Our Necessary Shadow
The Nature and Meaning of PsychiatryBy
Reviewed by Mira de Vries
"I wrote this book to give an understanding of what psychiatry is, what it can do and what it cannot do." With this explanation the author starts his introduction. He goes on to acknowledge that zillions of books have already been written on the subject representing a broad spectrum of views for and against psychiatry. "[W]hich should you believe? Should you believe either? Is it perhaps possible to believe both?...I hope to clarify some of these contradictions so you can decide for yourself. ... I hope I have succeeded in conveying both sides of the debate." Yet the reader knows what Burns wants him to conclude before opening the book: we need psychiatry. The title says so.
Why do we need psychiatry? Because, according to Burns, it works. He repeats this sentiment in a variety of wordings scores of times throughout the book. How it works, how often it works, and how its efficacy is determined he mentions nowhere. "I made a decision to keep this book free of references" he states in the acknowledgments even ahead of the introduction. Fair enough. A reference makes a statement look scholarly but doesn't make it true. However if you're going to rest your entire case on this one claim, expecting the reader to accept it on faith won't do. In fact I don't. Psychiatry does not work, ever. Nobody gets better from it, only worse. My source for this is the testimony of my own eyes and ears.
"Establishing and sustaining a trusting relationship with a troubled and suspicious patient is a skill," he posits, suggesting that psychiatrists have this skill. "It is simply not the case that psychiatrists only focus on symptoms and prescribing pills." This is not fact, it is propaganda. In my country some psychiatrists never even meet the "patient" but rather base their opinions about him/her on discussions with the nursing staff and social workers. When there is actual contact between psychiatrist and "patient" it more likely adversarial than "trusting".
This type of propaganda continues in Chapter 1, entitled "What to expect if you are referred to a psychiatrist" in which Burns makes all sorts of claims for psychiatrists' skills and abilities such as "intuition" and "see[ing] through ... emotional understatement" being "slow to pass judgment" and "feel[ing]" when someone is depressed. He sums up with "I think psychiatrists as a group tend to be warmer, more approachable and more understanding than most doctors."
Chapter 2, The origins of institutional psychiatry, presents some history and ends with more propaganda: "a mini-revolution with the introduction of new and dramatically effective specific interventions."
In Chapter 3, The discovery of the unconscious, he states "Mesmer's methods seem like so much hocus-pocus today but they were a radical break with a superstitious past." Is hocus-pocus not superstitious? "The magnetizers ... established that we have ideas and memories of which we are not conscious." They didn't establish that, they claimed it. Such claims justify the psychiatrist attributing to his "patient" thoughts and memories that he does not have. Thoughts and memories are by definition consciousness. Unconsciousness is precisely the absence of thought and memory such as during a coma or general anesthesia. "[T]he reality of an unconscious mind has been accepted by most professionals working in the field." That doesn't make it exist.
"The rise and fall of psychoanalysis" occupies Chapter 4, the fall being brought about by "effective antipsychotics and antidepressants." It is true that some people manage to hang on to their ordinary lives for many years while taking antidepressants -- which are synthetic cocaine -- just as other people manage to do so while taking real cocaine (for instance Sigmund Freud and popular Washington DC mayor Marion Barry). But "antipsychotics"? I have yet to meet someone on these drugs whose life is not utterly destroyed.
Chapter 5 deals with a variety of (mis)treatments introduced during the interwar period, such as malaria, insulin shock and ECT. Burns believes in the efficacy of ECT and plugs it several times throughout the book. About insulin shock he states, "The apparently wonderful earlier outcomes are now thought to be due to unintentional selection of patients most likely to recover and optimistic attitudes of the staff caring for them." More likely reports on "wonderful outcomes" were based on wishful thinking, as are the wonderful outcomes Burns himself reports in his book. Such untruths are the mainstay of psychiatry.
Chapter 6 deals with The impact of war, and contains some valid observations. "Big personalities have always had a disproportionate effect on the course of psychiatric advances." If the word advances is changed to practices that is certainly true.
Chapter 7 deals with the transition from coercion in large institutions to coercion "in the community" made possible according to Burns (and other psychiatrists) by the "drug revolution." He neglects to mention that budget cuts, not drugs, emptied the institutions. He calls this shift "our strongest assurance against the abuse and poor practice that have disfigured periods of our history." Were this but true. For the unwanted, battered, and homeless "in the community" means that they are now denied the one service that they ever really needed: shelter. Furthermore shooting people up with depot neuroleptics (misleadingly called antipsychotics) and not sticking around to watch them deteriorate helps blind psychiatrists and psychiatric nurses to the harm they do. Poisoning people and subsequently leaving them on their own and helpless in this condition is no less abuse and poor practice than what went on in the institutions of yore (and still goes on).
