All in the Mind

Who Needs Psychiatry?

Most human beings have undergone moments of emotional disturbance and have at times engaged in unwise and irrational behaviour due to inexperience, extreme stress or intoxication. Our unconscious may have created sensory illusions, echoes of past ordeals. Many of us have felt the need to withdraw, if only temporarily, in a world of our own. A sense of insecurity, guilt or just personal fascination can lead us to obsess with actions, issues or objects. We may even sink into a mire of introspective self-worthlessness, known to others as depression. In some of us these tendencies may prevent us from leading our lives in a way that others may consider normal or functional.

If somebody behaves in a dysfunctionally irrational way, there may be two kinds of explanations. The first, and intuitively most obvious, is that something out there, whether a recent occurrence or a distant childhood memory, has altered his or her state of mind. Alternatively the brain itself could be defective. It's not quite that simple because drugs, medicines and food can change our metabolism and alter our mood. More to the point our brains rewire in response to environmental changes, especially during our formative years, but by and large we may seek either psycho-social (also known as environmental) or neurological causes of our troubles. Neither psychology nor neurology can exist in isolation. The former deals with the software and the latter with the hardware, which unlike computer hardware, may be subject to a process of continuous adaptation known as neuroplasticity.

Some behaviours are not only subjectively dysfunctional or culturally inappropriate, but immoral and dangerous to the rest of the community, e.g. If a person became convinced that all red-haired men were evil and proceeded to murder all such individuals in his neighbourhood, it would be perfectly correct to detain the perpetrator and thus protect the wider community. Psychologists may wonder what traumatic events caused the murderer to commit these heinous acts and neurologists may wonder if his brain had an inherent defect or had been afflicted by a physiological disease.

A short definition of psychiatry would be the study of pathological behavioural patterns or according to the Free Online Dictionary, the branch of medicine that deals with the diagnosis, treatment, and prevention of mental and emotional disorders. A psychiatrist treats an aberrant behaviour as a disease. A complex of associated behaviours is then classified as a disorder. A psychiatric diagnosis is thus nothing more than a synopsis, albeit in erudite language, of observed symptoms, indeed the word clinical often preceding labels such as depression means just involving or based on direct observation of the patient. Surprisingly few people labelled with behavioural disorders have had their clinical diagnosis confirmed by PET or fMRI brain scans, but if any abnormalities were detected only an experienced neurologist would be able to make sense of the data. Nobody receives a psychiatric diagnosis based on the results of a brain scan and yet confusingly many victims of traumatic brain injuries and epilepsy manifesting conspicuous deficiencies in parts of the cerebral cortex allegedly responsible for reasoning and socialisation lead very successful lives free of psychotic episodes.

Psychoactive drugs rightly attract a great deal of controversy, but surely if they did help alleviate the worst symptoms of emotional distress and prevent extreme antisocial behaviours, the professional category responsible for their administration would be psycho-pharmacology.

Some see psychiatrists as the last line of defence when other law enforcement and social care professionals cannot deal with extremely abusive, dangerous or self-destructive behaviour. Psychiatry differs from psychology in defining aberrant behavioural patterns as endogenous diseases, which may have environmental triggers but are nonetheless inherent to the affected individual. Many parents and other close relatives go along with the psychiatric model because it absolves them of all responsibility. Schools, social services, police, state and corporate entities all tend towards psychiatric explanations for the same basic reason.

Don't Blame the Parents

This has long been the rallying cry of the burgeoning mental health industry, myriad charities, public and private sector institutions very much in the public limelight. Whenever anti-psychiatry raises its dissenting head, its advocates are vilified and often likened with Robert D Laing, and accused often in highly emotive language, of blaming parents. This misses three essential points:

  • Parents are only part of a child's environment and thus cannot be blamed for numerous other factors such as heightened social competition, mass consumerism, peer pressure, pervasive media etc.
  • Parents may themselves be victims of childhood neglect and adult stress, with a serious sense of inferiority, social alienation or addiction to hedonistic pursuits such as gambling.
  • If we stress the psycho-social causes of personal problems rather than endogenous biological causes, parents, and other close relatives and friends, have a greater role to play in rehabilitation. Many become depressed or experience psychotic episodes precisely because they lack full integration with their family and community. Even where neglectful or abusive parents are a large part of the problem, they may, except in the most extreme cases of abuse, be part of the solution.

So let's abolish psychiatry altogether. In some cases we may find answers in neuroscience, but in most we'd better take a good look at each other and wonder what we as individuals or as a society have done wrong to make an increasing number of us go insane.

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