A Call to Arms. The future of psychiatry is at stake.



Psychiatry is fast approaching a death spiral which we as a society may not be able to recover from. In many residencies, psychotherapy is not even being taught. Many psychotherapists of all professions – psychiatric, psychologists, and social workers have been intimidated by specious neuro-biochemical theories, while others have simply given up. And now, there aren’t many remaining good therapists in practice anymore.

The chemical imbalance theory of somatic psychiatry has almost completely replaced a genuine understanding of human struggle. The underlying theory of somatic psychiatry is that the source of human struggle is considered to be the brain itself, rather than the person. Treatments that follow from this simplistic, mechanistic, and reductionist notion have been to act directly on the brain, which in my experience leads to problematic and misleading outcomes. The real source of human suffering is not the brain. It is in the person, the human being, in the context of damage to his play of consciousness. This damage is the consequence of deprivation and abuse from our emotional environments in the formation of our personalities. This takes place in relation to the unique constellation of our temperaments.

My life’s work has taught me that the art, the science, the discipline, and the wisdom of psychotherapy attends to this damage. Tragically, over the course of one generation, psychotherapy has become almost extinct and has been replaced by drugs. There are no miracles and no shortcuts, as drugs, like the rest of its bedfellows, ECT and lobotomies, always promise. We have repeated the same mistakes over and over again, and we are doing so today.

Even the APA, when pushed, acknowledges that the chemical imbalance theory is not really true. Never mind that this simplistic and false theory lacks any credible validation. Although they now add in that there are also vague, environmental factors, whatever those are. But this is all a ruse.

‘Chemical imbalance’  has been accepted by psychiatry and the general public as completely true. People believe that psychiatric conditions are ‘illnesses’ that should be treated by pharmaceuticals – so-called ‘biological depression’, anxiety, psychoses, and even the fictitious ADHD – with antidepressants, benzodiazepines, anti-psychotics, and amphetamines. See – “No It’s not the Neurotransmitters. Depression is not a biological disease caused by an imbalance of serotonin.”

In addition, it is common that therapists are confused by contemporary neuroscience. I find the explosion of neuroscience a wonderful thing. To discover how the brain works is illuminating and fascinating. Any theory of mind has to be consonant with the way the brain actually works. However, a superficial understanding of neuroscience often mistakenly seems to support the neurotransmitter theories of the mind. What many neuroscientists don’t understand is that an understanding of the brain also has to be consonant with the way human nature actually operates.

Human nature operates through our consciousness. The more we understand the workings of the mind, we come to understand that consciousness is organized in the brain as a play, as stories, with characters, feeling relationships between them, scenarios, plots, landscapes and set designs. We evolve our characters over the course of a twenty years of child raising. The biology of the brain creates and informs our character as a whole. Parts of the brain like neurotransmitters and the various brain modules do not operate independently. They operate as a whole to simply create the play of consciousness itself. See – “The Secrets of Consciousness, the limbic-cortex is organized as a drama in the brain.”

Psychiatric problems reflect how the traumas of deprivation and abuse, in concert with our temperament, create our character. Psychotherapy is the best way to heal from the pain and symptoms of being human. In the context of a safe therapeutic relationship, we can mourn the problematic pains of our lives to a write a new play that is more consonant with loving and authenticity.

Human beings have complex inner lives, and psychiatric problems flow from the great mysteries of life. The idea that human struggle reflects a problem with neurotransmitters is absurd and insulting on the face of it. We do not suffer from mysterious brain diseases. To truly be a psychiatrist in the spirit of what was always intended requires a lifetime of dedication to plumb the reaches of human mystery.

I very frequently get comments from other psychiatrists who say, ”I give antidepressants and do therapy. It helps the therapy”; “Why limit yourself to just therapy as if one size doesn’t fit all conditions. Use everything in your arsenal and give drugs when they are needed.”; Many psychiatrists believe that walking some middle road is an open minded and superior position. And anything different from this is deemed to be dangerous and narrow minded. This, of course, begs the most important issue – do antidepressants, benzodiazepines, amphetamines help, or do they cause harm? If one studies the real efficacy, they are not useful. I’m making a stronger case than they are just not useful in the long term. Even regarding short term crises, i.e. depressed, suicidal, or anxious, etc. the use of drugs is misguided. It is, in fact, not hard to reach a patient, which results in the short term crisis passing. The very introduction of a drug removes it from the human sphere and falsely confirms that a crisis is a biochemical disorder and needs a biochemical fix. This is not true. Once people falsely believe a drug fixes what ails them, they depend on that drug. The real issue, whatever it may be, anger, masochism etc., needs to be addressed in a real way to truly get to the bottom of it. I believe these uses of drugs interfere with therapy, and do not permit real mourning and healing. Real therapy is useful under all circumstances.

