This blog examines a tension between two branches of psychology that are dominant today with regard to the treatment of mental illness. It is a tension that has not yet come to the fore in social discussion regarding the appropriateness of a particular psychological branch in such treatment. The view I am proposing is that the two branches I am considering – psychiatry and cognitive behavioural therapy (hereafter referred to as CBT), can be at loggerheads, and this ought to be known. In the interest of helping patients, it needs to be far more clearly discussed where psychiatry ought to begin and end, and the areas of mental health in which CBT is more appropriate and effective. Indeed, I will argue that psychiatry – which I perceive as the deployment of strong medication, often against the patient’s will in a setting of immense state power including psychiatrist’s power of forcible detention without trial, can sometimes be counter-productive to the patient, and indeed very dangerous. This entire blog is based on my own analysis of my own experience of mental health challenges, though I hope no reader is silly enough to regard my recounting as in any sense ‘narcissistic’, for it is designed to help others who, in rare circumstances, may have the misfortune to experience something similar. So, my own story:
In 2001, I was Sectioned under the Mental Health Act for psychosis, detained against my will for over 5 weeks, until the acute symptoms had waned. Despite the dubious legality of this Sectioning wherein I had not been violent to anybody, nor shown any sign of suicidal thoughts, I have always accepted there was a need for treatment by medication. At that point in time, I had experienced a couple of hallucinations without being on illicit drugs, I had become rather manic, and had begun to act on some curious delusions believing they were true. Yes, I did need treatment, and am grateful to psychiatry for providing this treatment. Although in the psychiatric hospitals I was detained, there was little or no therapy, little or no communication between psychiatrists and myself regarding what the hell was going on, and the fact that two of the patients in the first hospital I was in were Al-Qaeda terrorists, and although I had begged staff to let me go home with a sincere promise that I would take the medication, I do, of course, recognise it can be risky sending someone home even if they promise to take the required pills, because they may have access to alcohol, or other drugs at home, and there probably is a necessity for a closer monitoring than this in the situation of psychosis. OK, so that is where psychiatry is useful, and appropriate. Where it had had ceased to be useful and appropriate was in the subsequent years.
By Summer 2001, psychotic symptoms had gone. Nevertheless, it was still required of me to see a psychiatrist every month even though I was no longer under Section. What then developed was an acute and chronic ‘panic disorder’. A panic disorder is not a psychotic symptom but something very different that nevertheless falls under the broader rubric of ‘mental health problem’. In this panic disorder that lasted over 15 years, I had difficulty going out without the deployment of Lorazepam, which is a strong variant of Valium. Even going for a walk would normally entail going back, retreating, when I experienced anxiety. The branch of psychology ‘CBT’ understands that behaviour – the retreating, the tactic of avoidance, as affirming to my brain that I am indeed at risk, which solidifies an agoraphobia that is difficult to overcome. Indeed, it has a tendency to worsen until the underlying logic of it is addressed.
CBT understands that always in a panic disorder, the individual has something called a “feared consequence”. What is more, the feared consequence is irrational, although usually it is based on some bad experience or other. Then, the experience of anxiety, gets amplified in the mind, and is interpreted by the individual as confirming the notion that the feared consequence is real. The individual cannot see his or her feared consequence is irrational, instead, everything seems to confirm it. So, panic disorders always end up becoming life-limiting which is why they are called ‘disorder’. All humans experience anxiety now and then, but it is only when that anxiety is taken by the individual to confirm an irrational feared consequence, that an ordinary human experience, can become debilitating, even affecting one’s ability to work or form strong relationships.
OK, so what was my feared consequence? It was the fear of insanity. As one whose prior psychosis had been partly caused by studying for a PhD in philosophy when I wasn’t ready for it, and the theory was really wonky, nevertheless at that time I had high hopes for being able to contribute something substantial to humanity. It was therefore catastrophically disturbing to me to have gone into psychosis, and I did not enjoy my time in the psychiatric hospitals. So, despite the feared consequence in relation to the panic disorder being irrational, it was nevertheless understandable in terms of my own life. However, that is not to blame psychiatry that was acting with good intentions, and yes, did need to be deployed in relation to a psychotic patient.
Where psychiatry was at fault was in the way it sustained the panic disorder. I ought to have been let go after I was released from The Section. Instead, because I had these new symptoms, psychiatry had the arrogance of assuming my psychotic episode was not just a one-off episode and that I now ought to be free of them; instead, they treated the panic disorder as if it was a continuation of the psychotic episode. They elongated the prescriptions of anti-psychotic medication, and insisted I was routinely sent for blood tests to make sure I was taking them. But the panic disorder was an entirely different kettle of fish to the psychotic episode, and it needed a different form of treatment to anything psychiatry had up its sleeve. Indeed in 2005, because nothing seemed to working, psychiatry even increased anti-psychotics to a level that is beyond the recommended dose in the patient information leaflet that comes in all boxes of pills.
From the point of view of the actual condition I now had – the panic disorder – the tactic of continuing or increasing anti-psychotics, was wrong. From the vantage point of CBT, it can be understood that not only turning back, retreating, avoiding situations reaffirms the irrational fear, there was another ingredient in the reaffirming of fear that even CBT didn’t quite grasp. The repeated taking of anti-psychotics was also sustaining the fear. Because, the belief I ought to take the anti-psychotics on the grounds I feared insanity could do nothing other than send a message deep into my brain that yes, I need these to avoid insanity. The taking of anti-psychotics was logically similar to agoraphobic retreat. Psychiatry had ceased to be useful for me, but was now fuelling the problem.
This is why I would like to see CBT argue against psychiatry and enable the spheres of their own appropriate influence to be more clearly delineated.
There are other reasons as well why anti-psychotics should preferably only be used in limited circumstances: they shorten life-expectancy by 25 years. Having known about this problem for nearly 10 years now, the problem that patients on long-term use of anti-psychotics tend to die around 25 years younger than the general population, psychiatry needs to own up. Instead, psychiatry has done something even worse – they have blamed the poor mortality on the fact that lots of patients’ smoke tobacco. This is irrational. The reduced mortality of smokers in relation to non-smokers is a mean average of 7 years. How could that possibly become a mean average of 25 years if you are a smoker with a mental health problem? Mental health problems do not have any effect on the heart or lungs, which are the two main sites for deaths caused by smoking. Yet psychiatry has shifted the blame, and has become even more intrusive against out-patients as well as in-patients who have difficulty being able to smoke now in hospitals, even outside, caused by psychiatry’s lies. Now, if you unlucky enough to see a psychiatrist, most of the questions bear no relation to knowledgeable psychology, but tend to be about how much you smoke. This total degeneration of psychiatry into a useless pathetic cess-pit of pseudo-science ought to be contested, and I think CBT professionals would be useful people to spearhead the fightback.
barryessex 