Earlier I was doing some research on 12 step programs. I had hoped to learn that their success rates were magnificent, that they far surpassed the programs propounded by psychiatric practice. Well, I was half right. Their success rate isn’t well known but those other programs — the ones put together by the high priesthood of psychiatry — their success rates probably hover somewhere between 1 in 30 and 1 in 40. That’s technically lower than the rate of spontaneous remission of the disease of addiction (i.e. the rate at which people left to their own devices will just suddenly quit one day) which, I suppose, means those programs are actually bad for you. (I can’t for the life of me find where I read this right now, but I’ll edit and cite something in the near future.)
The question has a problem, and unfortunately the problem is endemic to all sorts of modern mental health practices: nobody has a fucking clue what’s going on because nobody bothers to do any solid, peer-reviewable research and god forbid you should mention that the most appropriate study would follow former patients months and years after their treatment, that, oh reader, is just not cost-effective. No, much better to pop a new pill, make up some new and even more cockamamie laws, or how about some LSD and nude psychotherapy — that always hits the spot!
You may have noticed I’m a bit sour on psychiatry. Sour in a way that only someone who has been ground in its gears for a long, long time can be. Bluntly, I don’t believe in psychiatry, it’s not science. It’s actually a proliferation of half-cocked experiments perpetrated upon human guinea pigs by a Sanhedrin of fools who meddle with power greater than their wisdom. Meddling with power greater than our wisdom has been a time honored tradition of our species and normally I vociferously support it (Go on, Eve! Eat that apple! Or, you know what, if you’re not eating it, just hand it here!) but in this case we have an entire profession of pseudo-scientists groping in the dark and ruining lives every time they misstep.
My favorite line in all psychiatry is in the opening paragraph of every label included with those alluring, little, orange bottles. It reads, “it is not understood exactly how [your favorite pills] work.” That’s just fucking great. If I, as a mechanical engineer, fed you a big smile and said something like, “Well, it’s not understood exactly how this helicopter flies, but why don’t you go for a ride anyway,” you’d never get on the thing. If a doctor was going to put you under the knife and he confided, “Well, I don’t understand exactly how this surgery works,” you’d probably piss yourself. If some stick-up kid put a gun barrel in your face and admitted, “I don’t know exactly how this thing works,” you’d probably shit yourself then die (I hope you were wearing a diaper). But everyday we dutifully pop the pills prescribed to us — SSRI’s, anti-depressants, mood stabilizers, anti-psychotics — pills intended to radically alter our brain chemistry though no one knows how, and that seems okay to us.
Why do we know so little about all these pills? Well, take a turn through the DSM (Diagnostic and Statistical Manual of mental disorders) one day. Look closely in the appendices about drug information. Notice anything off? Oh, right, most of these pills had little more than a six week experiment conducted before the AMA approved them for market sales. That’s even better than fucking great! Let’s just run this through a quick six weeks — that way we can make sure it takes at least 7 weeks for someone to die of it (or have a crippling psychotic break) — and next thing you know it’ll be mass market money, money, money… MONEY! As a long time addict I can absolutely assure you, this business model is much more effective than that used by street dealers. Not to mention you don’t have to work on the street corner. You can sling rock from the comfort of your very own office.
To dig even a little further, the DSM itself is shadier than a Harlem street corner. I recently read an excellent book, The Psychopath Test, by Jon Ronson, the same Brit that wrote The Men Who Stare At Goats. Ronson writes that the DSM was birthed in a crowded conference hall filled with a parliament of psychiatrists jockeying to get the mental disorders they backed into the book. Usually the loudest shouter won. In any case very few illnesses were cut. Anyone with even a wild basis and a checklist for the symptoms of a disease eventually found their way into the book. From the DSM I to the DSM II (second revision) the book grew almost fourfold. The result? Diagnosis of psychiatric conditions soared and quickly reached epidemic levels. Where before we had been a fairly sane nation, we were all suddenly gripped by depression, anxiety, aberrant personalities, schizoaffective disorder, you name it.
