Four Ideas for Improvement of Psychiatry: An Expansive Discussion

Introduction

Whilst psychiatry has a dark history, it has come a long way from lobotomising treatment resistant patients in modern psychiatric-medical pharmaceutical interventionist glory. It has given a life-line to many people in need of chemical reorganisation of neural networks and cognitive patterning in the brain. However, I have some informed and reconciled ideas for improvement herein.

Main body of argumentation

Whilst I do not consider myself as having an anti-psychiatry disposition per se, four ideas for improvement are:

1. Currently, even if you’re treatment responsive to medication intervention(s), you’re still labelled as having a mental disorder, eliciting an unwarranted stigmatisation. Instead, I would recommend a finding of what I have termed and conceptualized as a medicoza. This means that treatment responsive people are no longer considered to have a mental health condition, as their cognitive patterns have been restored to be within a normal threshold of functioning;
2. A psychiatric test for a delusion is if beliefs held by an individual is non-understandable to same cultural peers of similar cultural backgrounds. This is moralising the group over the individual, and potentially punishes those who go beyond their cultural indoctrination. For a positive finding of a medical delusion seemingly ‘bizarre’ beliefs must be entangled with and implicated in acutely harmful behaviour;
3. More nuanced distinguishing between physicalist-materialist diseases of the brain, with conditions that are socially caused, and in some instances an overlap between the two, is paramount, I argue; and
4. Detainment, discussed here of the medical variety, is a serious deprivation of a person’s liberties and is against a person’s will, as well as is forced medical treatment (with or without psychotropic medication). Just as with penal incarceration, ‘medical detainment’ would be more socially robust in requiring a consensus of psychiatrists, a jury of ordinary citizens, along with an anthropologist, to produce an authenticated forced detainment order of a person. The forced medical treatment of pharmaceutical drugs also should require the same burden of proof discharged through unanimous findings of the aforementioned panel, but it should also require intensive enforced psychotherapy – moving from moderate to intensive psychotherapy intervention as needed – before resorting to pharmaceutical psychotropics.

Rationale and elaboration on the first idea for improvement:

I have written extensively, in publications, re the need for a new category of medicoza, for a ‘labelling’ of treatment responsive persons. Herein persons who presented with psychiatric symptoms that are subsequently resolved through appropriate prescribing of medication, who have been compliant for, say, at least 6 months or a year, are not taxonomically lumped in with patients who are not treatment responsive and are thus unnecessarily burdened with psychiatric stigma and a lack of complexity in the distinction between the two categories treatment responsive and treatment non-responsive.

Rationale and elaboration on the second idea for improvement:

On the second point for improvement within and of modern psychiatric medicine, the (bio)medical establishment, of which psychiatry is a part, needs to encourage ‘the bona fide anthropologist’ in individuals. This is the mandate for the humane adoption of the humane aspects of a foreign culture into one’s own identity and informal and formal philosophical individual disposition(s). This is done through immersion in other cultures, in good faith, to respectfully adopt humane aspects of/to foreign culture, not appropriation. This is to promote bona fide cultural synthesis and humane contagion of memes¹ (Dawkins 1976). This necessarily and imperatively involves, and individually and socially mandates, a deconstruction of culturally-centric judgement and facilitates the deep and engaged study of other cultures – particularly through scientific immersion in ethnographic fields – i.e. the bedrock methodology of scientific anthropology, and/or reading and absorbing oneself in other anthropologists’ ethnographies. This is the scientific study of culture(s).

Further to this, a culturally messy conception of delusions resides in the definition, in the DSM-5-TR, that (medical) delusions, with the individual (not group psychosis) as its locus, is “fixed beliefs that are not amenable to change in light of conflicting evidence” or “as a fixed, false belief that is firmly maintained and resists correction by overwhelming evidence and rational argument” (Frances 2017, p. 10). Let us lay out, as an outset, pertinent and bona fide thought-experiments, incumbent on everyone for reproducing a liberating, pluralist, humane politics of truth-perspectives:

The medical establishment could diagnose Christians as having a medical delusion for their belief that (the historical) Jesus was the only son of God. Certainly, the purported historical Jesus himself would have been medically ‘deluded’ by today’s psychiatric diagnostic criteria (but I argue even this would be erroneous since the requisite harm component would be missing!). So to some psychiatrists, Christians could be considered to believe in the same ‘deluded’ religious metaphysics as historical Jesus, as well as the psychiatric charge by some that Jesus himself was mentally ill! What we are dealing with here, is a deductive purported group/cultural delusion: the vast majority of Christians, however, in their faith in Jesus’ purported lineage as God’s only son, are not medically delusional, and some may not even be culturally delusional – it depends greatly on their ability to reconcile ideas around philosophy of historical and psychoanalytic truth. Against a finding of medical delusion for the vast majority of Christians, this vast majority are able to live productive lives in work and personal relationships – i.e. the harm component of a medical delusion is absent in these people.

