From: ben.merhav@gmail.com <ben.merhav@gmail.com>
Date: Sat, Mar 27, 2010 at 2:14 AM
Subject: MY COMMENTS ON THE Dr Nimesh G Desai, MD ARTICLE
To: bob@sourcewatch.org
http://18thoutlawpsychiatry.blogspot.com/
by Justicle Lover
I have considered psychiatry in India before, in one of my autobiography weblogs ( see : http://7thautobiography.blogspot.com/2009/12/my-22nd-open-message-to-all-people-of.html). There is no basic difference, it seems from the article below, between the attitude of psychiatrists in India and those of their colleagues in other countries. Yet the overwhelming injustices, huge class and Hindu caste gaps and discrimination, and the horrendous suffering of hundreds of millions of people there at the hands of the ruling class in India, demand international attention and solidarity with the suffering people.
Such urgent needs must exclude psychiatry, because its practitioners can only increase and exacerbate the trouble for the suffering people. It is for these reasons that I wish to comment on the article below by Dr. Nimesh G Desai, MD. My comments are in red within the article.
http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2005;volume=47;issue=4;spage=185;epage=187;aulast=
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Antipsychiatry: Meeting the challenge
Nimesh G Desai
India,
The healthy nature of any debate with 'proponents for' and 'opponents against' a theme or a subject, in any form, and its beneficial effects are well known and recognized. The value of such debates on issues having importance in the growth of any discipline of science, including those of the medical sciences is immense, and yet it would be unthinkable to be dealing with 'anti-cardiologists' or 'anti-paediatricians'! The fact that 'antipsychiatry' has existed in one form or the other for some time, and indeed has sometimes been vehement enough to approach psychiatry as a demon to be exorcised, is noteworthy.
( The author's comparing psychiatry to other medical specialties, like cardiology and paediatrics, is a common fallacy among psychiatrists everywhere. They all wrongly consider psychiatry as a "medical specialty" without having even a shred of scientific evidence for such a claim. Psychiatry is a malignant growth on the scientific body of medicine. Therefore anti-psychiatry is the normal and honest view of psychiatry).
The opposition to the involuntary custodial care in psychiatric hospitals, which has been one of the major reservations from the antipsychiatry groups, is quite understandable, as is the demand for a more humane approach to psychiatry; but it has often gone beyond these basic issues. The range of opinions and strong advocacy positions within the loosely formed group of antipsychiatrists, and the impact it has had on psychiatry requires to be understood, besides recognizing the enormity of the challenge and the need to meet the challenge effectively and levelly.
(While the admission by the author that "opposition to the involuntary custodial care in psychiatric hospitals...is quite understandable" is welcome, yet what is required is action, rather than lip service. The global reality is that psychiatric coercion remains a basic requirement of the psychiatric dogma and practice. Therefore psychiatry must be outlawed to stop its violations of human rights, and to save the lives of its patient-victims).
Although there were criticisms of the theory and practice of psychiatry in the nineteenth century, the strident criticisms from different perspectives articulated during the second half of the twentieth century have been collectively termed as 'antipsychiatry' by David Cooper, a South African psychoanalyst. [1],[2] The first of the major steps in this direction was taken by a science fiction writer, L. Ron Hubbard, who founded the Church of Scientology in 1950, with the goal of 'eradicating psychiatry from the face of this earth'. [3] His book, Dianetics: The modern science of mental health, prescribed the techniques of rundown (a series of steps to produce a certain end result), introspection rundown designed to handle a psychotic break (by isolating the person wholly with all the attendants completely muzzled, till the person is out of his psychotic break) and auditing (looking back through a person's past to find some memory that is causing problems to the person at present).
In 1969, the Citizens Commission of Human Rights (CCHR) was founded by scientology 'to expose the evils of psychiatry'. [4] The attacks on psychiatry and psychiatrists by scientologyCCHR have continued, and indeed have increased with many celebrities joining hands. One striking example is of the Hollywood actor Tom Cruise who advocated in January 2004: 'I think psychiatry should be outlawed.' On the other hand, the undesirable impact of following scientology has also been noticed, a striking case being of one Lisa McPherson who died in 1995, brought dead to the hospital with significant weight loss, bruises and bug bites, having been put on 'introspection rundown' to handle a psychotic break. [5]
(Whether by mistake or by design psychiatrists tend to equate anti-psychiatry with the Church of Scientology or with its CCHR body. The author wrongly follows this fallacy too. Myself, like many other people who are opposed to psychiatry, neither belong nor follow the Church of Scientology/CCHR).
