03.27.09
Psychiatry and 1984
This is probably my last post in this blog, unless something truly important comes up. First of all, I am no longer formally authorized to write about psychiatry, because I don’t do it anymore; I withdrew from my residency program and thus relieved myself of any and all responsibility.
Secondly, and most importantly, I realized that psychiatry is not an evil in itself, but only a symptom of the malady that the whole Western society seems to be suffering from. To criticize psychiatry without regard to our society’s economy, politics, history or ecology is like treating depression without regard to a person’s lifestyle, income, diet or love. Such treatment, and such critique, generates a lot of visible ‘action’ but is in fact pointless and doesn’t help.
Besides, there are people who’ve said everything long ago and with such clarity that I can never hope to achieve. When’s the last time you read Orwell’s 1984? This book doesn’t even mention psychiatry, but it contains everything that there is to understand about it. If you’ve read and understood this book, I really have nothing else to say to you; and if you haven’t understood it, then no amount of my blogging is going to help you anyway.
And remember: Freedom is when you can say that two by two equals four, even if your Party (or your Doctor) claims otherwise. That’s all there is to it, really.
05.01.08
About Sex for a Change
Becoming a psychiatrist in order to practise good psychiatry is much like becoming a sex worker in order to have good sex. In both cases the real-life concept of the profession contradicts the declared goal. Assuming the role of a sex worker essentially denies you of good sex, because people who like, and are able to participate in, good sex – at least the way I understand it – don’t go to sex workers. The same way, calling yourself a psychiatrist puts a cross on your hopes to perform good psychiatry, because people who like, and are able to participate in, good psychiatry – at least the way I understand it – don’t ever go to psychiatrists.
I am not trying to define good psychiatry here. The definition is no less elusive than that of good sex.
03.24.08
Things You Can Control
I don’t usually spend much time or energy on forums, but recently I posted something somewhere about the official psychiatry’s lack of interest in deeper dimensions of the human soul. I also said that the psychiatric industry is concentrating its effort on the search for and implementation of the easy-to-do “quick-fixes”, whereas what therapeutic work is supposed to be about is the more complex and gradual process of self-exploration and spiritual growth. To this somebody responded with the phrase that I’ve heard a lot of times before: “You can only care about the things you can control.”
Suddenly the stupidity of the saying dawned on me. If you think about it, this motto of the modern science, when applied to the matters of the soul, becomes most arrogant, narrow-minded and barbaric. Out of the immensely complicated system of the human mind which we don’t understand, where everything is interconnected with everything else, we arbitrarily choose one or two buttons that we are evolved enough to be able to press, and decide to disregard everything else because we can’t control it anyway. We behave like a child or a monkey inside the cockpit of a 747, who thinks that you fly the aircraft with the yoke and the pedals, and all those blinking lights are there for illumination. Well, maybe this plane will fly… for some time.
03.04.08
A Tragic Mistake
Am I too naive to think that the principal aim of a hospital should be to help its patients? Well, apparently I am, because during the last two years that I have been working at one of the nation’s top psychiatric hospitals, I’ve seen very few examples that would back up this idea. The overwhelming majority of people and procedures employed by the psych hospital have very different objectives, ranging from maximizing the profit to minimizing the effort, and culminating in an all-consuming urge to cover one’s ass. Read the rest of this entry »
02.25.08
Mania and Depression
It surprises me that the official psychiatry makes a philosophical distinction between the states of mania and depression, while it is quite obvious to me that the two are one and the same. That is to say, the similarity between them is wide and profound, while the apparent difference is only a superficial nuance.
Let us consider a traffic light as an example. When it is red, it is very different from when it is green. But think about all the forces in background that are responsible for the traffic light operation. The power plant that provides electricity, the cables that conduct it, the engineering of the light bulb and the physics of light, as well as the philosophy of the city traffic and its regulation – all are absolutely the same in both states, and what is different is only the position of a small relay on the very surface of the process.
In exactly the same way, both mania and depression stem from one common background force, and the difference is only in the way a person reacts to it. When a big black cloud starts to cover the sky and nothing seems to matter anymore, some people succumb to it and halt all activity; others choose to run away from it in denial, putting on a tremendous buffoonery of omnipotence and invulnerability. Sooner or later they are exhausted and the cloud gets them.
