I wish I could get my mind around the mystique of the medical profession, psychiatry specifically, and how the significance has been buried in hype. Psychiatry is now “in vogue,” the latest panacea for individual and collective woes. I see that in the professional literature, where the “opiate crisis” has brought psychiatrists to the forefront of bids for federal funding. Psychiatrists are lobbying Congress for the expansion of telemedicine, because there are not enough shrinks to meet demand. We have psychiatrists pushing for “evidence based medicine” and “collaborative care,” and for new drugs to treat diverse symptoms, like tardive dyskinesia. We’re seeking new treatments, such as transcranial magnetic stimulation and vagal nerve stimulation to alleviate symptoms.
With all this expertise and innovation, we have yet to offer cures—or hope for cures--for any psychiatric problem. Instead, we have invented new mental disorders, such as adult Attention Deficit Hyperactivity Disorder (Adult ADHD), which now justifies lifelong prescriptions for amphetamines, highly controlled substances.
Nor do we consider the systemic causes of the mental illnesses. The psychiatric community consoles itself with partially effective treatments for problems like Post Traumatic Stress Disorder (PTSD), but there is never a whisper that we could prevent a great deal of PTSD by stopping US aggression and wars around the world.
In many ways, the medical profession functions like a secret society, with insider knowledge gained through the rigors of medical school and residency. In this context hazing is the norm, not the exception, and those who survive the trials join the ranks of abusers and feel justified in passing on the whip-based approach to “the healing arts.” In short, doctors are driven, and they drive others. This is believed to be a sign of strength. It is also a cause of burnout, job dissatisfaction, and physician suicide.
Psychiatry, more than any other medical specialty, has historically attempted to blend art and science to heal the mind. For me, it offered hope of setting people free of limiting beliefs and expanding their minds to new levels of awareness. It turns out this was a naïve fantasy, because that’s not how it works in practice.
The “art” of healing has given way to the “science” of healing, in a mechanized, piecemeal, statistically analyzed way, to the detriment of doctors and the patients they treat. Both doctors and the public seem caught in the illusion that medicine can do more than it can do. When the patient is dissatisfied, blame falls on the doctor. I wonder, though, if both have been hypnotized by unrealistic expectations, intensified by all the hype generated by advertising, insurance, government, and the magical belief that doctors possess some mystical knowledge known only to the select few.
I don’t think so, and anyone who does is bound to be disappointed. Medical school reveals not how much but how little we know about the human body, its intricate homeostasis, and its natural inclination toward health. Left alone, the body wants to be healthy.
The concept of healing the mind presumes there is something wrong with it, a belief reinforced by history and religion. Father of psychiatry, Sigmund Freud, postulated a semi-demonic “id” that vied with the controlling “superego” in symbolic good-versus-evil fashion reminiscent of God and the Devil in monotheistic tradition.
Under this scenario, the “mind” can never be healed, but the presumed relevance of psychiatry lies in its ability to control the mind through drugs and therapy. Thus painful emotions become pathologized and diagnosed by subjective criteria that psychiatrists pretend are “scientific.” The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the result.
A common stereotype about doctors is that they are money-driven, but I suspect they are driven more by a desire to be helpful. Yes, the money is nice, but by itself, it does not provide the fulfillment that satisfying work does. And, in recent years, the desire to be helpful has translated into a tendency to overprescribe pills and surgery. This is especially true in psychiatry, where success in alleviating suffering is hard to measure.
I wonder if the tendency to over-prescribe is a reaction to a deep sense of helplessness in the face of so much suffering. Do doctors and the public have unrealistic expectations for what the medical profession can do? Would it be appropriate to re-assess the paradigms we use to define mental or physical suffering in the context of society as a whole? Is it the individual’s problem or society’s problem that there is so much dis-ease and pain, or is it a combination of both? Shouldn’t psychiatrists and other physicians ask themselves and the public what, exactly, they are attempting to treat?
Oriental philosophy recognizes a spiritual component in all suffering, but we have ignored spiritual contributors in Western, allopathic medicine. The Oriental concept of life force, or “qi,” that arises from within and maintains life, including quality of life, presumes that problems begin at a spiritual level, then become progressively “dense,” through mental and emotional levels, until they eventually reach physical manifestation. Under this paradigm, uncomfortable emotions motivate change of attitude, belief, or action, in order to regain balance.
The Western “quick-fix” approach to pain, through pills or surgery, attempts to by-pass this internal signal system. Not surprisingly, the treatments often fall short of promises and expectations, while the problems themselves go unresolved.
It is said by some, including me, that all healing comes from within. Doctors or others may assist, but the patient’s belief and desire for healing are paramount. By putting responsibility for health outside ourselves, are we sabotaging our body’s natural self-correcting abilities?
It seems to me that psychiatrists would inspire more confidence by admitting they don’t have magic bullets and maybe never will. In most cases, the best we can offer is a compassionate “There, there,” and be a source of comfort and a touchstone for those who minds are bedeviling them.