When our current prevailing fad passes, and it will, what are we going to be left with? Our psychiatric community will be composed of empty prescriptions with nowhere to go. We have lost our center. And don’t worry contemporary psychiatry isn’t planning on folding its tents anytime soon. My fear is that it is already too late. The hope for the future depends on young professionals who think for themselves, people who are drawn to quest for the real item. But who is going to teach them? Will we have to start all over again? I hope that those of us who remain true, will rise up and put a stop to the present travesty. We need a clear paradigm by which science contributes to a fully lived human life, rather than diminishing it. We need to understand the real implications of psychiatric drugs. We need respect for our patients autonomy as they face their issues in therapy. We need to re-establish the proper place of psychotherapy, and to pass on its wisdom to the next generation has to be our goal. I hope self-respecting therapists will make their voices heard and not be intimidated by the profound pressures of the APA and big Pharma.

Image credit – copyrighted by Drsaulmarcus.com

7 replies
  1. Eliot Gelwan MD
    Eliot Gelwan MD says:

    Bob, I think you are throwing the baby out with the bathwater. I too am a psychiatrist who favors engagement with the human struggles of our patients as the real route to lasting amelioration of their problems. Yet I am a psychopharmacologist as well and I think you are painting with too broad a brush when you say, as the crux of your argument, “The very introduction of a drug removes it from the human sphere and falsely confirms that a crisis is a biochemical disorder and needs a biochemical fix.” This is only true in the hands of the wrong prescriber, who does not adequately and artfully convey a more realistic understanding of the value and limitations of medication treatment. I know how to talk to my patients about this and I suspect you are as well. I do agree that psychiatry is at a crossroads in which the need for this, and the skill to do so, is not developed in our younger colleagues. This is to our detriment and, more importantly, the profound detriment of our patients.

    • Robert Berezin
      Robert Berezin says:

      I don’t mean to sound like I am pushing my book, but I hope you will read it. It gives a full presentation of what I can only say in extreme shorthand in a blog. I obviously agree about the crossroad in psychiatry, and I am very worried about it. I would very much welcome a discussion.

  2. Matt Faw
    Matt Faw says:

    Eloquently put, Bob. I have to admit, I’ve never thought about it in quite that way, and have assumed that the drugs were useful or even necessary. Of course, the high profile cases of Robin Williams and Tony Scott committing suicide while on anti-depressants definitely re-frames the question. And I think about (as a pedestrian example) how my mom fed us margarine, insisting it was healthier for us, but having no idea that trans fats are the worst thing for you. So I agree, that what may seem like a boon today, may reveal itself to be a bane, tomorrow.

    Having read your book, I must say it portrays a form of therapy that really makes sense to me, on an intuitive level. And I also believe that the human body has within it, great capacity for balancing itself, even healing itself, especially if guided to do so. I can see how psychoactive chemicals could actually rob the individual of the opportunity to come to balance within himself.

  3. Craig
    Craig says:

    I have been under psychiatric care in the past and have had both good and horryfying experiences. However, I am tired of hearing how dangerous the psychiatric world is, and how safe the world of psychotherapy is.

    I have been in therapy in the past, and in many instances it has been beneficial, it has also been disastrous. I was going through tremendous upheaval six years ago, and placed my life in the hands of a trained reputable therapist. Her lack of empathy and hasty need to obliterate my denial mechanisms exposed a horror of underlying fears/neurosis, the weight of which plummeted me into psychosis. As a therapist one would think that she had the wisdom to tread delicately in the mind of a vulnerable patient, I was ignorant to believe that what she was doing was right. It has taken 6 years to recover from the damage caused, I continue to work through the conflicting messages I received. The harm caused far exceeds any difficulties I may have had with medication.

    I have met psychiatrists who are reluctant to over-prescribe, who have great belief in psychotharapy and who have suggested alternative healing modalities – e.g. diet, exercise, spirituality. I have never met a doctor who has believed that medication can fix the woes of the human condition.

    The psychiatrist has the drug and the psychotherapist the mirror, both of which can save or destroy lives.

  4. Betty J. Ruth
    Betty J. Ruth says:


    I’ll just add one more dimension to this as a professor of social work ethics. For those of us trying to teach the next generation how to practice, the pressure is on to give the message that failure to arrange for prescriptions is tantamount to malpractice. We are urged to “manage” suicidality or other strong emotions by referring out to psychiatry for meds immediately, no questions asked, since we are not doctors. To do less than this is to practice below the “standard of care,” as specified by the licensing boards, the insurance panels and the enterprising lawyers who want to hold us accountable for harms to clients. While I support authentic accountability, I worry a lot about whether these boards really know what it means to work with people, to sit with them, to bear witness to their struggles, to walk the walk of strong emotions, to sort through conflicts and traumas. We may know the seratonin theory is dead, but it would be new news to a lot of people who regulate us and sue us and monitor us.

    Lots of education to do, both within our professions and beyond.


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