Recent publicity around Tom Cruise and the Scientology organisation has brought the movements position on psychiatry and psychology once again into the public arena. The founder of Scientology, Ron L. Hubbard, declared in 1951 that medicine in general, and psychiatry in particular is "an art, not a science"; his system in contrast was "an organized science of thought built on definite axioms" which "contains a therapeutic technique with which can be treated all inorganic mental ills and all organic psychosomatic ills, with assurance of complete cure”.
Among the "psychosomatic" conditions Hubbard claimed to cure were asthma, poor eyesight, colour blindness, hearing deficiencies, stuttering, allergies, sinusitis, arthritis, high blood pressure, coronary trouble, dermatitis, ulcers, migraine, conjunctivitis, morning sickness, alcoholism, the common cold, tuberculosis and leukaemia. In total, Hubbard claimed in Dianetics: The Modern Science of Mental Health, "70% of Man's listed ailments" could be cured through the use of Dianetics.
Dianetics and its 1952 successor, Scientology, were initially organised as a substitute for medicine, and psychiatry in particular. Hubbard was quite clear about his goals: "Bluntly, we are out to replace medicine...” In a similar vein, he declared that "We are not even vaguely propitiative toward medicine or psychiatry, and we are overtly intent upon assimilating every function they are now performing." he set himself 3 years to achieve the goal of supplanting medicine. That was in 1952.
Scientology is not the only movement opposed to psychiatry. The Anti-psychiatry Movement refers to a collection of social and philosophical groups that challenge the fundamental tenets and practices of psychiatry. Within these movements, common criticisms include: that psychiatry applies medical concepts and tools inappropriately to the mind and society; that it often forces people to accept treatments against their will; that it excludes other approaches to mental distress/disorder; that its integrity is compromised by links to the pharmaceutical industry.
For the most part, these are arguments about the practices of psychiatry, not about the reality of mental illness. However, one of its strongest criticisms is of the system of categorical diagnoses used by medicine to identify, diagnose and subsequently treat mental illness.
There are two widely accepted standards in use: the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, and the mental health section of the World Health Organisation’s International Statistical Classification of Diseases and Related Health Problems (ICD); the author’s collaborate closely, and currently both systems use the same diagnostic codes.
Critics claim these classification schemes are are not founded on good science and do not reflect appropriate clinical practice. they also assert that the psychiatric care experienced by many is demeaning and controlling, a source of stigma rather than healing.
Some anti-psychiatrists seem to be worried mostly about being associated with the negative experience of psychiatry which some patients report. Other critics are not so much opposed to psychiatry as upset by the dominance of “biological” psychiatry; they want to promote an approach to mental health contrary to current mainstream theories and methods.
Critics of psychiatry generally do not dispute the idea that people experience emotional or psychological problems. They even acknowledge that some psychotherapies benefit some individuals. Their argument is that such problems do not meet the definition of illness and that psychiatry and is methods serve mainly to medicalise human behaviour and so act as an instrument of social control.
A central argument of anti-psychiatry is that adherence to majority values may be used as the benchmark for of mental health. Delusions (false beliefs) by this definition would fluctuate with the majority's opinion. This is not the case, of course ~ the formal scientific definition of a delusion requires that the a delusional belief must be false, fixed, impervious to logic and not held by other people who have a similar background. Furthermore , the existence of a delusion does not, of itself, constitute a mental illness.
Nevertheless, using this definition, critics of psychiatry argue that radical and advanced thinkers such as Galileo, would have been characterised as delusional since their ideas were widely held to be incorrect when they were originally formulated. Galileo was in fact prosecuted as a heretic; had psychiatrist been available in his day, he would probably have been declared sane .... but still heretical!
If the logic of Anti-psychiatry held true, now that Galileo’s heliocentric model of the solar system is widely accepted, the opposing belief might now be considered a "delusion"; but there are still people who deny Galileo’s insights and while we might consider them eccentric, they are certainly not threatened with treatment because of that.
One prominent example of a psychiatric diagnosis being used to reinforce cultural bias and oppress dissidence was the diagnosis of drapetomania, coined in the United States of America prior to the American Civil War. Using this “diagnosis” psychiatrists were able to declared slaves who possessed “an irrational desire for freedom and a tendency to try to escape slavery” to be insane. It is argued that similar processes continue to occur today, with recent examples of homosexuality as mental illness and naughtyness in children (Oppositional Defiant Disorder) put forward as examples.
Many people may feel that psychiatry pathologises them simply for being different. Some people diagnosed with Asperger's Syndrome or autism hold this position, and there are certainly parents who value the uniqueness of their “autistic” children and do not desire to "cure" them, much as there are members of the deaf community who do resist hearing aids and bionic implants for their children, fearing it will diminish them as members of their non-hearing communities.
