Dear the mental health establishment:

We are not fooled at all. You may drop the pretense that mental health care is scientific.

We understand that most of you are in good faith trying to be helpful. But we’re still in the medieval stage with this stuff and it’s time to admit it.

The drugs you prescribe are sometimes helpful but have outrageous side effects, and often cause the opposite primary effect from the intended one. While we applaud your research efforts, the current products are often ineffective or dangerous. And let’s not even get into the surgical ideas here.

Psychotherapy in its myriad forms is mainly religious and not practical. Great theories of the human mind and soul are invented out of thin air and applied to patients with an assumption of authority that is entirely undeserved. We know what’s going on. You’re kicking the TV and congratulating yourselves when the picture looks better. The sheer number of psychotherapeutic methods and their incredible variation suggests that any egotist with a Ph.D. and a charismatic argumentative style can invent a new school of therapy and get away with it. There are no standards.

This isn’t science. It isn’t medicine. In fact, the intellectual standards of this field would not be accepted at a good hair salon.

Please, please get real with us and just admit you’re making shit up out of desperation. It’s not like we can’t tell already.


The “patients”

30 thoughts on “Dear the mental health establishment:

  1. You’re kicking the TV and congratulating yourselves when the picture looks better.
    that is brilliant.

    the standard is that every “new” idea has already been thought up (all the fucked up things freud wrote down into books? he stole ALL of it from greek philosophers and other theorists before him, and simply recorded it as a single unified theory), no matter what it is. and that we will, to some degree, already know whether they are bullshit or whether they can do some good sometimes. the reason that there is no unified theory in psychology is that the human mind is the complex and varied instrument that it is, and there will never BE a single thread that runs through all the minds of all the people of all the world. and it is why our science, the most difficult to execute, the most difficult to measure, the most difficult to define, is not taken seriously by so many people. i can understand why you feel this way, but if you feel that much hate for the institution itself, why do you still look to it? quit what treatment you’re going through, if you really believe that all it does is shoot in the dark and abandon any standards of science.

      i am not trying to be sassy, either, i am just saying that there’s no reason to stick with something that only makes things worse.

        It doesn’t only make things worse. It’s just not reliable or understood. Overall I have benefited from mental health care. I’ve also been dealing with it since 1986 with extremely mixed results and lots of downright contradictions between health care providers.
        I don’t think we should stop trying. I do think that the arrogance of calling this stuff “science” is literally medieval, and that part makes me angry.

      I don’t have much of a choice, actually. People who’re having mental trouble of any kind are only socially tolerated if we are “in therapy” or “on meds”. Otherwise, you see, we’re bad people and not patients.
      In any case I have benefited somewhat. But it’s all haphazard. If I go to the doctor with a femoral neck fracture or non small-cell carcinoma it’s all pretty well understood, even what they can’t fix. If I go to two psychologists in one day I’ll hear two totally contradictory theories of the human spirit, and then I have to choose by flipping a coin.

        because treating a psychological disorder is NOT AS SIMPLE as cutting out a tumor or repairing a broken bone. there is not only the physiological, but the emotional/cognitive things that YOU ARE CONTROLLING. i’m sorry if you aren’t all better with a wave of a magic wand, but it’s never going to be so simple. never. honestly? there’s no benefit to be had when you’re that hostile toward the methodology and the treatment. you’re the one who chooses to keep putting yourself through it (i know you would like to say that society dictates it, but it is still your choice to make unless you are unable to care for yourself independently). i’m sorry that depression will never be as easy to cure as an ear infection, but no situation improves without proactive effort. if you don’t like the doctors or their methods, get new ones. i’m a member of the shittiest HMO, with the most limited availability/choice of doctors, and i still manage to take control of my situation in the ways that i can. how could i ever expect to find help in something i detest, something that i don’t respect, something that i think is harmful and irreverent of my humanity?

