A PHILOSOPHY WARNING for today's psychiatry.
psychiatry today suffers from a false sense of philosophical complacency.
A PHILOSOPHY WARNING – psychiatry today suffers from a false sense of philosophical complacency.
I adapted this from posts I put up on the Critical Psychiatry Network, a group of some 350 psychiatrists around the world.
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There is a central philosophical dilemma which cripples today’s psychiatry but which practitioners in the law manage to cope with perfectly well. Just take a moment to see why this is so devastating to our humane psychiatry.
Take the commonplace legal problem – “when you picked up that spade, did you intend to dig or to kill?” This in law, turns on the crucial legal concept of ‘intent’. The law couldn’t function without it – neither can DSM-psychiatry.
The word ‘intent’ does not appear in DSM-5 – except to note – “this page left intentionally blank” --- the editors preserve ‘intent’ for themselves, but deny it their clientele.
You take a careful clinical history – BUT what has the patient done for themselves to ameliorate matters? DSM-psychiatry says this is a non-question – according to the DSM, the person in front of you has no agency, no ‘intent’, no ability to intervene on their own behalf – they suffer chemical mismatches which a pill may help, but can never be expected to cure. The very philosophy of DSM-III, IV and 5 prohibits you from engaging with their own personal initiative – to do so runs counter to this chosen and deliberate policy of excluding ‘intent’, of agency. And it matters.
Psychoactive drugs, as Dr Joanna MonCrieff pointed out decades ago, work by ‘intoxication’ – they interfere with cognition, and therefore with ‘intent’, and even more obviously, with agency – think ‘drunk’. DSM-psychiatry doesn’t mind – in fact their very medical philosophy is based on a mechanical clockwork, non-agency, human. Is yours?
Winnicott set out to engage the agency of his young patients – he didn’t doubt they had ‘intent’. Exclude this at your peril (and your patient’s). Again, it matters – philosophical complacency leads to all manner of pharmaceutical (i.e. iatrogenic) damage, as we keep rehearsing on this list – but centrally, it endorses the fundamental absence of ‘intent’. DSM-psychiatry elects to live without ‘intent’ -- do you?
Lately GPs are being advised to tell their patients with, say, depression, to take more exercise, or go for walks – philosophical complacency makes this meaningless, unless you first admit a facility for initiative, for ‘intent’. As my earlier paper pointed out, no other healthcare can progress without it, either – (link below). I recently published 10 philosophy papers, spelling out how this impacts on clinical practice – my advice to you is not to follow current myopic psychiatric pontifications.
In the hope that you may still be interested in where psychiatry has gone so critically awry, I attach another of these papers, with a link below. I see this as the fullest explanation for the psychiatric mire we currently find ourselves in – with which Winnicott had no truck – but which will remain intact until this philosophical nettle is grasped.
Ask your non-psychiatric colleagues – they’d all agree with Winnicott. What else is a Critical Psychiatric Network for?
Rock on, and think hard – clarity cures -- discourtesy and obscurantism doesn’t.
Bob
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Why Dysfunctional Medical Flaws Have Cramped Psychiatrists Since 1980 https://www.davidpublisher.com/Public/uploads/Contribute/617f83e4ef9c5.pdf
The Scientific Evidence That “Intent” Is Vital for Healthcare is at -- https://www.scirp.org/journal/paperinformation?paperid=79128 [no pay wall].
~~~o0o~~~
The above raised a query from one on the list, regarding where the ‘‘unconscious” fitted into all this philosophising –
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Good point, J, thanks for raising it. It’s not been satisfactorily addressed since well before Polonius – even Shakespeare ducks the issue too --
“I will be brief. Your noble son is mad. Mad call I it; for, to define true madness, what is't but to be nothing else but mad? But let that go.” Hamlet.
Stand back a minute, and take a look at what’s happening in psychiatric clinical practice. Out of the person’s mouth comes a stream of unintelligible words/thoughts/actions. They don’t make sense. They’re ‘mad’.
The real philosophical challenge is that this is not an ordinary issue of ‘incomprehension’, as if the sufferer were suddenly talking in Serbo-Croat or whatever. No, there is a clear pattern there, a clearer determination to proceed on a path which makes sense to the sufferer, but to no one else. Their determination is that they are right, and everyone else therefore wrong – this is striking.
They don’t see themselves as mistaken, that’s not in their view – they may seem odd to themselves, but that’s the way the world looks, and if violence, discourtesy or revenge is on the agenda, then who are they to object?
One way of looking at this is to imagine that when we talk or think, we are negotiating our way around objects in our mental furniture. We posit such and such a circumstance, and think up ways around. It’s morning time – where’s breakfast?
The essence of cognition, rational cognition, is that there IS a thread, at least one the speaker/thinker can see, and is trying to follow. This in itself is utterly mysterious, along with consciousness -- it is the most elusive philosophical challenge you can think of – but it works. Entropy begone !
Or it works generally – breakfast arrives, our pension plans work out – all because we are blessed with the ability to think ahead, and take appropriate remedial action.
Now, Breuer’s break-through, his momentous discovery in Freud’s terms, was to respect the person’s ability to think straight – and to light on the one clear reason he or she, no longer did so.
This is where the simplicity comes in – and compared with limbic, amygdaloid, cingulate-do-dahs or pre-frontal machinations, it is indeed simplicity itself. The sufferer is indeed thinking along a clear pathway – but there is an unseen blockage, a snarl up, which the sufferer cannot see, but which they take note of, and thereafter redirect their thoughts/actions to avoid. Something which is feared but unvisualised, mucks them up.
