Why I’m a happy psychiatrist

The world we live in, is UNCERTAIN. And where today’s benighted psychiatry could and should help – it drugs.

Why I’m a happy psychiatrist

The world we live in, is UNCERTAIN. And where today’s benighted psychiatry could and should help – it drugs.

There is a better way than making us all zombies. But it does require some rather heroic wrenching of our established ideas – and no progress is remotely possible, unless you can see what’s at stake, where we need to be going, and at least some inkling that it all makes sense.

There are two indispensable concepts which any healthy psychiatry must have, and both have been actively excluded from today’s medical practice – they are INSIGHT, and PATIENT AGENCY.

What follows here, I first wrote for a bunch of ‘critical’ psychiatrists, one of whom, P, touched on this. I responded, thus.

Alas P, your scepticism covers only the half of it. The uncertainty of which you speak is not only indelible, but cosmic. In today’s reality, whether practical or clinical – only INSIGHT, and PATIENT AGENCY, can even remotely begin to rescue us – any one of us, whether patient, philosopher, or physician.

I list two types of uncertainty – (1) uncertainty of facts, and (2) uncertainty of emotions. No one likes either, and you’d be surprised how many cling to empty dogmas, or obsolete “Authorities” (especially those long dead, or French), by way of nominal certainty. Sad really, but there it is.

And it does take a huge dollop of philosophical confidence to acknowledge the first. Science was naïvely dreamt of as abolishing (1) factual Uncertainty. This of course, ignores Kant’s failure to refute Hume, and was finally undone by the Uncertainty Principle – nothing moves without electrons, and the more you know about where an electron is, then the less you can ever know about where it’s going next. This in itself is an awkward insight – and so is all too easily misunderstood, overlooked and obliterated. Fancy having to place on the altar of “Scientific Certainty” the fundamental notion of “The Uncertainty Principle” – no one would welcome this, and not everyone acknowledges it, either.

If you want clinical confirmation of this uncomfortable fact, just look at all the scientific data that Professor Peter Gøtzsche meticulously produces – impeccable – but utterly ignorable. [He has written widely, and with ever increasing frustration.]

If Science really did hold sway, as people cosily imagine it should – then Peter’s commendable groundwork would carry the day – instead it is as routinely ignored, and disparaged as INSIGHT, and PATIENT AGENCY currently are by today’s prevailing DSM-psychiatry.

So to (2) emotional Uncertainty. Few philosophers, or even those aspiring to philosophy, can really grasp just how fluid and amorphous and non-static consciousness is. It weaves and flows like quicksilver – in fact its very fluidity, and its intrinsic sui-generis, is its claim to fame. If it were anything else, it wouldn't work. Being as predictable or definable as an algorithm, or clockwork, would mean never thinking up something new, something that wasn’t there before, to solve our daily problems. Indeed we need it to start sorting out our everyday Uncertainties – that’s what consciousness is for.

So there you have the two Uncertainties – factual and emotional. Yet we humans crave Certainty. We go to inordinate lengths to glean even a whisper of it – too often at the wilful sacrifice of our ineffable reasoning.

And here, to our rescue, comes PATIENT AGENCY. Again, the philosophically naïve will not notice that if you take Patient Agency for granted, then you are also swallowing Free Will whole, you are demolishing a Clock Work Universe. And most importantly for psychiatry – you are empowering the individual to check through their very own unprocessed rage, so as to take full responsibility for seeking, and then obtaining INSIGHT, into it.

Ho Hum – the reason I am such a happy, inspired and enthusiastic psychiatrist – is that I hammer away at PATIENT AGENCY for all it’s worth. The decisions, willpower, ‘intent’, or whatever you want to call it, on the part of the person in front of me, carries the day – if I don’t manage to enlist THEIR agency (never mind mine,) then we’ve gained nothing.

They don’t know what’s going wrong with their consciousness, their emotions. They don’t see an answer to either type of Uncertainty, but especially not to their (2) emotional uncertainty. And there isn’t one, unless we/they can liberate, and then deploy, their very own PATIENT AGENCY.

Well, I don’t expect everyone to rush out and buy my books exploring these fascinating themes. But I do expect those on this network to listen respectfully, to ponder how it is that a man of my years can blend these apparently incompatible and disconcerting notions together, and thereby gain what we all yearn for – peace-of-mind.

Peace-of-mind is only to be found by relating to others. Ich und Du, is the way Martin Buber so wisely expressed it. And the recent Quaker World webinar did the same, by putting ‘Ubuntu’ centre stage – i.e. “I am because we are”, or in Latin – sum propter sumus – knocking poor old Descartes into a cocked hat – but there.

Rock on y’all.

Bob

~~~o0o~~~

 Professor Bob Johnson, Consultant psychiatrist (retd).

DSc(hon), MRCPsych, MRCGP, PhD(med computing), MA (Psychol), MBCS, DPM, MRCS, School of Psychology, University of Bolton, BL3 5AB, UK.      GMC num. 0400150