        I think you’re missing what I’m saying, and I’m not saying something as bad as you think.
        First of all, orthopedics and oncology *are* really complicated. They aren’t hobbies, and there are deep unsolved problems there still. We didn’t understand them well for thousands of years, and most of the real advances in medicine (as opposed to surgery) happened after WWII. Before that it was mainly well-intentioned ignorance.
        I’m saying that we’re still in that stage in psychiatry. That doesn’t mean that mental health care is “something I detest”, or a waste of time. It does mean that it’s prescientific. This may well be the generation where we find a lot of answers, much like the 1940s was for medicine. Failing that, we are still kicking the television.
        I do resent the implication that somehow it’s the patient’s fault if we don’t get better. After 18 years of “proactive effort” I think I’ve been fairly cooperative myself. Please don’t insult me by assuming that I want a “wave of a magic wand” when I have spent about as much time as you’ve spent living fighting this damned thing. That’s really not nice. I’m a survivor, give me a little credit here.
        My point — and I urge you to read it carefully — is that calling the current state of mental health care “medicine” or “scientific” is arrogant. We’re not there yet. It’s a disservice to patients to promise something that isn’t there. I appreciate the efforts of mental health practitioners, and I wish them luck. But my appreciation is colored by a deep skepticism.
        If you had a car that was broken for 18 years and you had to spend $200 a week minimum on a mechanic and each time you got a new mechanic you were told that the old one was incompetent and that an entirely new approach was needed, wouldn’t you be feeling a little frustrated about now? Perhaps you might question if even the smartest and best-intentioned of mechanics didn’t understand the problem sufficiently, and that the whole field of auto repair was in an immature state. That’s where I am.

        i am sorry. and what i said about effort didn’t come out the way i meant it. what you say indicates to me that you place a lot of blame on the doctors; there are seven major schools of thought in psychology, and compounded with the ignorance of all of them that you find in psychiatry, it can be overwhelming. i understand. all i was meaning to say was that there is really no psychological disorder in existence that can be simply cured by a doctor. schizophrenia may be the closest to a medical psychiatric disorder that exists, but even that is not simply “here, pop this pill and that’ll be the end of that”. because the brain, both as an organ and as the mind, is so expansive, it will never be so simple. i don’t want you to be so discouraged, and i’m sorry that you are.
        so many people have worked so hard just to make psychology what it is today, and i believe that most negative attitudes about psychology come from negative experiences with people who do not represent what our science is at its heart (scientology, primal screaming, electroshock, you name it). modern psychology is still a young discipline, and there are still problems. but psychology revolves around the idea that the answers are all here, all available, and that it is absolutely compulsory that we seek and find them. so it isn’t like no one’s trying to make it any better. i guess that’s all i want to say.

      4. Appaise ta rage
        You know, at some level, it can be actually okay for a discipline to be non-scientific. For example: cooking is the cornerstone of civilization, and it’s scientific only in parts.
        That said, I hope one day to achieve the feat of perspective where a life of delerium and panic seems commensurable with an overbaked turkey.

        Please don’t insult me by assuming that I want a “wave of a magic wand” when I have spent about as much time as you’ve spent living fighting this damned thing.

        Whoah, take a Valium or something. No need to take it personally. Nobody’s said that psychiatry/pharmacology is worthless, or that it’s not fair that it doesn’t magically fix everything, or any of that. substitute is just saying that calling it a “science” is rather presumptuous, since we have only the most rudimentary idea of how the brain works, and the mechanism by which drugs and therapy cause physiological changes is basically still magic as far as we know. Not sure where this whole “detested, harmful, irreverent of humanity” bit came from…

        since you know nothing about me and are a total stranger, it is interesting that you think you know what i should take personally or not, or how i should feel about something. curious indeed.

