Madness of Psychiatry is a book for the general reader, which will interest psychiatrists and students. It is written by a psychiatrist with extensive academic, administrative, and clinical experience. It is illustrated with case studies and photographs. It describes the symptoms and syndromes of the severe mental disorders. It explains aspects of mental illness in court, and compulsory admission to hospital. It salutes electroconvulsive therapy and tentatively welcomes transcranial magnetic therapy. It grapples with deinstitutionalization, genius and suicide, and turns a critical eye on post trauma debriefing and recovered memory.
These are the views of the author. These are not necessarily the view’s of the German Journal of Psychiatry.
WHAT ARE WE TALKING ABOUT?
When I was growing up, people got most of their information about psychiatry from cartoons of patients lying on couches talking to a psychoanalyst, usually about scx. After more than a quarter century in the profession, have never seen a psychoanalyst’s couch. Nor, by the way, have I seen a padded cell or a straight jacket. Either my training and experience are lacking, or there was something wrong with the common stereotypes.
The general public now appears better informed.
But the quality of the circulating information is poor. Many heads are cluttered with “mental health” nonsense – the propaganda and wishful thinking of health authorities and the political correctness of pressure groups. For example, the wholesale closure of mental hospitals, compulsory debriefing of trauma “victims” and the recovered memory industry. These have all been uncritically nurtured and extolled by people who should have known better. This book is an insider’s view of psychiatry and psychiatric disorders, which are also called mental disorders, and related topics.
There is something about psychiatry and psychiatric disorders which people find strangely unsettling. Dr Josef Mengele, a German Nazi physician, tortured 400, 000 prisoners to death. Dr Harold Shipman, a British general practitioner, murdered at least 250 of his patients. Dr Ayman al-Zawahri, an Egyptian surgeon, was a central figure in the September 11 terrorist attacks on the USA. But in spite of the evil deeds by doctors in other fields, the psychiatrists are the doctors whom the public regard with greatest suspicion.
The definitions used in this field can be a little difficult to grasp, and often, like Russian dolls, they enclose terms which themselves need to he defined and the chase for a precise meaning continues. A simple definition of psychiatry is “a specialized field of medicine concerned with prevention, diagnosis, treatment and research of mental disorders”. We can forget about prevention and research for the moment, in which case, the crux of psychiatry is the diagnosis and treatment of mental or psychiatric disorders. That begins to sound a little spooky, but what are mental disorders?
Mental disorders have been defined as, “psychological syndromes that are associated with distress or disability”. Some experts will not attempt to define “psychological”, stating that “it cannot even be easily characterized”. Forced to come up with a definition, others state that psychological has to do with “the science of the mind”. Then, mind is defined as, “the totality of mental processes”. There is no widely accepted definition of “mental processes”, instead some experts prefer to state that perception and cognition constitute the mental processes. Yet others claim this list is incomplete and that the will and emotions deserve to be included. Perception has to do with the making sense of physical stimuli (sound, light, touch, smell, taste). Cognition has to do with mental activities such as thinking, conceiving, reasoning, among others.
Professor Nancy Andreasen of Iowa, USA, says that discussions about the nature of mental or psychiatric disorders provide “much heat but little light”, but that a definition is unnecessary as there is general agreement about which disorders constitute the mental disorders. Examples are schizophrenia, bipolar disorder, major depressive disorder and obsessive-compulsive disorder. These are conditions which may manifest altered moods (depression, elation, anxiety), beliefs which are not supported by evidence (delusions), the hearing of voices when no one else is present (hallucinations) and odd behaviour such as washing the hands a hundred times (compulsions).
The psychiatric patient is not faking. The patient who is suffering major depression is not being self-indulgent or attention seeking. The depression of mood may be so deep that recovery is beyond the control of the patient and he or she is incapable of responding to the advice “pull yourself together” or “snap out of it”. This disorder may be so severe and of such a type that the patient commits suicide. This may occur to an individual who, when well, would not contemplate such action, being strongly opposed to suicide because of family responsibilities, or on religious or moral grounds.
The patient suffering delusions is not pretending to believe things which others find laughable. He or she may be so convinced of the truth of their belief that innocent others, even loved family members, may be attacked or killed. The patient who has washed his or her hands ninety nine times may agree that logically, his or her hands must be clean, but may be unable to resist the compulsion to wash them one more time. More common examples include patients who are suffering anxiety (butterflies in the stomach, tremor of the hands, headache, worrying and irritability), who know they have nothing to fear, but cannot shake off the symptoms appropriate to danger.
We are what we think, feel and do. We pick up real signals from the external world (not hallucinations) and respond appropriately. These abilities form our essence or being, they are central to our ability to function logically, independendy and in accordance with our own plans and decisions. They enable us to function as autonomous (self-governing) individuals. Mental disorders, however, interfere with our ability to interpret the world accurately, to feel appropriate emotions, to think, to plan and to act appropriately to our external and internal circumstances. To lose a leg is a terrible loss, but to suffer a mental disorder is to lose the sense of control, of autonomy, of being a human being. It is no wonder that mental disorders are greatly feared and regarded with disgust.
Many measure their self worth bv what others think of them, or more precisely, what they think others think of them. While concern about what others might think serves to inhibit individuality and sets the scene for widespread disappointment, it is fundamental to honor, manners and duty’, and remains an important force in determining self-esteem. Mental disorders make people less productive and may even lead them to act in a socially humiliating manner (from being too anxious to respond to a greeting, to behaving in a sexually uninhibited, subsequently regretted, manner). This potentially damaging effect on social behavior is a further factor contributing to the threat posed by mental disorders. And of course, metal disorders, irrespective of actual or imagined impairment, are highly stigmatizing, which is yet another layer of potent threat.