Читать книгу Leaving Psychiatry - J. R. Ó’Braonáin. M.D. - Страница 3

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 the chapters discussing other issues wider than the fiction of the disorders or disorder groups as natural categories, or deconstructing the successful work of fiction that is the DSM. The attack is “meta” to the DSM, specific psychiatric disorders merely illustrative of a larger argument which is epistemological and political, even moral, in nature. Mine is an attack not simply against the bible of the church of psychiatry whose scripture I cast aside years ago, but against it’s very cannon and creed.

The audience for this book is everyone whose interest or personal experience falls within the orbit of what is called psychiatry or mental health, where mental health is paradoxically in practice a synonym for mental illness. Therefore, the audience includes the orthodox majority psychiatrists I’d like to foil yet who are immune from the voice of reason, the various minority heterodox spanners in the psychiatric wheel who call themselves critical psychiatrists (though curiously not critical enough to leave the profession and the comforts a qualification), junior doctors in psychiatry, nurses and allied health practitioners, and students of all the above. To budding trainees in psychiatry who pilgrim towards the good, the beautiful and the true through a road of free thinking and Socratic or scientific dialectic I’d plant this book as a sign alongside the path, a sincere plea that states “Go back. You will not find what you are looking for in psychiatry, and they are most definitely not looking for you either”. This is the sign I wish someone had given me all those many years ago, or rather the sign I gave myself and failed to read at the time. Finally, this book is also aimed at members of the lay public who might have sat across from this species of secular priest who might in turn have pronounced them sane or insane, of good cheer or bad. To you patients I would simply say some emperors are finely clothed in wisdom, this despite of their apprenticeship and career in psychiatry. Evaluate them as any person would another. I am very blessed to have known and been mentored by a few who have taken their wisdom and placed it in peril of moral and intellectual famine by the profession they have chosen. In refraining from providing personal acknowledgment, I will offer the highest of compliments by dissociation from heresy. Sadly however, the vast majority of psychiatrists are as naked in wisdom as the day they were born.

As if it wasn’t obvious, I’m using a nom de plume. In the fullness of time if the title of the book becomes a matter of past tense, i.e. having left psychiatry, I’ll be tempted use my real name. Apart from the tradition amongst some doctors to write in pseudonym so as to protect the anonymity of patients discussed, anonymity also protects me. For I continue to practice behind enemy lines as it were, and have seen firsthand what happens to the careers of others who dare question too far mainstream psychiatry and the professional guilds from which it draws its power. I should very much like to continue to pay the bills, whilst seeking to quieten a whispering conscience lest it become a scream that will trouble me from sleep. On this point I wish to apologize to the reader for not revealing more of myself, for I would contend that one cannot really cannot understand why a thinker formulates the thought and arguably the quality of the thought itself without understanding the thinker his/herself in all his or her foibles and biases. Every creation carries the stain of its creator. Ergo caveat emptor.

Two of many questions haunt me into writing this book, and haunt me they do as mine is not a captious critique. These are the topics of the final two respective chapters. The first is the degree to which I might find it possible to identify with philosophy of the late psychiatrist Thomas Szasz (some would say anti-psychiatrist, I would say he was neither). I invite the reader to review the works of Szasz first, and also others critical of psychiatry. These include Peter Breggin, Paula Caplan, James Davies, Peter Gøtzsche, David Healy, Niall McLaren, Joanna Moncrief, John Read, Jeffrey Schaler, and Robert Whitaker et al.

The final chapter is more radical still, as if it were conceivably possible to be more radical than Szasz, i.e. what if psychiatry, as opposed to other medical/surgical specialities, simply went away. Would it matter in the same way the maimed would stay maimed if the orthopaedists were to vanish? The answer, cutting to the proverbial chase and making friends and enemies before the first word is read is this; the world does not need psychiatry. Nothing would happen of necessity were it to vanish, nothing bad anyway.