        Maybe it was because you were so brutally judgmental of my own statements. Fimm isn’t an expert in you, but neither are you an expert in me. I’m still burning from that “magic wand” comment. It wasn’t like you to go off like that.

        i misunderstood something about what you had written (possibly because this is a very emotional issue for anyone who has ever had to deal with something themselves, and that colors a lot of what we say), and found a lot of what you said to be very offensive because it so unfairly ignores a great portion of what the issue really is. psychology will never be comparable to other medicines simply because of its unendingly self-referential nature. it may not be as clean-cut as many areas of medicine are today, but that certainly doesn’t make it an experiment in torture or worthless venture (which is what i saw you portray it as, in different words). honestly, i apologize for misunderstanding it, and for saying anything that hurt.

        I accept your apology.
        I still think you’re putting words in my mouth, though. I don’t call it an “experiment in torture” or a “worthless venture”; that’s an extreme extension of what I did say, which is that I think it’s prescientific, and that the mental health field presents itself as being more “clean-cut” than it is.
        I have to emphasize that I’m speaking as a long-term patient and not a random social critic who has wandered in and started yelling insults. I think you’ll find that many of us share this skeptical and critical attitude. Patients don’t start out being burned out. We begin the process very hopeful and ready to accept new ideas.
        Unfortunately, many mental health practitioners try to project white-coat omnipotence, or are very caught up in their own grand theoretical creations. After six therapists, fifteen different medications, a truckload of books, several specialized diets, one religion, and 18 years of depression, anxiety, and neurotic malfunction I find that air of certainty entirely unjustified.
        My current therapist and psychiatrist are both cautious, analytical professionals who understand the need for humility in a very young science. I can’t say the same for most of the rest I’ve encountered.

        i’ve been on the patient end, too, don’t get me wrong. i’ve had all the horrible doctors pumping me full of horrible medications at much too young an age and with much too few avenues attempted beforehand. i’ve been on antidepressants, anti-anxieties, antipsychotics, tranquilizers, stabilizers, all kinds of things that i really never needed. every medication was worse than the last, amplified every problem more than it quelled it, and they collectively turned me into something even my mother couldn’t recognize anymore, all before my sixteenth birthday. i certainly don’t blame you for rejecting that kind of approach, because i do too, and i very adamantly oppose the overuse of psychopharmacology that is so common now. but i also don’t think that my bad experiences discredit psychology in general. my bad experiences are what have prompted me to pursue the science of psychology.
        i know that there are a lot of bad doctors, but it is unfair to say that there is no science to the entire field. to judge the whole by one of its parts is unfair. that’s really what i’m saying. there are hundreds of thousands of people devoting their minds to understanding the mind, doing it correctly and methodically, studying things and re-studying them, observing things and re-observing them, not working on commission from pharmaceutical companies or trying to experiment on anyone just to see what happens. we can acknowledge that we can never have it as simple as a scientist studying mating patterns of grasshoppers, but that doesn’t make it not science. it’s an unfair judgment to project over the whole picture, when there is a population within the discipline of psychology working very hard to ensure that we all abide by the same scientific method as anyone else. the problem lies in the fact that so few of those people become psychiatrists because it’s so full of unethical pill-pushing and ignorance of the emotional and intellectual human being, and instead stay in research where none of the general population ever experiences them. that’s all. i just think there’s so much more to it than you think there is.
        good luck with the struggles that don’t find their ends very easily, and i do hope you continue to see improvement (even if it just takes care of one little step in the process, it’s still an improvement). it does take tremendous dedication to go through so much for so long, and you deserve a lot of credit for that.

        Whoah, take a Valium or something.
        You stole my comment. :((

        i’m sorry that depression will never be as easy to cure as an ear infection, but no situation improves without proactive effort.
        SWEET JESUS that’s a condescending statement.

  3. A-fucking-men. Once you’ve gone through a dozen antidepressants and start seriously considering electroshock therapy, you can’t help but think of the Far Side cartoon where a group of brain surgeons are gathered around an opened-up patient, going “Hey, look what happens when I press this part!” whilst poking around in his brains with their fingers.

