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COUCH IN CRISIS 

Moving Beyond Hatred of Psychiatry: A Brave Voice Speaks Out

By Ronald W. Pies, MD | May 24, 2012

Sometimes I wonder if hatred of psychiatrists is one of the few remaining forms of acceptable bigotry. If the vitriol on many anti-psychiatry Web sites is any indication, the answer may be yes. 

No, I’m not comparing psychiatrists to ethnic or racial minorities, or claiming that we deserve anybody’s sympathy. And I’m not talking about vigorous but constructive criticism of psychiatry, much of which is justified.1  I’m talking about the kind of visceral, rage-ridden hatred that makes the hairs on your neck stand up, or sends your heart plummeting to your stomach.

(MORE: Why Psychiatrists Must Confront Gun-related Violence)

“I hate shrinks. Shrinks should die. Shrinks are evil.” These are the kinds of comments recently cited by a brave, young woman who blogs under the nom de plume, Natasha Tracy. I generally oppose the use of pseudonyms among bloggers, particularly health care professionals who hide behind fake names to launch cowardly attacks on their colleagues. But “Ms. Tracy,” who is not in the health care field, convincingly explains the safety concerns that led her to adopt this pen name.

It turns out that Ms. Tracy has been diagnosed with bipolar disorder, and has been writing about her illness with courage and candor for about two years.2 As a specialist in bipolar disorders, I can say that Natasha’s understanding of this illness is more accurate and sophisticated than that of many physicians I have encountered over the past 30 years. But more than that: she shows uncommon wisdom and deep compassion, when it comes to discussing psychiatrists and psychiatry. Here are a few excerpted remarks from Natasha’s essay, “Hatred of Psychiatry Doesn’t Create Change”:2

“I hate shrinks. Shrinks should die. Shrinks are evil.” . . . OK I get it, you don’t like psychiatrists. Personally, I would find a more intelligent way to express an argument, but your point is clear nonetheless. You’re ranting. I get that. I rant. We all do. It’s a healthy expression of the frustration seen when dealing with so many things outside of our own control. But at some point you have to stop hating, wishing for murder, and committing moral condemnation and actually do something useful . . .  When we say we “hate” something what we really mean is our emotions have overwhelmed us to the point where we no longer think rationally. Something you “hate” can’t be redeemed, can’t be made better and contains no shades of grey . . . Hatred is a mucky darkness that lets you scream and yell all day but doesn’t let you move on to affect the thing you “hate.

. . . I have to engage with psychiatry in order to be a functioning human being. I understand [that] for all its faults, and yes, there are many, psychiatry saves lives every day. I understand [that] psychiatry gave me, and so many others, a life. And I understand blind hatred doesn’t help me get any better . . . .people need to engage the psychiatric system to treat their mental illness . . . I believe in: educating people, empowering people . . . encouraging patients to take their doctors to task . . . making people more active in their own health care [and] reducing prejudice.2

Those last two words are particularly important. Prejudice is a net that ensnares not only those who suffer from severe psychiatric illness, but also many of us who care for these individuals.3 Natasha is a member of the Society of Participatory Medicine, a non-profit organization dedicated to “. . . a cooperative model of health care that encourages and expects active involvement by all connected parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care . . . ”4 This is certainly a worthy model of healthcare, and one that ought to inform—and reform—psychiatry. But it is a model supported by mutual respect—it cannot stand on a foundation of hatred and prejudice.

The Roman statesman and Stoic philosopher, Seneca (4 BCE–65 CE) lived in turbulent times and knew firsthand of hatred’s toxic effects. He wrote that,

Hatred is not only a vice, but a vice which goes point-blank against Nature . . . Hatred makes us destroy one another. Love unites, hatred separates. Love is beneficial, hatred is destructive. Love succors even strangers; hatred destroys the most intimate friendship. Love fills all hearts with joy; hatred ruins all those who possess it. Nature is bountiful; hatred is pernicious. It is not hatred, but mutual love, that holds all mankind together.5

I do not know if Natasha Tracy has gone through the philosophy of Seneca; but Seneca’s philosophy has clearly gone through her.

Acknowledgments: My thanks to Dr. Glen Gabbard for his counsel on the premise of this piece; and to the Web site, www.healthyplace.com for permission to quote from Natasha Tracy’s blog.

 

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by Ronald Pies | July 02, 2012 1:24 AM EDT

I very much appreciate the comments from Ann Sparks, and would also note the crucial contributions to mental health care made by nurses, nurse practitioners, and clinical nurse specialists. I fully agree that "...As a society, we remain fearful and ignorant of psychiatric care and behavioral health in general...."and that, "Unfortunately that fear and ignorance is translated into hatred."

In my view, all of us in the mental health, medical, and nursing fields need to do a much better job of "reaching out" to the general public, educating them on the nature and treatment of psychiatric illness, and also--crucially--listening carefully to their concerns, fears, and criticisms. I also agree that mental health care ought to be holistic ("physical, emotional, sociological, spiritual") in nature, and that psychiatry needs to resist the financially-driven "tug" toward 15 minute "med checks" and merely writing prescriptions. At the same time, we should not devalue somatic approaches to treatment, including medication; rather, medication should be part of a continuum of care that includes psychosocial treatment, primary care, pastoral counseling, etc.