What Breuer did was to link this blockage with an earlier dreadful ‘catastrophe’, which not only could not be brought back into consciousness – but which disguised itself by fading away into ‘normality’. It was quite ‘normal’ for Alec to kill every two years – this is just what he did – he couldn’t (at first) link it to his brutal father in any rational way – he feared his parental figment as Freud and others on this list also do – but the link was as buried for him as was the whole scenario. This bit of his mental furniture was off-limits, it was a no-go area – do not enter, if you want to survive.
Here his very own survival mechanism has turned in on himself, and calumny, discourtesy or crime results. All eminently, coherently, provably curable – but only if the perpetrator trusts the interlocutor enough and feels safe enough to do so – simple, while remaining far from easy, depending on many factors – especially with those who have protected themselves with thick, inane, repetitive but concrete theorisations. . . . . (e.g. Freud.)
What Breuer discovered was that gently bringing these past scenarios into full view, cured them. The Simple Science of Sanity in a nutshell.
Of course, all who’ve spent a life time struggling with the philosophy behind madness, like Polonius did, don’t tend to welcome this with open arms. Indeed they work extra hard to block off suggestions that there is a simplicity, a cure in redirecting ineffable cognition into the one area into which it has forbidden itself to go. Ferenczi, me – any number of ‘mavericks’ bite the dust, in preference to breaking infant-rule number one – don’t upset mum/dad, or you're dead. Just look around and otherwise innocuous points become vested with life-death import, but only to the one whose mental furniture is blocked. Tee hee.
Rock on J, and thanx
Bob
~~~o0o~~~
Which in turn evoked a further response pointing out that much of this philosophy could be handled by students, and advising me to look at Yalom’s book, The Gift of Therapy. I replied as follows.
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Good to hear from you, S, and I’m delighted by two of the points you make – (1) philosophy 101; and (2) Yalom.
(1) -- Any High School student of philosophy could soon spot the brazen attempt of DSM to bamboozle the medical profession, philosophically.
If only more medics had half the philosophical confidence you need – none of the appalling iatrogenesis we can now see getting daily worse, could have occurred.
How many doctors have actually read the philosophic outrage that is perpetrated on page xxi, of DSM-IV? –
“... Although this volume is titled the Diagnostic
and Statistical Manual of Mental Disorders, the
term mental disorder UNFORTUNATELY implies a
distinction between ‘mental’ disorders and
‘physical’ disorders that is a reductionistic
anachronism of mind/body dualism. A compelling
literature documents that there is much ‘physical’ in
‘mental’ disorders and much ‘mental’ in ‘physical’
disorders. The problem raised by the term ‘mental’
disorders has been much clearer than its solution,
and, UNFORTUNATELY, the term persists in the title of
DSM-IV because we have not found an appropriate
substitute …” [emphases added.]
According to Dr Peter Breggin (in Toxic Psychiatry), the Board of the APA in 1978, prior to publishing the scandalous DSM-III (in 1980, where all the trouble started), decided that since all the money was going to the talk therapists, that they would ‘neurologise’ psychiatry. Can you credit this? It’s medical negligence, or corruption to use Robert Whitaker’s term, writ large.
If you want to hoodwink a populace that is already a bit nervous about the mysteries of the mind, why not throw a few technical and already fuzzy words at them? What could be better than – “a reductionistic anachronism of mind/body dualism.” An anachronism is always bad, and coupled with opaque mind/body dualism you can be laughing all the way to the bank, before the suckers wake up – as has happened. Whitaker cites the income of the APA going up from $10m to $70m a year – money speaks, but here at the expense of people’s mental health -- globally.
And just in case you missed the point, full of crocodile tears, they say “UNFORTUNATELY” -- twice. They actually bleat that you can’t write a textbook of psychiatry without using the term ‘mind. Of course, they don’t need to mention ‘mind’ ever again – who out there can challenge a bunch of psychiatrists who say the mind doesn’t exist, or at least doesn’t matter? Philosophic duffers are prime targets for psychiatric scammers. If you want a “philosophy warning” – here’s the one to start with.
So to (2) -- Yalom.
Fortunately for my longevity I had already ditched the worst of Freud’s self-defending confabulations. On page 45, Yalom talks blithely of observing that “the psychoneurosis becomes gradually replaced by a transference neurosis.” Bear in mind that transference originally arose from Freud’s hazardous notion of transferring your feelings about your parents, onto the therapist. Since I found that all murderers killed a parent-figure, as often a father-figure as a mother-figure – the infant is gender neutral – my fate would have been sealed in Parkhurst Prison before I’d opened my mouth – grrrrr.
And just picture the scene – I could hardly have cut a more laughable figure, not only with the UK’s most hardened prisoners, but also with the staff, had I taken Yalom’s advice (page xiii), to ask them “to disclose all feelings, thoughts, and dreams.”
I already knew that the way these patients disclosed their feelings was brutally, generally by murder – and my task was to find out why, and to offer them a more courteous mode of verbalising.
As for ‘dreams’ – again, if you find your reality is already too full of terrifying parent-figments (as Freud did when he was 41, in 1897), then dreams offer a fool-proof way of escaping – day-dreams work well enough in childhood – why not extend the same illusory ‘progress’ into adulthood? Well, I wanted to survive – that’s why I didn’t.
Rock on S, and thanks for raising these two points.
Best
Bob
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Professor Bob Johnson, DSc(hon), MRCPsych, MRCGP, PhD(med computing), MA (Psychol), MBCS, DPM, MRCS, School of Psychology, University of Bolton, BL3 5AB, UK. GMC num. 0400150