Psychiatry For Beginners

             Psychiatry is a speciality of the medical profession. It is paired with neurology, the medical speciality dealing, generally speaking, with nerves and brain, pain and movement disorders that result from damage to brain and nervous system.

Psychiatry, on the other hand, deals with so-called ‘mental disorders’, likewise believed to originate from the human brain. Differently from, for instance, psychology and ‘talk therapy’, psychiatry’s medical approach treats mental disorders with chemical means such as psychiatric medication. The Diagnostic-Statistical Manual of Mental Disorders, Fourth Text Revised Version (DSM-IV-TR), shows an extensive classification of psychiatric symptoms and lists types of mental disorders in several axes and hierarchies and outlines in detail the possible diagnoses according to symptom combinations and further criteria.

A psychiatrist diagnoses a patient on the basis of the patient’s experience report. There exist no available brain scans or other empirical indications for the presence of a mental illness or disorder, although great attention is given to the patient’s demeanour, mannerisms, appearance and reports of behaviour outside the psychiatric interview.

Many of those who find themselves in psychiatric care, have been brought here by family members exasperated with the person’s behaviour or talking, some are brought to hospital by the police or security personnel, many are referred by a generalist doctor or psychologist, many also enter psychiatric treatment of their own accord.

There are numerous psychotropic medications available, which have been developed, roughly, in the past fifty years, not counting traditional remedies but only synthetic drugs. Mood stabilizers can alleviate or prevent depression and/or mania, anxiolytics can lower anxiety, antidepressants might lift depression, antipsychotics treat psychoses. Psychosis is defined, roughly speaking, as a departure from reality, with, for instance, paranoid delusions of being watched or prosecuted, psychosis also includes hallucinations such as hearing sounds or voices that others do not hear.

Antipsychotic medication has been a prominent feature in most psychiatric patients’ treatment, in the past decade, as a new class of antipsychotic drugs, called “atypical antipsychotics”, was developed to replace the now “typical” ones, though these two types of antipsychotic are in essence very similar.

Formerly, antipsychotics were referred to as “major tranquillizers”, later also “neuroleptics”, that is to say, “drugs that catch one’s nerves”. Here is visible once again the intersection of psychiatry and neurology, visible clearly from the action of antipsychotic medication, which causes neurological adverse effects such as movement disorders, in return for flattening psychiatric symptoms. The mechanism of action of these medicines is by and large unknown, but it is believed that a blockage of dopamine receptors occurs in the brain and produces the silence of psychosis.

After the drug manufacturer Eli Lilly’s atypical antipsychotic Zyprexa (Olanzapine) came on the market in 1996, a number of similar drugs were developed by other companies to modulate on side effect profiles, which with Zyprexa, as with the older antipsychotics, were heavy and numerous: significant weight gain (20-40kg, i.e. 50-80lbs), thus increased risk and extensive incidence of diabetes; movement disorders such as slowed movement, akathisia (not being able to sit still) and tardive dyskinesia (similar to parkinsonism), dizziness, drowsiness, sedation, and lethargy. Zyprexa increases seizure thresholds and can cause stroke or sudden death; it triples tobacco consumption in smokers and incites non-smokers to smoke more (partly because nicotine patches are dispensed in hospitals), it blurs vision and causes eyesight troubles, and numerous uncommon side effects are not listed in Lilly’s description. The worst of these no doubt is the lethargy that puts all Zyprexa-patients, so to speak, “out of service”.

The analogous antipsychotic medications, such as Risperdal or Geodon, do not significantly differ from Zyprexa, though most drug companies have worked to limit the metabolic impact (weight gain) of their drugs, and some, such as Abilify, hardly cause any weight gain at all.

The exact mechanism of action of these drugs, and their long term effects, are unknown. By comparison with the older generation of drugs, the newer antipsychotics promise lower incidence of tardive dyskinesia and other movement disorders, as these are irreversible and no treatment is known, even though tardive dyskinesia is thought to be one of the most terrible side effects of drugs like Zyprexa. Tardive dyskinesia is called “tardive” because it is deemed to set in after a longer period of treatment, usually several years, or even, when treatment has been terminated.

So much trouble from only one drug! Mood stabilizers and all other psychiatric medication, of course, have their associated adverse effects as well: they might cause sexual dysfunction, dry mouth, irritability, hand, extremity, and lip tremors, excessive thirst, skin changes, sleep trouble, and like all medicine, liver, kidney or heart failure.

