A Psychiatrist at Large

The brain, behavior, and everything in between.

Psychiatry on Trial

Is it right to put psychiatry on trial?

Mens Sana in Corpore Sano. Juvenal, Satire X

Psychiatry has a special place in the Hall of Fame of medical specialties. Seen as either a villain or a hero, psychiatry, for the better or worse, tends to capture the public imagination. Not unlike some controversial stars that people seem to love to hate, time and again psychiatry breaks into the news, makes its talk show rounds as a special guest, is taken to court, is set free, placed on a pedestal, only to fall again in a cycle that never ends.

Witchcraft at Salem Village. Illustration by F.O.C. Darley, William L. Shepard, or Granville Perkins, 1876. Public domain.
Public Domain
Psychiatry is commonly vilified for creating bogus labels that masquerade as real medical diagnoses under the hidden agenda of reinforcing social control on the unruly and the rebellious. Often times psychiatry is seen as another face of the thought police that reinforces the rules of the powerful and the privileged on those who choose to ignore or challenge the rules of the social contract. The jury is out and states its verdict as guilty when it comes to either psychiatrists fabricating diagnoses to keep themselves and medical industry in business, or simply pushing pills or locking up people who just happen to be different.

Interestingly, other disciplines that work with the mentally ill under similar theoretical assumptions (ie, that there is such a thing as mental pain and distress which can be successfully tacked with standardized interventions) are not nearly as popular as psychiatry when it comes to public debate.

At the same time, while the psychological distress—intervention paradigm is shared between psychiatry, psychology and other counseling disciplines, psychiatry stands alone in its philosophical partisanship with brain-based theories of mental pathology. In other words, consistent with its medical affiliation, psychiatry has always been steadily invested in a view of the mind as a product of brain function.

It is this reason which places psychiatry under a different set of standards and expectations in the public eye. The public view of psychiatry is a direct reflection of the fact that the debate between materialism and idealism is still fought on many different fronts, including modern philosophical theory.

As a practicing psychiatrist I face one or another of the above criticisms on an almost daily basis.

When I chose this career I envisioned myself as working with the poorest and sickest of us all. Those who been hurt most, by demons mastering their minds to such an extent that they will end up roaming the streets, or sleeping under bridges only until choosing to go up and jump off, as their only way out of the pain and torment.

And I am grateful that I have had the opportunity to do exactly that. My accomplishments are small: helping a deeply depressed young woman to regain just enough mental strength to choose to get out of bed, or a middle-age father of three to decide to keep on living, not one day at the time, that is already too long but ten minutes at the time. These usually rank as major accomplishments.

There are those of us who treat the worried well in plush offices in Beverly Hills and the Upper East Side. But the mental illness that crosses a psychiatrist's path is usually far from its glamorous New Yorker cartoon depictions.

Psychiatry is far from perfect. But that is good, as perfection implies stagnation, and when it comes to complex relationships, such as the relationship between the brain and the mind, it's always better to take a critical stance. Instead of thinking about what we've accomplished as a completed body of work psychiatry should remain a perpetual work in progress—integrating the new data from an array of related disciplines, starting with neuroscience and ending with the philosophy of mind, and redefining itself as many times as it takes.

So while I can understand how some, including well intended journalists feel it's their civic duty to doubt the legitimacy of psychiatry as a science, the reality is there are too many among us still wounded by severe mental illness.

I hope critics understand that stating that psychiatry created mental illness also implies that people who experience mental illness are making it up (as it's not real to start with, is it?). Mentally ill patients are then only unwilling conspirators against themselves and should be able to snap out of it when psychiatry's wicked plot will be eventually revealed.

But this is simply not true. Further, in a paradoxical twist, this view only reinforces the stigma that it attempts to curtail. What it curtails instead is the foundation for advocacy work for mental illness research and care, which is already under dire straits in this country.

© Copyright Adrian Preda, M.D.

Adrian Preda, M.D., is an Associate Professor of Psychiatry and Human Behavior at the UC Irvine School of Medicine.

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