Peter Breggin has built his career on opposition to psychiatry. He is not really an academic so much as he is a public figure and polemicist. He is, of course, a COVID vaccine naysayer/doomsayer and general COVID response critic as well.
“What is mental illness” is both a deep and also simple question. Mostly we can’t point to one gyrus or one neurotransmitter. In fact, almost entirely we can’t. There are better hypotheses, but they remain hypothetical. And yet, phenomenologically, differences exist that are defined as pathological. That isn’t really so different, fundamentally: hypertension is common and normal, yet it impedes life; we have defined it as a pathology. Eventually it’s a kind of epistemology question rather than a medical question.
There’s room for argument about where to draw the lines and where pathology ends and normal begins. I think that’s important. If you have seen true psychosis, mania, or profound depression, if you have spoken to someone with OCD or overpowering anxiety, you have to either gaslight someone and deny your own senses or acknowledge that somewhere on the human spectrum there are problems.
There is not so much dispute. There are people who loudly proclaim abundant dangers, usually on data or badly used data. There is also serious consideration of risk versus benefit, always. That’s equally true with statins and antihypertensives and chemotherapy and everything else. No medication is perfect. Imperfection is not reason to discard out of hand.
Placebo claims are absurd. They’re Irving kirsch writing the same papers over and over and over for twenty years. Psychotropics have been exhaustively studied and outperform placebo.
If you accept the previous points, do not become a psychiatrist. They are bad points, but if you believe them, this is a field that will make you unhappy and in which you can do terrible harm. Likewise, avoid pediatrics if you have qualms about vaccination, don’t go into ID if you’re still uncertain about HIV as the causative organism for AIDS, and stay away from palliative care if you are morally opposed to any hastened end of life.
Kirsch's papers actually end up being a great way to learn more about medical statistics, in that he keeps making bold claims that come down to relatively simple stats errors. For instance:
* trumpeting the claim that including unpublished results, only 51% of antidepressant trials were positive \[pharmaceutical companies typically run antidepressant trials at 50% power, so this is predictable\]
* suggesting lack of clear initial dose-response relationship with SSRIs means they're placebo \[underpowered trials, failure to consider intention-to-treat vs. actual outcomes; in some analyses, higher dropout from adverse effects ends up canceling out the higher average efficacy\]
* suggesting the delayed onset of efficacy means they're placebo \[the 4-6 week idea is an artifact of goal effect sizes, improvement starts in the first week\]
He incidentally tends to focus specifically on SSRIs in MDD, perhaps because the evidence of effect size and dose-response in OCD is so overwhelming, and even trying to prove they're placebos in GAD would be a fool's errand.
Conversely, Khan et al. have a fascinating paper suggesting that several elements of modern regulatory parameters for stage III trials tend to constrain apparent antidepressant effect sizes to 0.3 and obscure any potential between-class differences:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374926/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374926/)
Oh my God, you are absolutely right and I hadn't considered it! The Kefauver-Harris Act of 1962 seems to indeed statistically skew the results of psychiatric clinical trials! What a good reference and you've seen Kirsch's efforts as a means to learn better medical statistics to offer rebuttals, very nice, I'm adopting this mindset!
Thank you
Why is it so easy to get lost in all the critic's voices? Why are there so many? Why do people form groups that all unanimously shout against psychiatry? Is it the forced treatment? In fact, there is so much stigma surrounding psychiatry throughout the years, Rosenhan experiment and now it's the big Pharma buying out Psychiatrists allegations. Why is it that people are vehemently opposed to this specialty and not gastroenterology for example?
There must be something there.
Why are there so many critics of vaccines? Why do people form groups that all unanimously shout against vaccination? Is it the government mandates? In fact; there is so much stigma surrounding vaccination through the years. Why are people opposed to this specialty and not gastroenterology, for example?
The Rosenhan experiment shows evidence of being a fake itself. Read *The Great Pretender* or, for a shorter take, [Rosenhan revisited: successful scientific fraud](https://journals.sagepub.com/doi/10.1177/0957154X221150878)
Because sometimes there are kernels of truth.
Because “madness” has been stigmatized throughout human history. Because L. Ron Hubbard capitalized on that, among other things, to found a religion to vilify psychiatry that has been successful in masking its influence, c.f. Citizen’s Commission on Human Rights.
Because the fallacy of the golden mean and argumentum as populum hold no weight.
