the other hand, when the covert is exposed it can
be seen to violate the honored values on which this nation was founded. The
question of the contribution of medical coercive psychiatry to civilization
is a question of what balance between social order and individual freedom
best serves human happiness? What balance of honesty and illusion? From the
events of the past century, it is evident that totalitarian societies, which
provide a high degree of social order, as well as free market capitalism,
which provides a maximum of individual freedom, are both obsolete extremes.
Nations, like ours, which began as free market polities, and nations like the
Soviet Union, which experimented with state communism, both failed and moved
towards each other. As western nations have become more socialist and closed
over the past fifty years, communism has collapsed into a chaotic free
market. Governments everywhere now seek to balance the mandate for social
order with the mandate for individual freedom.

The fact that coercive-medical psychiatry disguises social control as medical
treatment is a serious impediment to the public debate on the desirable
balance between social order and individual freedom. The handicap is
aggravated by psychiatry's repression of its critics. If the question whether
psychiatry functions as a supplementary instrument of social control cannot
be debated, then how can the question of the optimal balance between social
order and individual freedom be intelligently debated? The conclusion cannot
be escaped that medical-coercive psychiatry's repression of its critics does
not serve the advancement of civilization because it results in the
obfuscation of debate on serious ethical, social and political issues.

Whatever one's views on the desirable balance of social order and individual
freedom may be, the practice of psychiatric coercion and abuse cannot
possibly contribute to the development of a humane society. Depriving
individuals of freedom without trial by means of involuntary confinement in a
psychiatric hospital is an abuse. It violates the basic principle of
individual freedom under law. When people are involuntarily confined and
their keepers are undereducated and underpaid cruelty and abuse are bound to
result. The voices of the oppressed and abused are rising in numbers and
volume in opposition to medical-coercive psychiatry and the society which
permits, even sanctions its practices.

If mental illness is a social construct rather than a bodily illness, then
questions naturally arise about the use psychiatric drugs. What does it mean
to prescribe a drug for a metaphorical illness? When is it proper for an
individual to ingest mind altering substances? These questions bear on our
national policy on drugs. If psychiatric drugs are not given to treat a
genuine medical illness but to alter thought, mood and behavior, then what is
the difference between legal and illegal drug use?

Surprisingly, there is no consensual understanding of why people self
administer psychoactive drugs. It is a mystery to the experts who rely on the
medical-deterministic model. Indeed, it is a mystery to them because they
rely on it. They cite early or current deprivations, peer pressure, abnormal
brain chemistry, genetic predisposition, mental illness and the like as
causes. Many believe that people take illegal drugs to medicate themselves
for their (presumed) mental illness. But what does this explain? It is
circular and illogical. It implies that if a person self administers a drug,
it must be to treat a mental illness. But the taking of the drug is itself
also an illness -- addiction. On the other hand, psychiatrists can legally
force people to take mind and mood altering drugs for their alleged mental
illness in which case the drug taking is not considered an addiction but a
'treatment." If the patient becomes addicted to the prescribed medication,
the addiction is called a side effect, rather than an iatrogenic illness. The
logic is baffling but unexamined and unchallenged.

To understand the deed we must look to the motive. The logic may be baffling
but the motive is clear. Language is a tool, a socially useful tool. The
language of the medical deterministic model facilitates social control but
impedes understanding. The moral model impedes social control but facilitates
understanding. The medical deterministic model cannot explain why people use
drugs because the explanation of why calls for a motive, a purpose, and a
context. From the moral point of view, from the point of view of the person
as agent, the reason people take mind and mood altering drugs is simple, too
simple for scientists to accept. People take these drugs because, in some
way, they feel bad, are unhappy or dissatisfied and they want to feel good.
And the drug helps them to feel good enough to suffer the risks. All one need
do to confirm this as fact is to ask people. Our national failure to
understand why people use drugs, in spite of a decades of war against drug
users, is a symptom of the endemic repression of critical thought.