  4. There’ve been quite a few developments in psychiatry I’d regard as legitimately scientific (the discovery of lithium as treatment for manic-depressive illness would be an obvious example), but you’re damn right about psychotherapy in general. I’ve spent way too much time and money picking vainly through my totally uneventful childhood to be anything but cynical about pure talk therapy.
    “Kicking the TV and congratulating yourselves when the picture looks better” is the perfect metaphor for the treatment of depression these days. I’ve been helped by antidepressants, but I’ve also gone through at least a dozen drugs that either did nothing or had weird side effects or whatever…the only psychiatrist I’ve really trusted was also the only one who was completely upfront about the crapshoot nature of prescribing antidepressants.
    I could go on and on about this, but the Klonopin is starting to kick in. (Seriously.)

    1. There’ve been quite a few developments in psychiatry I’d regard as legitimately scientific (the discovery of lithium as treatment for manic-depressive illness would be an obvious example)…
      Is it? Because, while it’s certainly an effective treatment for some varieties of bipolar disorder, we still have no idea why it works. One can’t help but think of medieval doctors ascribing the success of their poultices and herbal remedies to a change in the balance of the body’s humours — even if it does actually work, it’s still primitive science.

      1. Yeah, the effect that most drugs have upon the brain’s neurotransmitter balance is pretty well understood. But how that translates into changes in mood or patterns of thought is still dark. All we can say is pretty much “This increases activity in this part of the brain, and we think that part of the brain is responsible for A and B, and maybe associated with C and D. It seems to make some people with Disorder X feel better.” The brain’s a very mysterious thing still.

  5. oh, honey.
    this dancing-on-the-edge of medievalism, these primitive treatment methods, these godforsaken fucking SHODDY answers they give to you when you ask them what to fucking SAY to another being experiencing real, unsolvable pain….the lack of real, well, answers……well….it drives one to drink, it does.
    that being said, i’m glad your two practioners are cautious. if it’s one thing i’ve learned in only the several years here down in the hole, it’s to NEVER trust omnipotence.

  6. sounds familiar. there’s no magic pill, magic therapy or guru that will make it all better.
    it’s all made up, and if the pasta sticks to the wall it’s ready to eat.

  7. Invasion of the very rigorous fractal braindowsers
    I think the Bob Newhart’s best piece of comedy in his whole long career was a short sketch when he was guesting on Mad TV.
    The sketch consisted of him playing a psychiatrist. Patients would would describe a problem to him (afraid of being in crowds, getting in pointless fights with parents, whatever). And he would try to cure the patient better by gruffly shouting “STOP IT! Just… just STOP IT!”.
    It was a true moment of artistic arrest.

  8. _YES_.
    While there are certainly some good ideas in psychology here and there, my one semester of it was enough to convince me “Wow, they are trying way too hard to sound like scientists.”
    In physics, they tried to explain complicated concepts with everyday words. In psych, they did just the opposite.

  9. Psychiatry seems still to be in an infancy in terms of a science. A science itself has always been based on observations, leading to threories, leading to experiments to either disprove, or fail to disprove the hypothesis.
    While I would say that the mental health field is attempting this, and succeeding to a degree, I am somewhat discouraged to see the general view of psychiatrists as someone taking notes on a yellow pad, and then miraculously finding a solution at the end of the hour. You’d think that it would require days of research, number crunching, case studies, and finding correlations between the subject’s environment and situation and other documented cases.
    The way that the field currently operates would make me classify it more as an “artistic science” (akin to architecture) more than a pure science. Research conducted in the field however, appears to be done with solid scientific methods. Holy crap, you’ve managed to bring out my engineering nature which I haven’t tapped into for years!

  10. agnosticism
    I’m already convinced that “depression” is about as sensible a diagnosis as “lacking in phlegm”. I don’t see any particular commonality among people who are diagnosed as depressed. Somebody who’s had behavioral problems since birth can get the same pill as someone whose wife died two weeks ago. And they call you mental.

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