The second major trend in anti psychiatry has been of psychiatrists and sociologists who have, for different reasons, questioned not only the coercive authority of psychiatrists and psychiatry in diagnosing and 'putting people away' for treatment in hospitals, but also the very basis of psychiatric diagnosis and the increasing 'medicalization' of mental illnesses. Interestingly, the 'seige from within' came almost simultaneously from two psychoanalysts across the Atlantic Ocean. In the UK, R.D. Laing, who started his writings in 1960, saw mental disorders or at least schizophrenia as an understandable and even normal response of sensitive individuals to a 'mad' world. [6],[7],[8],[9] He emphasized the importance of freedom and subjectivity over determinism, and believed that cure would occur when patients felt that they were free to make choices. For the diagnostic processes of modern psychiatrists, he used the term 'psychiatrosis' as a new type of mental disorder. About the same time, in the USA, Thomas Szasz in his writings questioned the existence of mental illness and medical diseases since they did not satisfy the Koch's postulates for tuberculosis and other infectious diseases. As a defender of radical individualism, he opposed involuntary hospitalization and treatment and argued that 'whereas in modern medicine new diseases were discovered, in modern psychiatry they are invented' and that mental disorders were no more than 'myths' of fraudulent impositions perpetuated by psychiatrists whose central intention was to preserve their privileged professional status. [10],[11],[12],[13]
(This is a confused/deceptive account by the author. Firstly, both Dr. R.D. Laing in Britain, and Dr. Thomas Szasz in the USA are psychiatrists. The late Dr. Laing opposed psychiatric incarceration and psychiatric drugs. Dr. Thomas Szasz is a professor (emeritus) of psychiatry. In his book, The Myth of Mental Illness, published some 50 years ago, he refutes the foundation of the psychiatric dogma regarding "mental illness". There are in the USA alone a good few dozens of psychiatrists who agree with these two rebel psychiatrists. Secondly, the author's attempt to redicule Szasz only turns against him, making the author's entire article ridiculous. The truth is that whereas in medicine illnesses are discovered, in psychiatry they are invented. To invent an "illness" is a fraud, of course ; and a genuine illness in the human brain is under research by neurology, not by psychiatry ! Thirdly, the author ignores altogether the dominant role of the pharmaceutical industry which is the main beneficiary from psychiatric drugs prescriptions, to the tune of hundred of billions of dollars a year, profits which allow it to bribe most of the psychiatrists, as well as other medical doctors and politicians).
The dissent from sociological thought and perspective came from two sociologists in the USA, viz. Erving Goffman and Thomas Scheff. In his book Asylums, Goffman described what he saw at St Elizabeth's, an institution with over 6000 patients with psychiatric illnessess. [14] He opined that psychiatrists used asylums as brainwashing machines to control disturbing individuals. His observations did draw attention to some serious weaknesses in mental hospitals, leading to desirable reforms, but unfortunately he overstated the point to the extent that there was no such thing as mental illness. The experience with deinstitutionalization in Italy and other countries has not yielded the benefits of exaggerated emphasis against all kinds of institutions, and has established the need and relevance for the process of reform of mental hospitals to become mental health institutions serving key functions. The process of deinstitutionalization, when carried too far, has had its undesirable effect in causing a rapid growth in the number of mentally ill homeless individuals. [15] In Thomas Sheff's 'labelling theory', individuals are 'labelled as deviant or mentally ill because they have isolated social norms or their behaviour is what a society considers unacceptable behaviour'. It was argued by Sheff that 'most chronic mental illness is, at least in part, a social role'. [16]
(The author does not understand or deliberately ignores the social and political roles of psychiatry. Apart from serving themselves psychiatrists serve the pharmaceutical industry, as well as the rest of the ruling class, not their patient-victims. In return they get the protection and legal power from the state, and bribes from the pharmaceutical industry. The author should read the articles by Dr. Joanna Moncrieff,MD, British Senior Lecturer in Social and Community Psychiatry, to understand what he is writing about. She would teach him the social and political role of psychiatry).