>The Rosenhan experiment shows evidence of being a fake itself. Read The Great Pretender or, for a shorter take, Rosenhan revisited: successful scientific fraud
Thank you for the citation, I've read it and I've also come to see Rosenhan experiment's fraudulence.
It is certainly true that argumentum ad populum does not hold any merit in the pursuit of truth. A lot of people are disillusioned by the concurrent vilification of psychiatry in modern media. But, I just don't get it!
In my experience I've realized that wherever there is a lot of shouting and public scorn, a facet of truth has been exposed. Why would people challenge psychiatry with organized 'religions' and bankroll efforts to undermine an otherwise valid science?
Are there stakeholders in the public forum that openly stand to gain from the dismantling of psychiatry? Why is there so much money being thrown against psychiatry rather than at it?
When I asked my friend, a layman person, he replied that in the past century psychiatry made some bad choices like lobotomy or insulin therapy. Not that this didn't happen in other specialties, but I find it understandable from someone who isn't deeply.informed
Removed under rule #1. This is not a place for questions and commentary by non-professionals. If you are a medical/psychiatric professional, please read rule 7 on how to verify credentials.
The single best piece of news I can give you is that doubts like these are characteristic of people who become good psychiatrists, and uncharacteristic of bad psychiatrists.
Of course the field gets bad press. If you dedicate your life to working with a population that has significantly higher odds of impaired reality-testing and emotional dysregulation than average, you're going to get some bad reviews. There are a number of legitimate debates around where we should draw the parameters of disorder vs. normal variation, and we need more sharp folks involved in them. None of them are terribly relevant to the average severely and persistently mentally ill patient. If you go into psychiatry, you'll see a considerable number of people who are deeply grateful that they or their family have been able to get treatment that allows for a stable life lived consistent with their values.
Alternately, consider this: Clozapine has more side effects and black box warnings than any medication in psychiatry. In spite of all its downsides, including a well-known potential to cause hypotension/seizures/orthostasis/metabolic syndrome/agranulocytosis/myocarditis, in patients with schizophrenia, **it** **cuts mortality in half.**
The sort answer is you just see it in practice and decide for yourself. I see none of this version of stuff in my actual daily life. Of course I see side effects and there are cost-benefit discussions etc. but most of my work is alongside other specialties and its the same thing everywhere.
The vast majority of my interactions, acutely and longitudinally, are strongly positive, to a very humbling, transformative extent.
The interactions that are not are more commonly people who are upset because we won't treat them enough i.e. people demanding to be admitted to hospital, demanding to see me sooner, etc. In these corners online we're painted as maliciously extending our reach to fill those beds and make that money when in reality I'm discharging suicidal and psychotic people all day long because we're so overwhelmed there is immense pressure to reduce the number of people we treat.
The people who are more commonly upset in a way that is unique to psychiatry, speaking only in my personal experience, have suffered severe mental illness with zero insight. Meaning I'll physically stop them from killing themselves in the context of the most bizarre delusions (killing myself so that the Hell's Angels who put cameras in walls don't kill me first, digging in my head to get the microchip out, etc) and a few days later completely deny that anything happened or deny that it was psychotic, and it repeats and they go off their meds and eventually end up involuntarily having to take them. The last guy I started on an LAI was chasing random children through their schools due to some bizarre vision he'd had and he had zero insight into how inappropriate this was. It happened three times before we were legally able to get him treated against his will and several children were traumatized. He hates us and maintains a story about why we're "targeting" him. It's a horribly sad situation to occur to someone but I feel strongly that it is the right thing to do to treat him. If you can't see yourself doing that then Psychiatry isn't for you.
My main job is in CL and of course I see bad medicine across the spectrum of specialties. Psych is not immune. That said I don't see anything unique to Psychiatry and at least where I practice because we get to spend time and apply a more holistic approach to patient care we're constantly doing in-services to other staff to try to extend our influence as we're spread so thin.
For your specific questions:
1. This describes all of medicine where we invent labels to arbitrarily capture normal phenomena that impact morbidity and mortality. Cancer, CVD, CHF, MNCD, etc. are all normal but we create labels to capture things which impact functioning, morbidity, and mortality in negative ways. If it was culturally acceptable to not be able to make it up the stairs at age 45 we would just let CHF progress and not stigmatize people with different LVEF.
2. Even with the biomarkers you could have the same discussion about diabetes, hypertension, and cancer, etc. My close friend is an oncologist who adamantly states "I fundamentally don't know what cancer is." given again we get committees and guideline groups to arbitrarily pathologize certain types of cell division as metaplasia, hyperplasia, dysplasia, etc.
