Psychiatry & Me Who Guards The Guardians?

By Don Pritchard

The author outlines the essentials of both professions and many of the problems.. These are clearly illustrated with interesting case examples from his own clinical experience. He gives clear details of the procedures involved. The interested reader is offered more complete details in appendices that set out the theoretical bases of both approaches to treatment. These are optional as this is not a textbook.
He points out that, at the beginning of the modern age of treating emotional distress, 95% of psychiatrists throughout the world opted for a method that has as its basis details of patients’ sex lives, and placed the emphasis in treatment on childhood sexuality. From that choice evolved psychoanalysis in all of its forms. He shows that treatments based on this model have very little in the way of positive research outcomes. The author makes the case that in choosing this path, the bases of science were ignored and the carefully developed, effective alternative therapies were not valued. The consequences, he states, have been severe for some patients caught in the psychiatric system and he gives shocking, recent details of psychiatric abuse. The book opens with his own history and family experiences, for reasons which he has outlined.
Concerns about the future direction of psychiatry are outlined

• Language: English
• Publisher: Don Pritchard
• Release date: Oct 8, 2017
• ISBN: 9781370961115

Don Pritchard

Born in Ranfurly Otago New Zealand where at nearby Waipiata my Mother was a nurse and my father a gardener. I went to primary school in Timaru and to Boys Technical College. I spent some time as a Journalist Cadet on the Timaru Herald and then as an apprentice electrician with the local MED. I moved to Christchurch to go to Canterbury University meaning to study Journalism but the course was not not offered in the year that I enrolled. I swapped to a Psychology Degree and studied Psychology, English,Sociology, Greek Philosophy and Art, Religious Studies ( Psychology and Philosophy) and Education. After graduation I gained a job as a Guidance Officer in the Education Department dealing with directing placing teens into suitable jobs. While there I applied for and won , a scholarship to study Clinical Psychology at my old University while being attached to a psychiatric facility. In my last year I tangled with the Health Department Psychiatric Director and decided to move to Australia. In Australia I began with an appointment dealing with distressed children and families, but found that it was not what I wanted so I moved to a large Psychiatric in Adelaide. I was appointed from there to the Senior role in the Health Department as the Chief. At the end of that appointment I was seconded to Adelaide University as a Senior Lecturer and taught a Master's course in Clinical Psychology. I was appointed Director of the Stress Management Clinic within the University. I left there and went to what was supposed to be a Locum job in Buckingham, England. On moving back to Australia I was employed in a private practice and by an American company, contracted to assess the suitability of applicants for the military, I then retired.

Book preview

Psychiatry and Me

Who Guards The Guardians?

A Personal History

Dr Don Pritchard

Copyright © 2017 Don Pritchard

All rights reserved.

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Table of Contents

Introduction

1. My Family and Other Influences

2. Time at University

3. Sunnyside Hospital

4. Time to Go

5. Finding Another Job

6. Interviews & A New Job

7. Exams & Alice

8. Psychoanalysis and Learning Theory

9. Treatment Problems

10. Adult Psychiatry

11. Hospital Organization

12. Trial in The Alice

13. The Care of Mentally Ill Prisoners

14. Queen Elizabeth and Psychiatric Training

15. The Community Centre

16. Love Actually

17. Limited Country Services

18. How to Become Depressed

19. Anti-Psychotic Drug Treatment

20. Charlie & Physical Health

21. Mad, Bad, or Just Unlucky

APPENDIX

a. Freudian Theory

b. A Learning Theory Primer

Our society tends to regard as a sickness any mode of thought or behavior that is inconvenient for the system and this is plausible because when an individual doesn't fit into the system it causes pain to the individual as well as problems for the system. Thus the manipulation of an individual to adjust him to the system is seen as a cure for a sickness and therefore as good.

— Theodore J. Kaczynski

The visitor looked carefully around the 750 year old library at Merton College in Oxford and saw Impressively peaceful rooms basking in the sunlight gently reflected from rows and rows of leather bound volumes which, at one time, contained all knowledge of the world. He then stated with a degree of finality that

‘All of the information in these volumes is now irrelevant except to scholars of history who were not very relevant to anything’

I felt inclined to agree with him. It made me wonder about the value of history and my own in particular.

Discounting theological treatises probably negates most of the Merton collection, which is information about other-worldly beings such as God and the Devil, and unavailable to proof. The collection does contain many texts on the treatment of the sick body and the sick soul as it was known at the time: Is all of that information now useless as the visitor suggested? I find it difficult to find a reason for retaining it except for the fact of being ancient texts.