We need only reframe the language of the drug discourse to understand the
rationale for using mind altering drugs, legal and illegal. The majority of
these drugs are either uppers, downers, pleasure enhancers, or psychedelics.
If you feel down you take an upper; if you are anxious you take a downer; if
you want to sleep you take a downer; if you want to stay awake you take an
upper; if you want to feel sensuous you take pleasure enhancer like ecstacy
or cocaine; if you are bored or curious and adventuresome you take
psychedelics. The psychiatric rationale is similar, only the language
differs: if the person is depressed (down) give them anti-depressants
(upper); if the person is anxious or manic (up) give them an anxiolytic or a
mood regulator (downers). If they suffer from their thoughts (thought
disorder) give them anti-psychotics (thought suppressors.) Pleasure enhancers
and psychedelics are regarded as dangerous and are prohibited.

The primary difference between the two groups of drugs is that psychiatric
drugs are manufactured by pharmaceutical companies, are legal, and are
prescribed by physicians, often against the patient's will. Street drugs, are
usually natural substances, are illegal, and are consumed voluntarily. There
are, thus, two classes of psychotropic (mentally active) drug users. One
portion of the population is advised or forced to take psychiatric drugs
which have similar aims and effects as the street drugs taken voluntarily by
another portion of the population who are hunted, prosecuted and imprisoned
for it. The people who take drugs voluntarily are regarded by medical model
adherents as suffering from the disease of addiction while the people upon
whom the drugs are forced are described as getting well as the result of
their treatment. If we examine this situation more carefully, the conclusion
is inescapable that the defining issue is social control. Psychiatric drugs
are used to control people whose thoughts, feelings, or behaviors are judged
out of control. The voluntary use of street drugs for mood regulation and
personal pleasure is prohibited. Arguably, the social motive of drug
prohibition is to keep people from dropping out of the work force or engaging
in unconventional, heretical, treasonous or otherwise disturbing behavior.
Thus, psychiatric drugs and drug prohibition have the same social function,
to keep people in line.

One may reasonably argue that the use of any psychoactive drug is contrary to
the welfare of civilization. On the other hand, every known culture has
tolerated the use of intoxicants and many have endorsed the use of
psychedelic sacraments. The medical model sheds no light on the question of
why human beings from ancient times to the present choose to modify their
mental state with natural substances. And it sheds no light on why increasing
numbers of people who have been prescribed psychiatric drugs are desperately
trying to withdraw from them. Something seems wrong here, and we aren't clear
on what it is because debate is suppressed.

Does it contribute to the advancement of civilization that increasing numbers
of people are acquiring psychiatric diagnoses as the result of innocently
seeking guidance for their troubles and pain? Managed care and insurance
companies require every person they reimburse for psychotherapy to be given a
serious psychiatric diagnosis. Psychiatric diagnoses are forced on anyone who
seeks help from a mental health professional paid for by a third party. And
psychiatrists are paid to supply it. A person's diagnosis becomes part of the
national data base. People are excluded from public office, from jobs, from
the military, from the priesthood, from school, and even from their children
based on psychiatric diagnoses acquired as a consequence of contact with
psychiatry. This information is not privileged because the state, the
employer, and the insurance company require the individual to give consent
for its release as a condition of their approval. The unintended and
unexpected result of the dominance of the medical model is the medicalization
of social control and personnel management and the obfuscation of our
understanding of human behavior.

Is civilization served by the deterministic view of human behavior and the
designation of suffering and deviance as illness? The causal-deterministic
view is amoral. The foundation of civilization is ethics, morality, and law.
If behavior is viewed as caused by the brain, then the citizen, who is
motivated by the desire for happiness to be virtuous and law abiding,
disappears. Causes may explain the behavior of creatures but not of citizens.
Behavior which is caused cannot also be intentional. If it is not
intentional, it cannot be ethical, virtuous or law abiding. "Cause" and
"intention" belong to different logical levels of discourse. If behavior is
caused, the individual cannot be held responsible. The language of science
and the medical model exclude the concept of personal responsibility. By
discounting personal responsibility for thoughts, feelings, and actions,
medical model psychiatry contributes to the erosion of the awareness of and
the respect for individual responsibility, which is a precondition for
individual freedom under law. Can anyone honestly say that this serves the
advancement of civilization?

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