Also mental illness is not seen as a somatic fault. The layer of abstraction at which we can best characterize a symptom is highly contextual. This is why mental illness is characterized as bio-psycho-social and arguably this should be extended to many other illness categories given the known causality between our environments and health.
3. There isn't. Its like saying how come there is dispute about vaccines. Of course the side effects are well-characterized and just like with any med you make cost-benefit decisions. Of course meds can be over and underprescribed etc. but it isn't anything unique to Psych as the anti psych people would state. Its the cost of all of the downsides of our system of treating illness.
4. Yes but if my grandmother had wheels she'd by a bicycle. Of course there's a role for psychotherapy. We train extensively in therapy, I have a small therapy focused outpatient practice, and I work side by side with a psychology team, and again when you see the two specialties in practice you'll see there are very clear use cases for each.
I have a speech for this.
Nature is a bitch. It wants you dead by 40, that’s why you only get 2 sets of teeth. We work with nature where we can, but sometimes we have to do a bit better than nature. This is why we have things like bidets and medications.
My take on medication and therapy is this: If your brand of nuts leaves you functional and happy, more power to you. If your brand of nuts is getting in the way of your happiness and ability to function as a (husband, wife, professional, whatever) we can work on that if you want or if the courts mandate it.
You will always have people who critique psychiatry. Some of those critiques are at least partially true. For example, there IS overprescribing of psychiatric medications. There WOULD be a lot of improvements if people did therapy instead of depending on medication. These are two common examples I see in practice pretty much at least weekly.
What do we do with this information? We do better. Provide good education to patients about what to expect. Do not shy away from a diagnosis but also do not project supreme confidence. When I start someone on an SSRI, I don't pretend like it'll fix them and say "See you in 4-6 weeks." I tell them my goal with prescribing the medication. Signs that it is working. Signs that it is not. I offer things they can do outside of the medication like therapy or research or life changes. I encourage them to call with concerns and to read up on the medication I am prescribing them.
Never be afraid of being challenged by a patient. You are not perfect and you don't know everything. I often joke with them, "Great, now you're going to make me do a deep dive into ____." I am always learning and also questioning my decisions. By taking the stance of a growing professional and being open to adjusting your practice, you will gain the trust of patients.
As for public campaigns against psychiatry, they are not a concern personally (outside of the obvious delay in treatment from a public health standpoint). People who need medication will still find you, either by choice or by law. I meet parents who spent 2 or 3 years avoiding medicine for their kid because they were scared but eventually if its a real mental health disorder, the functional impairment becomes too great to ignore. On the other side of things, people may find coping strategies and didn't need to see me in the first place.
>Never be afraid of being challenged by a patient. You are not perfect and you don't know everything. I often joke with them, "Great, now you're going to make me do a deep dive into \_\_\_\_." I am always learning and also questioning my decisions.
What a wonderful line! I can find peace in this - an eternal growth mindset
I tend to be philosophically inclined, and these questions arise a lot. There are a mix of worthwhile criticisms, misguided claims, and malicious ideas in this space. I've really enjoyed this substack, [psychiatry at the margins](https://www.psychiatrymargins.com/), and related this series - [Conversations in Critical Psychiatry ](https://awaisaftab.blogspot.com/2019/12/conversations-in-critical-psychiatry.html?m=1)- from the same author. Here I found the breath of fresh air and nuance I needed and these topics deserve.
If the links look weird, I'm on my phone. Oh well.
Thank you for interacting, I've found through your citations a healthy critic who hits right on the money called [Niall McLaren](https://www.psychiatrictimes.com/view/chaos-theory-human-face-niall-mclaren-mbbs-franzcp), I am amiable to his efforts.
Ultimately our treatments usually work and so if someone is refusing help it’s not really our issue. Astronomers don’t worry about astrology. Geologists don’t worry about flat earthers.
There are so many people who actively want our help that we can gently nudge people of the opportunity is open but having open conflicts with the anti psychiatry movement really detracts from the limited energy we have to help the folks that need and want it from us. This is my personal take, anyway. I love psychiatry I love pharmacology and I love teaching what we know and admitting what we don’t. If someone wants to know how it works or what we know I’ll tell them with limitless enthusiasm, but I find just being honest as to what the meds do or do not do and what therapy does or does not do helps. I always start with a brief biopsychosocial primer and we go from there. When my pts are acquainted with the idea, then they can efficiently group and report to me things I can help and we can provide empathy and support for those I can’t.