The third major force in antipsychiatry started in England in the early 1970s with the formation of the Mental Patients Union, led by the so-called 'survivors' of psychiatry, which has also gained its geographical and ideological influence, with the World Network of Users and Survivors of Psychiatry (WNUSP) being at the forefront of the movement. [17] Although their activities often deny the reality of mental illness and criticize the lack of sensitivity on the part of psychiatrists, the movement has led to bridging the gap between psychiatrists and users of their services in some parts of the world, [18] and can further help the process globally. This group has also recently been joined by human rights activists including lawyers, who are primarily opposed to any active or passive violation of human rights including involuntary hospitalization and treatment.
(Most of the patients advocacy groups, including some of the survivors of psychiatry groups are financed/bribed by the pharmaceutical industry to comply with psychiatry's demands. In any case, no reform of psychiatry is possible because the entire psychiatric dogma is based on fraud and on coercion. It must be outlawed now ! ).
As is evident, the different forces in antipsychiatry movement, even if they are not based on common theory or conceptualization, have been opposed to the power wielded by psychiatry and psychiatrists over peoples' lives, the lack of a humane approach and undue medicalization of psychiatry, and advocating the need for respecting and actively promoting some basic rights of mentally ill persons. It should be readily accepted that these are concepts we cannot disagree with or shy away from! Some of the practical implications of these concepts, e.g. the right to refuse hospitalization or treatment, may bring forth issues requiring negotiation, and some other tenets of the antipsychiatry school of thought, viz. demonizing psychiatry or challenging the very basis of diagnosis and treatment, may be more difficult to deal with, not only in our own limited professional interest, but genuinely in the interest of persons with mental illnesses and their families. The fundamental concept of 'respect for the person', from where the antipsychiatry thoughts and arguments come, has unfortunately been, in general, alien to psychiatry and psychiatrists, barring exceptions. The inherent, erstwhile paternalism of medicine does seem to have become so accentuated in psychiatry as to lead to nonconsensual approach in treatment being the norm. Some of the negative experiences of users of psychiatry and the ringside observers leading to various ideologies of antipsychiatry and some of the dangers portrayed are too real to be ignored! The issues involved in involuntary hospitalization and treatment, not to mention the multifarious misuse and abuse of the related provisions, have to be recognized with candour. Szasz's description of modern psychiatry 'inventing' diseases does not seem too far-fetched in view of the ever-expanding, seamless boundaries of the current systems of classification!
The benefits of the larger conceptual and ideological opposition of antipsychiatry to the practice of psychiatry at the macro level have been remarkable in the development and refinement of psychiatry. [2],[18] To be a believer and a practitioner of multidisciplinary mental health, it is not necessary to reject the medical model as one of the basics of psychiatry. Sometimes neither the psychiatrists nor the antipsychiatrists realize that the medical model of psychiatry, and the claim that it is a neuroscience, can be synchronous with the larger concepts of multidisciplinary mental health care and participatory mental health care. Some of the challenges and dangers to psychiatry are not so much from the avowed antipsychiatrists, but from the misplaced and misguided individuals and groups in related fields. The implicit danger and challenge at micro levels of mental health teams or centres are possibly more difficult to deal with as compared to the macro-level ideological challenge.
(This is the first positive passage in this article. Rather than continues to use lies, dishonest conceptions and distortions of reality the author seems to change his mind here, in patent contradiction to the earlier parts of the article. Thus, no more distortion of Szasz, no more rediculing and opposing anti-psychiatry, and no more defence of psychiatric coercion ! Instead, the author admits that "It should be readily accepted that these (namely, the complaints and demands of anti-psychiatry )are concepts we cannot disagree with or shy away from! "However, he still supports the "mental illness" dogma of psychiatry !).
