Psychiatric barbarism

Stephan Oliveira, a Brazilian psychiatrist, provides a rich phenomenological account for psychiatry in his book Barbarism and the human: Phenomenology, meaning of life and psychiatric practice, based especially on the work of Michel Henry and Jean-Luc Marion. These new French phenomenologists question the primacy of Husserlian intentionality and see the origin of human phenomena as more based on affectivity than their appearance in consciousness.

As I wrote in my article:-

The phenomenology of subjectivity and existence has implications for the nature of consciousness. The study of a person’s lived experience in the world shows that subjective experience and con­sciousness cannot be naturalised as physical pro­cesses. Our primary experience actually puts us in the world as embodied beings. It is what creates the foundation for scientific knowledge. An integrated personalistic concept of human beings is fundamental to any scientific understanding of the brain.

I’m not sure whether it matters how radical the phenomenological reduction is in its implications for psychiatric epistemology. I have emphasised in this blog the anti-cognitivist phenomenology of Thomas Fuchs (see eg. previous post) and the enactive psychiatry of Sanneke de Haan (see eg. another previous post). Both critique psychiatry from anti-positivist and anti-reductionist positions, as does Stephan, using the new French phenomenology. The experiential, subjective dimension of psychopathology needs to be recognised and accepted. Psychiatry should be understood as relational medicine.

What I like about Stephan's perspective is how he exploits the idea of 'barbarism' from Michel Henry. Doing so may create a more direct challenge to biomedical psychiatry than merely saying psychiatry needs to move to a more relational practice. The tendency to disregard subjectivity/affectivity by focusing on brain pathology can lead to patients feeling their experiences are being ignored. Treating people as objects is symbolic violence, and actual psychiatric practice, both in its history and currently, has shown its barbarity by its defiance of life.

The brain mythology of psychiatry

I’ve commonly mentioned Theodor Meynert (1833-92), a psychiatrist who thought he had delineated various ‘fibre-systems’ in the brain from his anatomical dissections; also deducing functions for these pathways (see eg. my editorial and previous post). The problem is that his findings were mere wishful thinking and they were eventually attacked and labelled as ‘brain mythology’.

Appreciating that primary mental illness is not localised in particular parts of the brain, by accepting that trying to do so is brain mythology, led to the distinction between organic and functional mental illness. Functional does not mean non-organic, in the sense that mental illness is not mediated by the brain. What it implies is that the brain functions more as a whole in such primary mental illness. People should not be reduced to their brain which is only part of them.

The distinction between functional and organic mental illness was wrongly abolished by DSM-IV (see eg. previous post). Psychiatry continues with its wishful thinking that abnormalities will be found in primary mental illness with its acclaimed findings from brain scans. However, these inconsistent results fail to be replicated, so that no biological markers have been found, which even mainstream psychiatry admits. It continues though with its brain mythology that more research will eventually find underlying biological abnormalities. It’s about time such wishful brain mythology is acknowledged in the modern age.

Psychological factors in antidepressant withdrawal should not be ignored

As a veteran of the antidepressant withdrawal debate (see eg. previous post), my views are often marginalised on Twitter (eg. see recent tweet by Adele Farmer, founder of the Surviving Antidepressants forum). My Antidepressant Discontinuation Reactions webpage still exists. My entry into the field was a 1997 BMJ letter. I elaborated my views in a book chapter. 

A recent special report in Psychiatric News provides information for psychiatrists about antidepressant withdrawal. It emphasises that low doses of Serotonin Specific Reuptake Inhibitor (SSRI) antidepressants still have high levels of Serotonin Transporter (SERT) occupancy, and essentially seems to relate withdrawal symptoms to SERT occupancy, without too much evidence. It also acknowledges the lack of research and knowledge about antidepressant withdrawal in general. 

As I have always said, it’s common sense to believe that discontinuing a drug which is said to treat depression will be difficult. Taking antidepressants affects our experience, so that it can be difficult to know whether what I experience is because of illness, the medication or ‘just me’ (see article by Sanneke de Haan). Making sense of our experience is important but may well not be easy, including when experiencing antidepressant withdrawal.

Throughout this blog I’ve emphasised the fallacy of blaming our brains for our psychological difficulties despite the attractions and temptations (see eg. previous post). Because antidepressants can affect our experience, if only because of the placebo effect (see eg. another previous post), then any apparent stability acquired on antidepressants may be attributed to the medication, even though it may be more to do with factors like the passage of time or change of circumstances. It fact, the social situation which caused the depression in the first place may not have really changed at all, or have been dealt with, leaving us with a sense that we are not really back to our true self (see eg. yet another previous post). It worries me that both mainstream psychiatry and critics that argue for brain effects of antidepressants causing withdrawal do not place enough emphasis on these psychological factors.