I need your help. To get your help, I will have to explain what I did and why I did it. And therein lies the problem; there are many reasons -no one succinctly explaining in any depth, all of them make some sense, but not much more than that.
I wrote ’Sins and Lovers’ mainly because I love writing. I had just finished ‘Oranit || Crossed Lines.’ My first book, a murder mystery, told the story of the establishment of Oranit. It got very good reviews and hardly any sales. Satisfied at my first attempt, I decided I would continue writing both cathartic and mystery murders.
What better subject than my profession-psychiatry? As in Oranit, I knew the ins and outs, and many shady labyrinths were the landscape. I love my profession, and I love the village I founded, Oranit. However, I am a good way from blind and far from naive. I wanted to tell the truth about both as they are- far from perfection yet admirable, loved, bearers of correctable blemishes and open to change.
As I wrote Oranit Crossed Lines, I found my love for my village reaching new heights. As I wrote Sins and Lovers, I became increasingly angry and frustrated. I was telling my readers thoughts and feelings which I knew were always there but neither acknowledged nor organized. I acknowledged something I had always known…
As both the books are essentially of a cathartic nature, I will supply a short history of myself so you can see where I’m coming from and where I’m going to. I was educated in the Aberdeen medical school in the 60s. The nigh on the revolutionary ambiance of the time influenced greatly. Even more so in Scotland; we knew of Ronnie Laing. His works fitted neatly into the political-philosophical mind-set we felt at the time.
In many respects, I never left the 60s. It may sound trite, but I still believe firmly in the Brotherhood of Man. I believe The Internet has enabled Power For The People- after all, knowledge is power and knowledge is at present universal. Although now in my 70s, I understand the Invade Wall Street people. I still cling to the idea that there will be revolution, and mankind will genuinely be free. Along the way, I have recognized that there is a sea of bullshit out there, and probably the only one truth is that evil exists.
As an Israeli, I have witnessed first-hand how much damage deceit, deception, and devious dwarfs can do. People have been killed, maimed and generations lost when solutions were so easy to find and never really sought. We have seen politicians more dedicated and close to their egos than to the people who elected them. We have people talk about dreams and led straight into nightmares. And it goes on and on. Nobody seems to learn from their mistakes; they are far too busy with engrossed pontificating to others’ views, which are quite irrelevant and based on very narrow thinking and lack of knowledge. Excellent causes get hijacked, and good people get lost.
The fire in my stomach from the 60s never went out.
I wrote my book, and I realized the smouldering embers of resentment in my subconscious were flaring into a full-blown fire. Something is deeply wrong with psychiatry.
Psychiatry clings to models and perceptions, which are no longer relevant in mainstream medicine and certainly not in psychiatry. Psychiatry which never left the past still refuses to recognize its own or at least learn lessons from its very chequered past. The shame, cohabiting and collaborating with repressive Nazi and Soviet regimes have been airbrushed away. The very fact that psychiatry could torture homosexuals is forgotten. Barbaric and disastrous therapies like insulin shock are as if they never existed. In the words of Napoleon- ‘they have neither learned anything nor forgotten anything.’ In the spirit of the past, naughty children of today are currently having their brains blasted by Ritalin and the many more expensive imitations. Why a poor defenceless child should be subjugated to this very bizarre treatment because he thinks differently is completely beyond me. Have they learned nothing? What will they be saying about this in 50 years’ time? What will the kids themselves be saying? What side-effects will they be suffering from which nobody thought? Why not ask the homosexuals who have their brains physically assaulted by surgery or, ECT what they think about the treatment they got, with the best of intentions, 50 years ago?
In medicine, diagnoses are based on accepted illnesses, with recognised causes, recognized treatment regimens and recognized outcomes. Psychiatric diagnoses are ephemeral and say little about the illness or its treatment. Psychiatric diagnoses shift like the Sahara in the wind is moulded and shaped by internal politics and the needs of the pharmaceutical industries. Psychiatry is unable to visualize or to examine in the laboratory any meaningful sign or symptom, which will enhance or is specific to a diagnosis. The diagnoses come with the regularity of El Nino, similarly switching direction and affecting the environment of all concerned.
The same psychiatry which blundered into the politics of Nazi Germany, and Soviet Russia is now bedfellows with many of the politically-correct movements. They have joined the ‘pampered society owes me everything, and I have to do nothing’ warriors.
Consequently, every negative feeling, personal shortcoming or happening has a diagnosis and as if almost by coincidence every diagnosis has a medication. And you can be damn sure that every medication, there will be one better, more effective and much more expensive. And this treatment is the inviolable right of every human being to have and receive no matter how much it costs or who pays.
Psychiatry still clings to the medical model. The medical model is virtually saying two things. There is one cause with many results and in the hierarchy of treatment, the doctor is at the apex. Both these concepts have been abandoned in medicine. We are fully aware that disease causation is multifactorial. We appreciate the social and psychological aspects of the disease process, and its treatments are equal partners with the doctor, in some cases even more so.
Put in simple terms the idea of the magic bullet, being shot by the magic physician who rides into town like the sheriff and right out again leaving peace and tranquillity, are passé. In the rest of medicine, we realize that we are treating illness and not curing it. By doing so, we realize prevention and rehabilitation is of paramount importance. The major illnesses and problems known to modern mankind-diabetes, hypertension and the aging process are no longer managed according to the old medical model.
Psychiatry which has the most incapacitated and chronic patients in the whole of medicine still clings to the magic bullet. Psychiatry, as seen in the medical model rules supreme. Mental health does not exist as such it has been captured by the medicating everything school of Psychiatry.
