A Tragic Mistake

Written 03.04.08

Am I too naive to think that the principal aim of a hospital should be to help its patients? Well, apparently I am, because during the last two years that I have been working at one of the nation’s top psychiatric hospitals, I’ve seen very few examples that would back up this idea. The overwhelming majority of people and procedures employed by the psych hospital have very different objectives, ranging from maximizing the profit to minimizing the effort, and culminating in an all-consuming urge to cover one’s ass. Among the people who genuinely tried to struggle with the system and help the patients, during these two years some have been fired, and some have “gotten used to it”, but no one lasted long. As a matter of fact, I am fairly close to losing my job right now, after an argument with a charge nurse yesterday, during which she tried to din into me that the most important thing for her was not to lose her license. Not that I cared too much, because I had already given the termination notice anyway.

Too many people assume uncritically that if they go to a psychiatric hospital they will get help; even more believe that their children/parents/spouses will be helped if they send them there. This is what all the propaganda is about. But it is a lie. A mental hospital in this day and age is not an institution of help - it is an institution of confinement, much like a jail. It is a place in which kept are people who have not committed a crime but have nonetheless made their relatives or friends very uncomfortable with their being around. This point is so obvious that it doesn’t even need to be proved; just look at all the door locks and security guards in any mental hospital. If this institution was helpful, people would want to be there, and none of this would be needed.

Really, think about all the homeless people, all the battered spouses, all the terrified youngsters going through a psychotic episode, all the misunderstood children and suicidal adults longing for understanding or at least for a pacific place to curl up in the corner and sleep it over. Think about everyone who needs to get away from their environment for a while. If the proclamations of the psychiatric industry had some truth in them, if there really existed a place where they could relax and get help, those people would line up to get into this kind of institution! Obviously, a psychiatric hospital is not such a place, because most of the patients hate it there and struggle to break out. Until, of course, they lose their life drive and become dependent on the system.

Now, this is of course not to imply that the mental hospitals are completely worthless. There are people, and many, out there who are either morbidly stupid or completely out of their minds. They cannot survive in a demanding environment of a today’s city and therefore need to be confined and cared for. But to assume that the same mental hospital is a helpful place for all the able people just going through a difficult time, is a tragic mistake.

People who send their relatives to a psychiatric hospital never find out what actually happens there. Parents are told all kinds of stories about how helpful the place is and how much therapy their children receive. They don’t know that the therapy is heartless and superficial, or that the place is extremely boring and unfriendly. They never see their kids crying and begging a nurse for a breath of fresh air after being indoors for days and weeks, or being dragged to their room on the floor by uncaring strangers. They never observe their kids’ free spirit being broken into submission; if they did, they would not forgive themselves.

If there is only one thing to be remembered out of this whole journal, it is this. Please, don’t put your children and loved ones in a psychiatric hospital for help. Put them there because you want to confine them, get rid of them, forget about them! Put them there because you don’t care, or because you hate them - but not because you love them. Don’t fool yourself thinking that you are doing them good. Because nothing can be farther from the truth.

Will the gene of schizophrenia help you?

So why am I not being too enthusiastic about psychiatric genetics? Why am I not excited by the prospect of uncovering the genetic basis of mental disorders, despite the proponents' claims that it should make diagnosis more reliable and eventually provide avenues for effective treatment?

Because these promises do not sound realistic to me. I have to admit that the question of psychiatric genetics is very interesting academically, and it is also readily funded by both drug companies seeking profit and the government seeking some kind of solution to the overwhelming quantities of mentally disturbed citizens. Still, I find it difficult to buy that genetic advances will benefit the real-world patients, and here is why.

First of all, the genetics of mental disorders is subtle and multifactorial. Therefore, even if some genetic predisposition could be statistically proven, in any concrete individual the environment plays a dominant role in determining whether the disorder will appear. In other words, regardless of whether a particular person possesses the wrong genes or not, his being sick or normal will largely depend on his life situation (which is exactly what we've known for a hundred years).

Let's take an example from oncology. There is a gene called BRCA1 that, if mutant, has been recognized as carrying much higher risk of breast cancer development. Now, in oncology the diagnosis can be made much more accurately than in psychiatry; the genetic association with BRCA1 gene is also simple and straightforward. Nonetheless, oncologists do not usually make predictions about any particular patient; even though the risk may be significantly increased, we still cannot say to the carrier or the mutant gene: "You will have breast cancer", or to the carrier of the normal gene: "You're cool, go home."

Whatever gene associations are found in mental disorders, they will not be enough to make predictions, because the environment plays a major role in the fate of any organism. Hence, we can only afford hunting for genes after we've done everything possible to fix the environment. Talking genetics when there are major problems in people's psychological well-being (look around!) is like cleaning the carburetor when the car's wheels are missing. It could help, but it's not the biggest concern right now.

