Why Psychiatry Should Be Abolished
as a Medical Specialty
by Lawrence Stevens, J.D.
Psychiatry should be abolished as a medical specialty because medical school education is not needed nor even helpful for doing counselling or so-called psychotherapy, because the perception of mental illness as a biological entity is mistaken, because psychiatry's "treatments" other than counselling or psychotherapy (primarily drugs and electroshock) hurt rather than help people, because nonpsychiatric physicians are better able than psychiatrists to treat real brain disease, and because nonpsychiatric physicians' acceptance of psychiatry as a medical specialty is a poor reflection on the medical profession as a whole.
In
the words of Sigmund Freud in his book The Question of Lay
Analysis: "The first consideration is that in his
medical school a doctor receives a training which is more or
less the opposite of what he would need as a preparation for
psycho-analysis [Freud's method of psychotherapy]. ...
Neurotics, indeed, are an undesired complication, an
embarrassment as much to therapeutics as to jurisprudence and to
military service. But they exist and are a particular
concern of medicine. Medical education, however, does
nothing, literally nothing, towards their understanding and
treatment. ... It would be tolerable if medical
education merely
failed to give doctors any orientation in the field of the
neuroses. But it does more: it given them a false and
detrimental attitude. ...analytic instruction would
include branches of knowledge which are remote from medicine and
which the doctor does not come across in his practice: the
history of civilization, mythology, the psychology of religion
and the science of literature. Unless he is well at home
in these subjects, an analyst can make nothing of a large amount
of his material. By way of compensation, the great mass of
what is taught in medical schools is of no use to him for his
purposes. A knowledge of the anatomy of the tarsal bones,
of the constitution of the carbohydrates, of the course of the
cranial nerves, a grasp of all that medicine has brought to
light on bacillary exciting causes of disease and the means of
combating them, on serum reactions and on neoplasms - all of
this knowledge, which is undoubtedly of the highest value in
itself, is nevertheless of no consequence to him; it does not
concern him; it neither helps him directly to understand a
neurosis and to cure it nor does it contribute to a sharpening
of those intellectual capacities on which his occupation makes
the greatest demands. ... It is unjust and
inexpedient to try to
compel a person who wants to set someone else free from the
torment of a phobia or an obsession to take the roundabout road
of the medical curriculum. Nor will such an endeavor have
any success..." (W.W. Norton & Co, Inc., pp. 62, 63,
81, 82). In a postscript to this book Dr. Freud wrote:
"Some time ago I analyzed [psychoanalyzed] a colleague who
had developed a particularly strong dislike of the idea of
anyone being allowed to engage in a medical activity who was not
himself a medical man. I was in a position to say to him:
'We have now been working for more than three months. At
what point in our analysis have I had occasion to make use of my
medical knowledge?' He admitted that I had had no such
occasion" (pp. 92-93). While Dr. Freud made these
remarks about his own method of psychotherapy, psychoanalysis,
it is hard to see why it would be different for any other type
of "psychotherapy" or counselling. In their book
about how to shop for a psychotherapist, Mandy Aftel, M.A., and
Robin Lakoff, Ph.D., make this observation: "Historically,
all forms of 'talking' psychotherapy are derived from
psychoanalysis, as developed by Sigmund Freud and his disciples
... More recent models diverge from psychoanalysis to a
greater
or lesser degree, but they all reflect that origin. Hence,
they are all more alike than different" (When Talk Is
Not Cheap, Or How To Find the Right Therapist When You Don't
Know Where To Begin, Warner Books, 1985, p. 27).If you think the existence of psychiatry as a medical specialty is justified by the existence of biological causes of so-called mental or emotional illness, you've been misled. In 1988 in The New Harvard Guide to Psychiatry Seymour S. Kety, M.D., Professor Emeritus of Neuroscience in Psychiatry, and Steven Matthysse, Ph.D., Associate Professor of Psychobiology, both of Harvard Medical School, said "an impartial reading of the recent literature does not provide the hoped-for clarification of the catecholamine hypotheses, nor does compelling evidence emerge for other biological differences that may characterize the brains of patients with mental disease" (Harvard Univ. Press, p. 148). So-called mental or emotional "illnesses" are caused by unfortunate life experience - not biology. There is no biological basis for the concept of mental or emotional illness, despite speculative theories you may hear. The brain is an organ of the body, and no doubt it can have a disease, but nothing we think of today as mental illness has been traced to a brain disease. There is no valid biological test that tests for the presence of any so-called mental illness. What we think of today as mental illness is psychological, not biological. Much of the treatment that goes on in psychiatry today is biological, but other than listening and offering advice, modern day psychiatric treatment is as senseless as trying to solve a computer software problem by working on the hardware. As psychiatry professor Thomas Szasz, M.D., has said: Trying to eliminate a so-called mental illness by having a psychiatrist work on your brain is like trying to eliminate cigarette commercials from television by having a TV repairman work on your TV set (The Second Sin, Anchor Press, 1973, p. 99). Since lack of health is not the cause of the problem, health care is not a solution.
