The Role of Culture in Mental Illness

Great Debates
41

Jab:

Appeal to authority. Spurious logic. I am not alone in my contentions.. But OK, I was being deliberately incendiary since it is no fun being on a soapbox without a “Them-representative” to square off against in front of the others, and I guess you’ll do. :slight_smile:
There are several levels of credibility you could assign to psychiatry’s claims for the existence of “schizophrenia”, or, for that matter, to my claim that there is no such thing as “schizophrenia”. Does it completely fail to exist in the sense that unicorns fail to exist, and am I making that claim? Does it exist only in the same sense that “stress” exists, i.e., something that is so broadly defined that it is indistinguishable from that which is “ordinary” and “normative” (and is that the essence of my claim that it is a nonreal phenomenon)?

Or perhaps it exists in the same sense that PMS exists: within a continuum of experience that includes virtually everyone (or virtually every woman in the case of PMS) except to the matter of degree, but for those it affects to a greater degree it constitutes a genuinely disabling phenomenon; but still failing to constitute sufficient reason for denying its alleged sufferers the right to hold positions of responsibility, as some have claimed that it does. Is that the type of claim that I am making?

Or, with respects to the OP, perhaps I am saying that “schizophrenia” exists as a diagnostic and patient-identity phenomenon the same way “multiple personality disorder” exists, but that the diagnostic criteria are so sloppy that their reasonably objective application is impossible, and that the structure of myth that has grown up around it, e.g., the “typical history” of child sexual abuse ritualized in satanic practice followed by the splitting of the self into several “selves” with no recollection of experience if experienced by a “different self”, etc? Is this closer to the claim that I am making?

To be sure, the allegory I use in the paper I cited above assigns “schizophrenia” to the same type of nonreality as “witchcraft”. Yet at various times in my life and in various contexts I claim to be a schizophrenic and a witch.

One gets a large part of one’s identity from one’s social environment, and much of that through the process of having an identity attributed to you by others. And our culture tends to attribute negatively-tinged identities to those who are weird or disturbing or whose behavior cannot be readily understood and predicted by others. But science (and medicine, which distinctly seeks to be viewed as a science) attempts to focus on those things that can be said to have an objective existence. BECAUSE they are viewed as bastions of objective appraisal, their claims should be subject to much more skeptical inquiry, and in most cases, via the peer review process and the application of stringent research methological standards, they are. This is not the case for psychiatric research, though.

So in what sense might “schizophrenia” exist? Well, I think it is true that under certain circumstances, people’s minds tend to go through a surrealistic (and disconcerting) phase in which the everyday meaning of things is confused with metaphorical and symbolic meanings; things take on great impact and import, a heightened drama; and as subsequent thought processes are built upon the existing structure when this is the existing structure, it is easy to end up embedded in a richly textured mental world that has a lot of emotion invested in it, but which is not coherent or comprehensible to other people. I also think that some people, by virtue of whatever factors make them up as an individual (perhaps including their genetic makeup, perhaps including variations in metabolic chemistry), are more inclined than others to slip into this type of mental state, or perhaps to be less able to re-integrate the fruits of this mental world into the everyday world and get their feet back on the ground, than other folks are. I think this is a genuine phenomenon, having been through it myself, and we could call it “schizophrenia” and perhaps could call folks who are more inclined than others to experience it “schizophrenics”.

But it is not a disease. The metaphorical meanings and the dramatic impact of them on the person who experiences them are not merely “brain static” and do not lack real meaning. And it is not caused by “chemical imbalances in the brain”. (If you had had the opportunity to check the brain chemistry of a sample of recently widowed and raped Bosnian women in Serbian concentration camps during the ethnic cleaning and mass rape venture of Slobodan Milosevic a few years back, you might find that their brain chemistry differed from that of a random sample of Baltimore Maryland shoppers. This does not mean that the differences in what they were feeling and thinking is caused by the difference in brain chemistry.)

The ability to point a finger and say "that’s ‘schizophrenia’ does not mean that ‘we can help you’, which is another strand of the belief system difficult to untangle from the whole idea of “schizophrenia”. Jab wrote:

Generally speaking, they can’t help you period. More to the point, I wish it were true that they can’t HURT you if you won’t let them. But because of the widespread belief in “schizophrenia” (defined as, and thought of as, THEY think of and define it, not as I’ve discussed it above), psychiatrists have been given the authority to impose treatment, and their treatment does not help “schizophrenics” cope with and integrate their schizophrenic experience. Their treatment does, however, damage people, and the institutional experience is devastatingly horrible overall.

