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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 psychia-
try'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
nonpsy-
chiatric 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 Mat-
thysse, Ph.D., Associate Professor of Psychobiology, both of Har-
vard 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 psy-
chiatrist 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 solu-
tion.
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
pub-
lished 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,
psychia-
trist 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 recog-
nition 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 physi-
cians - 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
prob-
lems. `...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 Electroconvul-
sive 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. Feel free to make copies.