The Hammer of Witchcraft, written at about the same time as the bulk of the Merton collection, is a medieval book in Latin (I keep a copy in English), called Maleus Malificarum and gives details about how to spot a witch and how to deal with her. The options would probably lead to death even if she were found to be innocent as the process of testing was torturous.. I am reminded of the possible consequences of a psychiatric label.

It was in fact, the handbook used in priestly training and in medieval times was used mercilessly to support allegations of devil worship. It would be a brave man who could now suggest a use for it apart from teaching how bad things were then but it does have modern parallels in our beliefs and our dependence on the modern equivalent, DSM V, which we will encounter soon in this book.

I would place current psychiatric knowledge in the same category as The Hammer, a set of arcane, mystical half-truths practised only by the anointed having the capacity to harm because it keeps people in need of help from receiving effective treatment from elsewhere.. The physical treatments now available can and do cause harm because of the very poor science underpinning the bulk of the outcome studies. The early psychiatric beliefs have much the same quality. They depended on faith but have hidden behind science and the consequences of that neglect is what I write about here.

Introduction

My evaluation of the psychiatric profession is based on the evidence of my long experience with psychiatry and the evidence of a great deal of basic research little of which I have included into this book as it is not a textbook or an instruction manual it is a recollection of experiences and my reflection on them. As I am a responsible author I can, and will, if requested, support all of the conclusions that I draw in this book with appropriate research references as I have been obliged to do with all of the scientific papers that I have written.

There are at least three reasons why I write about my experiences with psychiatry, the first is that I have seen ordinary Australians people brought down from humans who have been functioning well for the most part, to sub-humans lacking dignity grace and respect, after a stay in a psychiatric institution and I want to protest in the only way that I can.

Secondly, because I have experienced professionals enjoying all of the rewards of professional status, high esteem in society, and high salaries, on the basis of the presumed possession of a higher knowledge. I will be examining the reality of the latter in this book.

Finally, because to write my history I hoped to see what I could learn about myself. In some intangible way my past influenced the events recorded here. Is that a tall order? Probably, but it is worth a try.

How far does this condition of professionals earning on the basis of no evidence prevail in our society? Dentistry opinions are often flawed, physiotherapy chiropractic are largely based on traditional methods not developed from science,, and clinical medicine I found to my surprise, is not based on evidence from clinical studies. It is estimated that about 70% of GPs clinical practice is not based in evidence. (Google The Cochrane Collection) Has it happened before? Well yes, in the ninetieth century medicine had little knowledge that made a difference to, for example, the life span or to the general quality of life. The greatest benefit to the public over the last 200 years was public health measures, a higher standard of hygiene thanks to a clean water supply and adequate sewage disposal.

Most texts point to the actions of John Snow a physician who after studying the incidence of cholera in a London borough found a point common to many deaths and suggested that the water supply was contaminated as it drew from the heavily polluted Thames River. He took the handle of the pump so that it could not be used and the incidence of cholera dropped away giving good evidence of a water-borne pathogen.

This was simple practical science soon to become much more complex as the results from a flood of scientific investigations came to be known. The most prominent of which must be the investigations of the Pasteur’s who showed the influence of bacteria on health and the benefits of pasteurization, and vaccination.

Psychiatry did not have a John Snow and was left with theories of treatments that derive from the earlier part of the nineteenth century and from one man’s theorizing… I believe that we still have that misfortune as science did not figure at all in psychiatry at that time:

In the late 19th and early 20th centuries, most physicians held a somatic view of mental illness and assumed that a defect in the nervous system ay behind mental health problems. To correct the flawed nervous system, asylum doctors applied various treatments to patients' bodies, most often hydrotherapy, brain surgery, spinning chairs, electrical stimulation, a wide variety of substances and bizarre procedures in the hope of finding a cure.

One of the major therapeutic procedures from that time was bloodletting either from vein cutting or from leeching, that is placing blood-sucking creatures on to the skin of a patient. It might also include the slitting of a vein or artery until the patient became light-headed near to fainting and the blood was then discarded. France imported millions of the leeches yearly to meet the demand until controlled studies showed it to be a dangerous and ineffective nonsense. I love this, the main practitioners of blood-letting were the barbers who had the cutting implements for vein slitting and they advertised their profession with a pole which had a red stripe twisted thorough white, still used today by barbers.

Surgeons were therefore involved with the barbers and because barbers were not university trained then at that time they had no titles so the surgeons still often now call themselves "Mr.’ even though they now have the same basic training as any other physician ‘Drs’ in our society do not have university doctorates they have two undergraduate degrees so there is a split between professional and university qualifications. The ‘Dr’ is honorary but the title helps in acceptance and credibility. The Americans offer MDs (Doctors of Medicine) to undergraduates in medicine, DDs to dentistry, and similar titles to Vetinary Surgeons, Chiropractors and many others while still offering the same level of training as those from a British University. (And from here it gets very complicated when we get to titles in the university, interesting to me but is of no consequence here. Not everyone is as interested in academic titular foibles as I so I will not continue.)