That is why there is depression without mania, but there is never mania without depression. That is why the symptomatic treatment of both is bound to be inefficient. What we have to deal with is the black cloud. And to deal with our patients’, we first have to come to terms with our own…
02.24.08
What to read
This morning I started to doubt the idea of recommending books to people who say they want to know more about something . This is because everyone (if genuinely interested) is perfectly capable of finding the right books himself, and the method of selection is actually very simple.
If you want to figure out a particular concept, thing or event, just go ahead and read about it. It doesn’t really matter what you read; you can read everything you find, just as long as you don’t believe everything you read.
If the points of view start to resemble one another, try to find books that have the opposite opinion. If you can’t find them, you are dealing with a taboo; try to find out why it is a taboo. If the opposite point of view is available, try to find the books expressing the opinion that is contradictory to both original opinions. Then use your common sense to come up with your own point of view, and be ready to change it at any moment.
02.23.08
Wrong diagnosis?
One of the interesting problems in psychiatry, that I will have to bug my teachers about when I go to residency, is the issue of dealing with the consequences of a diagnostic error. How do you get rid of a person’s diagnosis if you think that its application had been unjustified?
The currently accepted definition of major psychiatric disturbances like schizophrenia implies the impossibility of being cured from them, and describes someone who has had symptoms in the past but is completely asymptomatic now as being in a state of persistent remission. In other words, a schizophrenic once diagnosed is a schizophrenic for life, even if he fails to produce а single symptom over the last decade or two. The truthfulness of this concept is questionable, but at least its reasoning seems non-contradictory. However, it can only be applied if we believe in the validity of the original diagnosis.
Given the ease with which psychiatric diagnoses are nowadays affixed to people, I feel compelled to question this belief in many cases. It is a known fact that in modern psychiatric institutions a diagnosis is often made in a hurry, with a certain degree of superficiality, and in an atmosphere of financial pressure that makes it necessary to use bold and definitive diagnostic labels instead of vague and temporary ones in order for the treatment to be reimbursed. In such circumstances, it seems quite plausible to suggest that at least in some cases the primary diagnosis had been made incorrectly, and therefore the asymptomatic patient in question is not in “remission”, but actually does not have this particular disease, and have never had it!
So what do I do with such a patient? How do I “take him off” of his diagnosis? The answer is not immediately clear.
01.19.08
The Point of Psychology
Psychology is definitely one of the most impressive achievements of our era. These days psychology is everywhere. The very meaning of ‘psyche’ in the popular culture no longer has any meaning unless associated with the facts and theories provided by psychological science. Some love psychology; some loathe it; great many make a living out of it. Some take it as a marvelous feat of the human race on par with the space conquest and Palm Treo telephones, and some think of it as an ugly byproduct of the industrialization funded by the government in an effort to better control the masses. But regardless of the stance we take, one thing is obvious: psychology, as we see it today, provides, at least in some cases, a means to understand the typical human behavior and the factors that it is influenced by.
The most important question therefore is: once we’ve understood it, what do we do with it? How does knowing psychology influence our behavior? Read the rest of this entry »
01.07.08
Don’t Talk About It! Do It!
In response to the critique of the psychiatric medications, many people try to discredit the effectiveness of psychotherapy. In math this is called ex adverso, or proof by contradiction; when one is unable to prove his rightness, he tries instead to prove that his opponent is wrong. But in math this approach is used very carefully, and only with two mutually exclusive hypotheses. In psychiatry, as in politics, the presumed mutual exclusiveness of the poles is only an illusion, a classic “choice without choice”. If you’re asked to choose between a coffee from McDonalds and from Dunkin Donuts, then you’re screwed if what you really wanted was a good coffee, or a tea, or if, for that matter, you were not thirsty at all.
Notwithstanding the bias behind the statement, if someone says to me that psychotherapy doesn’t work, I will probably agree. Read the rest of this entry »
12.31.07
If Drugs Were Good
Even if treating psychiatric symptoms with drugs were finally and unequivocally proved to be effective (which it has not even come close to), the question of whether it is ethically right to do so would still be problematic.
The easiest way is not always the best way, especially when dealing with such a complex system as a human persona in the web of its societal interactions. Very few people actually go to a psychiatrist “to fix the flat tire”, that is with only one specific easily fixable symptom in mind. And even when they do seem to have only one symptom, in the course of therapy the picture may prove to be more complicated.
