Why Psychiatry Should Be Abolished
as a Medical Specialty
by Lawrence
Stevens, J.D.
Psychiatry should be abolished as a medical specialty because medical school
education is not needed nor even helpful for doing counselling or so-called
psychotherapy, because the perception of mental illness as a biological entity
is mistaken, because psychiatry's "treatments" other than counselling or
psychotherapy (primarily drugs and electroshock) hurt rather than help people,
because nonpsychiatric physicians are better able than psychiatrists to treat
real brain disease, and because nonpsychiatric physicians' acceptance of
psychiatry as a medical specialty is a poor reflection on the medical profession
as a whole.
In the words of Sigmund Freud in his book The Question
of Lay Analysis: "The first consideration is that in his medical school a
doctor receives a training which is more or less the opposite of what he would
need as a preparation for psycho-analysis [Freud's method of psychotherapy].
... Neurotics, indeed, are an undesired complication, an embarrassment as much
to therapeutics as to jurisprudence and to military service. But they exist and
are a particular concern of medicine. Medical education, however, does nothing,
literally nothing, towards their understanding and treatment. ... It would be
tolerable if medical education merely failed to give doctors any orientation in
the field of the neuroses. But it does more: it given them a false and
detrimental attitude. ...analytic instruction would include branches of
knowledge which are remote from medicine and which the doctor does not come
across in his practice: the history of civilization, mythology, the psychology
of religion and the science of literature. Unless he is well at home in these
subjects, an analyst can make nothing of a large amount of his material. By way
of compensation, the great mass of what is taught in medical schools is of no
use to him for his purposes. A knowledge of the anatomy of the tarsal bones, of
the constitution of the carbohydrates, of the course of the cranial nerves, a
grasp of all that medicine has brought to light on bacillary exciting causes of
disease and the means of combating them, on serum reactions and on neoplasms -
all of this knowledge, which is undoubtedly of the highest value in itself, is
nevertheless of no consequence to him; it does not concern him; it neither helps
him directly to understand a neurosis and to cure it nor does it contribute to a
sharpening of those intellectual capacities on which his occupation makes the
greatest demands. ... It is unjust and inexpedient to try to compel a person
who wants to set someone else free from the torment of a phobia or an obsession
to take the roundabout road of the medical curriculum. Nor will such an
endeavor have any success..." (W.W. Norton & Co, Inc., pp. 62, 63, 81, 82). In
a postscript to this book Dr. Freud wrote: "Some time ago I analyzed
[psychoanalyzed] a colleague who had developed a particularly strong dislike of
the idea of anyone being allowed to engage in a medical activity who was not
himself a medical man. I was in a position to say to him: 'We have now been
working for more than three months. At what point in our analysis have I had
occasion to make use of my medical knowledge?' He admitted that I had had no
such occasion" (pp. 92-93). While Dr. Freud made these remarks about his own
method of psychotherapy, psychoanalysis, it is hard to see why it would be
different for any other type of "psychotherapy" or counselling. In their book
about how to shop for a psychotherapist, Mandy Aftel, M.A., and Robin Lakoff,
Ph.D., make this observation: "Historically, all forms of 'talking'
psychotherapy are derived from psychoanalysis, as developed by Sigmund Freud and
his disciples ... More recent models diverge from psychoanalysis to a greater
or lesser degree, but they all reflect that origin. Hence, they are all more
alike than different" (When Talk Is Not Cheap, Or How To Find the Right
Therapist When You Don't Know Where To Begin, Warner Books, 1985, p. 27).
If you think the existence of psychiatry as a medical specialty
is justified by the existence of biological causes of so-called mental or
emotional illness, you've been misled. In 1988 in The New Harvard Guide to
Psychiatry Seymour S. Kety, M.D., Professor Emeritus of Neuroscience in
Psychiatry, and Steven Matthysse, Ph.D., Associate Professor of Psychobiology,
both of Harvard Medical School, said "an impartial reading of the recent
literature does not provide the hoped-for clarification of the catecholamine
hypotheses, nor does compelling evidence emerge for other biological differences
that may characterize the brains of patients with mental disease" (Harvard Univ.
