The Embarrassing History of Psychology
I’m not very proud to call myself a mental health counselor. However, I take pride in telling folks that I’m a holistic mental health counselor. The majority of the people I meet tend to be skeptical of the psychological profession. I understand this sentiment, as I too tend to be very skeptical of the profession. When I ask folks why they are skeptical, I get a wide array of explanations from the unethical treatment of the lobotomy to the overuse and abuse of psychopharmaceuticals drugs. What most people think is weird is I completely agree with them.
For some reason, I love to make life challenging for myself and become that person going in the opposite direction. Maybe it’s a rebellious side yearning to tell the grand system of things, that it’s stupid. But I like to think that it’s my desire to bring back balance to something that is terribly out of balance. I recently came across a book that fully captures the ineptitude of the psychological profession. However, instead of taking offense, I think it should motivate the profession to clean up their act.
As a mental health counselor, I’m continually reading the current scientific research to stay up on the latest treatment strategies and understandings of mental health disorders. There are some great things that come from the research. However, much of the research is missing some crucial bits that seem to perpetuate some old cultural biases. As a result, the standard of care for mental health disorders is grossly, archaic. So why is the mental health care field so far behind and why aren’t they doing something about it?
In an attempt to answer this question, I recently stepped out of the world of research literature and read a book looking at the history of treatment of mental disorders all the way up to our contemporary treatments. Robert Whitaker is a journalist that takes an even hand look and explores this dark past of how we treat our mentally ill in the book titled, “Mad in America.”
I’ve heard the saying, “we learn about history, so history doesn’t repeat itself.” I’ve also heard the saying, “history is written by the victors.” I can’t help but see the crucial relevance of these two statements in psychology today. In receiving my bachelors in psychology, the history of psychology was an elective, as in not required. In receiving my master’s in mental health counseling there was no such class available nor was it required. Meaning, our professionals are bound to repeat the same mistakes in history. I did however, choose to take the elected class to discover that it was horrifically biased towards the dominant culture (the victors).
Whitaker (2002) points out that many of the third world countries around the world have far better treatment outcomes then we do here in the United States. Now you should be saying, “What! How is this possible? We have the money and the cutting edge technology!?!?” And what the scientific researchers of today should be asking is, “what are these third-world countries doing right?”
The answer is painfully simple and also not very profitable. Sadly, the latter is the first reason why most will look no further. The former is why most of the highly educated professionals will look no further. If the professionals knew their history, they would know that this solution has worked not only well but very well. Way back when, the Quakers of York started a facility that treated the mentally ill humanely. You got it; they treated them like human beings with basic civil rights. This basic human decency was the plain and simple treatment. Prior to this, torture was the standard of care for the mentally ill.
Surprisingly, the United States tried humane treatment and it did work. The U.S. created insane asylums where the mentally ill went to be treated well, they were fed, they had opportunities to do all kinds of fun activities, they were listened to, they got to spend time outdoors, and they were treated with respect. However, with this success, the asylums quickly became overcrowded, understaffed, underfunded, and these asylums became places of torture instead of safe havens. Once again, patients not only didn’t get better but they got worse. The media got wind of the horrific treatment and conditions, and the insane asylums were shut down. Unfortunately, the humane treatment strategy disappeared with it.
Today, our mentally ill are largely homeless and treated by police officers, jails, and prison systems. A hefty portion of our tax dollars goes to the continued abuse of our mentally ill, perpetuating the problem. Essentially, in the United States we criminalize people for being mentally ill.
So where does this dehumanization of our mentally ill come from in our culture? Well, history would tell us that there is an ugly thing in our past called eugenics. Eugenics is the idea of purifying the genes so that certain genes do not get passed down to the next generation. You may be saying to yourself, “this sounds an awful lot like something I’ve heard about in a history class in high school.” That’s right, Adolf Hitler’s desire to purify the races by killing off the Jews and folks outside of the Arian race is a form of eugenics. Believe it or not, the U.S. actually inspired Germany into this eugenics fad. The U.S. had several eugenic laws before they started to fall out of favor when Adolf’s concentration camps became public. It was common practice in the U.S. to sterilize the mentally ill and in many states it was illegal for the mentally ill to procreate. This attitude and belief suggests that the mentally ill are less than human. As a result, this some how warrants the attitude that the mentally ill can be treated in ways that we otherwise would never treat the typical human being. The dehumanizing of a group of people is the first step in justifying to “superior humans,” that it is okay to do horrific and often violent acts.