The second reason why genetics is unlikely to benefit the patients is that psychiatry has a tendency of rushing things into practice as soon as they are discovered (if it can be profitable, of course). It is theoretically possible that genetic discoveries will lead to the creation of the effective treatment for psychiatric disorders, but most likely this simply won't have time to happen. What will happen much sooner is that some type of genetic analysis will be implemented, and people who are at risk will be recommended to take the medications preventively.

This will be catastrophic, because the drugs can make a healthy person sick; so there will be no way of disproving that they were really needed. This will reinforce the sense of scientific correctness, and promote further treatment and propaganda efforts, supported by the drug manufacturers. The tradition of giving drugs to healthy people, mandatory genetic testing of children and adults, and the arising legal battles will change the whole landscape of psychiatry into something entirely different from what we know today.

In the resulting confusion the original goal of the genetic research (to develop treatment) will be postponed, as scientists of the day will concentrate on getting out of the current crisis. And everything will repeat again - only the counter of the innocent victims of psychiatric help will advance by a few tens of millions... but who counts them?

Drug Therapy: Does The Easiest Mean The Best?

From a conversation with a psychiatrist one typically gets the impression that the medications are the most powerful tool for treating mental disorders. Yes, you can try therapy, or lifestyle modifications, but if you are dealing with anything serious, the drug treatment is the only thing that has the real power to help.

At least partly, this conviction is based on the practical difficulty to use alternative treatments. For example, good psychotherapy exists but is hard to find and expensive; life style is possible to modify, but it requires significant time and energy invested into patient education and follow-up. Some patients cannot use these treatments even if they want to, because their mental disturbances result in the inability to understand and follow complex directions. The lifestyle modifications may be unattainable for economic or social reasons: someone whose entire family of nine lives in a one-bedroom apartment might want to modify his lifestyle, but be unable to do so.

A pill is certainly the easiest means of treatment, whether or not the most helpful. It can be used in any circumstances and by people of any economic, educational or social background. It is therefore true that medication therapy may be usable in cases when other types of treatment may not; however, any further implications about efficacy are much harder to prove.

Taking Medication Is Voluntary

Taking a psychiatric medication is a voluntary act. Unless you are brought to a psychiatric hospital by ambulance, or suspected of being a possible danger to yourself or others, or not obeying the directions of hospital personnel, or hallucinating, or not agreeing to take the drugs voluntarily for too long when the doctor deems it necessary, you cannot be given a medication against your will.

Nine Reasons Why Psychiatrists Believe In Drugs

It is very tempting sometimes to blame the evil psychiatrists for everything, as if they were in some kind of conspiracy against the rest of us. It is obvious, however, that such a large and diverse group of people cannot maintain any conspiracy for long. Besides, many psychiatrists I've seen are very nice people.

Of course there are financial "incentives," but they would not mean much if the doctors did not really believe that their drugs work.

I've been trying to think of the reasons why they believe it. It looks like the practice of a typical psychiatrist is organized in such a way that the more medications he prescribes, the more convinced he becomes in their helpfulness - sometimes in spite of his own logic and common sense. It is a classic self-reinforcing loop, and drug prescription almost becomes a bad habit.

Once you start prescribing drugs, you are practically doomed to continue, unless something causes you to strongly suspect that something is not right, and make a forceful effort to break out of the vicious circle. (Incidentally, this is probably the moment when the financial incentives play a major role, as the sudden exacerbations of suspiciousness in a psychiatrist are soothed by the large doses of cash.)

So far I have though of nine mechanisms of the erroneous self-reinforcement that the psychiatrists fall prey to.

1. Placebo response.
2. Lack of control group.
3. "Could be worse" logic.
4. Selective memory.
5. Selective interpretation.
6. Short-term efficacy of drugs.
7. Long-term dependence on drugs.
8. Lying to psychiatrists.
9. Attributing success to drugs instead of doctors.

I will discuss each one in more detail in the following posts.

Psychiatry Critique and Antipsychiatry

I would like to make myself clear: I am not an antipsychiatrist.

The easiest way to change your point of view is by changing its sign to create the opposite. In this manner, religion is converted into atheism, love into hatred, promiscuity into puritanism, and psychiatry into antipsychiatry. Although the result is as far from the origin as possible, the similarity between the two points of view is still apparent.

An atheist spends as much time and effort as a preacher thinking about God, only trying to prove His non-existence instead of existence. An antipsychiatrist still limits his thinking to the arguments of psychiatry, only trying to prove them wrong. And all of these people remain rigidly faithful to their points of view.

