Thursday, July 6, 2023

Problems with Psychiatry

 Paul Minot, MD, wrote a thread inviting other threads on the practice of psychiatry. Caveat, I have no idea of the credibility of any of these claims, but some make a lot of sense to me: 

"I've been practicing psychiatry for 38 years. I love my job, my peers, and my patients. but I've come to the conclusion that I'm participating in the biggest intellectual scam of this era. We claim to be a science, but have no understanding how thought or behavior is generated. Many billions of dollars are spent each year in an industry built on a corrupt body of pseudoscience, cultivated and exploited by monied interests for decades. This scientific fraud has been more successful than any other of our day. Our diagnoses are contrived by our guild, the APA, with the collaboration of monied interests--and are so unrelated to actual science that they are copyrighted and published to profit that organization. In the process of selling a corporatist, medication-oriented model of treatment, psychiatry has been stunningly successful in redefining what it means to be a human being. Meanwhile, 20 years of peak psychiatry has resulted in a 30% increase of suicide in the United States--and American psychiatry has absolutely nothing constructive to say about it. Please tell me what I've missed." 

Brian Muldoon added,

"The legal system creates a situation where anyone who steps out of line is vulnerable to litigation, but if you do what everyone else is doing you are safe. This kills all growth. . . . We need a new mechanism. Look at how type 2 diabetes has been proven to be reversible through diet but nothing changes in practice. Everything is written in stone now." 

The legal system and the insurance system. From what I've seen of psychotherapy so far, it's severely hampered and driven by insurance company regulations. We've been cautioned to make sure any notes fit with the DSM-5, and to use CBT language in our notes even if we don't use CBT as the dominant modality in the clinic. And don't ever expect to be able to see any client more than 8 times consecutively unless they can pay a pro bono rate out of pocket.

Daniel Kerlinsky, MD said,

"Two treatable pathophysiological processes have been ignored by psychiatry - treating CNS inflammation and treating demyelination. These are palpable but psychiatrists are not taught to examine the head and feel what a healthy brain feels like - and what we can add to recovery. Add one capsule of minocycline 50 mg [tetracycline antibiotics] at bedtime along with one tablet of clemastine fumarate 2.68 mg [antihistamine]. You'd be surprised 1-3 months later. There's no money for Pharma in old generic meds. Right now all of humanity has brain inflammation, post-inflammatory & demyelination effects."

This sounds suspiciously like he's witnessing the neurological effects of Covid on the brain. I'm not sure how a psychiatrist can feel the healthy brain during a typical session, but maybe he's got fMRI equipment in his office. I'm not sure about antibiotics without a specific cause, either, but it might be better than the alternative. Doctors have already suggested antihistamines anytime someone's infected with Covid.

Finally, Judy Melinek, MD said, 

My father was a psychiatrist and died by suicide. I’m a forensic pathologist, so I know a bit about suicide from the other end of things. Here’s my take: psychiatry is medicine of the mind but the mind has an organ and that organ is affected by the body and environment. If you want to reform psychiatry then first we have to acknowledge that it’s missing neurology & infectious disease training, and you need to fix sociology & politics. 

Suicide rates correlate with despair and easily accessible means. You have to fix the environmental factors too. Otherwise all you are doing is patching up soldiers so that they are healthy enough to go back into battle and get killed. If you are satisfied with helping individuals, then that’s great, but our entire educational & political system needs to be reformed to fix mental health itself. 

To fix suicide we need more than therapy & pharmaceuticals (standard psychiatry). We need to build interconnected societies that care for one another and robust social services for the poor, unhoused, drug-addicted. We need universal health care and basic income. We need to start caring about one another and find ways to support each other through difficult times, and we have to reform our educational system so that caring and conflict resolution are a part of how we raise the next generation. This also involves curbing or suppressing hateful and destructive aspects of our society, which includes a role for the press and social media companies. Algorithms that promote anger and divisiveness for clicks are in large part to blame for the despair we feel online.


More and more we're learning about how much physical aspects of our brain create what we generally call personality, and how much various diseases can also affect how the brain works. It's so much more biological than we previously thought, and, at the same time, so much more sociological. We need everyone to be cared for enough that there aren't huge swaths of people struggling to survive. We need basic income more now than ever before with the increasing numbers unable to work because of Long Covid. And we have to stop normalizing hate under the guise of free speech. There's nothing free about it - it costs us all. 

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