Monday, 4 May 2015

Mad in America Review

Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting

An Ethical and Epistemological Accounting
by Bonnie Burstow, PhD
Published April 1, 2015 by Palgrave Macmillan
This latest book by Bonnie Burstow, PhD critiques psychiatry, and effectively annihilates any claims that the profession might have had legitimacy.
Bonnie gives us a scholarly, but very readable, account of:
  • the history of psychiatry, ancient and modern
  • the significance and shortcomings of the DSM
  • the legal, ethical, and personal ramifications of involuntary "treatment"
  • the training of psychiatrists and the dynamics underlying their uncritical acceptance of their profession's spurious concepts and destructive treatments
  • the ways in which non-psychiatrist mental health workers are co-opted into the system, and become, often despite good intentions, supporters and active participants in the psychiatric travesty
  • the role and tactics of the psycho-pharma industry
  • the stark, destructive, degrading realities of electric shock "treatment."
In the final chapter, Bonnie offers us a glimpse of what an alternative approach might look like.
Normally when I write a book review, I include some quotes from the work to enable readers to judge for themselves the quality and content of the material.  With Psychiatry and the Business of Madness, however, this presented a problem, in that virtually every one of the 264 pages of text contains eminently quotable material.  Here's a short sample:
"… the problems with this institution run so deep that what might be construed as 'improvement' is not and cannot be sufficient." (p 21)
"… psychiatry consolidated its power and harnessed the newly acquired credibility of medicine not by being scientific but by mimicking the outward trappings of science and medicine." (p 44)
"A timely reminder:  No biological sign has ever been found for any 'mental disorder.'  Correspondingly, there is no known physiological etiology." (p 75)
"The concepts of 'open secrets' and 'bad faith' have explanatory value here.  An 'open secret' is a truth that everyone knows but does not acknowledge publicly.  Everyone knows the secret; everyone knows that everyone knows the secret, but except for the odd 'maverick' who can readily be dismissed, everyone respects the secrecy.  Let me suggest that there are a number of open secrets in the mental health field.  Open secrets that suggested themselves to me as I interviewed practitioners – mainstream practitioners especially – include:  There is something wrong with the drugs.  There is something wrong with much of the research.  There is something wrong with the very way that we are all operating." (p 163-164)
"All psychiatric drugs 'work' by obstructing normal brain function, causing dysfunction.  All substantially interfere with normal thinking and feeling.  All alter the brain's chemistry and structure, to varying degrees, fundamentally damaging the brain.  All alter the size of the brain, making it (or some part of it) either expand in size or shrink.  All are addictive.  All work in ways that make withdrawal difficult, in some cases, arguably, impossible.  All cause dysfunctions (and in some cases disorders) in various parts of the body.  All work by 'deactivating' to some degree, though some primarily activate.  What is experienced as improvement, correspondingly, is invariably one or more of:  sedation, stimulation, and the placebo effect.  The drugs to varying degree inherently mask the very dysfunctions that they create.  They obscure people's appreciation of their psychic state, and by extension, of the damage.  What goes along with this, there is a perilously close relationship between the purported 'therapeutic effect' and the 'toxic effect,' with the two at times being identical.  The toxic effect itself can manifest itself in mania and psychosis." (p 195-196)
"…the pharmaceuticals are the kingpin, the mainstay of the regime of ruling.  Successfully problematize that and the edifice crumbles.  In this chapter, to an appreciable degree, that has happened, for in the final analysis, however much people may cling to them – and I am in no way denying that there are people who regard them as a lifeline – no medical credibility can be attached to a substance that is not medical, that addresses nothing medical, that gives rise to medical disorders, and whose modus operandi is dysfunction and damage." (p 200)
"So what in point of fact does the research establish?  In short, that ECT is a profoundly injurious treatment that damages the brain, that substantially impairs memory, that gives rise to global cognitive dysfunction – and in the final analysis, it has no lasting efficacy." (p 214)
"While in the final analysis readers must reach their own conclusions, what the logic of this investigation indicates – and indicates powerfully – is that not just parts of psychiatry, but the discipline and the regime as a whole is epistemologically flawed and ethically unacceptable.  Nor is it 'fixable,' for the problems are fundamental, at the core. My invitation, accordingly, is that we as a society do what may have once seemed unthinkable – that we acknowledge that our approaches to problems in living and to 'problematic others' are tragically misguided and muster up the courage to begin again." (p 227)
"Given that psychiatry is blatantly not the answer to life's woes but indeed, one of the causes thereof, and given that there will always be some need for extensive emotional support, what do we put in its stead?  What we concluded is that tinkering will not serve us, that not only must we break with psychiatry, we have to rid ourselves of rule by experts, we need to stop 'othering,' we have to stop imprisoning, and beyond that, we need to fundamentally alter how we live with one another." (p 264)
This book is scholarly, in the sense that it examines the issues, painstakingly, fearlessly, and with impeccable logic.  But, more than scholarly, it is human-centered and compassionate.   There are lots of stories.  Some are tragic; some are hopeful; all are instructive.  Bonnie has drawn on her own personal and professional experiences to bring the issues vividly to life, and to help us see that the victims of psychiatry are not just the people who have experienced physical damage from the drugs and the electric shocks, but all of us who live in this psychiatrically pathologized, and alienated, world of "us" and "them."
Psychiatry and the Business of Madness reads seamlessly, and is a difficult book to put down.  I cannot think of a single issue in the psychiatric debate that is not covered – and covered thoroughly and convincingly – within its pages.  For those who wish to explore the various topics in greater depth, there are thirteen pages of references.
Please get a copy.  Read it, and tell others.  This book is a major milestone in the antipsychiatry effort, and stands as a monumental challenge to psychiatry's continued existence as a branch of medicine.
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Disclosure:  I have no financial links to this book or to any books/materials that I endorse.
Philip Hickey, PhD
Behaviorism and Mental Health: Philip Hickey is a retired psychologist.  He has worked in prisons (UK and US), addiction units, community mental health centers, nursing homes, and in private practice.  He and his wife, Nancy, live in Colorado, and have four grown children. His posts can also be seen on his website, Behaviorism and Mental Health.