limits of psychiatry

[megastalin]

I would really love to find a psychiatrist and/or psychologist who understands that mental health care is essentially lifelong palliative care and doesn't traffic in sugar and rainbows.

It's really the worst aspect of this day hospital thing. The forced nicety, the implication that some kind of a great comeback, some transformation is just around the corner if only we try hard enough if only we believe.

But that's not what's around the corner. Around the corner are new challenges at best and devastating crises at worst. Why pretend otherwise?

I firmly believe that once this civilisation returns to some form of rationality (which has, to put it lightly, fallen out of style worldwide) all of these therapeutic practices will be revised and most of them will cease to exist.

I keep looking at people here, they seem not all that responsive, kind of out of it. And I think to myself, surely they must have been admitted a few weeks before I did, this is the start of their treatment. But then the next day, I find out they've been here for 2 and half a months and are being released the next day!

They come in banged up, they leave banged up. The entire focus is on the process, not the outcome.

Psychiatry as it is now is like the astronomy of old before the heliocentric system. These astronomers, despite their fundamentally wrong model, were able to make accurate but limited predictions of the motions of the stars. So can psychiatry get the patient back from the ledge, with medication, with deep-sounding truisms (that don't stand up to further scrutiny) but can do little else in terms of elevating the patient's quality of life.

Why is this so? Because psychiatry is essentially solipsistic, it doesn't concern itself with the outside world, with social relations, or even the bare necessities of social life. No, as far as a psychiatrist is concerned, only you and your psyche exist. And once we get it somehow in order, while it being an open secret that we can't get it in order, something will mystically transform.

Eventually, soon, in a few centuries tops, this will be replaced with a kind of Marxist psychiatry that will center mental illness where it needs to be centered - in the society and group that generated the malady in the first place. It will be revealed that no mind or body is a wrong mind or body requiring medicalisation (in the broadest term, I don't mean just taking meds) but understanding and above all grace.

Until then, people like me, and there are so many of us, are left to contend with a system that we need to make us barely functional and alive, but that doesn't help otherwise and that's worse -- a system that is fundamentally violent and cruel and won't hesitate to punish you at a mere perception of being not quite contrite enough as you receive its ministrations.

Comments

[sabotabby]

To be the ideal approach balances the societal/cultural with "yeah, sometimes my brain just wants to kill me for no reason." But good luck finding both of those approaches in the same psychiatrist.

[megastalin]

Does it though? On what basis is your brain (my brain) separate from your Self (wants the kill me). You’re not actually balancing nature and nurture, you’re letting both of them off the hook alongside with any concept of personal responsibility too.

Dualism is not the answer, dualism is the problem. There is nothing (and especially not any mystical substance) separating the brain from the mind and body (Self). It’s one whole. The whole which interacts with other wholes and the symbolic order of society. In this interplay is where mental illness is generated because it’s the only locus where it could be generated.

This is not to negate biology, as it is clear that some illnesses like schizophrenia and autism are hereditary and have genetic components. But again, not even your genes are a separate entity from You. There are no separate entities within you. There is only the one whole living entity. This is the meaning of no body or mind is wrong by itself.

Difficulties in life and functioning which are the criteria to say something is an illness (why schizophrenia is an illness while homosexuality is not) arise in the interpersonal and social interactions of the Wholes, which are subjected to the symbolic order in addition to the natural order. They are entwined however, and any separation of the two is purely academical. I can give you a Christian analogy here. The natural order is The Father (God) and the symbolic order is the Word (Jesus Christ) who is as we all know begotten but not created (in the beginning there was the Word and the Word was with God).

So, it is from this, my view, entirely wrong to say that the these orders could stand in such opposition that one wants to kill the other.

Suicidality is not your brain wanting to kill your body. It’s you wanting to kill yourself because your pain has become unbearable. It’s a signal that you require help.

Now in my vision or Marxist psychotherapy this help would not consist of just meds and a few encouraging words but of consistent and persistent intervention in your life and your community so that you could be rehabilitated and reconnected to both of the orders in a harmonious way. It would be a deep examination of personality and ways in which both you and the community have made errors in mutual understanding and interaction.

Sorry for this to be so long. I believe in a worldview called Monism which is to say the least unpopular these days. If it’s a bit rambling it’s only because I’ve been thinking about these things a lot during my current treatment.

[sabotabby]

Hey, your blog, your prerogative!

A lot of my break from anarchism and mad pride had to do with the refusal to recognize the individual or the biological at all; I was expected to embrace my mental illness or else frame it as entirely socially constructed. Which I find interesting, as that sort of loops around to the mainstream, capitalist view of mental illness—it is only categorized as such if it interferes, specifically, with your ability to do work. The difference is that anarchists hated me for not celebrating my unique role in a future society, and instead taking psychiatric meds about it.