42

What is drapetomania?

43

Dr Pinky is my new favorite poster! Now, I just have to figure out what it was in my post that generated such a positive response.

  My grandfather was schizophrenic. I saw my first therapist in the third grade. I was diagnosed as schizoprhenic. I carried that label for six years. I have done a great deal of research on schizoprenia. I have reached two conclusions. It exists and I don't have it.

  Like fingerprints, every brain is different. However, if I were to turn over a dozen brains to a good neurologist or researcher, they could determine if any of the brains were from schizophrenics. There are significant differences in chemical composition and structure between the brains of schizophrenics and "normal" brains.

 It seems that the schizophrenia-does-not-exist-argument is this:
     Not everyone can agree on a definition
     Not everyone can agree on a cause
     Not everyone can agree on symptoms

Lets look at Christianity:
Not everyone can agree on a definition (Our sect is the only true Christianity etc)
Not everyone can agree on symptoms (All Christians wear crosses. No! All christians go to church every Sunday etc)

   So if I find a debate over the cause of Christianity, does it not exist?

   It seems to me that many posters are against therapists, and Psychiatry in general. Did you have bad experiences with therapists? Then again there is a group whose members are against psychiatry and make frequent posts to discussions like this one. That's right folk's, we could be up against $cientologists!
44

I am not a scientologist. I am a member of a DIFFERENT group that is against psychiatry and psychiatrists: their prior victims, in the form of the psychiatric inmates’ liberation movement.

I, like you (DocCathode that is), was once diagnosed schizophrenic. There does, of course, exist a logical position (in the Venn-Diagram sense) in which schizophrenics exist, but not everyone diagnosed schizophrenic is schizophrenic. My contention that they are a sloppy bunch of diagnosticians doesn’t in any way refute that, although it indicates that the number of people diagnosed who aren’t really schizophrenic is quite high. (It could also indicate that there is a large number of schizophrenics who have not been so diagnosed).

So I cannot rest my claim that schizophrenia doesn’t exist on the sloppiness of diagnostic procedures alone.

Allan’s corollary: If we stipulate that our ability to distinguish UFOs (whatever they may–or may not–be) from other explicable atmospheric phenomena is not good, that doesn’t prove there are no UFOs at all.

Obviously, in the denotative sense of “does the DSM-IV description of ‘schizophrenia’ describe a pattern of behaviors and experiences that actually exists”, there is schizophrenia. Just as there are, of course, Unidentified Flying Objects. As to what either of them MEAN, what they actually ARE, though…

Schizophrenia is conceptualized, popularized, discussed, treated, researched, and diagnosed AS A BIOLOGICAL DIFFERENCE OF THE BRAIN which is THE CAUSE OF disturbances of thought and feeling which, in turn, are conceptualized as ENTIRELY NEGATIVE, WITHOUT VALID MEANING, i.e., BRAIN STATIC. Just as the folks who “believe in UFOs” believe that they are ships piloted by intelligent extraterrestrial aliens who observe and manipulate affairs down here on earth.

As shorthand, many people on this board would probably say they “don’t believe in UFOs”, by which they do NOT mean that they do not believe that some flying objects are unidentified. In a similar vein, I say that there is no schizophrenia because in the sense that the field of psychiatry conceptualizes it, there isn’t.

45

Drapetomania was a mental illness that induced slaves to run away from their masters.

46

So which of the things in capitals do you disagree with Hunter? And why? Do you favor a revision of the diagnosis of schizophrenia or eliminating shcizophrenia from the books completely?
I am not attempting to be adversarial, I simply want clarification of your positions.

In ADD A Different Perception, Thom Hartmann takes the view that ADD is not a handicap, but a condition that is not advantageous in our society. He argues that ADD characteristics are well suited for hunting. Our society is made up of "farmers". The book is well written and its points well argued. Hartmann also describes a meeting with a shaman in Uganda. A friend tells him that in America, the shaman would be diagnosed with schizophrenia and treated accordingly. Hartmann raises, but wisely avoids answering, the question are all the world's shamans schizophrenics or are the many schizophrenics locked in institutions and given pills shamans misunderstood in a technological society.

 I agree with AHunter3, that the system has many flaws. Many of the therapists, psychiatrists and psychologists I've met should be fired, stripped of degrees and barred form ever working in the mental health field. But I've also met many people working hard to help their patients and willing to listen to them. We need reform, but if we get carried away we'll end up hurting more people than we help-exactly like the shrinks we're fighting.
47

Doc, for every 6-7 sadistic or uncaring shrinks or psych nurses, there is at least one totally devoted, compassionate psychiatric professional who does even MORE damage by trying to help, due to a failure to question the tenets of the medical model of mental illness.

