Tell me again that biopsychiatry isn’t a cult, then read this story of a clinician whose revelations are offered on the condition that he remain anonymous.
Biopsychiatry so dominates the whole field of mental illness that it is difficult to view the field from a different perspective… To give an alternative view, I call upon a report by a psychiatrist who substituted for a vacationing regular at a managed care mental health clinic. This psychiatrist has asked that he not be identified for fear of retaliation.
“The clinic was privately run, but it had the state contract to provide the local community mental health. I chose not to speak openly about my views, but to lay low and keep quiet… I did manage to lower the dose or discontinue the medications on most of the patients I saw. I was also able to get the court-ordered treatment rescinded on one patient, so all in all I was able to do some good…
Here’s what I learned: The whole mental health system seems to be relying almost exclusively on medications. If a patient requests medications, he is given it freely. If he requests any kind of counseling or therapy, he has to present his request before a review panel that will in most cases deny the request. When a patient was not doing well, everyone looked to me immediately to “adjust his medications.” If the patient was already adequately medicated, then the assumption was that the patient must not be “compliant.” No one ever seemed to consider the possibility that the medicines may not work, even if taken. Nearly every patient I saw was on multiple medications.
The majority of patients on Lithium and Depakote were not being adequately monitored with the required blood tests (I diagnosed 4 cases of lithium-induced renal impairment that should have been detected long before). Tardive Dyskinesia was very prevalent but frequently undiagnosed or misdiagnosed. Even in diagnosed TD, the offending agent was not discontinued, except in a few cases. Most patients had no idea what medicines they were taking or why. They take the medicine because everyone wants them to, or in some cases because their continued SSI, housing, and other benefits depended on it.
The whole system is infantilizing. Those people who take well to being infantilized, thrived in it (i.e., they became fully infantile). Those who didn’t were considered difficult.
I was hailed by the clinic staff and by many patients as a good psychiatrist, mostly because I was the first psychiatrist they had seen who bothered to talk with patients about their real problems. Apparently all other psychiatrists focus exclusively on medications and “symptoms.” The progress note and psych eval forms they gave me to complete were fill-in-the-blank checklists that were exclusively symptom-oriented. If I wanted to note any sort of psychosocial issue (like the patient going through a divorce, etc) I had to write it in the margin! I thought that pretty much said it all. I did a lot of scribbling in the margins in hopes that maybe someone would read it and be inspired to think of the person as a person, and not just as a set of symptoms.