Press, p. 148). So-called mental or emotional "illnesses" are caused by
unfortunate life experience - not biology. There is no biological basis for the
concept of mental or emotional illness, despite speculative theories you may
hear. The brain is an organ of the body, and no doubt it can have a disease,
but nothing we think of today as mental illness has been traced to a brain
disease. There is no valid biological test that tests for the presence of any
so-called mental illness. What we think of today as mental illness is
psychological, not biological. Much of the treatment that goes on in psychiatry
today is biological, but other than listening and offering advice, modern day
psychiatric treatment is as senseless as trying to solve a computer software
problem by working on the hardware. As psychiatry professor Thomas Szasz, M.D.,
has said: Trying to eliminate a so-called mental illness by having a
psychiatrist work on your brain is like trying to eliminate cigarette
commercials from television by having a TV repairman work on your TV set (The
Second Sin, Anchor Press, 1973, p. 99). Since lack of health is not the
cause of the problem, health care is not a solution.
There has been increasing recognition of the uselessness of
psychiatric "therapy" by physicians outside psychiatry, by young physicians
graduating from medical school, by informed lay people, and by psychiatrists
themselves. This increasing recognition is described by a psychiatrist, Mark S.
Gold, M.D., in a book he published in 1986 titled The Good News About
Depression. He says "Psychiatry is sick and dying," that in 1980 "Less than
half of all hospital psychiatric positions [could] be filled by graduates of
U.S. medical schools." He says that in addition to there being too few
physicians interested in becoming psychiatrists, "the talent has sunk to a new
low." He calls it "The wholesale abandonment of psychiatry". He says recent
medical school graduates "see that psychiatry is out of sync with the rest of
medicine, that it has no credibility", and he says they accuse of psychiatry of
being "unscientific". He says "Psychiatrists have sunk bottomward on the
earnings totem pole in medicine. They can expect to make some 30 percent less
than the average physician". He says his medical school professors thought he
was throwing away his career when he chose to become a psychiatrist (Bantam
Books, pp. 15, 16, 19, 26). In another book published in 1989, Dr. Gold
describes "how psychiatry got into the state it is today: in low regard,
ignored by the best medical talent, often ineffective." He also calls it "the
sad state in which psychiatry finds itself today" (The Good News About Panic,
Anxiety, & Phobias, Villard Books, pp. 24 & 48). In the November/December
1993 Psychology Today magazine, psychiatrist M. Scott Peck, M.D., is
quoted as saying psychiatry has experienced "five broad areas of failure"
including "inadequate research and theory" and "an increasingly poor reputation"
(p. 11). Similarly, a Wall Street Journal editorial in 1985 says
"psychiatry remains the most threatened of all present medical specialties",
citing the fact that "psychiatrists are among the poorest-paid American
doctors", that "relatively few American medical-school graduates are going into
psychiatric residencies", and psychiatry's "loss of public esteem" (Harry
Schwartz, "A Comeback for Psychiatrists?", The Wall Street Journal, July
15, 1985, p. 18).
The low esteem of psychiatry in the eyes of physicians who
practice bona-fide health care (that is, physicians in medical specialties other
than psychiatry) is illustrated in The Making of a Psychiatrist, Dr.
David Viscott's autobiographical book published in 1972 about what it was like
to be a psychiatric resident (i.e., a physician in training to become a
psychiatrist): "I found that no matter how friendly I got with the other
residents, they tended to look on being a psychiatrist as a little like being a
charlatan or magician." He quotes a physician doing a surgical residency saying
"You guys [you psychiatrists] are really a poor excuse for the profession. They
should take psychiatry out of medical school and put it in the department of
archeology or anthropology with the other witchcraft.' 'I feel the same way,'
said George Maslow, the obstetrical resident..." (pp. 84-87).
It would be good if the reason for the decline in psychiatry
that Dr. Gold and others describe was increasing recognition by ever larger
numbers of people that the problems that bring people to psychiatrists have
nothing to do with biological health and therefore cannot be helped by
biological health care. But regrettably, belief in biological theories of
so-called mental illness is as prevalent as ever. Probably, the biggest reason
for psychiatry's decline is realization by ever increasing numbers of people
that those who consult mental health professionals seldom benefit from doing so.