I disagree with all of the parts in caps (in my post a bit up above): schizophrenia, if we are to speak of it as a thing that does exist, is not an illness; is not caused by structural or chemical differences in the brain (although differences may create a greater or lesser predisposition towards “schizophrenicity”, if you will); and is not by any means entirely negative, at least not for all of us all of the time. (For most of us at least some of the time, yes; for some of us all of the time, also yes).

Insofar as it is a normative reaction or coping mechanism of the brain, the people who are (at any given moment) schizophrenic are schizophrenic at least in major part due to the context they are in, and that same context could cause a schizophrenic reaction in others so exposed.

For a variety of reasons–historical, financial, territorial (in the sense of academic and authoritative territory) and a slew of reasons pertaining to the social convenience of having a mechanism for removing inconvenient and disturbing people who haven’t broken any laws–the psychiatric system’s constituent professionals and contributing ancillary professions and industries are entrenched against change in the patterns we would need to change in order to have the system constitute a positive rather than a negative in our lives.

We would be happy to see the psychiatric profession drop its police powers (incarceration, forced treatment), divorce itself from the pharmaceutical industry, bite the proverbial bullet and discard the medical model of mental illness in favor of a holistic self/society interactive communication-and-coping model, focus on self-help and affirmative action and community building and group pride in identity politics, and cease to conceptualize the field as one ideally run by medical doctors. Even many of our opponents who DO believe fervently in the medical model and the wonders of forced treatment would love to see a huge influx of money sufficient to hire and keep competitively brilliant, dedicated, humanistic staff of sufficient size, create pleasant physical sites for community affairs and programming, facilitate individual job and social placement programming, pass laws protecting us from abuse and discrimination, and so forth.
None of that is gonna happen unless we–the folks so labeled–have and weild serious political clout. We are organized to that end as the beforementioned psychiatric inmates’ liberation front.

Admittedly, my sense of “our” and “us” is heavily sculpted by my face-to-face conversations with other psychiatric inmates / ex-inmates who are opposed to forced treatment, opposed to lies and propaganda about the services and treatment psychiatry has to offer, and who have negative horror stories to tell about the “help” we personally have received. There is a large population of folks with psychiatric diagnoses who are users of the system and are dependent on it, either voluntarily or without the ability or opportunity to make the statement that they’d rather opt out. But most of them are not doing well and getting on with their lives and recovering with the aid and assistance of the treatments, therapies, and support of the psychiatric system, whereas those of us with far more critical perspectives on the Mental Health system tend to fall into one of these two categories:

a) Needed help, sought it or accepted it when it was offered, went through miseries of varying degree and duration at the hands of the psychiatric profession’s “help”, and ceased voluntarily accepting such “help”. Often say that the “help” was significantly more traumatic than the original problem, whether the original problem persists or has been put behind them via other means; or

b) Wasn’t seeking help, didn’t consider themselves to have a problem (or at least did not agree with the psych profession that their problem lay within themselves and their ill brains), did not readily or completely accept the “help” but had it imposed on them anyway, to the detriment of their sense of self and personal liberty, and often much worse (including permanent brain damage, rape, bodily mutilation, and the creation of mood & thought disorders not present until after the psych profession’s intervensions).

48

Since I have stated that I find psychology a rather dubious discipline, I should perhaps elaborate lest someone suspect I have some sort of tie with Elron’s loonies. FTR, I’ve never been diagnosed with any disorder or been treated by any psychological professional.

What I object to most of all is the faddish nature of psychology. Far too many “illnesses” become, for want of a better word, popular. MPD, repressed memories, ADD, co-dependency. I’m sorry, but lumping a set of subjectively judged behaviors together and slapping a label on it does not a disease make, yet psychologists are eager to classify and categorize patients into nifty little cubbyholes.

Do I realize that psychologists are trying to help people? Of course. And I realize that many in fact do help people every day. There are lots of very interesting studies, and fantastic work being done with respect to neurological disorders. I do not disagree that there are mental illnesses. (I have a cousin in New Jersey, diagnosed with schizophrenia, who hears voices all the time. She thinks she’s telepathic, and she goes on dates with Jim Morrison in her mind.)