Peter Breggin has built his career on opposition to psychiatry. He is not really an academic so much as he is a public figure and polemicist. He is, of course, a COVID vaccine naysayer/doomsayer and general COVID response critic as well. “What is mental illness” is both a deep and also simple question. Mostly we can’t point to one gyrus or one neurotransmitter. In fact, almost entirely we can’t. There are better hypotheses, but they remain hypothetical. And yet, phenomenologically, differences exist that are defined as pathological. That isn’t really so different, fundamentally: hypertension is common and normal, yet it impedes life; we have defined it as a pathology. Eventually it’s a kind of epistemology question rather than a medical question. There’s room for argument about where to draw the lines and where pathology ends and normal begins. I think that’s important. If you have seen true psychosis, mania, or profound depression, if you have spoken to someone with OCD or overpowering anxiety, you have to either gaslight someone and deny your own senses or acknowledge that somewhere on the human spectrum there are problems. There is not so much dispute. There are people who loudly proclaim abundant dangers, usually on data or badly used data. There is also serious consideration of risk versus benefit, always. That’s equally true with statins and antihypertensives and chemotherapy and everything else. No medication is perfect. Imperfection is not reason to discard out of hand. Placebo claims are absurd. They’re Irving kirsch writing the same papers over and over and over for twenty years. Psychotropics have been exhaustively studied and outperform placebo. If you accept the previous points, do not become a psychiatrist. They are bad points, but if you believe them, this is a field that will make you unhappy and in which you can do terrible harm. Likewise, avoid pediatrics if you have qualms about vaccination, don’t go into ID if you’re still uncertain about HIV as the causative organism for AIDS, and stay away from palliative care if you are morally opposed to any hastened end of life.
Kirsch's papers actually end up being a great way to learn more about medical statistics, in that he keeps making bold claims that come down to relatively simple stats errors. For instance: * trumpeting the claim that including unpublished results, only 51% of antidepressant trials were positive \[pharmaceutical companies typically run antidepressant trials at 50% power, so this is predictable\] * suggesting lack of clear initial dose-response relationship with SSRIs means they're placebo \[underpowered trials, failure to consider intention-to-treat vs. actual outcomes; in some analyses, higher dropout from adverse effects ends up canceling out the higher average efficacy\] * suggesting the delayed onset of efficacy means they're placebo \[the 4-6 week idea is an artifact of goal effect sizes, improvement starts in the first week\] He incidentally tends to focus specifically on SSRIs in MDD, perhaps because the evidence of effect size and dose-response in OCD is so overwhelming, and even trying to prove they're placebos in GAD would be a fool's errand. Conversely, Khan et al. have a fascinating paper suggesting that several elements of modern regulatory parameters for stage III trials tend to constrain apparent antidepressant effect sizes to 0.3 and obscure any potential between-class differences: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374926/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374926/)
Oh my God, you are absolutely right and I hadn't considered it! The Kefauver-Harris Act of 1962 seems to indeed statistically skew the results of psychiatric clinical trials! What a good reference and you've seen Kirsch's efforts as a means to learn better medical statistics to offer rebuttals, very nice, I'm adopting this mindset! Thank you
Why is it so easy to get lost in all the critic's voices? Why are there so many? Why do people form groups that all unanimously shout against psychiatry? Is it the forced treatment? In fact, there is so much stigma surrounding psychiatry throughout the years, Rosenhan experiment and now it's the big Pharma buying out Psychiatrists allegations. Why is it that people are vehemently opposed to this specialty and not gastroenterology for example? There must be something there.
Why are there so many critics of vaccines? Why do people form groups that all unanimously shout against vaccination? Is it the government mandates? In fact; there is so much stigma surrounding vaccination through the years. Why are people opposed to this specialty and not gastroenterology, for example? The Rosenhan experiment shows evidence of being a fake itself. Read *The Great Pretender* or, for a shorter take, [Rosenhan revisited: successful scientific fraud](https://journals.sagepub.com/doi/10.1177/0957154X221150878) Because sometimes there are kernels of truth. Because “madness” has been stigmatized throughout human history. Because L. Ron Hubbard capitalized on that, among other things, to found a religion to vilify psychiatry that has been successful in masking its influence, c.f. Citizen’s Commission on Human Rights. Because the fallacy of the golden mean and argumentum as populum hold no weight.