E. Fuller Torrey, M.D., a psychiatrist, realized this and
pointed it out in his book The Death of Psychiatry (Chilton Book Co.,
1974). In that book, Dr. Torrey with unusual clarity of perception and
expression, as well as courage, pointed out "why psychiatry in its present form
is destructive and why it must die." (This quote comes from the synopsis on the
book's dust cover.) Dr. Torrey indicates that many psychiatrists have begun to
realize this, that "Many psychiatrists have had, at least to some degree, the
unsettling and bewildering feeling that what they have been doing has been
largely worthless and that the premises on which they have based their
professional lives were partly fraudulent" (p. 199, emphasis added).
Presumably,
most physicians want to do something that is constructive, but psychiatry isn't
a field in which they can do that, at least, not in their capacity as physicians
- for the same reason TV repairmen who want to improve the quality of television
programming cannot do so in their capacity as TV repairmen. In The Death of
Psychiatry, Dr. Torrey argued that "The death of psychiatry, then, is not a
negative event" (p. 200), because the death of psychiatry will bring to an end a
misguided, stupid, and counterproductive approach to trying to solve people's
problems. Dr. Torrey argues that psychiatrists have only two scientifically
legitimate and constructive choices: Either limit their practices to diagnosis
and treatment of known brain diseases (which he says are "no more than 5 percent
of the people we refer to as mentally 'ill'" (p. 176), thereby abandoning the
practice of psychiatry in favor of bona-fide medical and surgical practice that
treats real rather than presumed but unproven and probably nonexistent brain
disease - or become what Dr. Torrey calls "tutors" (what I call counselors) in
the art of living, thereby abandoning their role as physicians. Of course,
psychiatrists, being physicians, can also return to real health care practice by
becoming family physicians or qualifying in other specialties.
In an American Health magazine article in 1991 about Dr.
Torrey, he is quoted saying he continues to believe psychiatry should be
abolished as a medical specialty: "He calls psychiatrists witch doctors and
Sigmund Freud a fraud. For almost 20 years Dr. E. (Edwin) Fuller Torrey has
also called for the 'death' of psychiatry. ...No wonder Torrey, 53, has been
expelled from the American Psychiatric Association (APA) and twice removed from
positions funded by the National Institute of Mental Health ... In The Death
of Psychiatry, Torrey advanced the idea that most psychiatric and
psychotherapeutic patients don't have medical problems. '...most of the people
seen by psychotherapists are the 'worried well.' They have interpersonal and
intrapersonal problems and they need counseling, but that isn't medicine -
that's education. Now, if you give the people with brain diseases to neurology
and the rest to education, there's really no need for psychiatry'" (American
Health magazine, October 1991, p. 26).
The disadvantage to the whole of the medical profession of
recognizing psychiatry as a legitimate medical specialty occurred to me when I
consulted a dermatologist for diagnosis of a mole I thought looked suspiciously
like a malignant melanoma. The dermatologist told me my mole did indeed look
suspicious and should be removed, and he told me almost no risk was involved.
This occurred during a time I was doing research on electroshock, which I have
summarized in a pamphlet titled "Psychiatry's Electroconvulsive Shock Treatment
- A Crime Against Humanity". I found overwhelming evidence that psychiatry's
electric shock treatment causes brain damage, memory loss, and diminished
intelligence and doesn't reduce unhappiness or so-called depression as is
claimed. About the same time I did some reading about psychiatric drugs that
reinforced my impression that most if not all are ineffective for their intended
purposes, and I learned many of the most widely used psychiatric drugs are
neurologically and psychologically harmful, causing permanent brain damage if
used at supposedly therapeutic levels long enough, as they often are not only
with the approval but the insistence of psychiatrists. I have explained my
reasons for these conclusions in another pamphlet titled "Psychiatric Drugs -
Cure or Quackery?" Part of me tended to assume the dermatologist was an expert,
be trusting, and let him do the minor skin surgery right then and there as he
suggested. But then, an imaginary scene flashed through my mind: A person walks
into the office of another type of recognized, board-certified medical
specialist: a psychiatrist. The patient tells the psychiatrist he has been
feeling depressed. The psychiatrist, who specializes in giving outpatient
electroshock, responds saying: "No problem. We can take care of that. We'll
have you out of here within an hour or so feeling much better. Just lie down on
this electroshock table while I use this head strap and some electrode jelly to
attach these electrodes to your head..." In fact, there is no reason such a
scene couldn't actually take place in a psychiatrist's office today. Some
psychiatrists do give electroshock in their offices on an outpatient
basis. Realizing that physicians in the other, the bona-fide, medical and
surgical specialties accept biological psychiatry and all the quackery it
represents as legitimate made (and makes) me wonder if physicians in the other
specialties are undeserving of trust also. I left the dermatologist's office
without having the mole removed, although I returned and had him remove it later
after I'd gotten opinions from other physicians and had done some reading on the
subject. Physicians in the other specialties accepting biological psychiatry as
legitimate calls into question the reasonableness and rationality not only of
psychiatrists but of all physicians.
