Psychiatry Abolished as Medical Specialty?
Credits: www.antipsychiatry.org and Dr. Lawrence Stevens, J.D.
Why Psychiatry Should Be Abolished as a Medical Specialty
by Lawrence Stevens, J.D.
Psychiatry should be abolished as a medical specialty because medical school education is not needed
nor even helpful for doing counseling or so-called psychotherapy, because the perception of mental
illness as a biological entity is mistaken, because psychiatry's "treatments" other than counselling or
psychotherapy (primarily drugs and electroshock) hurt rather than help people, because nonpsychiatric
physicians are better able than psychiatrists to treat real brain disease, and because nonpsychiatric
physicians' acceptance of psychiatry as a medical specialty is a poor reflection on the medical profession
as a whole. In the words of Sigmund Freud in his book The Question of Lay Analysis: "The first consideration
is that in his medical school a doctor receives a training which is more or less the opposite of what he would
need as a preparation for psycho-analysis [Freud's method of psychotherapy]. ...Neurotics, indeed, are an
undesired complication, an embarrassment as much to therapeutics as to jurisprudence and to military service.
But they exist and are a particular concern of medicine. Medical education, however, does nothing, literally
nothing, towards their understanding and treatment. ... It would be tolerable if medical education merely failed
to give doctors any orientation in the field of the neuroses. But it does more: it given them a false and detrimental
attitude. ..analytic instruction would include branches of knowledge which are remote from medicine and which
the doctor does not come across in his practice: the history of civilization, mythology, the psychology of religion
and the science of literature. Unless he is well at home in these subjects, an analyst can make nothing of a large
amount of his material. By way of compensation, the great mass of what is taught in medical schools is of no
use to him for his purposes. A knowledge of the anatomy of the tarsal bones, of the constitution of the
carbohydrates, of the course of the cranial nerves, a grasp of all that medicine has brought to light on bacillary
exciting causes of disease and the means of combating them, on serum reactions and on neoplasms -
all of this knowledge, which is undoubtedly of the highest value in itself, is nevertheless of no consequence to him;
it does not concern him; it neither helps him directly to understand a neurosis and to cure it nor does it contribute
to a sharpening of those intellectual capacities on which his occupation makes the greatest demands. ...
It is unjust and inexpedient to try to compel a person who wants to set someone else free from the torment
of a phobia or an obsession to take the roundabout road of the medical curriculum. Nor will such an endeavor
have any success..." (W.W. Norton & Co, Inc., pp. 62, 63, 81, 82). In a postscript to this book Dr. Freud wrote:
"Some time ago I analyzed [psychoanalyzed] a colleague who had developed a particularly strong dislike of the
idea of anyone being allowed to engage in a medical activity who was not himself a medical man. I was in a
position to say to him: `We have now been working for more than three months. At what point in our analysis
have I had occasion to make use of my medical knowledge?' He admitted that I had had no such occasion"
(pp. 92-93). While Dr. Freud made these remarks about his own method of psychotherapy, psychoanalysis,
it is hard to see why it would be different for any other type of "psychotherapy" or counseling. In their book
about how to shop for a psychotherapist, Mandy Aftel, M.A., and Robin Lakoff, Ph.D., make this observation:
"Historically, all forms of `talking' psychotherapy are derived from psychoanalysis, as developed by Sigmund
Freud and his disciples ... More recent models diverge from psychoanalysis to a greater or lesser degree,
but they all reflect that origin. Hence, they are all more alike than different" (When Talk Is Not Cheap, Or How
To Find the Right Therapist When You Don't Know Where To Begin, Warner Books, 1985, p. 27).
If you think the existence of psychiatry as a medical specialty is justified by the existence of biological causes
of so-called mental or emotional illness, you've been misled. In 1988 in The New Harvard Guide to Psychiatry
Seymour S. Kety, M.D., Professor Emeritus of Neuroscience in Psychiatry, and Steven Matthysse, Ph.D.,
Associate Professor of Psychobiology, both of Harvard Medical School, said "an impartial reading of the recent
literature does not provide the hoped-for clarification of the catecholamine hypotheses, nor does compelling
evidence emerge for other biological differences that may characterize the brains of patients with mental disease"
(Harvard Univ. Press, p. 148). So-called mental or emotional "illnesses" are caused by unfortunate life experience
- not biology. There is no biological basis for the concept of mental or emotional illness, despite speculative theories
you may hear. The brain is an organ of the body, and no doubt it can have a disease, but nothing we think of today
as mental illness has been traced to a brain disease. There is no valid biological test that tests for the presence of
any so-called mental illness. What we think of today as mental illness is psychological, not biological. Much of the
treatment that goes on in psychiatry today is biological, but other than listening and offering advice, modern day
psychiatric treatment is as senseless as trying to solve a computer software problem by working on the hardware.