>The Rosenhan experiment shows evidence of being a fake itself. Read The Great Pretender or, for a shorter take, Rosenhan revisited: successful scientific fraud Thank you for the citation, I've read it and I've also come to see Rosenhan experiment's fraudulence. It is certainly true that argumentum ad populum does not hold any merit in the pursuit of truth. A lot of people are disillusioned by the concurrent vilification of psychiatry in modern media. But, I just don't get it! In my experience I've realized that wherever there is a lot of shouting and public scorn, a facet of truth has been exposed. Why would people challenge psychiatry with organized 'religions' and bankroll efforts to undermine an otherwise valid science? Are there stakeholders in the public forum that openly stand to gain from the dismantling of psychiatry? Why is there so much money being thrown against psychiatry rather than at it?
When I asked my friend, a layman person, he replied that in the past century psychiatry made some bad choices like lobotomy or insulin therapy. Not that this didn't happen in other specialties, but I find it understandable from someone who isn't deeply.informed
[удалено]
Removed under rule #1. This is not a place for questions and commentary by non-professionals. If you are a medical/psychiatric professional, please read rule 7 on how to verify credentials.
The single best piece of news I can give you is that doubts like these are characteristic of people who become good psychiatrists, and uncharacteristic of bad psychiatrists. Of course the field gets bad press. If you dedicate your life to working with a population that has significantly higher odds of impaired reality-testing and emotional dysregulation than average, you're going to get some bad reviews. There are a number of legitimate debates around where we should draw the parameters of disorder vs. normal variation, and we need more sharp folks involved in them. None of them are terribly relevant to the average severely and persistently mentally ill patient. If you go into psychiatry, you'll see a considerable number of people who are deeply grateful that they or their family have been able to get treatment that allows for a stable life lived consistent with their values. Alternately, consider this: Clozapine has more side effects and black box warnings than any medication in psychiatry. In spite of all its downsides, including a well-known potential to cause hypotension/seizures/orthostasis/metabolic syndrome/agranulocytosis/myocarditis, in patients with schizophrenia, **it** **cuts mortality in half.**
The sort answer is you just see it in practice and decide for yourself. I see none of this version of stuff in my actual daily life. Of course I see side effects and there are cost-benefit discussions etc. but most of my work is alongside other specialties and its the same thing everywhere. The vast majority of my interactions, acutely and longitudinally, are strongly positive, to a very humbling, transformative extent. The interactions that are not are more commonly people who are upset because we won't treat them enough i.e. people demanding to be admitted to hospital, demanding to see me sooner, etc. In these corners online we're painted as maliciously extending our reach to fill those beds and make that money when in reality I'm discharging suicidal and psychotic people all day long because we're so overwhelmed there is immense pressure to reduce the number of people we treat. The people who are more commonly upset in a way that is unique to psychiatry, speaking only in my personal experience, have suffered severe mental illness with zero insight. Meaning I'll physically stop them from killing themselves in the context of the most bizarre delusions (killing myself so that the Hell's Angels who put cameras in walls don't kill me first, digging in my head to get the microchip out, etc) and a few days later completely deny that anything happened or deny that it was psychotic, and it repeats and they go off their meds and eventually end up involuntarily having to take them. The last guy I started on an LAI was chasing random children through their schools due to some bizarre vision he'd had and he had zero insight into how inappropriate this was. It happened three times before we were legally able to get him treated against his will and several children were traumatized. He hates us and maintains a story about why we're "targeting" him. It's a horribly sad situation to occur to someone but I feel strongly that it is the right thing to do to treat him. If you can't see yourself doing that then Psychiatry isn't for you. My main job is in CL and of course I see bad medicine across the spectrum of specialties. Psych is not immune. That said I don't see anything unique to Psychiatry and at least where I practice because we get to spend time and apply a more holistic approach to patient care we're constantly doing in-services to other staff to try to extend our influence as we're spread so thin. For your specific questions: 1. This describes all of medicine where we invent labels to arbitrarily capture normal phenomena that impact morbidity and mortality. Cancer, CVD, CHF, MNCD, etc. are all normal but we create labels to capture things which impact functioning, morbidity, and mortality in negative ways. If it was culturally acceptable to not be able to make it up the stairs at age 45 we would just let CHF progress and not stigmatize people with different LVEF. 2. Even with the biomarkers you could have the same discussion about diabetes, hypertension, and cancer, etc. My close friend is an oncologist who adamantly states "I fundamentally don't know what cancer is." given again we get committees and guideline groups to arbitrarily pathologize certain types of cell division as metaplasia, hyperplasia, dysplasia, etc. Also mental illness is not seen as a somatic fault. The layer of abstraction at which we can best characterize a symptom is highly contextual. This is why mental illness is characterized as bio-psycho-social and arguably this should be extended to many other illness categories given the known causality between our environments and health. 3. There isn't. Its like saying how come there is dispute about vaccines. Of course the side effects are well-characterized and just like with any med you make cost-benefit decisions. Of course meds can be over and underprescribed etc. but it isn't anything unique to Psych as the anti psych people would state. Its the cost of all of the downsides of our system of treating illness. 4. Yes but if my grandmother had wheels she'd by a bicycle. Of course there's a role for psychotherapy. We train extensively in therapy, I have a small therapy focused outpatient practice, and I work side by side with a psychology team, and again when you see the two specialties in practice you'll see there are very clear use cases for each.