What really does chap my behind is the ridiculous Authority given to psychology and psychiatry, when much of it is based on subjective guesswork. In the eighties we had repressed memories of Satanic rituals and sexual abuse that were the cause of everyone’s problems. People were sued, families torn apart, and lives ruined over events that demonstrably never happened. “Oops.” Fifty years ago, merely being gay was a mental illness, even though it seems obvious today that the foundation for such a diagnosis was mere societal prejudice. “Sorry 'bout that folks.” I won’t even talk about lobotomies or electro-shock therapy except to say that it seems to be a whole lot easier to try out radical therapies if your patients are labeled as nutters. Simply put, “mental health professionals” have too much power built on too flimsy a foundation.

49

There’s actually a whole “branch” of psychiatry devoted to questions concerning the relationship between culture and mental illness known as Ethnopsychiatry. I guess the most well known name in the field is probably George Deverux, who wrote Basic Problems of Ethnopsychiatry and The Psychoanalysis of a Plains Indian. A fascinating topic, but unfortunately, I can’t really recommend either book as I found Devereux’s style of writing incredibly dry. But think about this:

“Devereux asks how one can determine if someone from an entirely different culture is emotionally ill. If a white, middle-class American male believes that he is possessed by witches and demons, then we would probably call him mentally ill. But if a member of a so-called primitive tribe in Africa holds such a belief, would we say the same thing? Presumably not. But does this mean that no member of this tribe may become mentally ill or is mentally ill only if he believes he is possessed by radar and microwaves (that is, forces that have no place in his culture)?” – Alford, C. Fred, Melanie Klien and Critical Social Theory.

Devereux goes on from there to speculate about the structure of the unconscious (which isn’t really relevant here) but I’ve always loved that quote as an example of how culturally relative the definitions of mental illness really are. Culture structures both the ways in which “mental illness” expresses itself and the ways in which it is conceptualized by the surrounding community. In point of fact, even the phrase “mental illness” is a missleading cultural construction, for who is to say that such-and-such behavior constitutes an illness? – A point made amply clear by AHunter3.

My basic take on “schizophrenia”, by the way, is also anti-psychiatric. I’ve worked in psychiatry a long time (8 years or so) and have to agree with AHunter3 that I’ve seen very little except abuse. I also think that “schizophrenia” has a meaning (admittedly difficult to figure out), and that it represents a coping mechanism in an extremely disturbed family situation. The “schizophrenic” is usually a family member chosen to carry the problems that nobody else within the family wants to deal with. In my opinion, the psychiatric community’s insistance that schizophrenia is purely biological disorder consititues a massive denial of the real problem.

But it is, of course, a great boon to the pharmaceutical industry.

50

I think that AHunter3 and I agree to large extent
on the problems, but disagree on the solutions.
A great deal of the problems seem to be caused by the
culture of academia. Theories become enshrined, regardless of how ridiculous (the Oedepus Complex springs immediately to mind). Proffessors foster the attitude that degree holders are superior to all other human beings. Jargon has gone from a tool to make things easier, to a way to keep out outsiders (like patients.). I’ve found these problems throughout the medical field.

     The first therapist I ever saw was a total Freudian. I could deny my urge to bed Ma and kill Pa for the whole session, it made no difference. Looking through my records, I was actually labeled "anal intrusive and phallic sadistic". I am familiar with Freud's stages of development-but what in the hell is anal intrusive?

       All the labels followed me until I found a shrink who did something no one else had. He listened to me, read my file and decided that he trusted his own evaluation of me more than a file.

       I have been committed against my will. There was an active group of patients who sold drugs. Some patients were raped, then intimidated out of reporting it. About the only rule that they managed to enforce was that patient's could not keep food in their rooms.

   On the other hand, I need medication. The psychiatrist I have now wanted to be sure that my problems weren't actually caused by medication. For two months things got steadily worse. At the two month mark I experienced panic attacks, various OCD's and the most fun of all my death phobia returned. She put me back on medication. I still have problems, but there's no comparison.

   AHunter3(I'll come up with a cute contraction of yer name when I'm less exhausted), are you saying that my brain chemistry is not the cause of my problems? If that were the case why would some medications help me and others not?

This post would be more ordered, but it's been a long day. I apologise for that long empty space in my last post. It's the result of an unrelated server problem.
51

Yes, that’s what I’m saying. You don’t suffer from a Thorazine deficiency disease (or any more modern analogue thereof).

If you pause and think on it, I’m sure you’ll realize the logical fallacy of concluding that the field of psychiatry must be correct in their diagnostic and etiological theory because their pills help you out. [If X then Y. Given Y, is X true?]