Diagnostic reliability and validity is not faultless and while the DSM and ICD are working to explore and reconcile discrepancies, inconsistencies exist, there are grey areas and some vaguely-defined or changeable boundaries between what psychiatrists claim are distinct illness states. However, this is true of all fields of medicine.
Both ICD and DSM manuals stress that it is crucial to ensure that symptoms are not due to an organic brain condition (eg stroke, tumour, head injury, intoxication), and today many patients are referred for brain scanning as part of the diagnostic process.
Critics have pointed out that the two main symptoms of 'Paranoid Schizophrenia', in both DSM and ICD manuals, namely 'delusions' and 'hallucinations', are also caused by physical conditions as trivial as 'heat stroke'. It has been claimed that hardly any patients in UK or USA Acute Units have their temperature taken on presentation to eliminate this as a possible cause, but on the other hand, there are many other symptoms which might alert a practitioner to such organic causes, and in any case, pulse, temperature, blood pressure and routine blood tests are performed routinely on all admissions in Australia and most of Europe, where the incidence and prevalence of mental illness is the same as in the USA and GB.
There are problems in relying on diagnostic criteria and tests normed in one culture or population in different countries, cultures, genders or ethnic groups. Critics often allege that Westernised, white, male-dominated psychiatric practices and diagnoses disadvantage and misunderstand those from other groups. This is a valid criticism supported by many studies; but how that invalidates psychiatry, or the members of the mental health communities who are the main instigators of these studies is unclear.
Psychiatrists prescribe drugs for adults and children, in certain situations, against the person's will. Psychiatrists claim that a number of medications have a proven efficacy for improving or managing a number of mental health disorders. Organisations such as MindFreedom International and the World Network of Users and Survivors of Psychiatry hold that psychiatrists exaggerate the evidence of medication and minimise the evidence of adverse drug reaction.
There is real concern that individuals are not given sufficient factual information for informed consent when entering into treatment,
The influence of pharmaceutical companies is a major issue for the anti psychiatry movement. As one of the most profitable and powerful in business groups it has strong links to psychiatry, regulators, including national governments. Drug companies fund much of the research conducted by psychiatrists, advertise medication in psychiatric journals and conferences, fund psychiatric and healthcare organisations and run health promotion campaigns. Their lobbying activities extend from high-level government and individual politicians to general medical practitioners, nurses and hospital pharmacists.
Many psychiatrists are members, shareholders or special advisors to pharmaceutical or associated regulatory bodies and there is evidence that research findings and the prescribing of drugs are influenced as a result. A United Kingdom parliamentary inquiry into the influence of the pharmaceutical industry in 2005 concluded: "The influence of the pharmaceutical industry is such that it dominates clinical practice" with serious regulatory failings resulting in unsafe use of drugs and the increasing medicalisation of society.
The number of psychiatric drug prescriptions have been increasing at an extremely high rate since the 1950s and show no sign of abating. Antidepressants and anxiolytic drugs are now the top selling class of prescription drugs, and other psychiatric drugs also rank near the top, all with expanding sales. Is this evidence that mental illness is a myth, as Thomas Ssazz asserted in 1960, or that we are finding more treatments that target the biological basis of a real illness? Possible neither; it may simply indicate how much economic value certain companies derive from our emotional distress.
The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, a controversial book by Thomas Szasz has been highly influential in the anti-psychiatry movement. Szasz argues that mental illness is a social construct created by doctors, and the term can only be used as a metaphor.
For Szasz, an illness must be an objectively demonstrable biological pathology. Sat the time he was writing, psychiatric disorders did not meet these criteria. Since 1963, however, science has made substantial progress in gathering evidence of the way the biology and structure of the brain goes awry in mental disorders. The chemistry at nerve cell junctions, the metabolism in different brain regions and subtle anatomical anomalies all point to mental illness as biological realities.
In some cases, the problems begin even before birth, as nerve cells fail to find their proper place in foetal development. Chemical malfunctions may impact on normal nerve cell wiring in childhood or later, and since genes produce the chemicals, they are strongly implicated in most major mental disorders.
Outside influences are no doubt at work as well. Traumatic experiences at an early age may predispose to immediate and delayed problems and to vulnerability at a later date, and some genetic and pre-birth problems have a long latency period ~ 18 years in the case of schizophrenia!
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Sorting out the ways the brain's biology cause or predispose to mental illness is almost as complex as the brain itself. For the most part the major disorders fall into three broad categories: schizophrenia and related disorders, mood disorders such as major depression and bipolar disorder (manic depression), and anxiety disorders including obsessive compulsive disorder and panic disorder.
The degree to which social, biological and other factors influence each other to produce any of these disorders is certainly complex, but the argument that mental illness is nothing more than a socialised effort to control individuals cannot be sustained. Mental Illness is real, and so thank goodness is its treatment.
