Once again, I just finished another consultation with someone from out of state who was desperate to find a therapist who he could talk to. He didn’t want to be pigeon holed into some DSM-5 reductionistic diagnosis. He didn’t want psychiatric drugs. He was desperate to find a psychiatrist who would understand him, who he could relate to, and could treat him with real psychotherapy. There should never have been a reason for me to consult with anyone from out of state. Unfortunately, the cynical and fraudulent takeover of psychiatry is all but complete. How many real psychiatrists are left?
How did this happen? Over the course of my career, I kept my head down and devoted myself to my craft, psychotherapy. I was certainly aware of the collusion between the APA and the drug companies. But as recently as ten years ago, I honestly did not know that things had really deteriorated this far.
Apparently, Dr. Jeffrey Lieberman and other like-minded psychiatrists, decided that psychoanalysis had too much power, and they wanted to transform the APA once again to the tenets of somatic psychiatry. The underling theory of somatic psychiatry is that the source of human struggle is considered to be the brain itself, rather than the person.
Treatments that follow from this simplistic, mechanistic, and reductionist notion have been to act directly on the brain, always with violating and destructive outcomes.
Somatic psychiatry originated with seizure therapy, or its first modern incarnation, insulin shock therapy (IST). It actually had its roots in the sixteenth century and was used psychiatrically around the time of the American Revolution. It was refined in 1927 into insulin shock therapy, when insulin was used to induce seizures as a treatment for drug addiction, psychopathy, and schizophrenia, with claims of a 50 percent remission rate. Papers were published in the American Journal of Psychiatry, starting in 1937. IST was widely used through the 1940s and 1950s. Its founding etiological principle was the (false) idea that seizures were the opposite of schizophrenia. Induce a seizure, and you balance out psychosis. In the 1930s, a more refined scientific explanation was developed for the (phantom) curative power of seizures. Its science proclaimed that psychiatric problems came from the autonomic nervous system. IST was said to work by blocking the nerve cells of the parasympathetic nervous system, thereby intensifying their tonus and strengthening their anabolic force. This restored the nerve cell, and the patient recovered. The corollary theory was that patients were jolted out of their psychiatric condition.
Next, we have lobotomies, originally called leucotomies. Lobotomies came onto the scene in the 1930s, having been invented and promoted by Antonio Egas Moniz. When I was a psychiatric resident, lobotomies were still fresh in psychiatric memory. The practice had only ceased in the early 1960s, after over twenty thousand people received this “treatment.” Let’s see … what was the science? The source of psychiatric problems was located in the brain, specifically the prefrontal cortex. The treatment of choice, then, was to ream out the prefrontal cortex with an ice pick. Respected MDs had a miracle cure and were the vanguard of the field. Science proved that lobotomies cured not only schizophrenia but anxiety, depression, low self-esteem, obsessive/compulsive disorder, and the unwanted behavioral problems associated with mental retardation (this is code for sexual behaviors). It was respected and celebrated in the psychiatric literature and validated in journals with documented studies and peer-reviewed scientific evidence. Lest you think this is an exaggeration, Moniz won a Nobel Prize in 1949 for his great and wonderful discovery.
Eventually, the validating follow-ups were shown to be fabricated and deluded, with self-promoting lies and half truths. Only after a great deal of harm were they debunked. And the ice picks were thrown into the trash heap of psychiatric history. We need to add that after lobotomies gradually attenuated, no one stopped and said, “What in the world did we just do?” How could sticking an ice pick in someone’s brain ever have been even a remote consideration? What was going on that such a grotesque medieval mutilation was actually adopted as a good thing to do? And how could it have been publicly and professionally embraced? However, as always seems to happen, amnesia quickly set in, and we forgot the brutal inhumanity that was so recently celebrated. And the considerable body of discredited scientific validation was never scrutinized for its contribution to and for having promoted such harm. Instead, science moved on to support the next somatic treatment in exactly the same way.
Next, we have electroconvulsive therapy (ECT), which came along soon after IST, in 1938. ECT was still a part of the curriculum in my own psychiatric residency in 1971. Entire psychiatric hospitals, built exclusively for ECT, were still operating, with no empty beds. Scientific studies and respected journals provided documented validation for placing electrodes on patients’ heads and applying huge jolts of electricity to generate seizures. Apparently, the jolt theory had gained traction. So we shocked the brain, instead of reaming it out. How humane. In addition to everything else, ECT also was touted as a cure for depression. It was allegedly proved that ECT was a safe, effective cure, with few, if any, drawbacks. The resultant memory loss not only was initially downplayed but was trumpeted as being therapeutic. (By the way, drugs are being developed today to chemically erase memories with the idea that this is therapeutic for trauma—same thing.) Later, under public pressure, ECT was refined to cut down on memory loss. The history of electroconvulsive therapy followed the same trajectory as lobotomies. Eventually, ECT showed itself to be the ineffective and violating practice that it is. But don’t get overconfident. Incredibly, in recent years, ECT has made a comeback and is being promoted once again, when its progeny treatments, antidepressants, don’t work.