While eugenics has largely become a thing of the past, its attitude still lingers in the American culture and traces of it can be seen in today’s treatment of the mentally ill. Aside from eugenics, there is a long history of Euro-American cultures treating the mentally ill as less-than, from outright torture to brain mutilating lobotomies.
We can all rest comfortably knowing that today, we no longer do these horrible things to the mentally ill. Not so fast, Whitaker (2002) also goes into the problems with our contemporary treatments of the mentally ill. It is not surprising that our contemporary approach is still flawed and suggests a treatment that is dehumanizing and violates some basic human decency. Typical treatment of the schizophrenic patient primarily consists of a prescribing either a “second generation” antipsychotic and if that doesn’t work, a first generation antipsychotic. This is sometimes complimented with talk therapy.
The first generation antipsychotics have fallen out of favor because they are known to cause a condition called tardive dyskinesia, which is similar to Parkinson’s disease. These medications are also highly sedating, cause weight gain, they can increase the severity of psychosis (this is particularly evident when medication is discontinued), along with a number of other common side effects. These drugs make the schizophrenic manageable but they can increase dopamine receptors. An increase in dopamine receptors usually creates an increase in schizophrenic symptoms. Essentially, these drugs are making the schizophrenic worse and more dependent on the drugs. This has created a seriously profitable situation for pharmaceutical companies. These drugs by no means, offer a cure. In other words, this treatment seems to be helping those who deal with the mentally ill. However for the mentally ill, the treatment is actually potentially harmful!
The “second generation” of antipsychotics came out touting that they were improved and minimized the side effects, particularly tardive dyskinesia. However, Whitaker (2002) points out that this is based on bad science. They compared the new medication to a group of schizophrenics that were suddenly taken off their old medication and given a placebo. Because the old medication typically worsened psychotic symptoms when the medication was suddenly discontinued, the comparison group was inappropriate and provided inaccurate and favorable results for the “second generation” drugs. Research also compared the new drugs to a group that was given an inappropriately high dose of the old drugs. These high doses were problematic and again provided favorable results for the new drugs. This inappropriate and misleading research led to the release of these new drugs despite the bad science.
Today, the research continues with the new drugs, which is proving that the “second generation” drugs are not all that different from the first generation of antipsychotics (Whitaker, 2002).
From my personal experience as a mental health counselor, patients are still complaining that they feel lifeless with and inability to feel basic emotions like joy, sadness, anger, or happiness. Patients struggle to motivate themselves to do anything physically active. The list of side effects is long, potentially permanently damaging, and largely unhelpful for most patients. It is no surprise that it is difficult to get patients to stay on their meds.
We need to be asking ourselves, are these contemporary treatments really appropriate, helpful, and humane? Are we still treating the mentally ill as someone less than human? If so, what justification do we honestly have to allow this attitude?
This is not to suggest that folks should suddenly discontinue their medication. As noted before, this could potentially make things worse. Patients should consult with their prescriber to come up with a plan to help minimize or slowly wean themselves off the medication if possible. An alternate treatment plan should be in place at the very least. I suggest looking into orthomolecular treatments; there is lots of research to support the success of orthomolecular medicine, including an entire scientific journal dedicated to this treatment.
Aside from this, we should be asking ourselves, ‘why can’t we treat the mentally ill with basic human decency?’ This is something many third world countries are doing successfully. Provide them with safe shelter, healthy food, teach them stress coping mechanisms, give them opportunities to work and help out, and allow them to have a voice and say in their treatment. Let this be our starting point. This all seems rather obvious to me but for some reason it seems to be eluding the profession.
Professionals also need to stop telling their patients that antipsychotic medication fixes brain abnormality or puts their brain chemistry back into balance (Whitaker, 2002). This statement is not true and the scientific research does not support this. Third world countries that prescribe these medications less are having better success than the United States; this is what the scientific research is supporting (Whitaker, 2002).
If you’re interested, I highly recommend reading “Mad in America” by Robert Whitaker. It’s a simple straightforward book that takes a fearless look at trying to understand the lack of progress found in mental health treatments. With plenty of citations, Whitaker (2002) does his research. The history of psychology is not only failing to be taught but it is taught with a terrible amount of bias. Whitaker (2002) successfully attempts to fill this void. Now if only people in the profession would take the time to read it and do something about it.
Whitaker, R. (2002). Mad In America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill. Perseus Publishing : Cambridge, MA