The Healing of Psychiatry
Robert A. Berezin, MD
Psychiatry is fast approaching a death spiral which we as a society may not be able to recover from.
In many residencies, psychotherapy is not even being taught. Many psychotherapists of all professions have been intimidated by specious neuro-biochemical theories, while others have simply given up. And now, there aren’t many remaining good therapists in practice anymore. The hope for the future depends on young professionals who think for themselves, people who are drawn to the quest for the real item. But who is gonna teach them?
The underling theory of somatic psychiatry is that the source of human struggle is considered to be the brain itself, rather than the person. Treatments that follow from this simplistic, mechanistic, and reductionist notion have been to act directly on the brain, physically, electrically, or chemically, always with violating and destructive outcomes.
I’m not gonna go through the sordid history of Insulin Shock Therapy, Electroconvulsive Therapy, and Lobotomies, which have have been mostly lost in the amnesia of history. But they should serve as a reminder, a morality tale, for the excesses and depravity by which psychiatric beliefs and practice can easily sink. Instead we are repeating the very same mistakes all over again. Whatever happened to “Do No Harm?”
Biological psychiatry’ is today’s incarnation of somatic psychiatry. The current form of its doctrine is that problems come from genetic or developmental neurobiological disorders of the brain. And the prescribed treatments for its phantom brain diseases are psychoactive drugs. The cure for human struggle has been reduced to a pill, as if pharmaceuticals address the agency of human suffering. ‘Biological’ depression and its Prozac cure are now so firmly embraced by psychiatry and our culture at large that it seems preposterous to even suggest that it is an urban myth. It is now taken as fact that there is a chemical imbalance in the brain (even though this has been recently disavowed by the APA). The depth and scope of what it is to be human has been exiled by this dangerous and destructive practice.
The pharmaceutical industry has been exposed, having been engaged in study suppression, falsification, strategic marketing, and financial incentives. In one generation, the APA, in collusion with the drug companies have destroyed psychiatry. The American Public has been sold a bill of goods. The specious claim is that we can now cure biological depression with antidepressants; biological anxiety with benzodiazepines; the fictitious ADHD with, of all things, amphetamines (which are being given to our children), schizophrenia with anti-psychotics; and manic-depression with today’s drug du jour.
Do not be intimidated by so-called evidence based theories. Ben Goldacre is his illuminating Ted lecture, “What doctors don’t know about the drugs they prescribe” shows the evidence in relation to antidepressants. A fifteen year review of antidepressant studies showed that 50% of 76 studies were positive and 50% were negative. All of the positive studies were published and all but three of the negative studies were suppressed and not even published. Approximately half of all studies that weren’t suppressed concluded that antidepressants are barely actually significantly more effective than placebo alone. In relation to the remaining studies, even the standard by which effectiveness is scientifically measure is absurd. What is accepted is that if antidepressants work 40% of the time and placebos work 30% of the time, it is deemed to be an effective drug. This means that the antidepressants apparently work 10% of the time in only 25% of the studies. So much for this evidence based theory. In addition to not being efficacious there are considerable side effects, habituation, drug tolerance, addiction, and horrible and frightening neurological and psychiatric effects if one tries to discontinue the drugs.
Psychiatry is in crisis. And we, as a society, are in crisis. It is of the highest urgency to save psychiatry from itself and save society from today’s psychiatry.
The real source of human suffering — and all psychiatric conditions — is not now, nor has it ever been, the brain. The issues are in the person, the human being, in the context of damage to the play of consciousness, which was created by deprivation and abuse in the context of our temperaments in the formation of our character. My life’s work has taught me that the art, the science, the discipline, and the wisdom of psychotherapy does attend to this damage. There are no miracles and no shortcuts, as drugs, like the other somatic therapies, always promise. All the issues of psychiatry operate purely on the human and social level, not the molecular level. Likewise, so does the appropriate and responsive treatment, psychotherapy.
Psychotherapy is a specialized form of human engagement that repairs the damage to one’s character by acting on the play of consciousness in the very way that it formed in the brain in the first place. All psychiatric symptoms are the expression of our problematic characters. By exploring, within the safe emotional holding by the therapist, we heal our unmourned pain as our psychiatric symptoms dissipate. We have thrown out the baby with the bathwater.
Psychotherapy is the real item. We must get back to it. It fosters the recovery of one’s authenticity and the capacity to love. This is the source of all psychiatric struggles. It taps into the heart of life’s mysteries and wisdom.