Anti-psychiatric viewpoints are nothing new (and have been discussed on Barbelith before), and I don't particularly see why the next ten years will see the death of my profession. I would like to see a definition of terms here, though, as I suspect 'psychiatry' is being equated simply with 'prescribing psychotropic drugs', with no acknowledgement of any wider role.
I think it's also important to point out that the relationship between psychiatrists - physicians generally - and the pharmaceutical industry is a different one within a socialised healthcare system, like the NHS, from that of private practice. As an NHS-based practitioner, I am subject to blandishments from various drug companies, all pushing their particular product, but my salary is not contigent on prescribing what they sell.
psychiatry is an industry, its relationship to mental illness is mutually dependent, and psychiatrists love creating dependency with the aid of pharmacology and other chemical warfare techniques upon its patients, who are running out of patience.
It's not an industry, it's a profession - and a fucking busy one. There is a constant pressure on our service, and we have more than enough patients, thanks. The idea that I "love creating dependency" is, frankly, risible, and I would thank you not to make sweeping statements about what motivates me. This model grossly simplifies doctor-patient relationships into abuser/abused or pusher/addict, and I find it rather insulting.
Rather than viewing the psychiatrist as a willing catspaw of the pharmaceutical industries forcing "chemical warfare" onto his unwilling (im)patient, you might do well to consider the other factors at work here. What, for example, is the pathway between individual and psychiatrist? Why do people seek out psychiatry? Why do they believe psychiatry can resolve their problems? Where does this expectation come from? How should psychiatrists respond to it?
Here's mine- the Psychiatric industry will move more toward a 'flat' power relationship where the doctor and patient co-operate more explicitly in their treatment, moving away from the analyst/analysand asymmetry and making the patient feel more involved and empowered.
This rather assumes that a) the 'flat' model isn't what we do already (or, at least, aim for), and b) it's what people want. I think it's what people say they want but, on the old Barbe-thread I've linked to above, I talk about why I think this isn't necessarily always the case.
The 'flat' model also takes little or no account of the fact that many are treated against their will, under the Mental Health Act. Whether or not you perceive this to be a malign and unnecessary tool of the eeevil drug-pushing psychiatric establishment, you must acknowledge that it rather throws a spanner in the 'explicit cooperation' idea.
Unfortunately I also think that many, many people will continue to view their problems as external, and expect their psychiatrist to 'fix' it with a pill for them, rather than contribute to their own recovery, exacerbating the proscription tsunami being encouraged by the pharmaceutical industry and allowing people to blame their doctors when they're still depressed a week later (for example).
This is another factor. There is a vast pressure on psychiatrists to resolve unhappiness related to social, economic, relationship or personality problems and, in our makeover culture, this often amounts to the passive expectation that a pill will sort it all out. The relatively recent tendency of pharmaceutical companies to market directly to the 'consumer' encourages this expectation, as does the astoundingly successful perpetuation of memes like 'chemical imbalance', despite the poor quality of supporting evidence. As often as not, I find myself in the position of having to resist the pressure - from the patient himself - to prescribe (what is perceived to be) a panacea for situational ills, with the result that I'm seen as "not giving me any help". It's perhaps unsurprising, then, that it pisses me off when I'm lazily characterised as a gleeful drug-pusher, a willing facilitator of dependence.
I hope the good moves in Psychiatry will allow a more flexible and realistic approach, but I fear that the bad trends already noticable will continue. What do y'all think? What changes are coming and do you think they'll be good or bad?
I think the "bad trends" are largely the result of global capitalism, and the attendant creation of desire, of perceived need. We're encouraged to believe we can and should be fitter, happier, more productive - and if we're not, it constitutes illness, a 'chemical imbalance', a fault to be fixed. Big Pharma is out of control, and I see it as the job of governments as well as individuals to resist its influence. There is a danger, particularly within private healthcare systems, of the 'flat' model described above boiling down to naked consumerism: person sees antidepressant advertised on television and consequently 'realises' he's depressed; person goes to psychiatrist to request antidepressant; psychiatrist prescribes antidepressant.
I like to think that any backlash against this will be a measured one, that cynicism about the way drug companies operate will not invalidate the fact that, for some, psychotropic medication is helpful. I like to believe the media will stop being party to the unhelpful stereotypes of 'chemical imbalances', 'wonder drugs' and 'medical blunders'. I like to think people might see their psychiatrist as more than a prescriber of drugs.
I'm not holding my breath, though. |