On November 30, 1990, the Geraldo television talk show
featured a panel of former electroshock victims who told how they were harmed by
electroshock and by psychiatric drugs. Also appearing on the show was
psychoanalyst Jeffrey Masson, Ph.D., who said this: "Now we know that there's no
other medical specialty which has patients complaining bitterly about the
treatment they're getting. You don't find diabetic patients on this kind of
show saying 'You're torturing us. You're harming us. You're hurting us. Stop
it!' And the psychiatrists don't want to hear that." Harvard University law
professor Alan M. Dershowitz has said psychiatry "is not a scientific
discipline" ("Clash of Testimony in Hinckley Trial Has Psychiatrists Worried
Over Image", The New York Times, May 24, 1982, p. 11). Such a
supposed health care specialty should not be tolerated within the medical
profession.
There is no need for a supposed medical specialty such as
psychiatry. When real brain diseases or other biological problems exit,
physicians in real health care specialties such as neurology, internal medicine,
endocrinology, and surgery are best equipped to treat them. People who have
experience with similar kinds of personal problems are best equipped to give
counselling about dealing with those problems.
Despite the assertion by Dr. Torrey that psychiatrists can
choose to practice real health care by limiting themselves to the 5% or less of
psychiatric patients he says do have real brain disease, as even Dr. Torrey
himself points out, any time a physical cause is found for any condition that
was previously thought to be psychiatric, the condition is taken away from
psychiatry and treated instead by physicians in one of the real health care
specialties: "In fact, there are many known diseases of the brain, with changes
in both structure and function. Tumors, multiple sclerosis, meningitis, and
neurosyphilis are some examples. But these diseases are considered to be in the
province of neurology rather than psychiatry. And the demarcation between the
two is sharp. ... one of the hallmarks of psychiatry has been that each time
causes were found for mental 'diseases,' the conditions were taken away from
psychiatry and reassigned to other specialties. As the mental 'diseases' were
show to be true diseases, mongolism and phenylketonuria were assigned to
pediatrics; epilepsy and neurosyphilis became the concerns of neurology; and
delirium due to infectious diseases was handled by internists. ... One is left
with the impression that psychiatry is the repository for all suspected brain
'diseases' for which there is no known cause. And this is indeed the case.
None of the conditions that we now call mental 'diseases' have any known
structural or functional changes in the brain which have been verified as
causal. ... This is, to say the least, a peculiar specialty of medicine" (The
Death of Psychiatry, p. 38-39). Neurosurgeon Vernon H. Mark, M.D., made a
related observation in his book Brain Power, published in 1989: "Around
the turn of the century, two common diseases caused many patients to be
committed to mental hospitals: pellagra and syphilis of the brain. ... Now
both of these diseases are completely treatable, and they are no longer in the
province of psychiatry but are included in the category of general medicine"
(Houghton Mifflin Co., p. 130).
The point is that if psychiatrists want to treat bona-fide brain
disease, they must do so as neurologists, internists, endocrinologists,
surgeons, or as specialists in one of the other, the real, health care
specialties - not as psychiatrists. Treatment of real brain disease falls within
the scope of the other specialties. Historically, treatment of real brain
disease has not fallen within the scope of psychiatry. It's time to stop the
pretense that psychiatry is a type of health care. The American Board of
Psychiatry and Neurology should be renamed the American Board of Neurology, and
there should be no more specialty certifications in psychiatry. Organizations
that formally represent physicians such as the American Medical Association and
American Osteopathic Association and similar organizations in other countries
should cease to recognize psychiatry as a bona-fide branch of the medical
profession.