Obviously, if you have found a medication that helps you cope, this is a good thing. You are having a need met.

But none of the existing psychiatric medications are clever little “magic bullet” pills that intervene in a specific and known brain or nerve process so as to alleviate a specific and known neurological disorder that constitutes a specifically isolated “mental illness”. What they do instead is interrupt, on a pretty broad scale, what nerve cells do. Over the course of the last 50 years, there has been some progress, albeit limited, in devising pharmaceuticals that intervene more effectively with neural tissues that deal with thoughts and feelings and less effectively with motor and sensory neural tissues, but they are still pretty blunt and general in their neuroleptic activity. Of course, that assumes that you have been placed on an “antipsychotic”. Other medications, such as SSRIs, have a different action, although often just as globally systemic in their effect on the body.

Minor differences exist between how your body and mind react to, say, a butyrophenone neuroleptic as opposed to a phenothiazine neuroleptic or a monoaminooxidase inhibitor. Different people react differently to different drugs. Your shrink, if you have a decent one, will try to find a chemical that reduces your unpleasant symptoms the best along with the fewest side effects.

52

**

I have already established that I have some major problems with certain practices within psychology/psychiatry. However, I fail to see why I should believe that your characterization of what constitutes schizophrenia is more accurate than theirs. I understand the idea that changes in brain chemistry and changes in perception or behavior is often a chicken/egg phenomenon. There is strong correlation but no definite causal relationship in many cases (although I am not nearly knowledgable enough about such things to say there are no cases where a proof has been established.) In other words, while they cannot necessarily prove causation by correlation, neither does such lack of proof give weight to your view of the way schizophrenia works.

While I would absolutely agree that psychiatry has too much power, often unchecked to boot, I would definitely oppose any movement away from the medical model toward the less rigorous, less inherently observable end of the spectrum. I find myself unquestioningly more convinced by neuropsychiatrists than by any of the lie-down-on-the-couch crowd. While pharmacological solutions may be overused, especially with children, they do seem to be more successful than talk-based therapy for countless people. While you personally may be helped by, and have confidence in, the buzzword-filled model you described above, there are many who simply will not be so well served.

IMHO, (and this is only a very casually interested layman’s grasp of the nature of things) there are two types of people that are generally classed as “mentally ill.” In one camp there are people with definite chemical/physical disorders that affect the brain. These people have an observable difference in their neurochemistry that evidence strongly suggests causes their troubles, or at least the troubling symptoms. Treatment for these people almost always involves drug therapies, and these are in general fairly effective. In the other camp are people who simply cannot cope or cope very poorly with whatever situations life throws at them. Sometimes this is a common situation others face with aplomb, while other times it is a great trauma. They are people with poor social skills, communications skills, or coping mechanisms. These people are often given drugs as well, but the treatment is nowhere near as effective for them. While the model you espoused above might serve those patients in camp two very well, I have great doubts about its ability to help the poor folks in camp one.

53

Hunt, I don’t think I’m manic depressive 'cause the
pills help. I think I’m manic depressive due to my analysis
of my life. The best shrink can only have second hand experience of what goes on in my head. Having first hand experience I know that my brain does not function properly. Based on that experience and some research I found that manic depression is the closest thing in the books to what’s in my head.

 I'm confused by yer last post. You first say that my problems are not caused by neurochemistry. You then say that the pills are helpful.
  If my brain doesn't need tweaking, why would pills help?

 Pthalis, don't underestimate the circumstances that may send some one 'round the proverbial bend. The largest group of "normal" people driven "insane" by circumstances are probably Vietnam vets. In all my time on the inside, I've never met someone sent there by a trauma which could be called normal.
54

Doc, I have a friend who suffers from chronic recurrent headaches. She has found, after years of experimentation and the help of many a doctor, that a large dose of plain old ibuprofen works about as well as anything to head off the headaches when they are developing. The pills give her relief.

They aren’t sure what causes her headaches. They’ve ruled out brain tumors, sinusitis, and they don’t fit the pattern of migraines, no one has been able to pinpoint the precise cause of her headaches.

But I’m still pretty confident when I say that her headaches are not caused by an insufficiency of Advil in her brain.

55

I think that’s a bit disingenuous AH. The ibuprophen is merely treating the symptom, pain, in a case where the condition is unkown. Besides, there are long-established treatments based on replacement of deficiencies of naturally occuring substances. Hormone therapies, insulin for diabetics, even iron supplementation for anemics who experience poor dietary uptake. There is certainly no reason in the world to think that the same general pattern cannot be true in the brain. While it is certainly true that pharmacological solutions are not appropriate for many patients, there is little doubt in most medical circles that it works very well for not a few patients.

