Synopsis "The Breakdown of Psychiatry: A Critique"
It’s a bull market in psychiatry these days. A simple search on the Internet of the words “majority of psychotropic medications prescribed without a diagnosis” shows the fury in the eyes of the bull. Lots of psychiatric medications are being prescribed to many people without a justifying diagnosis. A ton of money is being paid in psychiatry.On Wall Street there is a saying: “Bulls make money, bears make money, but pigs just get slaughtered!” When it comes to medicine, I haven’t seen a slaughtered pig yet. At least not in psychiatry, my specialty. Pigs getting fatter, that’s another story.In a bad economy the unemployment rate raises, inviting patients to regard minor imperfections as a diagnosis to blame unemployment on: “Doc, I have ADHD, do something”—discounting that in a good economy the conversation may not take place. In a good economy, patients with minor imperfections stand a better chance to of employment, thus of functioning just fine, not even close to considering a diagnosis. The psychiatrist must do what keeps the patient healthy, not what keeps the patient happy. Psychiatry in general is not about finding happiness, but about finding health. A tension is present between health and happiness. Early in training, a psychiatrist learns to say no, while communicating at the same time validation and support to the patient. The psychiatrist is not supposed to be a drug dealer with license.Health and consumption of healthcare are two different things. The goal of achieving health is at risk of turning into the goal of consuming healthcare, when professional organizations regard psychiatric patients as consumers. The difference is subtle, like between walking home and just walking.Through a flow of ideas, the society influences the normalcy for a person. For instance, when the society hires a psychiatrist to take care of a patient, the normalcy for the patient is fluid, subject to the flow of ideas between the psychiatrist and the patient. Consequently, if the psychiatrist engages in a dialogue with the patient or remains silent influences what is normal for the patient.A universe in itself, brain illness is powerful, tempting, alluring, and strong. It’s an attractor. The patient has to negotiate a way out of it. The bidimensional battle of good and evil in a healthy brain becomes the tridimensional battle of good, evil and disease in an ill brain.In the field of psychiatry, usually there is more to the story than what the patient says. When compared to a checklist of symptoms, listening to the story is important, as inferring from the story may be necessary, to sort out the line between what is going on and what the patient believes is going on.The unconscious is a negotiator at the table of the present, because time is always now, in the present, in the unconscious. The past is not the past but is the present in the unconscious. Time is a matter of consciousness. Outside awareness of time, a person is always in the now. A consciously familiar situation is the previous situation in the unconscious. The conscious “this feels familiar” turns into “this is happening again” in the unconscious.