An interesting study is the case of autism. In the early 1990s, the diagnosis of autism became standardized in the fashion of the DSM: there was a checklist of symptoms, a doctor studied his patient, made some check marks — if you’ve ever been to a psychiatrist you’ll know the whole process probably took less than 15 minutes, they like to move people in and out — then, suddenly, viola!, your kid had Asperger’s.
The wrench was that, in this case, the checklist covered such a broad spectrum of behaviors that almost any kid with a quiet or non-mainstream disposition could be diagnosed. Asperger’s came to mean you weren’t as friendly or conforming as everyone else.
The epidemic covered the land in a second darkness (—Tolkien). Fingers were pointed. You’ll remember when Jenny McCarthy and Jim Carrey started crusading against a certain vaccine reputed to have caused the outbreak. All over the civilized world, mothers refused to have their children vaccinated, instead they received regiments of psychoactive medication and behavior therapy from the earliest possible age.
But, as it’s come out now, the epidemic was caused by the psychiatrists themselves. They went through their neat little checklists, made all their neat little notes, boxed the quiet kids in the autism spot, the loud kids in the bipolar spot, and the middle ones in the Passive-Aggresive Personality Disorder spot. Today, the definition of Asperger’s and autism are both under review and it’s expected that they will change drastically. Psychiatry made a huge mistake, used millions of kids as guinea pigs for over two decades, the drug companies grew bloated and rich at the expense of working class families, parents struggled and pulled their hair out — desperate to get help and justice for their children, like McCarthy and Carrey — and what are we left with? The AMA said, essentially, “Oops. Our bad.”
Which brings me to what I believe is most salient: psychiatry is not science, not in the modern sense. It may be considered science in the medieval sense wherein physicians postulated on the four humours and used astrology as a diagnostic tool. Psychiatrists use checklists of sketchy origin, drugs whose mechanisms are not understood, patients become experiments and the primary maxim is if the cure works, you probably have the disease.
Even further, psychiatry rejects the most rigorous theories of modern science and primary among them are the theories of quantum mechanics. Its been theorized that the brain itself is more than a merely organic computer but that some of its workings are quantum mechanical (this is murky and only theoretical). The first and truest statement of all quantum mechanics is the Heisenberg Uncertainty Principle, formulated for our purposes, it states: whatever you observe, you also change, the observer is as important to any experiment as the experiment itself.
How pertinent! Here we have a two decade long outbreak of a terrible disease — Asperger’s — and its cause was not any particular imbalance of the patients diagnosed, the cause was the observers themselves.
And the problem extends beyond autism. A psychiatrist sits with you and from his impression of the visit sorts through his checklists and applies one that to his own understanding seems to fit. He then asks the questions that corral you into the checklist and before long — viola! — you have a diagnosis. Have you ever heard of anyone who went to see a psychiatrist who was not diagnosed with something from the DSM? If you take a cold to your general practitioner he’ll tell you to get some Robitussin, drink plenty of fluids, take vitamins and get the fuck outta my office. But I’ve never heard of anyone who came out of a psychiatrist’s office without a prescription for something.
Without science, without rigorous experiments, without peer-review, we’re left not with an effective medical science but instead a priesthood which declares revelations as it’s had them and impresses these revelations upon the defenseless masses. The popes of this priesthood are the researchers in drug development labs and psychiatric research centers; the bishops are the drug companies who hand down the policy and the pills; its priests are psychiatrists who interface with the public, receive their confessions and push the pills; its deacons are the psychotherapists who bridge the gaps and enforce conformity; its one god is money.
But then, I’m sour on the entire experience of psychiatry. I’ve been bounced around it hard and never found much that worked. The pills are temporary fixes, symptomatic relief. They help you just enough without ever actually curing anything. If you were cured you’d stop taking the pills and seeing the psychiatrist, that’s the last thing the priesthood wants. Have you ever been to church and been told you don’t need god?
Maybe your experience is better or just different than mine. Maybe you’re a psychiatrist and I hope I haven’t given too much offense. In any case, I ‘d love to hear about your own experiences with the field. Maybe you can convince me to actually listen to my therapist this time.