a) Bringing up the fallacies of “talking therapy” (usually with Freudian couches in mind) to bolster the scientific basis for medical-model psychiatry is a lot like using the silly claims of Scientology to argue in favor of faith-based healing. It’s a straw-man argument. Very very few of the folks who are critical of the modern practice of psychiatry are even remotely pro-Freudian.
b) I’ve said this before, so if you’ve encountered this, feel free to skip down: Once upon a time, round about the time Louis Pasteur’s discoveries were new and exciting, there was a lot of optimism that the peculiar ailments of the mind formerly thought due to ill spirits and whatnot would yield up their secrets to scientific inquiry and turn out to have causes similar to other diseases, and cures would be forthcoming. At this time, mental bins were largely modeled after those set up by Kraepelin and Bleuer, and did have doctors in charge of them although the “treatments” were coercive behavior-management models such as the so-called “moral treatment”. Anyway, to a major extent, the optimists were right: one widespread dementia pattern turned out to be caused by syphilis infection in its latter stages; a small handful turned out to be different manifestations of epilepsy; another common became understood as hypothyroidism; and so forth. But what happened was, once a true medical explanation was found for this or that “madness”, the treatment of that condition was lifted out of the awful grey domain of the mental sanitorium and taken over by doctors who actually practiced medicine: internal medicine handled syphilis, endocrinology laid claim to thyroid diseases, and neurology took over epilepsy and seizure disorders. This was in part necessary because people suffering from diseases that could actually be effectively treated and cured were not to be relegated to the company of folks for whom there wasn’t much real hope, and the keepers of the human warehouses in which they were held. Meanwhile, parallel to these success stories, the myth of appropriate medical treatment for mental patients in general flourished as window-dressing for institutionalizing nuts and keeping them locked up. Society’s conscience was salved by the notion that the people held in such places were getting the best treatment available for such unfortunates. For every generation since Pinel struck the chains from the psychotics in the Biticre in the late 1700s, the story has been “Oh, simply awful things were done to the poor mental patients a couple generations ago, barbarian places those insane asylums, snake pits I tell you! But it’s all better now, scientific, you know, compassionate and medicallly-based and they know what causes these problems and what to do about them, and the folks who are in there get the best of treatment”.
c) Psychiatry today is well-stocked with idealistic medically-trained personnel who are trying to do well by their clients. They are, as a general rule, very very heavily lobbied by the pharmaceutical industry from the time they apply to medical school through last week, to think of mental illness treatment in terms of “use this new miracle pharaceutical”. Despite that, many of the doctors practicing psychiatry are well aware that the search for a true etiological explanation for the mental illnesses, and for treatment that renders cures rather than simply making symptoms easier to manage, is a search as of yet unfulfilled. They use the tools available to them to lessen suffering as best they know how, and they have no incentive for standing on the rooftop shouting “We’re doing what we can but we don’t really know what the fuck we’re doing!”
d) There have been recurrent waves of oppositional thinking that have dismissed the medical model of psychiatry. With psychiatry perpetually making claims to etiological and curative knowledge that it simply can’t back up, there have quite often been people who have said “This isn’t a medical problem, give it up and rethink it”. The constellations of thinking, feeling, and behaving have been recast as social-psychological in origin, or political-social-psychological, or as non-pathological normal processes of growth and development, or as the mind’s healthy method of working through pathological psychological problems, or even as biological predispositions that only manifest as those symptomatic behaviors and etc under certain stress conditions but which are best treated by reducing the stress conditions.
e) What may be the most important shift in the last 35 years is the slow rise of self-determination among folks with psychiatric diagnoses. The opinions of the patients themselves regarding what the problem is and what to do about it runs the gamut — there is a Mental Health Consumer Movement largely comprised of people who believe in the medical model and wish to have access to the modern pharmaceuticals, but who want the same right to refuse unwanted medical treatment as any other medical patient, and who want to see psychiatrtic treatment and practice subjected to the same accountability and oversight as other branches of medicine. They’re tired of being the stigmatized patients of a “ghettoized” profession. And they want equitable insurance coverage for the treatments they need, and protections against discrimination against people with psych diagnoses, etc. Then there is a Mental Patients’ Liberation Movement which is generally opposed to the medical model (::raises hand to identify self: and whose members put faith in user-run self-help treatment modalities that don’t involve medication. These folks are even more vehemently opposed to forced treatment because not only do they insist on self-determination, they also believe most medical-model psychiatric treatment is dangerous rather than helpful. Many of them do not consider themselves to have any problem aside from the social problem of not being left alone by folks trying to impose unwanted psychiatric treatment on them. At any rate, what the two components of the mental patient self-determination movement have in common is the attitude that we should be allowed to choose for ourselves.
There is an undercurrent of belief within the other branches of medicine, even among doctors who believe that the mental illnesses do indeed have a biological component, that psychiatric medicine’s claims to medical professionalism are somewhere on a continuum between “best taken with a few grains of salt” and “absolute quackery touted by snake oil salesmen”. The history of psychiatry feeds into this, as does the presence of involuntary treatment.