There has been increasing recognition of the uselessness of psychiatric "therapy" by physicians outside psychiatry, by young physicians graduating from medical school, by informed lay people, and by psychiatrists themselves. This increasing recognition is described by a psychiatrist, Mark S. Gold, M.D., in a book he published in 1986 titled The Good News About Depression. He says "Psychiatry is sick and dying," that in 1980 "Less than half of all hospital psychiatric positions [could] be filled by graduates of U.S. medical schools." He says that in addition to there being too few physicians interested in becoming psychiatrists, "the talent has sunk to a new low." He calls it "The wholesale abandonment of psychiatry". He says recent medical school graduates "see that psychiatry is out of sync with the rest of medicine, that it has no credibility", and he says they accuse of psychiatry of being "unscientific". He says "Psychiatrists have sunk bottomward on the earnings totem pole in medicine. They can expect to make some 30 percent less than the average physician". He says his medical school professors thought he was throwing away his career when he chose to become a psychiatrist (Bantam Books, pp. 15, 16, 19, 26). In another book published in 1989, Dr. Gold describes "how psychiatry got into the state it is today: in low regard, ignored by the best medical talent, often ineffective." He also calls it "the sad state in which psychiatry finds itself today" (The Good News About Panic, Anxiety, & Phobias, Villard Books, pp. 24 & 48). In the November/December 1993 Psychology Today magazine, psychiatrist M. Scott Peck, M.D., is quoted as saying psychiatry has experienced "five broad areas of failure" including "inadequate research and theory" and "an increasingly poor reputation" (p. 11). Similarly, a Wall Street Journal editorial in 1985 says "psychiatry remains the most threatened of all present medical specialties", citing the fact that "psychiatrists are among the poorest-paid American doctors", that "relatively few American medical-school graduates are going into psychiatric residencies", and psychiatry's "loss of public esteem" (Harry Schwartz, "A Comeback for Psychiatrists?", The Wall Street Journal, July 15, 1985, p. 18).
The low esteem of psychiatry in the eyes of physicians who practice bona-fide health care (that is, physicians in medical specialties other than psychiatry) is illustrated in The Making of a Psychiatrist, Dr. David Viscott's autobiographical book published in 1972 about what it was like to be a psychiatric resident (i.e., a physician in training to become a psychiatrist): "I found that no matter how friendly I got with the other residents, they tended to look on being a psychiatrist as a little like being a charlatan or magician." He quotes a physician doing a surgical residency saying "You guys [you psychiatrists] are really a poor excuse for the profession. They should take psychiatry out of medical school and put it in the department of archeology or anthropology with the other witchcraft.' 'I feel the same way,' said George Maslow, the obstetrical resident..." (pp. 84-87).
It would be good if the reason for the decline in psychiatry that Dr. Gold and others describe was increasing recognition by ever larger numbers of people that the problems that bring people to psychiatrists have nothing to do with biological health and therefore cannot be helped by biological health care. But regrettably, belief in biological theories of so-called mental illness is as prevalent as ever. Probably, the biggest reason for psychiatry's decline is realization by ever increasing numbers of people that those who consult mental health professionals seldom benefit from doing so.
E. Fuller Torrey, M.D., a psychiatrist, realized this and pointed it out in his book The Death of Psychiatry (Chilton Book Co., 1974). In that book, Dr. Torrey with unusual clarity of perception and expression, as well as courage, pointed out "why psychiatry in its present form is destructive and why it must die." (This quote comes from the synopsis on the book's dust cover.) Dr. Torrey indicates that many psychiatrists have begun to realize this, that "Many psychiatrists have had, at least to some degree, the unsettling and bewildering feeling that what they have been doing has been largely worthless and that the premises on which they have based their professional lives were partly fraudulent" (p. 199, emphasis added).
Presumably, most physicians want to do
something that is constructive, but psychiatry isn't a field in
which they can do that, at least, not in their capacity as
physicians - for the same reason TV repairmen who want to improve
the quality of television programming cannot do so in their
capacity as TV repairmen. In The Death of
Psychiatry, Dr. Torrey argued that "The death of
psychiatry, then, is not a negative event" (p. 200),
because the death of psychiatry will bring to an end a misguided,
stupid, and counterproductive approach to trying to solve
people's problems. Dr. Torrey argues that psychiatrists
have only two scientifically legitimate and constructive
choices: Either limit their practices to diagnosis and treatment
of known brain diseases (which he says are "no more than 5
percent of the people we refer to as mentally 'ill'" (p.
