Psychiatry is holding us back

My nervous system has fallen over 3 times in the past eight years. I will skip the details, but the most recent time was a year ago, and I was "stage 5 suicidal" (out of 6!) for over a month.

I've seen many psychiatrists, psychotherapists, social workers, doctors, hypnotherapists, etc. I am doing much better now, mostly because I have a better relationship with my body and my expectations of life.

After all this, my feeling is that psychiatry is a legacy system. It's a creaking, inadequate, bloated thing that all the customers are using, and maybe 10% of them are still having a good time. Except in this case, instead of trading money for a service, these customers are exchanging acute suffering for a different, hopefully softer kind of suffering. We can't just throw the thing out, or all our customers are screwed. But boy, wouldn't it be nice to have something better.

This write-up is mostly "anxiety/depression/ocd" focused. I don't know anything about schizophrenia, or other, more rare spectrum disorders. I have no useful insight on those topics, and I think psychiatrists are critical in the care of folks experiencing those disorders.

Psychiatrists are not treating "mental health"

I have spoken to hundreds of people who experience "anxiety", "panic", "OCD", etc. There are many fine-grained diagnoses for these in the DSM, and personally I think they are all pretty useless.

Wikipedia article about the DSM-5

My personal experience is that most of these "disorders" are of the entire nervous system. There is a combination of starting conditions (biology, environment, upbringing) and present stress that leads to something going wonky, which leads to a truly staggering host of symptoms that we feel comfortable referring to in a medical context as "anxiety."

I would like to see these individual diagnoses thrown out, and instead treat them as "stress illness." In most cases, even if the patient was not feeling particularly stressed at the initial onset of their symptoms, the ones who experience them chronically are typically pretty damned stressed, and that loop of stress -> illness -> more stress -> more illness is quite typical regardless of specific symptoms.

I also think shifting focus to "stress illness" would lead to better research, training and diagnoses. Right now, most psychotherapists and psychiatrists focus on the mind—on its biology, hypothesized defects, thought patterns, etc. Medications are assumed to achieve their effects through their influence on the mind, even though they clearly have systemic effects, and we have little to no idea how they actually "work." (Never mind the number of off-label uses that psychiatric medications tend to have.)

There are some good organizations looking at things in this way. Here is one:

Psychophysiologic Disorders Association

They focus on chronic pain, but IMO this is again because the host of symptoms caused by stress and fear are so diverse, that to even explain what you're doing you need to focus on the endpoint. I don't object to that; I do object to diagnoses being so fine-grained that someone with an average case of stress illness can easily rack up 4-5 diagnoses through standardized self-assessments.

I'd like to see us admit that there is more than the mind at play here, and to expand our research and treatments accordingly. Because right now, psychiatrists are treating a host of problems that I think are not solely originating from the brain, but their lens is that the brain is the root cause.

I think psychiatrists still help

Psychiatrists still help. Psychiatry is not an evil profession; I just think it would benefit from significant change.

Psychiatric medications help many folks who experience "anxiety." I have been on long courses of both SSRIs and benzodiazepenes, and while the latter were somewhat terrifying, I survived, and perhaps they helped. I still take SSRIs, and I think they provide some support, even if they affect different people very differently.

What's helped more, though, has been focusing on how my entire body, mind, and nervous system process stress. Interestingly, the resource that has recently helped me the most is run by someone I dislike:

Irene Lyon's Somatic Practice courses

For the longest time, I thought I wouldn't benefit from "trauma healing" because I couldn't find anyone who wasn't creepy who offered it. But I went through Irene's 21-day program, and then through most of the "Smart Body Smart Mind" course, and it helped me immensely. It still continues to help me.

All this to say: I wish less creepy people were working on these approaches in ways that could be used more seriously in medical practice. Like it or not, if people feel sick, or anxious, or like they're dying because they haven't slept in five days and they are constantly sweating and their heart is beating out of their chest and they are having panic attacks every hour, they are likely to go see a doctor. If we could have more tools that help doctors acknowledge that our entire systems are involved in these states of "stress illness", I think that could be really helpful.

I don't think it's ever been better than this

I am grateful for what we have now. I know some people think that "anxiety" is on the rise, and that mental illness is a growing problem, and they may be right.

Personally, I think it's always been the case that humanity goes through phases where the nature of stress changes, and large numbers of people experience stress illness. You don't have to go far back to hear about how much physical suffering people experienced on a daily basis, and coupled with hopeless circumstances, led to "hysteria" or "nervous breakdowns." (Russian literature is a gold mine for this stuff. And it wasn't that long ago that American housewives subsisted on diets of wine and barbiturates.)

I don't think we're sliding backwards into a new plague of hopeless stress illness. I do think we can do a lot more to help people live with more health and ease than we do right now.

A lot of what I wrote is probably wrong

I'm just one person. I've read a lot of primary sources, and I'm connected (as friends) to quite a few health practitioners, including some psychiatrists. I've experienced an awful lot of stress illness. But this is still just one person's perspective. What's yours?