As an aside note and sideways reflection, to my personal knowledge, in one, or some sense, I believe that it is a partial(ist) truth that Jesus was a plagiarism of Pagan and even ancient Egyptian predecessors and may have been based on an astrological allegory. Emperor Constantine sought to make Christianity the official religion of Rome at least partially, likely, from his perspective, to cynically instill a slave-ethic in subordinated classes of people who would ‘happily’ toil in impoverished conditions believing they would get a ticket to a glorious afterlife: an intended politicized perversion, in trickery, of the Biblical verse – “[b]lessed are the meek, for they shall inherit the earth”. This is crude and sinister politicization of religious principles, for expediency of a repressive, imperial, ecclesiastical oligarchical power over people. Interestingly, if we apply and annex some of the philosophy of the greatest psychiatrist to ever walk to the earth – Dr Carl G. Jung, ‘a community of faithful believers’ (Žižek) in Christ may summon powers latent in the collective unconscious, surfacing from collective faith-based evolutionary pressures on meaningful identity phenomena: Jungian archetypes, through these pressures, may surface or register at the level of the personal unconscious or even, but more rarely, at the level of personal consciousness; perhaps even a person walking the earth today may embody, to some extent, the Christ archetype²³ – traced back to the power of the faithful community of believers. This theory is of an awesome kind of philosophical self-fulfilling prophecy – linking in with a direction of evolution. To wrap-up and in simpler terms: the power of the faithful believers may actively manifest the (Christ) archetype at the level of embodied identity, surrounding an individual, but not as a totalising identity: i.e. this individual would have a surplus of identity in name, familial and upbringing, for example, resisting a totality of the residing archetype.

It is also interesting to analyse and deconstruct the purported revelatory religious experience of prophet Mohammad. He purportedly believed he was visited whilst in a cave by ‘angel Gabriel’ who disclosed monotheistic God’s law. He went on to found Islam as a religious, political and cultural leader. Subsequently over 25% share of the global population affiliate themselves with Islam (Statista 2022). Is this, according to a psychiatric secular bias?, group psychosis inspired by an individual’s psychosis? Similarly with Christianity, I don’t think psychiatry has cause to intervene in the vast majority of cases in the freedom to choose and appropriate religious meaning around Islam. In all fairness, and as logical, is it not then a corollary that a person or persons with so-called ‘grandiose’ religious beliefs and/or experiences found new religions? I think so (if the acute harm component to substantiate a medical delusion is absent!).⁴

Unfettered meaning-making is the authentic social goal. Medical intervention can only legitimately proceed on the basis of an acute harm caused by insanity.

For some more contextualising information, please see Professor Sapolsky’s interesting take on schizophrenia (sustained psychosis) symptoms:

For some other notable intellectual commentators on psychosis and schizophrenia, please see Jung and Bateson’s insightful works thereon. Jung believed psychosis to be an invasive flood of unconscious processes into the conscious mind, whilst Bateson drew attention to a social causation thereof.

Rationale and elaboration on the third idea for improvement:

Considering psychosis, schizophrenia (lingering psychosis) and schizoaffective disorder (lingering psychosis causing manic and/or depressive states and/or behaviour(s)) as case-studies to elucidate this third vital insight for improvement and amelioration, let us distinguish ‘diseases of the brain’ versus social causation, and the overlap between the two in some cases. The vast majority of incidence in initial presentation of psychosis, schizophrenia and schizoaffective disorder are caused by chemical and/or anatomical physicalist deficiency and dysfunction of the brain. However, as Bateson (1972) argued, chronic subversion of the logical type in human communication (and mammalian communication in general) can be actuated against an individual who is a victim of sustained double binding (exposure to conflicting injunctions in oral and kinesic communicative-exchange) who also cannot escape the field – typically dependents who are subjected to covert abuse by an age-privileged or several age-privileged members of the family unit. If a covert familial abusive dynamic is found by a psychiatric medical professional, authoritative power(s) must be invested in the psychiatrist, to remove the victim from the field of abuse in which they were previously trapped, along with the power to medicate; both of which may be needed to restore ability to discern and act upon the logical type in communication.

