After Psychiatry? What Next?

by Phil on January 11, 2013

I ended a recent post arguing that psychiatrists should not have a leadership role in whatever kind of helping program eventually replaces the present mental health system, which is crumbling at the seams, conceptually and practically.

So the question arises – which profession is suited to a leadership role.  Of course, this begs the question – do we need any kind of formal helping system at all.  Perhaps what we should be doing as a society is strengthening the natural mutually-helpful bonds that already exist within our culture.  I can see a lot of merit in that position, and it may be that this is what will eventually happen.  But I don’t think it can happen right away.

As a psychologist, I would like to be able to say that psychologists are the clear choice for leadership once the psychiatrists have shuffled shamefully to the wings, but I find myself unable to say this with any confidence.  Psychologists, at least in America, have individually and through their professional associations repeatedly and consistently endorsed the spurious medical model to a degree that seriously undermines our credibility.

My choice – for what it’s worth – to lead a newly-conceptualized demedicalized helping profession would be social workers.  Of all the various professions represented in the field, they are most intimately aware of the social forces that drive so much counterproductive behavior.  In addition, the notion of a client-centered approach is, in my experience, more deeply embedded in their professional culture than is the case in other professions.  They are – again in my experience – pragmatic, practical, solution-oriented, and realistic.  They don’t just sit in offices and accept the client’s “office behavior” at face value.  They visit clients in their homes and are intimately familiar with the environmental forces that underlie human problems.

They have also – and perhaps this is the critical point – kept themselves at least somewhat aloof from the nonsense, venality, and destructiveness of the present bio-psychiatric-pharma industry

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Related posts:

  1. Psychiatry – The Sham Science
  2. Psychologists, Social Workers, and Counselors in the Mental Health Field
  3. Forensic Psychiatry
  4. Conflicts of Interest in Psychiatry
  • Aussie farmer

    Maybe professional counselors and then community based mentors as support and getting people involved in service clubs, sports, hobbies or dare I say it church groups. Mental health issues are on the increase as community spirit is on the decline. The way people chose who they speak with and associate with due to technology and changing social structures means people cna choose to associate with those who are like minded this has dramatically changed the social climate making it difficult for those who may be just a bit different. They are left out and excluded. Something that did not happen in small close communities of the passed.

  • Phil_Hickey

    Aussie farmer,

    This is an excellent point. With increasing isolation, it’s easy to go from just a bit different to out-and-out “crazy.”

    In the late 80’s, I was director of a county mental health center. My duties were largely administrative, but I had a middle manager, Robert, who was a true genius in these kinds of dynamics. He had a client (let’s call her Mary) who had a “diagnosis” of schizophrenia, and had remained pretty much closed up in her house for years, with little or no social contact. Robert also had another client – a young woman with a development disability, but fairly high functioning (let’s call her Susan). Susan desperately needed some purposeful activity.

    Robert and his staff had been trying to encourage Mary to go out for walks, etc… Finally she agreed to do this if someone would accompany her. So Robert hired Susan as an aide, her job being to go to Mary’s house every day and accompany her on a walk. The results were spectacular. Not only did Mary get out of the house, but she started meeting other people and developing social skills. And she began to find new meaning in life.

    This approach is in marked contrast to the clubhouse model – where the mental health center acquires a building, and arranges for all the “mentally ill” clients to meet there for a few hours each day. I don’t think I’ve ever seen much good come from these kinds of operations. In fact, it’s almost a perfect recipe for making people worse off than they were before. If the only people one encounters are people whose social skills are as poor as, or worse than, one’s own, it is unlikely that anyone’s social skills will improve.

    You apologized slightly for including church groups, but I think church groups and clergy people can be extraordinarily helpful in these areas. I’m not a religious person myself, but many people are, and I have seen numerous instances where people received very real help from clergy and church social groups.

    At one point in the 80’s, the mental health centers were beginning to get involved in the business of connecting clients with “natural” community-based support systems. It was called bridge-building or something like that. Anyway, the idea was that the counselor or therapist would conceptualize his/her role not so much as treating the problem, but rather as helping the individual connect with individuals and groups in the community, where he might be able to find a sense of belonging and possibly an increased sense of purpose.

    I’ve been out of the business for many years now, so I don’t know if there’s much of this kind of thing going on. Of course it flies in the face of the eat-your-pills-like-a-good-boy/girl philosophy, so perhaps it faded away.

    Once again, thanks for coming in with such an important and insightful comment.

  • Aussie farmer

    Been really thinking about social worker model. Interestingly this week one young lad who came from a drug rehab program for a work ready program with me quit his job this week after 18 months. He had overcome his drug addiction when he arrived but was on high levels of anti-psychotics drugs and anti-depressants. Within 4 months he had weaned himself off all these “medications” and has had no medication for 14 months. Sure he had some issues we worked through for example he explain to me that he felt really really angry one day. When we explored this we both concluded that this was normal but becasue of the level of medication he never had the opportunity to feel these feels before. We developed some strategies and never had a problem. I guess I am a fan of reality therapy approach and this work well. He had come from a very dysfunctional family background and his stories on manipulating social workers and psychiatrist was amazing. He knew his diagnosis and symptoms back to front so he and his brothers would act them out and get increased “legal”drugs which they traded for the speed etc which they wanted at the age of 13-14. He had been on these medications since “diagnosed” at 12 years old. Unfortunately he could not see his alcohol addiction as a issue which let to him just chucking in the towel. He has contacted me nearly daily and told me he is back on all his anti psychotics again. What he told me stunned me. It was suggested by his mother and others that this would give him a better chance of fast tracking housing, unemployment and other benefits. So I just asked “so what your saying is you playing the mental health card right now” Yes was his response.

    I though about this further and recognize professional helpers such as social workers also need “dysfunctional” people otherwise they are out of a job. Breakdown in community has bought this about as people feel they pay their taxes and give a bit to charity they don’t give the most important thing; themselves to others.

    I mentor people out of jail, give them a job a bit of stability and acceptance. However I had guys excited that they manage to qualify for a a disability pension when they are very capable of working. Human beings are very complex and I have to say I come across this page researching as I am doing a counseling course through Sydney Uni. Your an absolute breath of fresh air. I have over the last few years developed similar views to what I have read on this page through experience. I now have confidence to express those views very respectfully and direct people to this source. Keep up the good work.

    Funny story: Had a guy from rehab and was informed he had serious mental health issues and had psychotic events at times. One day whilst working he all of a sudden announced to me that he was having a psychotic event. I responded quickly and firmly ” hey mate we bit busy for one of them right now” and that was that. I quickly learnt his psychotic events aligned more or less perfectly when he was confronted with things he did not want to do. Now I am not saying this is the case for all but with the load social workers carry, the pressure in the event some one does flip out means that the power is in the “patient” and real discernment is missing.

  • Phil_Hickey

    Aussie farmer,

    Welcome to the ranks of the mental health heretics. Once you see it, you can never go back.

    Everything you mention rings true to my experience also. I have been aware of parents coaching their children in ADHD behavior, and in several towns I’ve become aware of mental health cliques who coach each other in the best ways to get disability status.

    I knew one young man (not as a client) who was receiving a military disability on the basis of alcoholism dating back to Vietnam. I had never seen him drunk or even drinking. But once a year or so he would go into town, get drunk, and get arrested. He would spend a night in jail, and thereby keep his disability income intact.

    By turning these various behavior problems into illnesses, the psychiatrists opened the door to these kinds of abuses, but they seem blind to the damage that it is doing to the people involved.

    Your work sounds like something really worthwhile. Keep it up.

    Best wishes.

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