176), thereby abandoning the practice of psychiatry in favor of
bona-fide medical and surgical practice that treats real rather
than presumed but unproven and probably nonexistent brain
disease - or become what Dr. Torrey calls "tutors"
(what I call counselors) in the art of living, thereby
abandoning their role as physicians. Of course,
psychiatrists, being physicians, can also return to real health
care practice by becoming family physicians or qualifying in
other specialties.In an American Health magazine article in 1991 about Dr. Torrey, he is quoted saying he continues to believe psychiatry should be abolished as a medical specialty: "He calls psychiatrists witch doctors and Sigmund Freud a fraud. For almost 20 years Dr. E. (Edwin) Fuller Torrey has also called for the 'death' of psychiatry. ...No wonder Torrey, 53, has been expelled from the American Psychiatric Association (APA) and twice removed from positions funded by the National Institute of Mental Health ... In The Death of Psychiatry, Torrey advanced the idea that most psychiatric and psychotherapeutic patients don't have medical problems. '...most of the people seen by psychotherapists are the 'worried well.' They have interpersonal and intrapersonal problems and they need counseling, but that isn't medicine - that's education. Now, if you give the people with brain diseases to neurology and the rest to education, there's really no need for psychiatry'" (American Health magazine, October 1991, p. 26).
The disadvantage to the whole of the medical profession of recognizing psychiatry as a legitimate medical specialty occurred to me when I consulted a dermatologist for diagnosis of a mole I thought looked suspiciously like a malignant melanoma. The dermatologist told me my mole did indeed look suspicious and should be removed, and he told me almost no risk was involved. This occurred during a time I was doing research on electroshock, which I have summarized in a pamphlet titled "Psychiatry's Electroconvulsive Shock Treatment - A Crime Against Humanity". I found overwhelming evidence that psychiatry's electric shock treatment causes brain damage, memory loss, and diminished intelligence and doesn't reduce unhappiness or so-called depression as is claimed. About the same time I did some reading about psychiatric drugs that reinforced my impression that most if not all are ineffective for their intended purposes, and I learned many of the most widely used psychiatric drugs are neurologically and psychologically harmful, causing permanent brain damage if used at supposedly therapeutic levels long enough, as they often are not only with the approval but the insistence of psychiatrists. I have explained my reasons for these conclusions in another pamphlet titled "Psychiatric Drugs - Cure or Quackery?" Part of me tended to assume the dermatologist was an expert, be trusting, and let him do the minor skin surgery right then and there as he suggested. But then, an imaginary scene flashed through my mind: A person walks into the office of another type of recognized, board-certified medical specialist: a psychiatrist. The patient tells the psychiatrist he has been feeling depressed. The psychiatrist, who specializes in giving outpatient electroshock, responds saying: "No problem. We can take care of that. We'll have you out of here within an hour or so feeling much better. Just lie down on this electroshock table while I use this head strap and some electrode jelly to attach these electrodes to your head..." In fact, there is no reason such a scene couldn't actually take place in a psychiatrist's office today. Some psychiatrists do give electroshock in their offices on an outpatient basis. Realizing that physicians in the other, the bona-fide, medical and surgical specialties accept biological psychiatry and all the quackery it represents as legitimate made (and makes) me wonder if physicians in the other specialties are undeserving of trust also. I left the dermatologist's office without having the mole removed, although I returned and had him remove it later after I'd gotten opinions from other physicians and had done some reading on the subject. Physicians in the other specialties accepting biological psychiatry as legitimate calls into question the reasonableness and rationality not only of psychiatrists but of all physicians.
On November 30, 1990, the Geraldo television talk show featured a panel of former electroshock victims who told how they were harmed by electroshock and by psychiatric drugs. Also appearing on the show was psychoanalyst Jeffrey Masson, Ph.D., who said this: "Now we know that there's no other medical specialty which has patients complaining bitterly about the treatment they're getting. You don't find diabetic patients on this kind of show saying 'You're torturing us. You're harming us. You're hurting us. Stop it!' And the psychiatrists don't want to hear that." Harvard University law professor Alan M. Dershowitz has said psychiatry "is not a scientific discipline" ("Clash of Testimony in Hinckley Trial Has Psychiatrists Worried Over Image", The New York Times, May 24, 1982, p. 11). Such a supposed health care specialty should not be tolerated within the medical profession.
There is no need for a supposed medical specialty such as psychiatry. When real brain diseases or other biological problems exit, physicians in real health care specialties such as neurology, internal medicine, endocrinology, and surgery are best equipped to treat them. People who have experience with similar kinds of personal problems are best equipped to give counselling about dealing with those problems.
