Furious Seasons

December 09, 2008

Psychiatrist Slams Psychiatry

The following was written by Gene Combs, a psychiatrist in Illinois who has also written books about narrative therapy, including "Narrative Therapy: The Social Construction of Preferred Realities." Combs is also an associate professor of psychiatry at Loyola University, Chicago. He wrote these thoughts to a friend and then passed them along to me and I am printing them here with his permission because it's refreshing to see someone be so reflective about his profession and the huge issues around "corporate psychiatry" and the bipolar label.

Share your thoughts in comments and please be polite.

"I'm a psychiatrist. I don't always like being a psychiatrist, largely because it seems my colleagues are either greedy, self-important, unreflective bozos (like I imagine Dr. Biederman to be) or ordinary people who have huge responsibilities and are caught up in a system that they don't know how to question, who assume that the very poor excuse for science that they get in their professional literature can be trusted and should be followed.

"Being a psychitrist, I'm caught up in the same web of discourses. Being a psychiatrist, the huge bulk of referrals I get involve questions about psychotropic medications. These days it's rare for a person to come with the question of whether or not to take a medication. It's usually that they want some advice as to WHICH medication. Often, it's not even that; it's that their teacher has told them they need Adderall, or they heard on television that Paxil would help them win friends and influence people.

"Being a psychiatrist, I prescribe medications many times a week. I try to do this thoughtfully. I try to stay up on which medication might do the most good for which constellation of symptoms, and to notice those time when the best choice might not involve medication.

"Being a psychiatrist who is also a family therapist and a student of postmodernism/poststructuralism, and of the history of my profession, I am deeply an disturbingly aware of how easily we delude ourselves. I try to cultivate an awareness of the many conflicting purposes at work in the world, and to find ways of acting that move the discourse toward 'the good' as far as I'm able to discern that.

"WHEW! That was quite a preface. Are you still with me?

"What I'm trying to say is, I'm not anti-meds. I am against corporate capitalism masquerading as science. I am, I think for good reason, highly suspicious of any and everything that comes from organized psychiatry these days. This Biederman thing is just the tip of the iceberg. Big Pharma is just one of the forces that is at play in the takeover of the University by corporate capitalism. The whole DSM project is a bitter joke, an embarassment to the name of scientific inquiry. Then there is the insurance industry, which treats the DSM as if it's real, and demands that if I'm going to be paid I have to put each person I see in a DSM pigeonhole whether they really fit it or not. This further contributes to the dumbing-down of my profession. I'm full of bile about this. I foam at the mouth about it at the slightest provocation. SEE? I'm doing it again, even though I'm trying to be reasonable here.

"Because of the over-reach of Biederman, and the bad effects of his influence I see several times a week in my own office, I'm very cautious about using the word 'Bipolar' in reference to anybody, adult or child, these days. The label used to have a meaning, but now, in my part of the country at least, it is being applied to anyone who shows any strong emotion in a way that causes anyone discomfort."

We need more people in psychiatry like Combs.

Posted by Philip Dawdy at December 9, 2008 12:03 AM

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Comments

yeah, i see the bad effects of Biederman's influence every single time i look at my youngest of 3 daughters. i'd like to say Biederman go to hell...and i just did. his influence is what most ppl do not understand. it's pure evil, and a crime against children at minimum the guy needs to resign, have his medical license removed and sit in prison.

Posted by: Stephany at December 9, 2008 03:26 AM

"I'm very cautious about using the word 'Bipolar' in reference to anybody, adult or child, these days. The label used to have a meaning, but now, in my part of the country at least, it is being applied to anyone who shows any strong emotion in a way that causes anyone discomfort."

Amen. And yes Stephany, Biederman needs prison, as do Nemeroff and so many more of these guys.

Posted by: Sally at December 9, 2008 06:53 AM

Wow, that is just such a great thing to post. Thank you so much. I wish you could post that every day for a month so that all your readers could see it. And boy, do I wish more psychiatrists would be so reflective and honest about their profession. How unusual is that sadly.

Posted by: Sara at December 9, 2008 09:34 AM

I've been pushing prison, too - pushing it for manufacturers who hid the lethal side effects of whatever atypical or SSRI or ADHD drug they happened to be pushing. So far, not a one of them has taken the perp walk.

Posted by: Sorrowful at December 9, 2008 11:13 AM

Refreshing!

Posted by: Lisa at December 9, 2008 03:19 PM

What is amazing to me is how few people educate themselves about their own or their childrens' health at all! I view doctors as consultants, not dictators. I make sure to research my symptoms as much as I can before going into a doctor, and make sure I fully understand why the doctor thinks my situation is such-and-such and why medication so-and-so is the best route.

I think a huge part of the problem is that the vast majority of health education seems to be being left to drug company advertising; I've met no one here in Phoenix who had anything even vaguely approaching the Health classes that we had for an hour each week from grades 1-9, or Career And Life Management from 10-12.

I'm also shocked and appalled at the remarkably assembly-line-esque treatment I've received at many doctor's offices here in the US. (I'm from Canada) For instance, when I went to see a certain dermatologist, I described my symptoms to the nurse, who then left me waiting for some little while until she suddenly was trailing the doctor in, who told the nurse (not me!) it was blahblahblah, here was a prescription, and walked out. Never spoke to me. Never even had me undress to look at the rash. I've never been so appalled - it was dehumanizing, it was unprofessional, and it was actually a wrong diagnosis!

Ok, my rant is over...back to the blog!

Posted by: Tyler Style at December 9, 2008 05:21 PM

Beautiful! Not only do I wish every psychiatrist and every psychiatric patient could read this. I'd like to give a copy to all my fellow supporters of single-payer health care. Too many of us assume that there is a substance out there, called "Modern Medicine" or "Health Care", which is always good, and all we need to do is to fight for access to "Health Care" for all, just as we would fight for every human being to have access to water.

But health care in a profit driven system is just merchandise. Drug companies and other private corporations will gladly sell us life-saving treatments. They will also gladly sell us treatments that may ruin our lives, or even kill us. They really do not much care which, as long as the money is good. And as long as the doctors who write the prescriptions are dependent on these same companies for their "education," the money will be just as good either way.

Hooray for you Dr. Combs, and keep foaming at the mouth.

Posted by: Johanna at December 9, 2008 07:33 PM

psychiatrist wrote "I'm not anti-meds. I am against corporate capitalism masquerading as science."

I am anti meds. Medications are for diseases. Diseases have to be pronounced and significant to warrant the application of medication.

Medications are inherently powerful as in if they were placebo , they would not exist. Medications should not be thrown about so frivolously because of the potential for damage to physical and mental/emotional health.

Posted by: mark p.s.2 at December 12, 2008 05:01 AM