As psychiatry professor Thomas Szasz, M.D., has said: Trying to eliminate a so-called mental illness by having a
psychiatrist work on your brain is like trying to eliminate cigarette commercials from television by having a TV
repairman work on your TV set (The Second Sin, Anchor Press, 1973, p. 99). Since lack of health is not the
cause of the problem, health care is not a solution. There has been increasing recognition of the uselessness of
psychiatric "therapy" by physicians outside psychiatry, by young physicians graduating from medical school,
by informed lay people, and by psychiatrists themselves. This increasing recognition is described by a psychiatrist
Mark S. Gold, M.D., in a book he published in 1986 titled The Good News About Depression. He says
"Psychiatry is sick and dying," that in 1980 "Less than half of all hospital psychiatric positions [could] be filled
by graduates of U.S. medical schools." He says that in addition to there being too few physicians interested
in becoming psychiatrists, "the talent has sunk to a new low." He calls it "The wholesale abandonment of
psychiatry". He says recent medical school graduates "see that psychiatry is out of sync with the rest of medicine,
that it has no credibility", and he says they accuse of psychiatry of being "unscientific". He says "Psychiatrists have
sunk bottomward on the earnings totem pole in medicine. They can expect to make some 30 percent less than the
average physician". He says his medical school professors thought he was throwing away his career when he chose
to become a psychiatrist (Bantam Books, pp. 15, 16, 19, 26). In another book published in 1989, Dr. Gold
describes "how psychiatry got into the state it is today: in low regard, ignored by the best medical talent, often
ineffective." He also calls it "the sad state in which psychiatry finds itself today" (The Good News About Panic,
Anxiety, & Phobias, Villard Books, pp. 24 & 48). In the November/December 1993 Psychology Today magazine,
psychiatrist M. Scott Peck, M.D., is quoted as saying psychiatry has experienced "five broad areas of failure" including
"inadequate research and theory" and "an increasingly poor reputation" (p. 11). Similarly, a Wall Street Journal editorial
in 1985 says "psychiatry remains the most threatened of all present medical specialties", citing the fact that "psychiatrists
are among the poorest-paid American doctors", that "relatively few American medical-school graduates are going into
psychiatric residencies", and psychiatry's "loss of public esteem" (Harry Schwartz, "A Comeback for Psychiatrists?",
The Wall Street Journal, July 15, 1985, p. 18). The low esteem of psychiatry in the eyes of physicians who practice
bona-fide health care (that is, physicians in medical specialties other than psychiatry) is illustrated in The Making of
a Psychiatrist, Dr. David Viscott's autobiographical book published in 1972 about what it was like to be a
psychiatric resident (i.e., a physician in training to become a psychiatrist): "I found that no matter how friendly
I got with the other residents, they tended to look on being a psychiatrist as a little like being a charlatan or magician".
He quotes a physician doing a surgical residency saying "You guys [you psychiatrists] are really a poor excuse for the
profession. They should take psychiatry out of medical school and put it in the department of archeology or
anthropology with the other witchcraft.' `I feel the same way,' said George Maslow, the obstetrical resident..."