Finally, we come to everybody’s bête noire-the pharmaceutical industry. This pharmaceutical industry is universally disliked, never in my experience, has an industry single-mindedly invested all its energy into richly deserving its bad name. The double-headed hydra of psychiatry and the pharmaceutical industry still exists. Research, the search after the holy Grail-magic bullet- so important to all of us and so believed by many others is at their behest. No research will be carried out to show that the drug does not work. The research will be presented to accentuate what is good for the pharmaceutical industry and do the opposite for whatever is bad. The power of the research funds in psychiatry is immense.
The ‘you scratch my back, and I scratch yours’ symbiosis between the industry, and the psychiatric profession is still alive and well. It cannot be otherwise because there is far too much money, power privilege and prestige involved.
There are two other aspects, which are discussed far less in general discourse but are both important and have undesirable effects.
The medical model is dead. Along with it is the doctor-patient relationship. A pentagonal structure has replaced the dyad. The additions are the health provider, the government and the quasi-legal apparatus and representation. The additions have made strange bedfellows. They could act for the good, but they do not.
The health providers and central government are part of the medical organization which employs the doctor and provides health for the patient who no longer has any contact with his therapist apart from receiving therapy. This may sound trite, but in many cases, the patient’s choice is limited if not nullified. More importantly, the patient no longer pays the therapist directly nor does he have any say in how much the therapist receives. The patient no longer fully pays for his therapy or therapist. In the dyad situation, costs were highly relevant, and the doctor-patient thought together about the cost-effectiveness in real terms. The monetary consideration not only no longer undertaken, but it is completely taboo. There is an overwhelming belief which has been encouraged by the pharmaceutical companies that more expensive his best; new is best. The claim is unmitigated tripe, but the doctors are being brainwashed by the pharmaceutical industry and the patients are encouraged to seek only the best because those are their rights, and they have at their beck and call the many quasi-legal bodies which are there to represent them- or so they claim.
The health providers are setting up systems whereby there are fulfilling obligations made upon them by whoever empowered them to act. They have to behave and perform according to standards which in many cases are arbitrary and have nothing whatsoever to do with real needs. The main purpose is to cap utilization, and they have nothing to do with measuring and providing genuine needs. The health provider has to cope with three serious problems, the fourth, less consequential one being the patient. The three major problems are the government, the professionals working in the body and his budget. The professionals have to be kept happy; this means letting them do what they want to do and not forcing them to do what they have to do. What does this mean in real terms? In an ideal world, the chronic patient would have a complete set of community-based rehabilitation services. Generally speaking, the services are labour-intensive yet low-cost. On the other hand, the doctors, who prefer working in hospitals are not going to consult out in the boondocks. The government wants a quiet life; it wants to stay within a budget and without complaints. And who will do the complaining? The fresh quasi-legal organizations which have sprung up alongside the new creaking mental health services.
These new enablers and self-appointed do-gooders are in themselves a very strange bunch. On the one hand, they see themselves as the emancipators and protectors of subjugated mental health sufferers. On the other, they see themselves as warriors fighting to get the optimum possible treatment for the downtrodden neglected patient. Unfortunately, they also subscribe to the ‘most expensive must be finest’ policy.
Before finalizing I cannot avoid some disparaging words for the many psychologists and social workers. I refer to those who convert with the fervour of a zealot to the flavour of the month therapy and then behave similarly to latter-day Christians converting the heathens. They adopt a belief system which describes everything possible about how and why man exists and behaves and yet is quite unsuitable for the patient. We then hear brilliant statements like ‘the patient is not suitable for the therapy.’ They seem to be very proficient at explaining both why the patient needed the therapy and why it didn’t work. They are far less adept at explaining why the vast majority of psychotherapies are terminated within three visits, in the public sector, there are hardly any therapies, which go to full term and are finalized as planned in the first session.
Services are about two things: professionalism and payment. As we have seen above professionalism is very esoteric and, like beauty, is in the eyes of the beholder. Payments are made up of two factors, how much is put into the system and how much is wasted? Enormous waste riddle the psychiatric system, like most of the public health sector. Two wastes are the insistence on not using generic drugs as if this was some insult to the receiver even though the effects are largely similar, and the costs are much cheaper than original medications. The second is the high cost of medical insurance paid by the professionals, and this is due to a strained relationship that the insurer has with the health provider. There is no reason why insurance should not be limited.
I am presently writing a third book, an alternative psychiatric textbook which I hope will be out by the end of the year. I will finalize by listing some of the suggestions.
Regulation of the relationship between the pharmaceutical industry in the medical profession. Now new research should be allowed if it is not needed. There can be no relationship whatsoever between physicians and the pharmaceutical industry. An independent body should oversee and license: research, its findings, its implications, the role and place of the new therapy and its advice for marketing including any contact and give information to the patient.
Psychiatric services should be set up where the locus of therapy is the community and not the hospital.
Health providers must provide mental health teams where the psychiatrist is a consultant. Psychiatrists should only use generic drugs, unless there is an accepted reason why not. The teams are responsible for the casework of any mental health case no matter whether the patient is in the community or hospitalized.
Regulating, auditing and monitoring health teams should be done at a governmental level making sure that the services are adequate, professional and economical.
In any dispute between the patient and the therapist or health provider, there must be an arbitration system set up under the supervision of a central body. There will be a pre-set set of fines and compensations.
I can well imagine that I’ve managed to annoy just about every reader. On the other hand, I’m pretty sure that there are some points that everybody will agree.
Having ‘sung for my supper’ and explained where I’m coming from can I humbly turn to you and asking for volunteers to read my book Sins and Lovers? If you agree, you will not only get a complimentary copy, but my sincerest of pleas cum beg to receive a positive review and get sales moving on Amazon.
You may contact me at firstname.lastname@example.org to receive a complimentary copy of SINS AND LOVERS