56

My point exactly (i.e., I’m NOT being disingenuous). Psychopharmaceuticals are prescribed because they treat symptoms. That is all that they are known to do. If there is an actual medical condition causing the symptoms, its existence remains hypothetical, its causes unknown, its etiology no more than unresolvable conjecture, and its direct treatment–as opposed to symptom management–equally so.

Many of the theories regarding the etiology and mechanisms of “mental illnesses” were historically derived by latching onto a pharmaceutical because it did a good job of addressing symptoms; studying what the heck it is that the pharmaceutical does in the brain; and then reasoning backwards that the “mental illness” must consist of an insufficiency of that activity, or of a general disposition in the opposite direction.

I don’t mean to imply that nothing can be learned from the process of saying, in essence, “But when we give her Advil (or Navane), the headaches(or affective disorders) go away, so SOMETHING that the Advil (Navane) is actually doing may be key to our understanding of what is causing her headaches (affective disorders) in the first place”.

But it is important to realize that the original condition may be caused (or precipitated) by things other than the condition of the body. When I say “there is no such thing as ‘schizophrenia’”, it is a shorthand way of saying “we don’t know that the set of behaviors and felt experiences that we call ‘schizophrenia’ are in fact due to a physiological condition, and we need to cease to proceed on the assumption that it must be, that it has to be.” The girl with the headaches could have chronic headaches because her kids yell and scream, which leads to calls from the downstairs neighbors which gets her upset, and the kids don’t obey her because her boyfriend beats and belittles her in front of them.

Even though the Advils really do address her symptoms rather nicely.

57

I think I understand your postion now Hunt. It seems we agree on more things than we disagree on. Sadly, only the patients see that the emperor is naked. When we tell anyone, they give us more pills.

58

Okay… I’m a bit confused now. Earlier you seemed to be calling for a divorce of psychiatry from the physiological model of mental illness and a retreat from psychopharmaceuticals. In your last post, however, you seem to concede that pharmaceutical treatments can be effective even if perhaps not greatly indicative of the root source of the trouble. While I understand that we’re running up against the wall of mind/body duality when you talk of whether a brain change causes the behavior change or vice versa, if a treatment is effective and suggests a model that produces viable results, then what exactly is the problem with it? One thing that seems absolutely certain to me is that talk therapy is so inherently non-quantifiable that its proponents would have far less chance of proving its case than would something with physical evidence to point to.

While I have no doubt that teaching coping methods, communications methods, and various other talk therapies are sufficient for many people, I still have to wonder: Considering the tortured history that psychology has gone through, why should we abandon the physical model when it seems to have some very strong evidence, and also seems to be meeting with success in many cases? I don’t dispute that specific terms and definitions, perhaps schizophrenia, may be actually describing disparate phenomena with similar symptoms. Perhaps there are several different ailments that present the same symptom profile, and that is why some respond to drug therapies and others to talk therapy. Regardless, why a call to abandon a model that seems to produce valid results in favor of a variation of one which hasn’t had stellar results in the past?

59

Pthalis if I understand Hunt correctly, and I think I do now, I can explain.

Correct me if I misrepresent you, AHunter3. You position seems to be this:
Shrinks don’t really understand what is wrong with patients. Patients problems may be caused by brain chemistry. Shrinks do not really understand the role of neurochemistry in mental illness although they claim to.
They give them labels that may not match that patients symptoms. These models may be outdated, or otherwise without validity.
Some pills help some patients. Shrinks don’t know why this is, and try pills at random until they find one that works. A shrink may force pills on a patient whose brain has no chemical problem. A shrink may force a patient to take medication that makes things worse. The pills may even be the cause of the problem.

Hunt doesn't want to eliminate these pills. Hunt wants a thorough examination  of the basic assumptions the system is based on, retraining of personell, and a restructuring of the bearaucracy. A change equivalent from the transformation of "snake pit" facilities to the hospitals of today.
60

Well, such pronouncements are all right on the face of things Doc. I certainly agree that no doctor should be able to force medication on a patient without overcoming a very high bar, like a demonstrated danger to himself or others. (Demonstrated being the key word in that.) Beyond that, I think there’s little that can be done other than what we are doing now. Even ordinary medical doctors have to resort to the “try this pill then” method of treating many complaints.