The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
Interview with Patrick Landman
EM : You are an opponent of the current system of diagnosing and treating mental disorders but you are also a trained and practicing psychiatrist. Can you talk us through how you reconcile those two conflicting viewpoints?
PL : I’m an opponent of the use of psychiatric diagnosis insofar as it represents an essentialization and possible stigmatizatio—hence its legitimate refusal by some patients who have been labelled in this way; it has no scientific basis, no real prognostic value and in general does not help us establish the right course of action.
Psychiatric diagnosis is always based on a comparison or a distance from a standard, an idea of a “normal” human being. But no such being exists, it is a fiction and its criteria vary from one culture to another, from one historical period to another. I am more interested in what the subject has to say about his experience and through listening I try to identify, beyond the complaints and symptoms, what obstacles he faces in trying to fulfill his desire and the ways in which these obstacles manifest and are organized – in other words whether we are dealing with a neurosis or a psychosis.
These points of reference help me better navigate the therapeutic relationship and empathy, including, if this seems necessary in order to protect the subject from certain excesses, prescribing medication. There is often a tension between listening and medicalization, but with experience this tension can be managed. You must approach every case individually, with a non-ideological clinical attitude.
EM : You are a French psychiatrist. Are there some clear or major differences between European psychiatry and American psychiatry that might interest a person in distress to know about ?
PL : Yes, I think that European psychiatry has remained more attached and focused around the traditional clinic, which takes into account not only observable behavior, but also the history, environment and possibly family psychopathology and the social context. In Europe, biology is therefore only one factor amongst others; it is not yet as dominant as in the United States.
The use of medication is therefore not always considered as the primary therapeutic focus, but at best only as a tool giving us access to the subject and making interaction possible. In addition to medication, we also use psychological care: psychotherapy, group work, institutional work, retraining and reinsertion for chronic patients. Unfortunately, the situation in Europe is highly heterogeneous and the influence of the DSM is increasingly more apparent.
EM : If you had a loved one in emotional or mental distress, who would you want them to see or what would you want them to try? Would you recommend that he or she see a psychiatrist first, or someone else?
PL : I think I would suggest to them to go see a clinician who is psychoanalytically or psychotherapeutically trained and thanks to their background they have had a personal experience of having worked on themselves, their own symptoms or emotions. I would add that it matters little whether this person is a psychologist or a psychiatrist, as long as he or she has the experience of having worked in a psychiatric hospital with highly disturbed patients, because this is necessary in order to be able to take care of people in severe mental distress.
EM : Psychiatrists are medical doctors who can prescribe medications. What is your opinion about whether so-called psychiatric medications are genuine medicine or chemicals with powerful effects or something in between?
PL : Psychotropic medication is not real medication like antibiotics, but it has effects on the brain, which can be used to calm a certain situation. They can also be abused and they should never be the only tool, but should only be used as part of an overall framework of caring for a patient, rather than just caring for their brain and simply trying to reduce or normalize their behavior.
EM : What major changes would you like to see in the way that people in emotional or mental distress are helped? What is your hope for the future?
PL : Psychiatric care policies should be to a lesser extent subject to the demands of medical economy. Clinicians should receive more training in listening to their patients; they should be more sensitive to the social dimension of mental illness, as well as to the harmful effects of different types of discrimination; they should pay more attention to speech; we should reject the overuse of psychiatric medication and the excessive restriction of liberty, the use of detention measures; more support should be given the associations of users of psychiatry, who often have great experiential expertise and fight for more respect for patients and their civil rights. I would like to see better access to care, both from a financial and from a geographical point of view.
Patrick Landman is a French psychiatrist, child psychiatrist, psychoanalyst, lawyer, a researcher associated with the University of Paris, Chairman of Stop DSM France, a blogger (foreign correspondent) at Mad in America, and the author of "Tous Hyperactifs" (Paris, 2015, Michel Albin)
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at firstname.lastname@example.org, visit him at http://www.ericmaisel.com, and learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com
To learn more about and/or to purchase The Future of Mental Health visit here
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