Leaving Psychiatry
J. R. Ó’Braonáin. M.D.
Contents
Introduction
Ontogeny; Entering Seminary.
Ontology; The Keeper of the Keys.
Epistemology; Cogito Ergo Cogito.
Relativity; The Truth Makers.
Demonology; I, Father Karris.
Morality; The Psychotherapy of Dorian Gray.
Bio-Alchemy; Tabula Ruina.
Responsibility; Akrasia and Enkrateia.
Sanity; On Agreeing to Disagree.
Thanatology; On Private Property.
Liberty; Climbing Mt Szasz.
Possibility; What if it All Went Away?
Introduction
Custom would dictate that a book such as this should proceed from an introduction, though it is with some trepidation I write this as it remains to be seen if the book of my intention becomes a book in fact, much less a successful one. It may come to be a pamphlet little longer than the introduction preceding it, or rambling stream of consciousness which will make a good doorstop. Each of the chapters could easily be elaborated into books themselves, were they each to be developed. Yet insomuch as the book is a personal catharsis of my angst with psychiatry, better out than in one might say, and why prolong a birth that is past it’s term of confinement. The affective urgency is simply too great to cast down on paper what you are gracious enough as to read, and finally be done with it. If I fail, it shan’t be on account of either brevity or pleonastic fury.
Moreover, the introduction is the part of the book I’m usually least likely to read. After all, what of substance is within it save for as a summary of what is to come, the introduction being inadequate in itself? That having been said, the introduction of this pamphlet/book is perhaps the most important part, as it will lay out in advance the mode and method of argument I’ll be following, what rules I intend to not to observe, and why. Hopefully this will dispel much criticism before it comes my way. Though logically sound where logic is employed, it is not intended to be a complete piece of analytical philosophy. Rather it is an unavoidably polemical personal reflection of my own career in the world of clinical psychiatry, very much an experienced view from the inside of the machine and the frontline of the so called war against so called mental illness. As such it is remotely possible my own experiences (technically speaking a large collection of mere anecdotes) are an aberration, with hospitals and clinics and other practitioners outside of my own experience practicing something entirely different, altogether orientated towards the truth and altogether corrosive to my argument. This is to be doubted, as I have practiced far and wide and also vicariously made use of stories told by others, along with availing myself of the rubbish that is regularly published and perpetuated in the literature endorsed by the international psychiatric intelligentsia.
Secondly, there is no pretence to this autoethnography being a piece of so called science, research or even good journalism. It is not the shadow of an adaptation of a doctoral thesis and I don’t intend to fetter the book with footnotes, references and statistics ad nauseum, if for no other reason than my own laziness and fervent love of informality. A caveat to any would be critic would be this; should I make a statement taken as a matter of fact of the world as it is, or fact of history of something said or done open to challenge, I have the confidence that it will be all too easy to locate my vindication in a journal article under a pile of another papers under a further pile of papers. It all becomes a fatuous poker game of seeing the opponents piece of research and raising the stakes with a journal article conducive to one’s own side of the argument, when the matter of debate is something ultimately philosophical anyway and something hermeneutical, i.e. related to the interpretation of data. Many works of so called psychiatric research are heavily bias, ghost-written by pharmaceutical companies, contrary to common or good sense, not successfully replicated and have data uncoupled from the interpretation of the data that is placed in the conclusion, this being especially the case with works that necessarily impact upon the philosophy of mind and what maketh a man (or woman) and their place in the world, which is essentially everything within the world of psychiatry come the end of the day. I’ll even be using an example of a major article that employs references that even have nothing to do with the text citing them. I’m additionally reminded by what the great statistician and father of clinical trials Sir Austin Bradford Hill said of treatment effects
“you need neither randomisation, nor statistics, to analyse the results, unless the treatment effect is very small”.
The spirit and implication of such a comment is simply that some facts are obviously the case or not (meaningful facts anyway), and much sophist mischief can be made with what one wishes to hide in, or conjure out of, mere numbers, invocations of “peer review”, “science”, “evidence base” and other spells and incantations, and window dressing a piece of writing into ostensive impressiveness with a litany of references will not save a poor argument from the ruin it deserves. Needless to say, treatment effects are predicated on a certain “x” being treated. What this “x” is, or if it is, is a serious can of worms assumed to have been adequately opened and answered by psychiatry as a basis for praxis. But has it been answered or can it be answered? I would say “no” to both questions. Now I shan’t be making any claims controversial to my own experience and to those of thousands of other persons in the world. Is it not it enough to say “read this book”, or “read that author” or “go out in the world and see as I have”? Why waste your time with more, and besides, whether you be friend or foe I’m preaching mostly to the converted already.
Neither will this book be an exhaustive critique of the prevailing, dare I say it, delusion in psychiatry that mental illnesses such as schizophrenia, ADHD and major depressive disorder are brain diseases, “neuro-genetic diseases” and the like. Many others have taken these myths to task and many books written, though these voices of truth are utterly dwarfed by the psychiatric machine. Though I can only claim to have personally read from a couple of these gadfly’s, here and there this text will provide links to authors said to be critical of psychiatry for the reader to explore more widely and make up their own mind.
Neither will I claim to have thought of anything original, for there is nothing new under the sun. Occasionally what enters the mind might be an original thought to me, accompanied first by some blush of hubris soon supplanted by that dark cloud of doubt that someone must have thought or said the same thing before, and thought and said it better. As a prolific collector of books I almost never read beyond the second chapter, when I do read other works this deflationary intuition almost always empirically crashes one’s ego back down to Earth. Moreover, usually the one taken to be the author of an original thought is not the first. Even my admissions of unoriginality will surely be unoriginal itself, and so on ad infinitum. But let’s not make a pretence to mysticism here. The very assertion of my admission to unoriginality is part of the case in point. For if others share my conclusions, perhaps we share an anti-psychiatric delusion or an iconoclastic destructive “paranoid” personality. Or alternatively perhaps I’m onto something else good, and true and beautiful, and so are they. Sometimes one needs many years of education to discover deep truths. Sometimes we receive many years of ideology masquerading as education, the resultant being a trenchant disbelief in the obvious as our egos vainly leap to the defence of endless hours of wasted study. My experience and argument is my greatest weapon, the medical and other qualifications useless before the fact. Let the best argument win I say. All are welcome into the arena, and the argument with appeal to authority will not save you from harm.
Though it might seem otherwise, neither will this book be a chapter by chapter expansion and critique of the “disorders” as per DSM and ICD 11 (i.e. the American Psychiatric Associations Diagnostic and Statistical Manual and the World Health Organizations International Classification of Disease). For such an approach would, in some sense, give the disorders legitimacy and fail to escape the categorical and medicalized frame. These disorders will be addressed aplenty for sure, yet addressed incidentally within