In the chapter exploring psychiatry's legitimacy Burns discusses some of its best-known critics, Foucault, Goffman, Szasz, and Laing. (There were and still are many others.) Although he heads this section "The rise of anti-psychiatry" he acknowledges that none of these critics considered themselves anti-psychiatrists, nor were they part of a coordinated movement, but rather each was highly individualistic. That's a refreshing improvement compared to other authors who sweep all of these names under the same carpet. Ten points for Burns. He credits them with "leaving a lasting legacy both within the profession and in our wider understanding of the human condition." He is least enamored of Szasz, although I am impressed that contrary to many other opponents of Szasz, Burns has actually read at least some of his books and made an honest attempt to understand his point of view. He states "I find him deliberately simplistic." That is true and Szasz was aware of it. He called it his "shorthand". Burns further finds fault with Szasz for rigidly adhering to the view that there can be no "real illness" in the absence of an identifiable physical cause. Here too Burns has a valid point. When we don't know the cause of a strange behavior, and we usually don't, it is just as wrong to assume the absence of a physical cause as it is to assume the presence of a physical cause. But then Burns pulls a fast one on us. He asks rhetorically "What would Szasz have made of the accumulating evidence of relative over- and under-activity of neurotransmitters in various psychiatric disorders?" We don't have to wonder, we know exactly what Szasz made of it. What do you make of the fact that no such evidence exists? There isn't even a method for determining the activity of neurotransmitters in human beings. Burns has already admitted in Chapter 1 that the only lab tests done in psychiatry are to monitor the effects of the chronic poisoning. The role of neurotransmitters is theory and conjecture, not fact, promoted by the pharmaceutical industries to justify selling their products. Burns then continues to criticize Scientologists for their controversial therapies as though Szasz were somehow responsible for them. Although Szasz agreed to lend his name to Scientology's offshoot Citizens' Commission on Human Rights, he was not a Scientologist and didn't believe in Scientology.
Next comes a chapter in which Burns attempts to expose some of what he considers the sins of psychiatry. He is to be commended for mentioning the T-4 program, albeit briefly. Most psychiatrists know nothing about it. Under the header "Psychotherapy oversteps the line" he states about certain non-mainstream therapies "Having submitted yourself to something that is gruelling and unpleasant there is a strong incentive to believe it works." Why would this be true for alternative psychotherapies and not for ECT?
In a chapter dealing with psychiatry and the law he makes some fair points. "[C]ourts want all the help they can get." The contribution of psychiatrists in perverting the course of justice is mentioned in a different chapter in the discussion of recovered memory syndrome, but could have been mentioned here too. Even if somebody really is crazy, that does not prove he committed the crime in question. "Psychiatry seems to be safer when it restricts itself to 'abnormalities' or differences that are obvious even to the layperson." In other words, lay people can judge that someone is crazy just as well. A very valid point regarding law he makes in a later chapter. "The wording in [compulsory treatment] legislation is convoluted and, frankly, rarely bears careful scrutiny." In other words, the content of coercion laws is irrelevant, as neither psychiatrists nor judges respect the safeguards for human rights. They don't have to. They aren't accountable to anybody.
We're nearing the end. The next chapter is "A diagnosis for everything." Most psychiatrists agree that the DSM, a thick catalog of diagnoses, goes over the top. But few campaign for abandoning it, and neither does Burns. He would be happy to shrink it. Like so many others authors in the field, he has his pet (non)diseases. "I have never come across a diagnosis of caffeine-induced insomnia." Burns would also like to see addictions and personality disorders tossed out, not because they don't exist but because the people who answer to these criteria are annoying and psychiatrists don't know how to deal with them. He's rather naive to imagine that abolishing categories from the DSM will change anything. Psychiatrists will simply resume labeling annoying people schizophrenic like they did before the DSM introduced special categories to accommodate them. And psychiatrists will continue drugging them into oblivion like they do everyone else. He continues "One in ten of ten-year-old boys in the USA ... is currently prescribed stimulants for ADHD. Now, wherever the threshold should lie ... this level surely cannot make sense." What should USA child-psychiatrists do, apply some sort of scale, and prescribe stimulants only to the top (or bottom) percentage that makes sense to Burns? If "One in ten cannot make clinical sense" then what doesn't make sense is the clinic (diagnosis and treatment).
The last chapter (except for a brief epilogue) is the apparently obligatory prediction of the future, which he calls "The rise of neuroscience." I will not fault the author for it as such chapters always contain nonsense -- nobody can predict the future. Thankfully he does have some very welcome news for us. "The main threat to psychiatry's survival may ... be ... a dramatic fall in the number of doctors choosing to go into it. ... Most doctors coming into psychiatry in [the USA and UK] are foreign graduates ... who are often disappointed by not being able to get surgical or medical jobs." I haven't noticed this influx of foreign graduates in the Netherlands but that could be because they don't speak Dutch. Nonetheless we too have a supposed shortage of psychiatrists. Perhaps fewer physicians are willing to spend their careers making and keeping people sick and disabled by poisoning them. If this shortage does herald the end of psychiatry, it is a terrible pity that it is taking so long.