GUEST POST: Psychiatry and its Tragedy, by Nelson Borelli, M.D. 12/19/2012Posted by ALT in Guest Post, Philosophy/Spirituality.
Tags: dissident psychiatrist, mental health, mental illness, moral agency, Nelson Borelli, psychiatry
I am honored to present another guest post from reform-minded (former) psychiatrist Dr. Nelson Borelli. His website and manifesto are well worth reading, and the thoughts he puts forth here about moral agency and psychiatry come at a very important moment in the national dialogue about these topics.
By Nelson Borelli, M.D.
ALT_mentalities kindly invited me to write a critique on the practice of psychiatry. I accepted it with reluctance for several reasons.
First: There is not much original thought I can add to the matter after the monumental contribution of many others, Thomas S. Szasz and Karl Menninger in particular.
Second: Psychiatry,— and I will use that word to include psychiatry and other enterprises such as clinical psychology, social work and all “therapies,” and most respective practitioners — are faith-based organizations, not open to rational thinking and dialogue, let alone change.
Third: History seems to show that critiques to psychiatry are perceived as callous attacks to “science”, to psychiatry practitioners, and to the “mentally ill.” This is usually followed by the hardening of the faith and more closing of the thinking.
Yet I’ll try; the youthful vitality of ALT_mentalities inspires me.
Saving the Underdog
Psychiatry’s tragic course began in the sixteenth century when the political rulers lined up for execution of a woman because she was a “witch.” But a well-connected doctor saved her life by showing she was a sick woman, not a witch. The doctor was Johann Weyer. His deed was certainly good but the reason was bad. That saving-the-underdog became a tragedy of unlimited proportions. After half millennia the tragedy is still with us and it is growing.
The “witches’ law” was wrong then; many social intolerance laws are wrong now. Bad laws should be confronted morally, politically, because that is what they are. They are manmade laws.
Confronting them by “biological-disease” means results in tragedy. The heroic “biological”, medical shortcut is bad. It has built-in badness because it results in bad consequences for the hero (psychiatry) while the moral problems remain unresolved.
Visitors from another planet would be sympathetic to us in learning about our seemingly unsolvable moral problems: When does life begin in the unborn child? Is it permissible to unplug life-supporting equipment from the terminally ill? If so when? Is abortion permissible and if so when and in what circumstances? Should we abolish the death penalty in the USA? Do children have rights? If so what rights, at what age? Do we go for gun control or the Second Amendment? What are the boundaries between Personal and State rights? Et cetera.
Contemporary psychiatry is suffering the bad consequences of the heroic acts of “saving-the-underdog.” Psychiatry is discredited. Self paying patients are fewer and fewer. Third-party payers refuse to pay for “services.” The only thing that keeps the psychiatric industry alive is the state-sponsored/enforced “mental illness/mental treatment” dictum. Nor has the psychiatric industry’s “stigma” cry been working well either.
It is an unnecessary, self- inflicted tragedy, to put it mildly, (for the profit factor cannot be ignored). Psychiatry could be of help to the many folks who suffer from emotional problems. Psychiatry could have room in medicine as a (soft) branch of it. Although the causes and pathology of emotional problems remain obscure, they could continue to be investigated by scientists interested in the field. Emotional problems could be dealt with by professionals who are patient enough to deal (humbly) with diagnoses’ uncertainties by using trial-and-error techniques.
There are already some significant scientific contributions on the relationship between bodily physiology and the perception of emotional reactions. Psychoanalysis and related disciplines have also contributed to the understanding of human emotional conditions. Even the dreadful, drug-pushing, disease-manufacturing pharmaceutical industry has made some contributions. However limited the knowledge of psychiatry at present, there is room within medicine and related disciplines for a respectable Psychiatry specialty.
But that would require present day psychiatry to drop the “mental-illness” ideology.
Psychiatry & Moral Agency
At the core of the “mental illness” ideology is the notion that a person can lose moral agency, this is that the person is no longer able to know what he/she likes or dislikes, or is not able to form and execute (“correct”) personal opinions due to a “biological ill condition.” That is that the person has become “mentally ill.”
That is wrong.
The fact is that humans’ opinions cannot be (biologically) ill. This is a travesty with terrible consequences such as the deprivation of civil rights to citizens who have not committed any crimes.
A court of law may order involuntary psychiatric treatment, known as “Civil Commitment” for a “mentally ill” person. Although the large majority of the “mentally ill” persons are not subjected to involuntary treatment, all “mental Illness” diagnoses suggest possible Civil Commitment, that is, deprivation of personhood.
The fact is that psychiatry is not able to predict criminal behavior on a given person. No legally responsible psychiatrist would publicly state to what percentage of probability a person would act criminally because there is no publication of any scientifically conducted study that objectively demonstrates such a prediction.
Human opinions can be wrong, or right, with respect to a prevailing social code of ethics. A quick look at the history of humans’ opinions shows that even very “important” opinions, come and go. Examples: The learned ones used to sure the Earth was flat. Now the learned ones differ as to whether humans were created or evolved. These are human opinions; they may be errors. But they are not forms of “insanity” or “mental illnesses.” Incidentally, the utterance “sick opinion/belief” is only a pejorative metaphor, an unfortunate metaphor because it is often used literally.
Unfortunately (or fortunately) we humans were born without a God-given “user’s- book.” If we were we might be angels of God like Adam and Eve were before they CHOSE to eat the apple.
Ever since, we are born with the ability to choose. We are born to be on our own stewardship.
One may or may not choose to use the Biblical story, but the fact is that each one of us is ultimately responsible for the management of our lives. We have to manage our lives by the use of science or inspiration and hope for the best. No guarantee of success.
Be aware of false “saviors” such as psychiatry that offer you the “the brain-made-you-do-it” way out as a means of angelic tranquility. If you go for it you become a robot; a Mental Patient Green Card carrier, with entitlements but deprived of personal moral agency.
Personal Moral Agency
Personal moral agency means that one is born with the ability to know, choose and act in accordance to what one thinks is right. Just in case: What you think is right may not be what others think is right.
Psychiatry did not get a “users’ book” from God either. Psychiatrists’ opinions on persons’ life management can be wrong, very wrong! Psychiatrist Egas Moniz won the 1949 Nobel Prize on the “benefits” of lobotomy on “psychotic patients.”
How to manage your life? Simple: Each of us gets information, input, from the world around us and from our own bodies. It’s up to each of us to look, examine, re-examine the information, look for more information and consult with others as needed. Then we reason. Then we act, execute. The more we work on the information, particularly information-that-I-do-not-want-to-know, and do the reasoning, the greater the chance that we would be pleased with our acts or execution at a later date. Of course there is no guarantee that we would be pleased with our acts at a later day. We humans are not perfect, period.
The more one practices on information gathering and reasoning, the greater the chances to be content with our acts at a future date. Unfortunately, just too often people choose to delegate to others the information gathering and reasoning. In so doing, they dull their minds; this is the ability-to-mind. Minding is an inborn ability. However, the quality of minding depends on how much we practice it.
The tragedy of psychiatry will eventually end in the same way other tragedies ended: the death of the hero. In this case, the “mental illness” heroic attempt to “solve” humans’ moral problems.
Good, serious psychiatry is badly needed. But even more needed is for us to get in touch with, to honor and respect our precious minds and humanness.