THE AUTHOR, Lawrence Stevens, is a lawyer whose practice has included
representing psychiatric "patients". His pamphlets are not copyrighted. You
are invited to make copies for distribution to those who you think will benefit.
1998 UPDATE
"I view with no surprise that psychiatric training is being systemically
disavowed by American medical school graduates. This must give us cause for
concern about the state of today's psychiatry. It must mean, at least in part,
that they view psychiatry as being very limited and unchallenging. ...there are
no external validating criteria for psychiatric diagnoses. There is neither a
blood test nor specific anatomic lesions for any major psychiatric disorder.
So, where are we? ... Is psychiatry a hoax, as practiced today?" From a
letter dated
December 4, 1998 by Loren R. Mosher, M.D., a psychiatrist, resigning from the
American Psychiatric Association.
1999 UPDATE
According to an article in the September 1999 American Journal of Psychiatry
titled
Attitudes Toward Psychiatry as a Prospective Career Among Students Entering
Medical School, by David Feifel, M.D., Ph.D., Christine Yu Moutier, M.D. and
Neal R. Swerdlow, M.D., Ph.D.:"The number of U.S. medical graduates
choosing careers in psychiatry is in decline. In order to determine whether
this disinclination toward psychiatry occurs before versus during medical
school, this study surveyed medical students at the start of their freshman
year. ... these students begin their medical training viewing a career in
psychiatry as distinctly and consistently less attractive than other specialties
surveyed. More than one-quarter of the new medical students had already
definitively ruled out a career in psychiatry. New medical students rated
psychiatry significantly lower than each of the other specialties in regard to
the degree to which it was a satisfying job, financially rewarding,
enjoyable work, prestigious, helpful to patients, dealing with an
interesting subject matter, intellectually challenging, drawing on all aspects
of medical training, based on a reliable scientific foundation, expected
to have a bright and interesting future, and a rapidly advancing field of
understanding and treatment. ... Contrasting these results with previous
studies suggests that an erosion has occurred over the past two decades in the
attitudes that new medical students hold toward psychiatry." [underline added]
2000 UPDATE
"Psychiatric disorders are vastly different from physical disorders, however,
because our understanding of how the normal brain works is incomplete. ... We
know very little, however, about the neurological processes of learning, memory,
thoughts, reasoning, and consciousness, and the production of emotions. ...
The treatment you receive depends on the orientation of your psychiatrist, not
on a solid foundation of knowledge about the etiology and pathogenesis of the
disorder itself." Edward Drummond, M.D., Associate Medical Director at Seacoast
Mental Health Center in Portsmouth, New Hampshire, in his book The Complete
Guide to Psychiatric Drugs (John Wiley & Sons, Inc., New York, 2000), pages
8-9. Dr. Drummond graduated from Tufts University School of Medicine and was
trained in psychiatry at Harvard University.
2001 UPDATE
"...biopsychiatry is a belief system, no more scientifically valid than any
religion or philosophy. ... Iatrogenesis is defined as a
doctor-inflicted injury, illness, or disease. ... In malpractice, a doctor is
found guilty of acting against medical code in violation of the so-called
standard of care. However, malpractice is only one kind of clinical
iatrogenesis and is actually the least of our worries. Most of the damage
inflicted by modern medicine occurs within the standard of care of ordinary
practice. As noted, 106,000 Americans died in 1994 from medications that were
administered properly, makng this the fourth leading cause of death,
while two million more suffered from serious side effects. ... Among
institutional psychiatrists and psychologists, there are two major strategies of
'treatment': drugs and behavior modification. There really is nothing
else seriously discussed, and it would be fair to say that in institutional
mental health 'treatment' is synonymous with 'manipulation.' ... institutional
mental health's diagnoses are unreliable and invalid - and thus unscientific -
rendering them more diversionary than useful. ... Know that sticks and stones
may break your bones, but DSM* does permanent damage."
Bruce Levine, Ph.D. (psychologist), Commonsense Rebellion: Debunking
Psychiatry, Confronting Society (Continuum, New York, 2001), pp. 65, 103,
178, 269, 277.
*The
DSM is the Diagnostic and Statistical Manual of Mental
Disorders published by the American Psychiatric Association.