I also agree that "The Psychiatric/Mental Health community needs to come together with other health disciplines to promote integration rather than separation and compartmentalization...." Sadly, mental health treatment (including psychiatric treatment) is often devalued and marginalized even by other health care professionals--even at the level of medical education (where medical students are often discouraged from going into psychiatry). In short, we are all in this together--and hatred, directed against anyone, has no place in the struggle to reduce the suffering caused by psychiatric illness.

Thanks again, Ms. Sparks!

Cordially,
Ron Pies MD

by Ann Sparks, RN, APN, FNP-BC | July 01, 2012 5:07 AM EDT

I have practiced as a Registered Nurse for 25 years and just completed my degree as a Nurse Practitioner. I have worked in Acute Care, Behavioral Health and Addictions, Cardiology, Home Health/Hospice and the ER. I have a passion for viewing every individual from a Holistic perspective. We humans cannot be compartmentalized in the way that modern medicine has done. Yes, we need specialists, but both primary medicine and the specialists need to bring in all aspects of health (physical, emotional, sociological, spiritual) into the equation.

As a society, we remain fearful and ignorant of psychiatric care and behavioral health in general. Unfortunately that fear and ignorance is translated into hatred. An individual's loathing gives a feeling of coping and protection, when in all reality, it is harming the individual AND SOCIETY.

Psychiatric and Psycho-social care needs to be integrated into our societies health and education from the get-go. Psychiatric disorders and mental health are NOT black and white, but they are on a continuum of wellness. Psychiatric illness happens just as much as physical illness. Yet people seem to think that they are "above"it, and they are untouchable, unable to become mentally ill. Well, that cognitive distortion is, itself, evidence of deficient mental health.

The Psychiatric/Mental Health community needs to come together with other health disciplines to promote integration rather than separation and compartmentalization. The "Them v Us mentality" needs to stop. Unfortunately, the medical community is nearly as ignorant and biased against behavioral medicine as the general public!

As long as people believe they can't be touched by mental illness, the loathing will continue to grow in our society

by Ronald Pies | June 01, 2012 5:33 PM EDT

Posted on behalf of Dr. Melvin Gray

Hi, Mel-

Many thanks for taking the time to write on my commentary. You are quite right re: hatred's destructive effects on the individual. It is very much in keeping with the saying from the Talmud :

"Why is the evil tongue called the thrice-slaying tongue? Because it slays the person saying it, the hearer, and the person spoken about." [R. Samuel ben Nahman, Arachin 15b]

Best, Ron

from Dr. Gray:

Hi Ron,

I find your reply to [Ms.] Tracy thoughtful and very much to the point;
however hatred can not only destroy others but it restricts,limits,and does harm to the
individual who possesses such an emotion.Their humanity is severely restricted
as is their moral and intellectual abilities .

Best wishes,
Mel

by Ronald Pies | May 25, 2012 2:00 PM EDT

Many thanks for the kind comments, Steve, and I very much look forward to your writing on "psychism"!

Cicero said that, "Hatred is inveterate anger", and certainly, it is our job to understand all sources of anger. At the same time, we can work toward replacing hatred with compassion and understanding, no matter who is its target.

Best regards,
Ron

by Steve Moffic | May 25, 2012 10:36 AM EDT

This is a very important blog, Ron (although I could say that about all of yours). But this one in particular includes the voice of a critic, but one who can be a constructive clinic. Goodness knows, in my attempts to interact with the "haters" of psychiatry, I've been called many things I would never have wanted my dear, belated mother to hear.

I would have us, though, consider that we are part of the same process that applies to racism and the other isms. In certain ways and for certain reasons, psychiatrists, our patients, and our critics all get unduly discriminated agains due to stigma.

I think we need a rallying call to address this. I've recently come to call this PSYCHISM! More writing to come on this.

Steve

Article Comment Pages: 1 2 Next


More like this

Dr Marcia Angell and the Illusions of Anti-Psychiatry

Moving Beyond Hatred of Psychiatry: A Brave Voice Speaks Out

Must Mental Illness Be Uncommon?

Psychism: Defining Discrimination of Psychiatry

Also by Dr Ronald Pies

The Madness of a Stranger—In Our House

Moving Beyond Hatred of Psychiatry: A Brave Voice Speaks Out

DSM-5’s Bereavement Bind: Time for an Independent Review

After Bereavement, Is It “Normal Grief” or Major Depression?

Once Again: Grief Is Not a Disorder, But It May Be Accompanied by Major Depression

Mental Illness Is No Metaphor: Five Uneasy Pieces

Why Psychiatrists Must Confront Gun-related Violence





References
1. Pies R. How American psychiatry can save itself: part 2. Psychiatr Times. Mar 1, 2012 www.psychiatrictimes.com/display/article/10168/2040753.
2. Tracy N. Hatred of psychiatry doesn’t create change. http://www.healthyplace.com/blogs/breakingbipolar/2011/05/hatred-of-psychiatry-doesn%E2%80%99t-create-change/. Accessed May 24, 2012. [Note: ©2012 HealthyPlace.com, Inc. All rights reserved.]
3. Sartorius N. Guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry. 2012;11:61-62.
4. Society for Participatory Medicine. http://participatorymedicine.org/.
5. Davis CH. Greek and Roman Stoicism and Some of Its Disciplines. Boston: Herbert B. Turner & Co.; 1903.


 
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