Why Psychiatry Should Be Abolished as a Medical Specialty (Part 1)

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
counselling 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 counselling. 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.