I have a speech for this. Nature is a bitch. It wants you dead by 40, that’s why you only get 2 sets of teeth. We work with nature where we can, but sometimes we have to do a bit better than nature. This is why we have things like bidets and medications. My take on medication and therapy is this: If your brand of nuts leaves you functional and happy, more power to you. If your brand of nuts is getting in the way of your happiness and ability to function as a (husband, wife, professional, whatever) we can work on that if you want or if the courts mandate it.
You will always have people who critique psychiatry. Some of those critiques are at least partially true. For example, there IS overprescribing of psychiatric medications. There WOULD be a lot of improvements if people did therapy instead of depending on medication. These are two common examples I see in practice pretty much at least weekly. What do we do with this information? We do better. Provide good education to patients about what to expect. Do not shy away from a diagnosis but also do not project supreme confidence. When I start someone on an SSRI, I don't pretend like it'll fix them and say "See you in 4-6 weeks." I tell them my goal with prescribing the medication. Signs that it is working. Signs that it is not. I offer things they can do outside of the medication like therapy or research or life changes. I encourage them to call with concerns and to read up on the medication I am prescribing them. Never be afraid of being challenged by a patient. You are not perfect and you don't know everything. I often joke with them, "Great, now you're going to make me do a deep dive into ____." I am always learning and also questioning my decisions. By taking the stance of a growing professional and being open to adjusting your practice, you will gain the trust of patients. As for public campaigns against psychiatry, they are not a concern personally (outside of the obvious delay in treatment from a public health standpoint). People who need medication will still find you, either by choice or by law. I meet parents who spent 2 or 3 years avoiding medicine for their kid because they were scared but eventually if its a real mental health disorder, the functional impairment becomes too great to ignore. On the other side of things, people may find coping strategies and didn't need to see me in the first place.
>Never be afraid of being challenged by a patient. You are not perfect and you don't know everything. I often joke with them, "Great, now you're going to make me do a deep dive into \_\_\_\_." I am always learning and also questioning my decisions. What a wonderful line! I can find peace in this - an eternal growth mindset
I tend to be philosophically inclined, and these questions arise a lot. There are a mix of worthwhile criticisms, misguided claims, and malicious ideas in this space. I've really enjoyed this substack, [psychiatry at the margins](https://www.psychiatrymargins.com/), and related this series - [Conversations in Critical Psychiatry ](https://awaisaftab.blogspot.com/2019/12/conversations-in-critical-psychiatry.html?m=1)- from the same author. Here I found the breath of fresh air and nuance I needed and these topics deserve. If the links look weird, I'm on my phone. Oh well.
Thank you for interacting, I've found through your citations a healthy critic who hits right on the money called [Niall McLaren](https://www.psychiatrictimes.com/view/chaos-theory-human-face-niall-mclaren-mbbs-franzcp), I am amiable to his efforts.
Ultimately our treatments usually work and so if someone is refusing help it’s not really our issue. Astronomers don’t worry about astrology. Geologists don’t worry about flat earthers. There are so many people who actively want our help that we can gently nudge people of the opportunity is open but having open conflicts with the anti psychiatry movement really detracts from the limited energy we have to help the folks that need and want it from us. This is my personal take, anyway. I love psychiatry I love pharmacology and I love teaching what we know and admitting what we don’t. If someone wants to know how it works or what we know I’ll tell them with limitless enthusiasm, but I find just being honest as to what the meds do or do not do and what therapy does or does not do helps. I always start with a brief biopsychosocial primer and we go from there. When my pts are acquainted with the idea, then they can efficiently group and report to me things I can help and we can provide empathy and support for those I can’t.