For centuries psychiatry has seesawed between two opposing models of assessment and treatment. One is biological, focused on the obscure physiology of the brain; the other is psychological, focused on the even hazier functions of the mind. Each school of thought has competed for dominance of our profession, indifferent to the obvious truth that psychiatric health depends on proper functioning of both the brain and the mind. This truth signifies that any qualified psychiatric assessment would require a full understanding of both these entities, and that treatment would require an eclectic array of tools. But that has never been the prevailing model of psychiatry.
There are two driving forces that have led to this philosophical divide in our profession. One is academic: To date we have no scientific explanation as to how these two realms intersect. The other is economic: Throughout its history, psychiatry’s prevailing treatment model has been dictated by its marketability. And we’ve never had more customers than we do in this biological era, now that we’re able to deal in pills–you know, real medicine. The side effects thereof have included the elevation of a psychiatrist’s status to “real doctor” at last–a title rarely conferred on any of the psychoanalysts in their bygone era.
But all that good shit hasn’t changed the inherently eclectic nature of psychiatric illness. It was the cultural impact of psychiatry’s first and only rock star, Sigmund Freud, that made psychoanalysis all the rage in the first half of the 20th Century–but psychoanalysis eventually declined in popularity because it was time-consuming, expensive, and not broadly effective. The medications that have taken its place are certainly much less time-consuming, less expensive, and applicable to more patients than psychoanalysis was. But their efficacy is less than impressive, their risks and long term side-effects poorly understood. Psychiatric medications are now often prescribed in brazen disregard of all that we don’t know about our patients, under the vain assumption that our limited knowledge and tools are all that we need. Because, after all, that’s entirely consistent with community standards of care nowadays–it’s what we get paid to do.
The idea that our thoughts, feelings, and internal struggles can be reduced to mere chemical reactions is IMO indefensible–not just because it’s so damned demeaning to our patients and ourselves, but also because this reasoning has no firm basis in science. The physiological nature of thought remains an utter mystery to us all–yet our patients are not merely biological entities. They have thoughts, affections, strengths, weaknesses, hopes, fears, struggles, and goals that are just as real as our own. Such abstractions are contributory to most if not all psychiatric disorders, but aren’t usually taken into consideration while we’re treating those pesky “symptoms”–you know, those things we used to call “feelings,” back in the day when we were taught to listen to them.
The dogma of contemporary psychiatry drives me crazy. Its reductionist model is inane; its science is institutionally corrupt. But what bugs me most of all is that it lays claim to an understanding of human thought and behavior, of happiness and healthy function–and yet it doesn’t exhibit one shred of wisdom. Because the first component of wisdom is the humility of knowing and appreciating what you don’t know. And by just that measure, contemporary psychiatry clearly has no freaking clue.
I aim to tear down the myths of biological psychiatry by any means necessary–which includes public education, common sense argument, strict application of the scientific method, and a healthy dose of well-deserved mockery. Not because I hate psychiatry; I love practicing psychiatry, and believe that most psychiatric practitioners mean well. But we are selling ourselves and our patients short by blindly accepting our institutionally corrupted science, and a willfully stupid treatment model that simply can’t stand up to any rigorous logical scrutiny. There are plenty of fellow psychiatrists who already know how absurd the model is, but can’t bring themselves to dispense with it–because it’s our de facto job description in this era.
I often tell people that I’m well suited to psychiatric practice, because I’m much more comfortable with ambiguity than most people are. But it’s apparent that not all psychiatrists share this trait. Many of us cling to the biological model because we have an abiding need for “knowledge” in our profession, even if it’s irrelevant knowledge. I look forward to a time when the credibility of this absurd model has been dashed, and my profession has been dragged into the humility of our ambiguous truth–deprived of these glib, dehumanizing fictions.
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