Possibly the worlds greatest Psychiatrist

What a toxic fiasco – surely at the start of the twenty-first century we can do better than Picchioni and Murray’s review of schizophrenia1. Doubtless their review faithfully reflects current views of psychosis – but what an awesomely impoverished view that is. When the term ‘medical model’ is deployed to abuse psychiatry, then some effort to restore medicine’s good name should at least be attempted. Sadly those accusing present-day psychiatry of reducing sufferers to ‘mindless unfeeling robots’ will find ample supporting evidence here.

But first, why no reference to the abundant data that neuroleptics prolong psychoses? For 50 years there has been a continuous stream of damning evidence – from the Nine Hospital Study2 when after 12 months the non-drugged group were twice as healthy, through WHO studies in the 1970s3 where if you developed schizophrenia in countries too poor to afford neuroleptics you went back to work within 3 years, to the latest4 where stopping medication improved recovery rates eight-fold. You’ll be much better off going against what the doctor says – hardly the best basis for any medical practice. Even flimsier whiffs of iatrogenic damage should be intolerable in any medical speciality, especially one as important as psychiatry.

Whichever way you define psychosis, and the definitions offered are unhelpful, it is self-evidently a disease of the mind. Yet this most important of all human organs, is never mentioned. Half baked philosophy, such as the banal obfuscation about ‘mindbody dualism’ in DSM–IV5, doesn’t help – but if doctors use their own minds to puzzle out diagnoses, surely they should afford the same courtesy to their clients.

Not only are sufferers from schizophrenia presented as mindless – they are also seen as emotionless. In the opening sentences of their review, everyone is allowed to feel fear – except the sufferers themselves. And yet this is the key to the disease, as also to its cure – eliminate the fear by extending the ‘healing hand of kindness’, and recovery rates rocket, as they did in 17966. Recent fMRI studies7 indicate how fear degrades cognition. Reducing fear allows sufferers to blossom. When psychiatrists reintroduce emotions into their practice, as I was trained to do8, their tasks become infinitely more rewarding.

Robots and automatons are incapable of intent, let alone consent. Yet consent is the foundation stone of democracy, indeed of civilisation, and thereby also of the stable mind. By enlisting it, rational thought becomes available in even the severest psychosis – a happy outcome that remains unobtainable as long as doctors refuse to allow themselves to talk openly about infantile terrors and traumagenesis.

Picchioni and Murray’s review is based on meta-analyses. A rather different perspective emerges in a public debate9. Here parents and others eloquently describe their suffering, and the damage done by medication. Also on display is a psychiatric nihilism bordering on the inhumane – enough to make you wince. Psychiatry should be queen of all medical specialities, but first it must eliminate every last thing portraying human beings as ‘mindless unfeeling robots’.

Dr Bob Johnson