Psychiatrogenesis (Whither Psychiatry or Reform)

This article by T.N. Tampiyappa has been published by Mad in America. It begins:

“Having worked in multiple public services in the UK and Australia over the last 27 years, the constant personal struggle has been, ‘Am I doing more harm than good?’

Sadly, the conclusion of this reflection is that iatrogenesis is the norm from diagnosis to treatment, and doing good is the exception. Diagnoses, especially ‘borderline personality disorder’ and ‘schizophrenia,’ lead to a pathological, limiting view of oneself and enshrine a nocebo effect that is difficult to shrug off. Medication treatment may provide some symptom improvement, but also comes with a panoply of side effects and withdrawal symptoms.

The reason I went into psychiatry was that, unlike other medical disciplines with clear pathogenesis, clinical markers, and effective interventions, psychiatry was a much more ethereal specialty. Here, there was a balance to be made between the ‘is-ness’ of the clinical encounter and the socio-politico-psychological cultural context in which the meeting was taking place.

There was no room for hubris or certainty; medication sometimes worked, hospitalisation may help in a crisis, self-harm may be a vitally important survival mechanism for someone. You could never get ‘comfortable’ in the job; every day was challenging, and being an expert in psychiatry seemed oxymoronic …”

You can read more from here.

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