Psychiatry creates the divide between normal and illness and calls it a science. It uses sophisticated tools of evidence to justify social stigma and it does it so well that its fooled itself. I always refer to the example of homosexuality because its such a good example. It was stigmatised and so became psychopathologised. Yet how often does the wise psychiatrist question the other diagnoses and ask whether they're really illnesses or just normal.
Psychiatry is a profession that uses clusters of external symptoms to map experiences which are often internal. There is no concept of the lived experience psychiatrist (more on this later) which is an idea I have that would be the future of good psychiatry. Its very simple: people with lived experience go through psychiatric training - only they will possess the full knowledge of the experience and the knowledge of the textbooks. Depression would be treated by people who know what depression is. Treatment of psychosis, mania and all the other dimensions and domains currently medicalised by people who lack the real knowledge of these experiences would be revolutionised to become effective and ethical.
Their great lack of wisdom is most seen in the use of medication. The prophylactic use of psychiatric medication, i.e. the lifetime of taking medication for the mind after one crisis or episode, is foolish. Trust me, I'm a fool so I should know. A person can become unnecessarily drugged as an unintended punishment for a single hospitalisation and repeated hospitalisations can mean this regime is enforced through the medico-legal framework because of the introduction of Community Treatment Orders in the amended Mental Health Act (and in other legislation outside the UK).
Its not meant to be a punishment but the removal of certain emotions, range of emotions or expression of emotions is punishment. These are the very things that make us human and make the human experience liveable. To mess with them is dangerous and should be done with a care, and very differently to the current sledgehammer approach favoured by psychiatry's foolish wisdom.
Perhaps its greatest error is to disregard the pre- and extrapsychiatry mental health systems. Its an ignorant assumption that the only people capable of understanding mental health are psychiatrists. The converse is likely to be true. Spiritual, religious, cultural and other forms of extrapsychiatric mental healthcare have existed for generations. As far back as Roman times mood stabilisers were used for madness but these were very low doses of lithium found in certain spring waters. There are many examples of mind healers outside psychiatry and psychiatry is becoming influenced by them in the 21st century, for example Mindfulness Cognitive Behavioural Therapy is in part Buddhism.
And the last two 'wise' idiocies come together in another absurdity: the medicines for the mind prescribed by doctors and psychiatrists are usually given by people who have never tried nor would try them. There are some anecdotal stories of consultant psychiatrists making trainees try psychopharmaceuticals but this is very rare. There are more stories of doctors and other mental health professionals being averse to taking medication because of the stigma of mental illness and medication of mental illness in their profession. Last year a local doctor in Enfield was struck off for self-prescribing antidepressants; he could have got another doctor to write the prescription but that would be admission of illness, or weakness.
I think perhaps the motto is aspirational rather than a description of the RCPsych and the collective consensus of thought they represent. I really hope that it will describe them one day but they really should have an accurate motto.
"We're way out of our depth but we've got loads of science to justify our foolishness. Just try not to remind us of the mistakes of the past because those were wise mistakes."
or
"The legal drug dealers."
Or perhaps you can think of something more snappy?
Add them below in the comments box
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