I don't know if psychiatry - in general - is good or bad. I think that psychiatry could be used to help people. I think it could be one of the most humane and rewarding professions. This is why I had become a psychiatrist (I wouldn't like to practice in the United States today, but that's another story). I am fascinated by the works of Jung, Assagioli, Laing and others who took the art of psychiatry one step further, from simply "fixing" people to fit the social average, to helping them achieve self-realization and spiritual growth.

This said, I can't help noticing that today psychiatry in America is practiced in a very strange fashion. It is no longer art, but science. It is not uncommon to meet a psychiatrist who knows a lot about biology and chemistry but has no idea how to talk to people. (You wouldn't go to a concert where the musicians know all about the physics of sound and theory of composition, but cannot actually play, would you? What if they had shown you their certificates?)

People are being lied to or confused on every step of the way. Every first-time patient that I saw at the hospital was convinced that since he had signed in voluntarily, he may leave at any moment - which was of course not the case. People are distracted from solving their real-life problems by the unnecessary talks of genetics and chemical imbalance. People are told that the prognosis of schizophrenia is better with drug treatment, but it is not proven. People are told that what matters is the symptoms, and not the cause of their depression, but it is ridiculous. They are told that modern drugs are safer than the older ones, but it is a lie. They are told that the drugs are scientifically proven to work, but it is a mystification.

At the same time, most of the doctors are very nice people, and they really believe that what they do is good. I don't know how that happens, but I see that for some reason many professionals have adopted rather simplistic and superficial views of human nature, reducing it to mere behavior, and refusing to understand its depths. I have seen psychiatrists making a diagnosis of schizophrenia and prescribing a drug to the patients complaining of hearing voices, without even so much as asking what those voices were saying. They are simply not interested - and with good reason: the drug that they prescribe will still be the same.

I am not even going to mention here the enormous financial pressures that psychiatry now has to endure. It is a subject for a long discussion.

To sum it all up: psychiatry in general is not good or bad per se, but at this point of its development in America it seems to be hurting more people than it helps, while proclaiming the opposite. Thus, although psychiatry may be helpful to some people, in dealing with it a healthy degree of skepticism and common sense needs to be maintained.

No Test Required

Another interesting point that Mr. Jeff Griffin makes in the interview I mentioned yesterday is that psychiatrists do not have to use any objective medical tests in order to make a diagnosis or prescribe a medication.

Some tests have been developed, and are even used in clinic and in research. All these tests consist of questions and answers. They are not, strictly speaking, objective. What they provide is a quantative scale. The result of such a test is usually a number, that the researchers can compare with other numbers received from other research. Yet, this number still depends on the subject's ability to understand the question, willingness to answer it truthfully, as well as the interviewer's manner of gathering the information.

So, these tests are subjective, if convenient for comparative measuring. Yet, even they are not required in clinical practice. A subjective judgment of a psychiatrist alone is still enough to detain someone in a psychiatric hospital, label him with a diagnosis and give him medications agains his will. Strange as it is, this is the law.

Nine Million Time-Bombs

In a television interview Jeff Griffin, the Executive Director for the Western U.S. of the Citizens Commission on Human Rights, talks about some of the problems that our society faces in connection with the expanding power of the psychiatric industry.

This interview shares the common problem of nearly all critics of psychiatry: the extreme persuasion and bitterness. They lash out the abuses of psychiatry, and call it all kinds of bad names. It is perhaps not surprising. Anyone who spent some time uncovering psychiatry's dark secrets would probably become bitter in the process; but while their words may be correct, their very tone of voice and style of speech stand in the way of accepting their arguments. The listener can't help thinking that maybe all this is just another political game.

Nevertheless, Mr. Griffin, who has been fighting psychiatry for many years, mentions some extremely important points in this interview. One of them is the 9 million children who currently take one or more psychotropic medication.

He calls them "9 million time-bombs" and explains that in nearly every single case of school shooting or other mass-murders made by children one or another psychiatric drug was involved. The interview was apparently filmed before the Virginia Tech; I happened to watch the news on the day when it happened, and the reporters mentioned several times that the guy had been taking psychiatric drugs, although this information was not mentioned again in the subsequent media coverage.

We have never before given so much drugs to children as during the last decade; the drugs that are capable of causing restlessness and homicidal ideas, particularly in the withdrawal period. We have yet to find out what these kids will be like when they grow up. With the economic crisis that the US and its health-care system is facing, many of the people taking one or more psychotropic drugs will be forced to go into withdrawal. Jeff Griffin is right to be concerned.

Depression Meds

There was a guy at a party the other day, who worked for a pharmaceutical company. He said: "Imagine that! They try to sue our company claiming that one of its medications for depression causes suicides. I mean, how stupid is that? They are already depressive, we try to help them, and then they sue us!"

A very nice interpretation, I thought. He had a PhD, and he didn't have a clue. I wonder, do at least the CEOs of the pharmaceutical companies know what they are doing?