Ideally, the doctor would inform the patient what effects to expect, both mentally and physically, both therapeutic and adverse. Unfortunately, information, and informed consent, are not the strength of psychiatric practice, as doctors are often under pressure to treat their patients and prescribe fast. This pressure can be financial, as drug companies promise benefits to those who prescribe their products, or pressure might come from the patient’s family members impatient to see change in behaviour, or of course, if the order comes from court of the police, there is no way around psychiatric treatment, regardless of the patient’s consent or knowledge of side effects.

Such forced treatment is currently referred to as “assisted treatment” and usually employs antipsychotic depot injections that last weeks or months and are administered in ambulatory or inpatient clinics, in the most dramatic cases using restraints on the patient; but restraints in psychiatry are more often used in hospitals to check violent patients in the immediate threat of harm than to inject against somebody’s will.

ECT, electro-convulsive therapy (electroshock) is the last bastion of patient respect, as it requires the patient’s consent practically everywhere. ECT can help lift depression or put a halt to a number of bizarre mental phenomena, though it will need to be repeated periodically. It causes memory loss, which, psychiatrists assure, is an adverse rather than a desired effect of this treatment.

The use of drastic and violent means in psychiatry, is the extreme, but not rare; in quieter cases, when patients are halfway agreeable or to weak to sustain an argument, sooner or later the lines between voluntary and involuntary treatment become indistinct, as patients become too lethargic to act, but are angry and despairing with their medications. Sadly, such patients can spend many superfluous years under the influence of antipsychotic drugs and suffer irreversible damage, and due to their excessive sleeping and lethargy, turn to a vegetative lifestyle and miss out on much beautiful life.

Except from the patient’s perspective, it is more convenient for all involved to continue with treatment than deal with the sequels of bringing someone back to life, someone who had been unlucky enough to be mentally tortured, or thought of as unbearable, or accused of potential criminality.

Those are the tools of psychiatry, few but terrible. Misinformation and bullying, persuading a lethargic mind to consent, involuntary hospitalisation, physical violence, permanent control, and declarations of mental incompetence in order to proceed with unwanted treatment. What a charming, sympathetic and trustworthy array!

The transient blurring of mental disorder and criminality as it emerges from newspapers and media, film, and social fear of the other, has brought the world what it has today, wild demonisation of mental diversity, and psychiatric abuse. Behind everyone’s back, behind tight closed doors, when patient confidentiality becomes the universal excuse for locking away dirty files, to protect not the patient but the doctor. Doors close on me and you once for all, in a system that once you are in, never again you will leave; never again will you be cleared of lifelong diagnoses, gossip and stigma, suspicion and countless disadvantages.

Out of social fear, out of environment pressure, out of legal comfort, out of financial gain, out of unthinking following the mainstream, out of inability to admit mistakes, no member of the psychiatric machinery, though all are kind people, has time to think about consequences, as long as the faint complaints of a shattered patient can be brushed off as insanity.

Many have felt the practices of the mental health system to be criminal, and an instrument of terror, much rather than a medical speciality, and that this repression which blurs mental illness and criminality, untenably reprimands in advance those thought to potentially become harmful to society. Many have felt bewildered by what they saw happen on psychiatric wards or how their loved ones changed appearance and character on antipsychotic meds. Many of those who saw psychiatry from the inside, have been shocked and traumatised, pure and simple.

Most people hardly have any psychiatric contacts, are queasy or afraid of psychiatry, because they know so little and hear such terrible stories of serial killers and their insanity. Many imagine that psychiatrists are here to help the depressed and tortured. They are, they do help, in some cases; yet all too often, the patient’s welfare is secondary to the elimination of certain thoughts. These thoughts, tormenting as they are, are far from uncommon, but currently said to be false, abnormal and dangerous. They might be.

Psychosis can be awful and frightening, and end in suicide, murder, or crime, in extreme cases. It leads to deviant behaviours and social marginalisation, hand in hand with homelessness. As a continuous rather than episodic condition, psychosis is serious trouble. Although it has existed since the beginning of mankind, the past half century brought to day antipsychotic medication, relegated the psychotic from madman asylums, to their homes, in silent abdication under the influence of medical substances that make a person unable to work, enjoy him or herself, or to get out of bed.

Welcome to the present times. Welcome to the dark ages. Welcome to the dim-lit room of taboo, the grey area that so screams for enlightenment. Our soul shall be ruined, if as we do, we practice science without conscience. The soul of our time, as any other time also, the soul of our time is in ruin.

Rabelais knew it in 1523: Science sans conscience n’est que ruine de l’âme.