{"id":58591,"date":"2015-08-12T10:00:39","date_gmt":"2015-08-12T14:00:39","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=58591"},"modified":"2015-08-18T09:48:00","modified_gmt":"2015-08-18T13:48:00","slug":"the-center-stage","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/08\/12\/the-center-stage\/","title":{"rendered":"the center stage…"},"content":{"rendered":"
I’ve been preoccupied with other matters for a month or so, and looking at my posts – I’m afraid they’re kind of just newsy as a result. I’m free of those distractions at last, and find some things that deserve thinking about rather than just reporting. One such thing is the post I’d like to go back to by James Coyne on the PLoS blog<\/font> Mind the Brain<\/a><\/em> called Barney Carroll on domesticating psychosis<\/a>. It’s a short post that’s long on substance and freely available on the Internet, so I’ll skip the summary. It’s about Dr. Coyne’s recent presentation BPS’s Understanding psychosis and schizophrenia – a skeptic’s perspective<\/a> as a visiting lecturer at the Royal Edinburgh Infirmary, University of Edinburgh<\/font>. It’s obviously about the British Psychological Society’s Report, Understanding psychosis and schizophrenia<\/a>. It’s a testimony to a frequent commenter here, Dr. Bernard Carroll, his keen eye and skillful and sometimes piercing writing style. And it’s about both Dr. Coyne’s and Dr. Carroll’s thoughts about the BPS Report. All of that is sitting right there for the reading. I wouldn’t miss it. <\/div>\n

I’ve had a lot to say about that Report along the way myself, the views of the retired old psychiatrist I see in the mirror. But Dr. Coyne used a YouTube video of Kris Kristofferson singing The Silver Tongued Devil and I<\/a> to illustrate Dr. Carroll’s wordsmithery – and posted Janis Joplin’s Me and Bobby McGhee<\/a> [a Kristofferson classic] below it. Those videos reminded me of an earlier and much different time. Kristofferson himself embodied the contrasts of those years – a Rhodes Scholar, Air Force Captain, Ranger, and helicopter pilot who turned down an English Instructorship at West Point to become a songwriter in Nashville. Those were interesting times. <\/p>\n

In 1974, I was a fully trained Internist fresh out of the Air Force myself, and my 1960s mindset was solidly in place. I showed up in a psychiatry residency, drawn by an interest in the psychology of my medical patients. I had rarely encountered psychosis, but I found myself working in a charity hospital emergency receiving unit during the maximally chaotic days of deinstitutionalization – days when psychosis was everywhere, or so it seemed from my new vantage. The simple sentiments of the Beatles’ sixties, "all you need is love<\/em>" and "give peace a chance<\/em>," came face to face with the stark terror that psychosis can be. In Dr. Carroll’s words:<\/div>\n
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…the clinical reality of decompensating psychotic patients smashing furniture to stop the voices, smearing faeces, living in filth, going to the streets, eating out of dumpsters…"<\/div>\n<\/blockquote><\/div>\n
and more. In those days, I assured my internal medicine friends who teased me for changing to "the easy life<\/font> of psychiatry"<\/em> that my second residency was definitely more challenging than my first – knowing full well that they couldn’t possibly know what I was talking about. It wasn’t the hallucinations or the paranoid delusions ["secondary" symptoms] that made Acute Schizophrenia so paralyzing, it was the gross breakdown in the basic elements of mental life – emotional signaling, logical and abstract thinking, a capacity for pleasure, a solid identity sense, etc [the "primary" symptoms]. That first year of residency was spent learning about a version of human experience that I hadn’t previously even imagined. <\/div>\n

I had already thought about the 1960s mentality reading the BPS Report. The anti-establishment tone, the discounting of the dire changes in mental functioning, the simple solutions to complex phenomena were all familiar from those salad days in my own past. But Dr. Coyne’s musical interlude helped me remember the time when my own sixties naivet\u00e9<\/span> first met the stark reality of psychosis, and I understand more fully what bothers about that BPS [British Psychological Society] Report. It’s as reductionistic as that of the other pole of the antipodes, those psychiatrists who talk as if antipsychotic medication compliance<\/font><\/em> is all there is to treating people with psychotic illness. Dr. Carroll’s term is dead center – "Domesticating<\/font> Psychosis" – as are Dr. Pies’ “Trivializing<\/em><\/font> the Suffering of Psychosis…<\/a>” <\/a>and Dr. Pierre’s “Romanticizing<\/font> psychosis<\/a>”.<\/p>\n

Much of the BPS Report was about empathy and collaboration, about kindness and respect, about the humanistic values that are an integral part of any interaction with the people who come looking for help – essential ingredients of medical care from long before science caught up. These are hardly new discoveries or unique to the profession of psychology. They are the bedrock of the values I’ve known for my fifty years in medicine, psychiatry included. <\/p>\n

So the notion that there’s some concrete impersonal ‘disease model<\/em>‘ as it’s presented in this Report or in the anti-psychiatry blogs can’t help but grate. I have to actively remind myself that it’s true that there are psychiatrists [that I sarcastically refer to as the KOLs] who do naively speak as if brain science is all there is; who have abetted an epidemic of inappropriate overmedication [that I’m as pissed off about as any psychologist]; who, by the way, are the negative stimulus for this blog in the first place; and who discredit the legitimate biological psychiatrists that have contributed so much to our knowledge and patient care. So I’m mad too. With that reminder, I can usually back off from reacting.<\/p>\n

But this BPS report has obviously gotten to me, gotten to a lot of us. I said my emotional response was complicated. Even now, I can still feel those 60s feelings that were perhaps appropriate for things like Segregation, the Cold War, or our misbegotten war in Southeast Asia. But they don’t come close to encompassing the magnitude that is psychotic illnesses – back then or now. This Report was too much the polemic, too "sixties", too politically correct, and too simplifying. It attempted to "make nice" with one of the more painful and devastating afflictions that can befall a human being, particularly the young. And while we can all be excited with the cases that recover, there are many who have a very different trajectory.<\/p>\n

This post sat in my draft folder for two or three weeks because I didn’t want to sound like an "anti-psychologist." I’m not such a critter. Many of my favorite teachers, students, and colleagues are psychologists [and social workers]. My reaction wasn’t because of the discipline difference and I’ve certainly qualified as being sympathetic to over-medication issues. But I am surprised at this report overall. It feels like the same kind of thing that happened in psychiatry – a group with a strong ideological bias grabbed the reigns and taken the center stage… <\/div>\n","protected":false},"excerpt":{"rendered":"

I’ve been preoccupied with other matters for a month or so, and looking at my posts – I’m afraid they’re kind of just newsy as a result. I’m free of those distractions at last, and find some things that deserve thinking about rather than just reporting. One such thing is the post I’d like to […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-58591","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/58591","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=58591"}],"version-history":[{"count":25,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/58591\/revisions"}],"predecessor-version":[{"id":59228,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/58591\/revisions\/59228"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=58591"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=58591"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=58591"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}