(pp. 84-87). It would be good if the reason for the decline in psychiatry that Dr. Gold and others describe was
increasing recognition by ever larger numbers of people that the problems that bring people to psychiatrists have
nothing to do with biological health and therefore cannot be helped by biological health care. But regrettably, belief
in biological theories of so-called mental illness is as prevalent as ever. Probably, the biggest reason for psychiatry's
decline is realization by ever increasing numbers of people that those who consult mental health professionals seldom
benefit from doing so. E. Fuller Torrey, M.D., a psychiatrist, realized this and pointed it out in his book The Death
of Psychiatry (Chilton Book Co., 1974). In that book, Dr. Torrey with unusual clarity of perception and expression,
as well as courage, pointed out "why psychiatry in its present form is destructive and why it must die." (This quote
comes from the synopsis on the book's dust cover.) Dr. Torrey indicates that many psychiatrists have begun to realize
this, that "Many psychiatrists have had, at least to some degree, the unsettling and bewildering feeling that what they
have been doing has been largely worthless and that the premises on which they have based their professional lives
were partly fraudulent" (p. 199, emphasis added). Presumably, most physicians want to do something that is
constructive, but psychiatry isn't a field in which they can do that, at least, not in their capacity as physicians -
for the same reason TV repairmen who want to improve the quality of television programming cannot do so
in their capacity as TV repairmen. In The Death of Psychiatry, Dr. Torrey argued that "The death of psychiatry,
then, is not a negative event" (p. 200), because the death of psychiatry will bring to an end a misguided, stupid,
and counterproductive approach to trying to solve people's problems. Dr. Torrey argues that psychiatrists have
only two scientifically legitimate and constructive choices: Either limit their practices to diagnosis and treatment of
known brain diseases (which he says are "no more than 5 percent of the people we refer to as mentally `ill'"
(p. 176), thereby abandoning the practice of psychiatry in favor of bona-fide medical and surgical practice that
treats real rather than presumed but unproven and probably nonexistent brain disease - or become what
Dr. Torrey calls "tutors" (what I call counselors) in the art of living, thereby abandoning their role as physicians.
Of course, psychiatrists, being physicians, can also return to real health care practice by becoming family physicians
or qualifying in other specialties. In an American Health magazine article in 1991 about Dr. Torrey, he is quoted
saying he continues to believe psychiatry should be abolished as a medical specialty: "He calls psychiatrists witch
doctors and Sigmund Freud a fraud. For almost 20 years Dr. E. (Edwin) Fuller Torrey has also called for the
`death' of psychiatry. ...No wonder Torrey, 53, has been expelled from the American Psychiatric Association
(APA) and twice removed from positions funded by the National Institute of Mental Health ... In The Death
of Psychiatry, Torrey advanced the idea that most psychiatric and psychotherapeutic patients don't have
medical problems. `...most of the people seen by psychotherapists are the `worried well.' They have
interpersonal and intrapersonal problems and they need counseling, but that isn't medicine - that's education.
Now, if you give the people with brain diseases to neurology and the rest to education, there's really no need
for psychiatry'" (American Health magazine, October 1991, p. 26).
The disadvantage to the whole of the medical profession of recognizing psychiatry as a legitimate medical
specialty occurred to me when I consulted a dermatologist for diagnosis of a mole I thought looked suspiciously
like a malignant melanoma. The dermatologist told me my mole did indeed look suspicious and should be removed,
and he told me almost no risk was involved. This occurred during a time I was doing research on electroshock,
which I have summarized in a pamphlet titled "Psychiatry's Electroconvulsive Shock Treatment - A Crime Against
Humanity". I found overwhelming evidence that psychiatry's electric shock treatment causes brain damage,
memory loss, and diminished intelligence and doesn't reduce unhappiness or so-called depression as is claimed.
About the same time I did some reading about psychiatric drugs that reinforced my impression that most if not
all are ineffective for their intended purposes, and I learned many of the most widely used psychiatric drugs
are neurologically and psychologically harmful, causing permanent brain damage if used at supposedly therapeutic
levels long enough, as they often are not only with the approval but the insistence of psychiatrists. I have explained
my reasons for these conclusions in another pamphlet titled "Psychiatric Drugs - Cure or Quackery?" Part of me
tended to assume the dermatologist was an expert, be trusting, and let him do the minor skin surgery right then
and there as he suggested. But then, an imaginary scene flashed through my mind: A person walks into the office
of another type of recognized, board-certified medical specialist: a psychiatrist. The patient tells the psychiatrist
he has been feeling depressed. The psychiatrist, who specializes in giving outpatient electroshock, responds saying
"No problem. We can take care of that. We'll have you out of here within an hour or so feeling much better.