.

As an example very erroneous knowledge widely accepted and acted on, the whole medical world at one time believed that our moods were controlled by the balance of the ‘humours’, or body fluids. The four humours of Hippocratic medicine are black bile, yellow bile, blood and phlegm. The beliefs were were overtaken by newly published theories of cellular pathology that is by the results of scientific research. The rationale of bloodletting was to get the blood humour into balance with the other three. The humoural theory was found to be satisfactory for over 2000 years.

Without pursuing the many reasons why these unsupported beliefs were accepted. it still happens. Think of the nonsense promoted by the vitamin pushers in our own time: Even when faced with clear evidence of their failure to work, they are still sold in huge qualities. Look how long it took to convince governments to stop paying for homeopathic remedies,and they are still sold and consumed in large quantities.. A search on Google will show that the scientific base is close to nil. The field of alternative medicine is alive and well.

One of the powerful reasons for the continued interest in unproven practices was termed post hoc ergo propter hoc in Latin and it means ‘after the event, therefore due to the event. The phrase refers to the quite natural inclination of us all, to attribute a recovery from say, the flu or an illness, to the last pill that we took. It may have had nothing to do with the outcome but if it was taken with the intent of helping then relief is attributed to the efficacy of the intervention.

Almost all common human health disorders have a limited life span measured usually in days or months and will improve over time and this includes the psychological disorders such as depression. When recovery occurs without specific intervention then it is referred to as ‘spontaneous remission’. A recent study indicated that over a year 23% of adults will experience remission of depression without treatment in three months, 32% in six months and 53% in a year. The recovery rates for children and adolescents were better than for adults and the elderly. If an anti-depressant was taken at any time prior to recovery then the improvement would be attributed to its action. This is not the placebo response which offers different control problems in research. Placebo refers to an inert substance given to simulate treatment and which has a known positive in about 33% of persons, even me! There is an extensive literature on the effect but sadly no complete answer. It is important in any trial of therapy to control for this powerful effect.

The reluctance to change whether you are a professional or not is exemplified by the sad story of Dr Semmelweis a Hungarian physician who in 1847 discovered that the incidence of puerperal fever (also known as childbed fever) could be drastically cut by the use of hand disinfection in obstetrical clinics. Despite various publications of results where hand-washing reduced mortality to below 1%, Semmelweis’s observations conflicted with the established scientific and medical opinions of the time in Europe. His ideas were rejected by the medical community though he had the data but not the reasons for success as germ theory was not really confirmed until Pasteur in 1880.. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings so they carried totally neglecting their hapless patients’ wellbeing.. The medical students came straight from examining dead bodies and then without washing, physically examined the women.. Dr Semmelweis was, at the end of his life confined to a lunatic asylum but his condition did not negate his data.

The questions that I am keen to assess are basic.

• Have we progressed in our knowledge of human psychological functioning since these times and are we better at helping persons with emotional disorders. If not then why not?

• Have we got better at what we do through an understanding of science?

• What has controlled the development of theory and consequentially practice and is it effective?

In the first Chapters I give an introduction to my own formative learning experiences at home and to satisfy my need to write a history. The intervening chapters document the conditions of the time in psychiatry and the experiences from which I draw conclusions and look at alternatives to the medical annexation of misery control. I then describe my first year in a psychiatric hospital as the only Clinical Psychologist in South Australia at that time and the problems attendant on that. I hope that details of clinical practice and of the theoretical differences between the Psychiatrists will contribute to an understanding of the problems.

If after reading the last chapter, a review of one person’s recent treatment you do not agree that there has been little progress over the last fifty years then I would respect that opinion…maybe. In the following chapters I explain as clearly as the material will allow the theoretical and practical difficulties that occurred in the profession at that time and I give plenty of practical examples of intervention and of my hospital experiences.

My Family and Other Influences

I had at one time thought that my father was a brutal and unfeeling man. He used to physically thrash my brother, who was admittedly, hyperactive and an inadvertent trouble maker, by putting his head between his knees to hold him and then beating him either with some of the kindling wood or with his razor strap. At times I lived in fear of these beatings. My brother managed to avoid much of it by simply running away, returning after some hours to a slightly defensive Dad and agitated mother. My sisters denied ever being hit by him so I suppose he was exercising his Edwardian-based powers of discipline. I still feel uncomfortable relating these events. My brother said that he had nightmares of Dad belting him even after fifty years.

Backing our opinion of brutality was his treatment of the unwanted kitten litters with unopened eyes which was to place them into a