Psychiatry 2017 – Rebirth Or False Dawn?

SIR SIMON WESSELY has agreed to help “the government … ensure that people with mental health problems receive the treatment and support they need”  October 2017.   Sounds worthy enough, but what if the problem is deeper?  What if this enquiry misses the point, and it’s today’s psychiatrythat needs an independent review?  Step outside the Royal College precincts and problems festoon.  Perhaps psychiatry itself warrants scrutiny.  This opinion piece cites two ugly evidentials, then slices into psychiatric policy using Occam’s Razor.  Much has changed, not all to the good, since this writer gained full membership of the Royal College of Psychiatrists in 1973, 44 years ago.

Ethics are central to all medical practice.  If your specialty was accused of “institutional corruption”, or indeed of any sort of moral turpitude, what would you do?   Suppose the Law Department of Harvard University, no less, produced abundant written evidence that, among other things, today’s psychiatry inflicts “social injury” – what then?   Whitaker, 2015, pulled few punches – the very title of his book, hurts – “Psychiatry under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform”.  Will Sir Simon take this mix of law and ethics into account?  Do you?

Doctors toil long and hard for their patients’ health.  They pursue challenging lines of treatment which they are confident, will benefit their patients in the long run – the reason doctors sleep easier at night, is their confidence that people ingesting medicines they’ve prescribed will improve, not worsen.  Ideally follow up studies should cover decades, where even the least hint of trouble provokes deep objective scrutiny.  The practical NHS fact is that it is GPs who do most repeat prescribing of conventional psychiatric drugs – long term outcomes therefore impact as much, if not more, on primary healthcare, not secondary.

In 2014, three long years ago, Harrow reported that those taking conventional psychiatric drugs over a 20 year period, continued to suffer morepsychiatric symptoms, than those notmedicated, by a margin of 68% to 8%. Would you tolerate outcomes this bad in your speciality?  Are prescribed drugs keeping exceptionally vulnerable patients ill?  What will it take to debunk Moncrieff’s (2008) “The Myth of the Chemical Cure”?  Are GPs being misled?  Are they unwittingly increasing “social injury” simply because too many psychiatrists pay neither Harrow nor Moncrieff enough heed? Is this, in reality, “the treatment and supportthat people with mental health problems … need”?  If not, will Sir Simon say so?

Graph from Harrow’s paper

Moving swiftly on from grim to grail, there’s nothing like 20 years in general practice, plus an MRCGP, for blowing away many medical myths and much psychiatric guff. Shining through it all is Osler’s genius – “listen to the patient, s/he’s telling you the diagnosis.”  Solid gold. Saved me countless times.  How did Osler know that what the walking wounded need most, is a good hard listening to?  But what if they stop tellingthemselves? – aye, there’s the rub.

“It’s my frontal lobes, doctor” – however many decades you spend in general practice, you will never hear this in your morning surgery.  Why?  Because you need your frontal lobes to work out what’s wrong – and if they are on the blink, then so are you.

Psych-iatry in Greek, is “doctor for the mind”, or more poetically, “for the soul”. The ability to think things through is our evolutionary salvation – it is also the key to psychiatry.  So when the mind goes “blank”, then that mind is dysfunctional – it’s ill.  And there’s one circumstance in which everybody can see that that is just what happens – trauma.  The gunfire has ceased, the car crash was years ago, the abuse is no longer – except the sufferer cannot “see” these real facts – their frontal lobes won’t let them – all they’ve got are blind-spots, which allow these obsolete terror/tortures to inflict interminable agony.  Everyone else can plainly see it’s all over – why can’t they?

And right on cue, Bessel van der Kolk describes brain scan evidence showing frontal lobes and speech centres going “off-line”, when trauma/terror is recalled – they’re zombified.  It’s as if they’ve had a stroke.  Now ordinary cerebro-vascular-accidents respond well to intensive and expert physiotherapy – so why shouldn’t “frontal strokes” do similarly?  Coaxing an individual, in propitious circumstances, gently to repeat certain phrases which they otherwise block – i.e. “verbal physiotherapy” – has, in the writer’s clinic, produced interesting outcomes, even with psychotic symptoms.

Occam’s Razor insists single facts work best, and here – uniquely everin all psychiatry – is objectively scientifically proven frontal ischaemia.  Physiotherapy avoids pitfalls inherent in psychotherapy, to say nothing of our current neurotransmitter mayhem. Cognitive Behavioural Approaches stumble with non-functioning frontals.  And, worse, as Moncrieff concludes, all psychoactive drugs work by “intoxicating” frontal lobes – no wonder plethoras of prescribed medication mishit psychotic and other irrational symptoms.  I wish Sir Simon well, don’t you?

797 words                                         Sunday, 22 October 2017

[no conflict of interest, no finance nor patients involved, single author.  Submitted to both the Lancet and the BMJ – no reply from the first, bumbled reply from the second – sealing any prospect of realism in today’s psychiatry.]

Dr Bob Johnson

Replacing ‘social defeat’ with ‘social delight’ – for all.

Consultant  Psychiatrist,  (retired)         

MRCPsych, MRCGP, Diploma in Psychotherapy Neurology & Psychiatry (Psychiatric Inst New York),

MA (Psychol), PhD(med computing), MBCS, DPM,  MRCS.

GMC speciality register for psychiatry               reg. num. 0400150

Author Emotional Health ISBN 0-9551985-0-X         &    Author Unsafe at any doseISBN 0-9551985-1-8