Rationale and elaboration on the fourth idea for improvement:

The panel must unanimously agree there is the need for medical detainment through assessing if there is cognitive behavioural patterns in the accused⁶ whereupon there is a nexus from this to seemingly bizarre thoughts and/or delusions which are causing acute harm to the accused and/or to other people by the accused. Other criteria could be assessed as relevant in symptoms of excessively tangential thinking, excessive loose associations, and chronic subversion of ability to discern the logical type in communication; these must also be sufficiently acute in harm as to require medical detainment. Hallucinations (auditory, visual and/or tactile) are very serious symptoms in that it is most probable that they need medical detainment and forced medical treatment using pharmaceutical psychotropic(s).

The jury of ordinary citizens and anthropologist on the panel guard against medicine or medical science being used in ways that are particularly and excessively sociocentric⁷ which would also, in some cases, genuinely qualify the charge of cultural imperialism⁸, as manifesting. Psychiatry as a mechanism of cultural imperialism would be the imposition of established political conformity as a hegemony against the culture of genuine and free-thinking. Laudingly, although rather crude, especially in isolation, there is an extant psychiatric mechanism protecting discrimination against non-Western groups who have beliefs and meaning-generation radically different from Western conceptions: “delusions are deemed bizarre if they are…not understandable to same-culture peers” (American Psychiatric Association 2013, p. 87).

Anthropologists are professionals trained in the detection of sociocentric bias, through the scientific method of immersion in other cultures suspending native cultural judgement and bias to arrive at deep and thick understandings of the cultures they study through fieldwork and then leading to their ethnographies. What anthropologists have uncovered is a radically different pool of meanings throughout the world and populations, many of which have high social functionality; in many cases these are residing outside of the some intellectual tendencies of Western hard-science, often deployed as a (rather dogmatic) yardstick of verifiability⁹, which may, in many cases, be too insular and/or stifling. But all this may be in the process of changing attitudes to the so-called ‘supernatural’. For example, there has been increasing interest in the putative phenomenon of non-local mind which is “the [purported] ability of one mind to influence another mind from a distance” (Henneberg and Saniotis 2016, p. 107). These forms of putative intuitive modes of consciousness involving non-local mind, are ‘normal’ to many Indigenous cultures for instance. Further to this, some renowned evolutionary psychologists contend:

“It may be time to…grant human intuition a little more respect that it has recently been receiving. The evolved mechanisms that undergird our intuitions have been subjected to millions of years of field testing against a very rich and complexly structured environment” (Cosmides and Tooby 1996).

Within Western-centric psychiatry, with the notable exception of Dr. Jung who pointed to the intertwining of rational and intuitive modes of human consciousness and its dialectical interplay with unconscious effects and forces, there tends to be an over-emphasis on rationality. This ignores the more Dionysian aspects to human being-in-the-world which resist or preclude our rational faculties and our species exclusive ability and penchant for reasoning. The province of intuitive modes of being are often-case welded to ‘the supernatural’ in cultivating religious and spiritual knowledge and theological experience(s). To quote the title of the anthropologist of neurotheology Dr. Michael Winkelman’s books: Supernatural as Natural. The supernatural is natural in our species, which exists aside from rationality as well as intertwining with it in other instances. Failure to acknowledge this amounts to an excessively narrowly materialist and debilitating and disempowering philosophy of humanity and its virtue. The rational and spiritual both need cultivating, both on their own and in reconciling their inevitable overlap. For example, one could have knowledge of God a priori (“theoretical deduction rather than empirical observation”) (Oxford Languages). If this – overcoming the estranging of the rational and the spiritual and without denouncing the latter – is cultivated, it is very good and nourishing for the human soul.

What is needed is the uninhibited freedom of meaning-making in cultural subjects:

“These intuitive (non-rational) unconscious and precognitive modes of thought…[are]… important for spiritual, religious and shamanist magico-religious freedom of cultural subjects in the micro and macro meaning-making processes, and [importantly] trigger a release from monophasia” (Willoughby 2020, p. 40).

