One of the subtle but underlying factors that keep the great divide active between psychiatry’s medical model of human emotional suffering, and the alternative paradigm that challenges it, is the existence of a class system based on meritocracy, that accounts for some of psychiatry’s rigidity in considering an alternative paradigm position. The credible research that supports such an alternative view is often ignored, which is inconsistent with the scientific method that psychiatry claims is the legitimizing foundation of its theory and practice. I’m offering a partial explanation of why such valuable research is ignored.
My remarks here are based on working side by side, every day for over 30 years with my friends and colleagues who are psychiatrists. Some of them seemed to suffer from what I would, in good nature at times describe to them, as an addiction to deference!
Most psychiatrists come from middle class backgrounds and have accomplished a huge feat to get an MD and to practice psychiatry. They are accorded deference in a professional hierarchical class structure based on merit, that reflects another way that our classist society stratifies itself.
Their daily and decades long experience is that every nurse, secretary, and other mental health professional in every clinic and hospital, will defer to their judgment and authority, due to their status and more advanced degree and license to practice medicine.
The medical settings where they work positions them at the top, in terms of pay and status and authority, and the huge power to prescribe medical treatments that are exclusive to their profession. Sometimes these treatments can only be done on a doctor’s order, such as ECT, forced and voluntary medications, and restraints.
Having worked along side psychiatrists everyday for all these years, I can only say they have always been shocked when I did not defer to them.
They would want the last word in every decision about every treatment they authorize or drug they prescribe with “their patients,” as they proprietarily call consumers, because they believe their license requires them to take sole responsibility for the quality of care given.
When necessary I would not give them the last word. I hold my obligations to the people I serve as an ethical and sacred trust too.
From decades of experiencing psychiatrists’ reactions to me when I would professionally, and while showing them all due personal respect, not defer to them about decisions that effect the consumers I served, I learned that a huge obstacle to the honest debate that non-psychiatrists would have with them, is caused by the fact that such questioning of a psychiatrist’s theory, research and practice is so often experienced by them as impertinence.
In those 30 years I was almost always the only professional I knew who openly and consistently would not defer to them if need be. It slowly occurred to me, that a regression to the psycho-familial grips a great many psychologists and other professionals in the field, when faced with the psychiatrist’s expectation that they should defer.
The old adage that children are to be seen and not heard, feels like the unspoken message, and in fear of surrogate parental anger, a child-like regression seems to block some adult care givers from speaking up with psychiatrists.
There are real time consequences for other professionals challenging the psychiatric authority that claims an absolute position of superiority in the meritocracy hierarchy. That hierarchy replicates the power dynamic we experienced with our parents.
In addition to serving consumers 40 hours per week for 30 years, I believed that part of my service as the elected president for 16 of those same years, of my 250 white collar union mental health staff unit, was to embolden co-workers to question authority and stand up for themselves and the rights of the consumers we served. As human rights activists, we needed to do that with mental health system administrators and politicians as well.
Sadly, only a handful of my co-workers were consistently able to speak truth to power.
So, if you are a psychiatrist reading this now who probably never has experienced any response but being deferred to for the reasons I have given, you may feel like the psychiatrist who glared at Bob Whitaker all through a presentation Bob was doing, that I heard him report about at a conference.
As I heard Bob’s telling of the story, it went something like this- the glaring psychiatrist approached Bob after his presentation. Bob was hoping for a forthright exchange about the research issues that he had offered for consideration. The psychiatrist instead said something like, “I came up to tell you that I am not interested in your ideas or to discuss them with you. I just want you to know this Mr. Whitaker, I do not like your attitude.”
This exchange with Bob, captures the feeling tone of all of those times I would respectfully challenge the stated opinions of psychiatrists, as for example, when I witnessed them telling many consumers I served in therapy, that they had a life long, genetic based brain disease, that would require them to be on medication for the remainder of their lives.
First things first. Don’t defer to anyone who says what you do not believe to be true.
First published at Mad in America.