It has been argued that after the 1970s, the antipsychiatry movement became increasingly less influential, due in particular to the advances in psychiatry and neurobiology and in general to the improvements in the efficacy of available treatment. [19] Yet, in some countries it still remains influential in formulation of mental health policy. There is a fair possibility of the disparate forces of antipsychiatry gaining momentum and influence in countries of the developing world such as India, not in the least contributed to by the effects of globalization. Such a development could be hazardous for the society in general, given the possibility that the debates often do not remain ideological but tend to get acrimonious and personalized easily, and the benefits of the science of psychiatry have not been far reaching as yet for other advocacy groups such as families of treated persons to get their voice heard equally. On the other hand, the fact that the understanding and acceptance of psychiatry is steadily improving and that some good work in community participation in mental health services has already begun may be the encouraging factors in meeting the challenge of antipsychiatry. The nature and enormity of the challenge is evident, and yet it needs to be met with as levelly and meaningfully as possible. The response pattern of nonchalance or acrimonious name-calling or labelling is not likely to help, nor can the psychiatrists permit themselves to feel demoralized or threatened. In addition to competence and evidence base for the practice of psychiatry, psychiatrists and their allies- the patients and their families who avail of psychiatry services do not see themselves as 'survivors' but 'beneficiaries'- could do well as to understand the criticisms emanating from these antipsychiatry groups, and the processes contributing to such criticisms. As it so happens, there are millions who have benefited from services provided by psychiatrists, even if they remain silent, or even unaware, bystanders of this discourse on psychiatry and antipsychiatry. At the same time, the need to listen attentively to the voices of dissatisfaction or dissent, however small, is paramount, especially if the discourse is dispassionate and with mutual respect. Moreover, the willingness to accept the valid criticisms and the possible abuses or 'wrongs' of psychiatry, as well as to be open to a dialogue or multilogue and review of practices if required would not only be strategically sound but also ethically warranted. Many ideas and observations from antipsychiatry are worthy of careful consideration, even if overstated or exaggerated. It may not be easy for psychiatrists, but the time is bygone when psychiatrists could abrogate to themselves the right to know and decide what is best for mentally ill persons. The need is not to react defensively or in counter�offence, but 'to democratize mental health by linking progressive service development to a debate about contests, values and partnerships', as Bracken and Thomas put forth in their view of 'postpsychiatry', which takes the debate beyond the conflict between psychiatry and antipsychiatry, distancing itself from the therapeutic implications of antipsychiatry. [20] Let us recognize and meet the challenge, so as to accommodate all possible viewpoints, and enrich the concept and practice of psychiatry for human welfare.
References
| 1 | Cooper D. Psychiatry and antipsychiatry. London: Tavistock; 1967. |
| 2 | Berlim MT, Fleck MPA, Shorter E. Notes on antipsychiatry. Eur Arch Psychiatry Clin Neurosci 2003;253:61-7. |
| 3 | www.scientology.com |
| 4 | www.cchr.org |
| 5 | www.lisamcpherson.com |
| 6 | Laing RD. The divided self. London: Tavistock; 1960. |
| 7 | Laing RD, Esterson A. Sanity, madness, and the family: Families of schizophrenics. Baltimore: Penguin; 1964. |
| 8 | Laing RD. The politics of experience. London: Penguin; 1966. |
| 9 | Laing RD. Self and others. London: Tavistock; 1969. |
| 10 | Szasz T. The myth of mental illness. New York: Hoeber-Harper; 1960. |
| 11 | Szasz T. The manufacture of madness. St Albans: Granada; 1973. |
| 12 | Szasz T. The second sin. New York: Anchor Books; 1974. |
| 13 | Szasz T. Schizophrenia: The sacred symbol of psychiatry. Oxford: Oxford University Press; 1979. |
| 14 | Goffman E. Asylums: Essays on the social situation of mental patients and other inmates. New York: Penguin; 1961. |
| 15 | Lamb HR, Bachrach LL. Some perspectives on deinstitutionalization. Psychiatr Serv 2001;52:1039-45. |
| 16 | Scheff TJ. Being mentally ill: A sociological theory. New York: Aldine; 1966. |
| 17 | www.wnusp.org |
| 18 | Dain N. Critics and dissenters: Reflection on 'antipsychiatry' in the United States. J Hist Behav Sci 1989;25:3-25. |
| 19 | Garfinkel PE, Dorian BJ. Psychiatry in the new millennium. Can J Psychiatry 2000;45:40-7. |
| 20 | Bracken P, Thomas P. Postpsychiatry: A new direction for mental health. BMJ 2001;322:724-7. |
--
Palash Biswas
Pl Read:
http://nandigramunited-banga.blogspot.com/
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