Despite the assertion by Dr. Torrey that psychiatrists can choose to practice real health care by limiting themselves to the 5% or less of psychiatric patients he says do have real brain disease, as even Dr. Torrey himself points out, any time a physical cause is found for any condition that was previously thought to be psychiatric, the condition is taken away from psychiatry and treated instead by physicians in one of the real health care specialties: "In fact, there are many known diseases of the brain, with changes in both structure and function. Tumors, multiple sclerosis, meningitis, and neurosyphilis are some examples. But these diseases are considered to be in the province of neurology rather than psychiatry. And the demarcation between the two is sharp. ... one of the hallmarks of psychiatry has been that each time causes were found for mental 'diseases,' the conditions were taken away from psychiatry and reassigned to other specialties. As the mental 'diseases' were show to be true diseases, mongolism and phenylketonuria were assigned to pediatrics; epilepsy and neurosyphilis became the concerns of neurology; and delirium due to infectious diseases was handled by internists. ... One is left with the impression that psychiatry is the repository for all suspected brain 'diseases' for which there is no known cause. And this is indeed the case. None of the conditions that we now call mental 'diseases' have any known structural or functional changes in the brain which have been verified as causal. ... This is, to say the least, a peculiar specialty of medicine" (The Death of Psychiatry, p. 38-39). Neurosurgeon Vernon H. Mark, M.D., made a related observation in his book Brain Power, published in 1989: "Around the turn of the century, two common diseases caused many patients to be committed to mental hospitals: pellagra and syphilis of the brain. ... Now both of these diseases are completely treatable, and they are no longer in the province of psychiatry but are included in the category of general medicine" (Houghton Mifflin Co., p. 130).
The point is that if psychiatrists want to treat bona-fide brain disease, they must do so as neurologists, internists, endocrinologists, surgeons, or as specialists in one of the other, the real, health care specialties - not as psychiatrists. Treatment of real brain disease falls within the scope of the other specialties. Historically, treatment of real brain disease has not fallen within the scope of psychiatry. It's time to stop the pretense that psychiatry is a type of health care. The American Board of Psychiatry and Neurology should be renamed the American Board of Neurology, and there should be no more specialty certifications in psychiatry. Organizations that formally represent physicians such as the American Medical Association and American Osteopathic Association and similar organizations in other countries should cease to recognize psychiatry as a bona-fide branch of the medical profession.
THE AUTHOR, Lawrence Stevens, is a lawyer whose practice has
included representing psychiatric "patients". His
pamphlets are not copyrighted. You are invited to make
copies for distribution to those who you think will benefit.
1998 UPDATE
"I view with no surprise that psychiatric training is being systemically disavowed by American medical school graduates. This must give us cause for concern about the state of today's psychiatry. It must mean, at least in part, that they view psychiatry as being very limited and unchallenging. ...there are no external validating criteria for psychiatric diagnoses. There is neither a blood test nor specific anatomic lesions for any major
psychiatric disorder. So, where are we? ... Is psychiatry a hoax, as
practiced today?" From a letter dated December 4, 1998 by Loren R. Mosher, M.D., a psychiatrist, resigning from the American Psychiatric Association.
1999 UPDATE
According to an article in the September 1999 American Journal of Psychiatry titled Attitudes Toward Psychiatry as a Prospective Career Among Students Entering Medical School, by David Feifel, M.D., Ph.D., Christine Yu Moutier, M.D. and Neal R. Swerdlow, M.D., Ph.D.:"The number of U.S. medical graduates choosing careers in psychiatry is in decline. In order to determine whether this disinclination toward psychiatry occurs before versus during medical school, this study surveyed medical students at the start of their freshman year. ... these students begin their medical training viewing a career in psychiatry as distinctly and consistently less attractive than other specialties surveyed. More than one-quarter of the new medical students had already definitively ruled out a career in psychiatry. New medical students rated psychiatry significantly lower than each of the other specialties in regard to the degree to which it was a satisfying job, financially rewarding, enjoyable work, prestigious, helpful to patients, dealing with an interesting subject matter, intellectually challenging, drawing on all aspects of medical training, based on a reliable scientific foundation, expected to have a bright and interesting future, and a rapidly advancing field of understanding and treatment. ... Contrasting these results with previous studies suggests that an erosion has occurred over the past two decades in the attitudes that new medical students hold toward psychiatry." [underline added]
2000 UPDATE
"Psychiatric disorders are vastly different from physical disorders, however, because our understanding of how the normal brain works is incomplete. ... We know very little, however, about the neurological processes of learning, memory, thoughts, reasoning, and consciousness, and the production of emotions. ... The treatment you receive depends on the orientation of your psychiatrist, not on a solid foundation of knowledge about the etiology and pathogenesis of the disorder itself." Edward Drummond, M.D., Associate Medical Director at Seacoast Mental Health Center in Portsmouth, New Hampshire, in his book The Complete Guide to Psychiatric Drugs (John Wiley & Sons, Inc., New York, 2000), pages 8-9. Dr. Drummond graduated from Tufts University School of Medicine and was trained in psychiatry at Harvard University.