Finally, we come the current incarnation of somatic psychiatry - neurobiological psychiatry, and its so-called treatment—drugs. Psychiatric drugs are next in the lineage of “treatments” whose focus is to act upon the physical brain. History is repeating itself.
Our contemporary science has now apparently proven that human problems come from genetic or developmental neurobiological disorders of the physical, anatomical, biochemical brain. The somatic treatments for these neurobiological, genetic, synaptic hormonal neurotransmitter diseases are brain drugs—psychoactive drugs.
In one generation, the APA, in collusion with the drug companies have destroyed psychiatry. The American Public has been sold a bill of goods.
People actually believe that human struggle is a brain disease. It is now taken as fact that there is a chemical imbalance in the brain and psychoactive drugs is just what the doctor ordered. We can now cure biological depression with antidepressants; biological anxiety with benzodiazepines; the fictitious ADHD with, of all things, amphetamines; insomnia with benzodiazepines, and other bizarre psychoactive drugs; Likewise the belief is that schizophrenia and manic-depression should be treated with drugs (In my experience, there may be a place for the use of some drugs – In schizophrenia when the self and its primal play flies apart, it generates a state of terror, the dimensions of which are far more powerful than regular anxiety. The resultant terror/rage is the worst and most unbearably frightening state of all potential human experience. And likewise, in manic-depression the central feature is that feeling, which is ultimately a rage state, cannot be contained by the ruptured play. It spins out of control without limits. However, drugs are not the treatment. The issues are not some brain thing, but human issues. People with schizophrenia and manic-depression are no different from you and me. The appropriate treatment is psychotherapy which deals with the human story.)
The real source of human suffering is not, nor ever has been, the brain. The issues are in the person, the human being, in the context of damage to the play of consciousness, created by deprivation and abuse in the formation of our character.
My life’s work has taught me that the art, the science, the discipline, and the wisdom of psychotherapy attends to this damage. There are no miracles and no shortcuts, as drugs, like the other somatic therapies, always promise. Never mind the harm done. We have repeated the same mistakes over and over again, and we are doing so today.
It doesn’t seem to matter that the chemical imbalance theory has been discredited. It doesn’t seem to matter that the multibillion dollar pharmaceutical industry and its influence peddling in academic psychiatry has been exposed as financially and scientifically corrupted and manipulated. The drug companies have engaged in study suppression, falsification, strategic marketing, and financial incentives. A complete picture of the studies that pretended to validate antidepressants has now emerged which confirms that they do absolutely nothing. (See – “No, it’s not the Neurotransmitters, Depression is not a biological disease cause by an imbalance of serotonin.”) It rakes in a whopping 70 Billion dollars a year for the drug companies. Unfortunately once people embrace a false belief it is so hard to think clearly again. I’m told its irresponsible to be so extreme. A thoughtful psychiatrist would use both drugs and psychotherapy. Apparently this sounds reasonable in today’s climate. Doing harm is never reasonable.
Human struggle is now, and always has been, the real issue. The very idea that drugs can cure what ails is an insult to the human condition.
I am well aware that the history of psychotherapy is checkered. Its practice suffered from dogmatic theories and miscast beliefs, which worked to the detriment of responsiveness to our patients. Although my own roots are in psychoanalytic psychotherapy, I moved on to develop the psychotherapy of character. It is a specialized form of human engagement that repairs the damage to one’s character by acting on the play of consciousness in the very way that it formed in the brain in the first place. All psychiatric symptoms are the expression of our problematic characters. By exploring, within the safe emotional holding by the therapist, we heal our unmourned pain and our psychiatric symptoms dissipate. We have thrown out the baby with the bathwater. There are many people who want psychiatry to be destroyed. I am not one of them. I know how valuable, life saving, and rewarding good psychiatry can be.
Psychotherapy is the real item. We must get back to it. It fosters the recovery of one’s authenticity and the capacity to love. This is the source of all psychiatric struggles. It taps into the heart of life’s mysteries and wisdom.
Robert A. Berezin, MD is the author of “Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain”