Oppression by psychiatry is not unique to tyrannies

The Argument

Chinese mind manipulation is offensive -- but there's a culture of autocracy in the practice in the West.

On Books

May 13, 2001|By Judith Schlesinger | Judith Schlesinger,Special to the Sun

China has been using psychiatry to punish its dissidents -- a shocking revelation. While the punitive resourcefulness of police states is hardly news, this recent report rocked the psychiatry profession, triggering cries for global censure and fears that the entire discipline would be "tarnished." The irony is that psychiatry has always been oppressive -- even in the allegedly enlightened West -- given its imperious mandate to judge, manipulate and medicate what it decrees as undesirable behavior, and its sacrosanct power to lock up those who violate its norms.

It rests on haughty assumptions: that doctors, the sole arbiters of what's appropriate or delusional, know more about patients' inner lives than the patients do themselves, and that, if therapy stalls, it's because of the customer's stubborn "resistance" to such higher wisdom.

The American Psychiatric Association sets the universal standards for pathology with its DSM manual, that elastic guide that oozes through our social landscape like the Blob, engulfing every tic in the human condition from bad handwriting (Expressive Language Disorder) to an overreliance on mochaccino lattes (Caffeine Intoxication). Despite its billing as a "scientific" document," it's an open secret that "Diagnostic and Statistical Manual of Mental Disorders" categories are hammered out through backroom trading, then stamped into the public mind in a worldwide, methodical campaign of communal gaslighting. The official diagnostic criteria may be vague, overlapping, and empirically wobbly, but they define "real" disorders because -- well, because psychiatry says they do.

This is an old story: psychiatry as squasher of creativity and personal freedom.

Psychiatrist Thomas Szasz, the field's most prolific critic, has been flying this banner for 40 years, cranking out dozens of genre classics like "The Manufacture of Madness" (reprinted by Syracuse University Press in 1997) and "Psychiatric Slavery" (ditto, 1998) and buzzing around psychiatry's flanks like a determined insect with a small stinger.

Still, the beast lumbered on, slouching toward the medicalization of all suffering, aided by three eager allies: the public, which welcomes biological absolution for psychological difficulties; managed care, which has squeezed all the dialogue out of treatment in favor of expedient pill-pushing; and the drug companies, which are cleaning up billions on the whole parade.

But something new and drastic has been happening: their combined weight has heaved the whole system over on its head. Lately, psychiatrists are less oppressors than oppressed, increasingly controlled by higher authorities that dictate whom they will treat, with what, how and for how long. What began as a benign attempt to get treatment parity -- to have mental problems treated like medical ones by insurance companies -- has turned into a Sorcerer's Apprentice nightmare, with psychiatrists tormented by the very tools they once found so useful.

This shift is evident in angry new books that hiss at evil corporate entities rather than psychiatrists, who are lately being cast as exploitable pawns. Psychiatrist Peter Breggin, who "talked back" to Prozac and Ritalin in two previous bestsellers, takes on the new hierarchy in "Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications" with David Cohen (Perseus Books, 320 Pages, $24). Apparently, psychiatric journals are totally dependent on ads from drug companies, which also regularly dispense nifty perks to seduce doctors into prescribing their products.

The FDA relies too heavily on industry statistics when approving drugs, data which are notoriously prone to massage and gathered in 4-6-week trials -- far too brief to assess the long-term safety of any drug. The authors claim that "biochemical imbalances are the only diseases spread by word of mouth," in what they call "one of the most successful public relations campaigns in history."

Greed is also the focus of "Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil and Other Antidepressants with Safe, Effective Alternatives" (Simon & Schuster, 383 pages, $25) where psychiatrist Joseph Glenmullen claims that "75% of patients are needlessly on these drugs for mild, even trivial conditions." He warns that the FDA apportions just 4 percent of its budget for monitoring patient reactions after drug approval, relying on "spontaneous reports" from doctors who rarely come forward.

Worse, Glenmullen estimates that only 1 percent of known "serious events" (dangerous side effects) are revealed in a deliberate exercise of arrogant paternalism, as manufacturers and prescribers claim patients will be too "alarmed" and "fragile" to deal with the truth. What we need, he suggests, is "a national data base to reveal practitioners' financial ties to drug companies, with full dollar amounts." Today's villain is a few greedy psychiatrists in league with the suits, rather than the power lust of the profession itself.

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