Just lie down on this electroshock table while I use this head strap and some electrode jelly to attach these
electrodes to your head..." In fact, there is no reason such a scene couldn't actually take place in a psychiatrist's
office today. Some psychiatrists do give electroshock in their offices on an outpatient basis. Realizing that
physicians in the other, the bona-fide, medical and surgical specialties accept biological psychiatry and all the
quackery it represents as legitimate made (and makes) me wonder if physicians in the other specialties are
undeserving of trust also. I left the dermatologist's office without having the mole removed, although I returned
and had him remove it later after I'd gotten opinions from other physicians and had done some reading on the subject.
Physicians in the other specialties accepting biological psychiatry as legitimate calls into question the reasonableness
and rationality not only of psychiatrists but of all physicians. On November 30, 1990, the Geraldo television talk
show featured a panel of former electroshock victims who told how they were harmed by electroshock and by
psychiatric drugs. Also appearing on the show was psychoanalyst Jeffrey Masson, Ph.D., who said this: "Now
we know that there's no other medical specialty which has patients complaining bitterly about the treatment they're
getting. You don't find diabetic patients on this kind of show saying `You're torturing us. You're harming us.
You're hurting us. Stop it!' And the psychiatrists don't want to hear that." Harvard University law professor
Alan M. Dershowitz has said psychiatry "is not a scientific discipline" ("Clash of Testimony in Hinckley Trial
Has Psychiatrists Worried Over Image", The New York Times, May 24, 1982, p. 11). Such a supposed health
care specialty should not be tolerated within the medical profession.
There is no need for a supposed medical specialty such as psychiatry. When real brain diseases or other biological
problems exit, physicians in real health care specialties such as neurology, internal medicine, endocrinology,
and surgery are best equipped to treat them. People who have experience with similar kinds of personal problems
are best equipped to give counseling about dealing with those problems. Despite the assertion by Dr. Torrey that
psychiatrists can choose to practice real health care by limiting themselves to the 5% or less of psychiatric patients
he says do have real brain disease, as even Dr. Torrey himself points out, any time a physical cause is found for
any condition that was previously thought to be psychiatric, the condition is taken away from psychiatry and treated
instead by physicians in one of the real health care specialties: "In fact, there are many known diseases of the
brain, with changes in both structure and function. Tumors, multiple sclerosis, meningitis, and neurosyphillis
are some examples. But these diseases are considered to be in the province of neurology rather than psychiatry.
And the demarcation between the two is sharp. ... one of the hallmarks of psychiatry has been that each time
causes were found for mental `diseases,' the conditions were taken away from psychiatry and reassigned to
other specialties. As the mental `diseases' were show to be true diseases, mongolism and phenylketonuria
were assigned to pediatrics; epilepsy and neurosyphillis became the concerns of neurology; and delirium due
to infectious diseases was handled by internists. . One is left with the impression that psychiatry is the repository
for all suspected brain `diseases' for which there is no known cause. And this is indeed the case.
None of the conditions that we now call mental `diseases' have any known structural or functional changes in
the brain which have been verified as causal. ... This is, to say the least, a peculiar specialty of medicine"
(The Death of Psychiatry, p. 38-39). Neurosurgeon Vernon H. Mark, M.D., made a related observation
in his book Brain Power, published in 1989: "Around the turn of the century, two common diseases caused
many patients to be committed to mental hospitals: pellagra and syphilis of the brain. ... Now both of these
diseases are completely treatable, and they are no longer in the province of psychiatry but are included in the
category of general medicine" (Houghton Mifflin Co., p. 130). The point is that if psychiatrists want to treat
bona-fide brain disease, they must do so as neurologists, internists, endocrinologists, surgeons, or as specialists
in one of the other, the real, health care specialties - not as psychiatrists. Treatment of real brain disease falls
within the scope of the other specialties. Historically, treatment of real brain disease has not fallen within the
scope of psychiatry. It's time to stop the pretense that psychiatry is a type of health care. The American Board
of Psychiatry and Neurology should be renamed the American Board of Neurology, and there should be
no more specialty certifications in psychiatry. Organizations that formally represent physicians such as the
American Medical Association and American Osteopathic Association and similar organizations in other
countries should cease to recognize psychiatry as a bona-fide branch of the medical profession.
THE AUTHOR, Lawrence Stevens, is a lawyer whose practice has included representing psychiatric
"patients". His pamphlets are not copyrighted. Feel free to make copies.