Monophasia can be defined as the political inculcation of obedient, excessively repetitive rote labour, and over-work, social fact¹⁰ (Durkheim 1895). This has overlap with the extant phenomenon of cultural imperialism. This is caused by the colonial and capitalist social norms and modes of production, alongside and within which psychiatry has manifested. This – monophasia – is linked to the surplus-value¹¹ exploitation of workers (see Marx 2013, pp. 120-127; 146-152) particularly by big business and wealthy investors. We want and need more emphasis on personalized, not sociocentric, psychiatric practice and praxis, where the edification of polyphasic and enchanted ways of being occurs more seamlessly within Western society. Ergo, psychiatry must shrug off its monophasic biases. Westerners must be allowed, free from psychiatric over-diagnosis, to adopt and embody the cultivated spirituality, that may be classed within a polyphasic episteme¹², of many non-Western cultures, for individuals in genuine cultural synthesis.

Regarding the humanizing interplay between rational and intuitive modes of consciousness and meaning-making:

“These processes inevitably involve a dialectic between and integration of Apollonian (rational) and Dionysian (intuitive and socio-emotional) modes of thought and consciousness” (Willoughby 2020, pp. 39-40).

Thus, without an acute harm component, legitimate psychiatric practice must not impede or impinge upon the exigency for freedom and liberty in individual meaning-making and cultural interplay. Somewhat extraneous from this article, for more development on the double source of the Greek deities – Apollo and Dionysus – and their dichotomous relationship, see Nietzsche (1999, pp. 119-138).

The imperative for this panel is especially incumbent given there is, in a monetary economy, more demand for a psychiatrist or psychiatrists labour the more diagnoses they make. So checks and balances on psychiatric power need serious attention and redress. The financial kick-backs from pharmaceutical companies for prescribing or forced medicating certain drugs is currently quite low in Australia (where the author lives). A study found “2.3% of Australian psychiatrists received a payment from a pharmaceutical companies” (Forbes et al 2023). This is reassuring. However, in the United States “[o]ver half of active psychiatrists (55.7%) received some form of payments from pharmaceutical manufacturers” (Rhee and Wilkinson 2020). This would point to a higher rate of medical corruption in the United States, with more perverse incentives apparent.

Conclusion

These are some rationalised and carefully reconciled ideas for the progression of psychiatry as an engaged humane science, and integral branch of modern medicine. Greater cooperation between psychiatric medical professionals and their clients and patients, as a part of subject-subject relations in medicine generally – will pay a great social dividend to all!

References and Works Consulted

American Psychiatric Association 2013, DSM-V (Diagnostic and Statistical Manual of Mental Disorders, no. 5).

Bateson, G 1972, Steps to an Ecology of Mind, The University of Chicago Press, Chicago, pp. 244-278.

Britannica, ‘cultural imperialism’, https://www.britannica.com/topic/cultural-imperialism

Cosmides L, and Tooby J 1996, ‘Are humans good intuitive statisticians after all? Rethinking some conclusions from the literature on judgement under uncertainty’, Cognition, Vol. 58, No. 1.

Dawkins, R 1976, The Selfish Gene, Oxford University Press, Oxford.

Durkheim, E 1895, The Rules of Sociological Method, Simon and Schuster.

Forbes, M, Bhowon, Y and Parker, L 2023, ‘There ain’t such a thing as a free lunch: Pharmaceutical company payments to Australian psychiatrists’, Australian Psychiatry, December, Vol. 31, No. 6.

Frances, A 2017, Twilight of American Sanity. A Psychiatrist Analyzes the Age of Trump, HarperCollins Publishers, New York.

Henneberg, M and Saniotis, A 2016, The Dynamic Human, Bentham Science Publishers, Sharjah.

Holy Bible, Matthew 5:5-13 TLV (Tree of Life), https://www.bible.com/bible/314/MAT.5.5-13.TLV

Horrocks, C and Jevtic, Z 2009, Introducing Foucault. A Graphic Guide, Icon Books Ltd, London.

Hyde, M and McGuinness, M 2008, Introducing Jung. A Graphic Guide, Icon Books Ltd, London, p. 25.

Martin, J January 10 2018, ‘Žižek Has a Lot to Say About Christ, but Should the Church Listen?’, https://churchlifejournal.nd.edu/articles/zizek-has-a-lot-to-say-about-christ-but-should-the-church-listen/

Marx, K 2013, Capital. A Critical Analysis of Capitalist Production, Wordsworth Editions Limited, Hertfordshire.

Merriam-Webster Dictionary, ‘sociocentrism’, https://www.merriam-webster.com/dictionary/sociocentrism#:~:text=noun,of%20one’s%20own%20social%20group