Obviously there are many points of contention between mainstream biological psychiatrists on the one hand, and those of us who condemn this system as spurious and destructive. Much of what I’ve written on this website over the past four years has been an elucidation of these differences.
Today I would like to focus on just one of these differences: disempowerment of clients in the psychiatric system, and empowerment within frameworks that are more psychosocial/behavioral in nature.
Within a psychosocial/behavioral system, if a person is routinely doing something that is counter-productive, or harmful, or sub-optimal in some manner, the working hypothesis is: either that the person has acquired the habit of operating in this way in these circumstances, or has not acquired the habit of operating in a more functional/productive manner, or both. It is also assumed that the habit acquisition has occurred in accordance with the normal principles of learning.
A bio-psychiatrist, on the other hand, assumes that the individual has an illness – a brain malfunction – which causes the problem behavior.
Obviously these two approaches are radically different – indeed, I would say incompatible. But what I’d like to focus on in this post are the implications of the two perspectives.
The implications of the psychiatrist’s perspective are:
1. The individual cannot, from his own resources, do anything to ameliorate his “illness.”
2. To effect any change in his behavior, he must take the psychiatric drugs which the psychiatrist prescribes.
The implications of the psychosocial/behavioral perspective are:
1. The individual is the only person who can effect the behavioral change, though he might need some help, either from natural helpers (family, friends, colleagues, etc.) or professional helpers (counselors, social workers, psychologists, etc.).
2. In those cases where professional assistance seems needed, the blueprint for effective assistance is:
a) to help the individual understand the factors/circumstances that brought about the problem in the first place. This might include: a history of trauma; an impoverished learning environment during formative years, absence of effective coaches/teachers, etc.;
b) to help the individual identify and define the problem in specific terms; perhaps dismantle the problem into component parts;
c) to encourage a sense of competence and empowerment;
d) to develop, with the individual, specific plans for replacing sub-optimal habits with habits that are more productive.
The psychiatric perspective, besides being based on the spurious illness premise, breeds a sense of failure and disempowerment. In addition, the damage caused by the drugs militates against the development of the competencies that are needed to address and solve problems. This tragedy is compounded by the fact that the individuals in question are often beset, to begin with, by a profound sense of incompetence/helplessness. They tend to be people who do not have a great track record at tackling problems and overcoming obstacles.
In this regard, psychiatrists often criticize those of us who espouse a psychosocial/behavioral approach on the grounds that we are, by implication, blaming the parents. The “logic” is that if a child reaches adulthood without having achieved certain basic competencies, this is tantamount to blaming the parents for not teaching these competencies during the formative years. By contrast, psychiatrists point to their own illness system, an essential feature of which is the notion that the illness (e.g. “schizophrenia”) arose out of the blue, as it were, and that therefore, nobody is to blame.
Psychiatrists pitch these ideas with particular force towards consumer groups such as NAMI and, in my view, there’s little doubt that the “no-fault” aspect of biological psychiatry has been a major factor in the extent to which this philosophy has been accepted.
I have discussed this issue of blame on previous occasions, but last weekend an incident occurred in our own home that I thought was very illustrative of these dynamics and that warranted sharing.
Our older daughter, her husband, and their two sons were visiting. The younger son, Paul, is just over two years old. One of his favorite toys is a hedgehog named Charlie. Charlie “lives” in a little case that looks like a miniature lunch box.
At one point I was doing some work in the garage, and Paul came out to see me, and to show me his hedgehog. He took Charlie out of his case, and we all had a nice visit. Then Paul decided to go back into the house. When he got to the connecting door, however, he had a problem. Charlie was in his right hand; the case in his left hand – leaving no hand to open the door.
My immediate instinct was to go over and open the door for him. But instead, I paused. Paul studied the situation for a moment, then tucked Charlie under his chin, opened the door, and went inside.
If I had acted on my first impulse and opened the door, Paul would have rewarded me with a smile and a thank you, making it more likely that I would continue to do things for him. Instead, he got to solve a problem for himself, and reinforced in me the behavior of waiting to see how he copes.
What we call a sense of competence or empowerment in adults is the result of thousands of small successes of this sort during childhood. And conversely, what we call a sense of powerlessness in adults results from a lack of such successes. There are many ways this can happen, but one of them, paradoxically, is through overly conscientious parents who do too much for their children. Finding the right balance between helping our children versus letting them do things for themselves is one of the very difficult challenges of parenting. All conscientious parents struggle with this, and do what seems right in the circumstances. Some parents do too much for their child, and deprive him/her of the chance to find a sense of success. This is simply a fact – not a matter of blame.
I’m not suggesting that a sense of incompetence/powerlessness underlies all behavioral/emotional problems. But, in my experience, it is a significant factor in many cases. It is also the context in which the psychoactive drugs, because of their disempowering implications, are particularly destructive.
People need feelings of genuine success. Chemically-induced alternatives are no substitute.