(Standard disclaimer: Not all anarchists.)

My spine has also tried to kill me in the past, and I see no real distinction between saying that my spine is trying to kill me and my brain is trying to kill me. The brain isn't a special organ; it can malfunction for all sorts of reasons. Of course my brain and my spine are both me (in that sense, the tumour was also me) but as a rhetorical framing—I need to deal with this part of me that is causing me harm—I find the separation useful.

I'm ending my time in psychotherapy after around 25 years, so it's a strange time for me. I found it helpful, if overly individualistic, since a lot of what is going on with me is socially/economically based. That said, my ability to push back on the latter relies on my ability to exist in the first place.

[megastalin]

I think I understand where you're coming from. Despite how it might seem from my writing here, I am not anti-psychiatry and I don't believe people should "embrace their illness" and go off their meds. Embracing depression or schizophrenia seems the same as "I'm embracing my diabetes so I'm eating all the sugar I want and not taking insulin." Preposterous.

Regarding the capitalist view, you are correct. Still, an illness is basically defined as an inability or a difficulty in function, whether it's physical or mental functioning.

What I'm trying to get at perhaps clumsily, is that I disagree with mainstream psychiatry about both the etiology and treatment. They claim it's basically found solely in the individual, something (but we don't yet quite know what) malfunctions in the brain and you're depressed. Or you're having paranoid thoughts. And their treatment is likewise individual (even when it takes place in a group therapy setting), take your meds, "better yourself," "make a commitment to yourself," "fight," etc.

But when you listen to what the people are actually saying in the therapy groups (If you've been in therapy for 25 years you've probably sat in at least one circle) it nearly always has to with their social environment. They have "bad mothers," or they're lonely, or they find it hard to connect with others. This is never really brought into focus despite it featuring so prominently in discussion. The social and group dynamic is always reduced back to the individual and how the individual can deal and cope with it. Basically, to individual biology, but what I am trying to say is that the natural and the symbolic always work together.

A digression: it's becoming more and more clear with genetics, that genes can not only encode traits but encode "recipes" for traits to be socially transmitted and learned. If there's such a link on a genetic level between the individual and the social, how can we still cling to dualism?

So, why can't the community be more involved? We now have dating apps, and before dating apps we had matchmakers and even just friendly setups. Clearly, we recognize dating, love, and marriage as something that the community should try to facilitate. So why can't it be the same for mental health?

Why do we confine mental health to the clinic and to a professional's office and to hospitals? Mental health should be a societal Praxis. Not embracing illness, not making excuses for our dysfunctions wherever they may come from (hopefully one day we can know for sure), but working together to overcome, connect, and give mercy to each other.

[sabotabby]

I definitely get it. I'm just very skeptical of outsourcing anything to "the community" (again, having been "released to community care" when there was no community to care for me). It becomes a chicken-and-egg scenario where we can't have mental health as societal praxis until society shifts but we can't shift society unless we deal with our own mental health crises.

[theradicalchild]

Getting to the roots of mental illness should definitely be key to resolving it, something all my pill-pushing psychiatrists seemed to not grasp, and I paid the price.

In my case it was my parents exploiting my poor in-person communication skills as an autistic, but every time I try to bring this up to them they deny, deny, deny, and I don’t want to get on their ugly dark sides since they pay my rent.

Interesting you bring up the term Marxist—I know it’s liberally and I think in many cases incorrectly used—but I had read The Communist Manifesto and one thing that resounded with me was parents exploiting their children, one of the stories of my life.

[illuvium]

honestly, the idea of getting cured at all is ridiculous to me. what happens to you will always stay with you and that's unchangeable unless you have really selective memory (but even then the funny thing is that the body will remember, so. back to the unchangeable idea). things happen and all you can really do is manage it or at least pretend you can so you can go back into the labor force and do as you do. i totally agree with your point regarding psychiatrists taking you in isolation. the real issue i see is where people refuse to entertain the notion that things don't happen in vacuums and that there's always context to the people you see and the events that happen. in any case, i think normalcy as a concept is a real joke since it's so subjective. this might not mean too much, but i do hope you feel better, though

[igenlode]

They were running a programme on the radio this afternoon about 'the youth mental health crisis' -- something like 25% of *all young people* in Britain now being reported as having diagnosable mental health conditions, a significant proportion of that being 'anxiety' -- and I cannot but feel that it seems very obvious that the problem is not the young people. Not, at any rate, unless their genes have been damaged en masse by their parents' poor diets or low-level doses of pesticides or microplastics in the environment while they were growing up, or any of the other hypotheses that have been put forward as to how our civilisation is somehow busy poisoning itself...

If you have a human society with that level of generational breakdown in it, then the conclusion would seem to be that the problem is not with the humans but with the society.