To the Editor:
Robert Klitzman’s “That Way Madness Lies” (Op-Ed, March 4) represents much of what’s wrong with the modern psychiatric approach. To illustrate why psychiatric financing should not be cut back, Dr. Klitzman recounts what can be called a “violent mania” story: a patient who hears voices ordering him to kill. Dr. Klitzman in effect inflames the public’s fear of the “mentally ill” in order to gain more public support for psychiatry. This is a cheap dramatic technique with a devastating long-term impact. It increases the public’s fear of people labeled mentally ill, reinforces the humiliating stigma and discourages any genuine empathy toward them.
Ironically, this stigmatization is one of the main reasons so little money is allocated to helping psychiatric patients. Psychiatry cannot have it both ways: it cannot brandish the image of the violent maniac and then bemoan the lack of public enthusiasm for paying for care.
Dr. Klitzman’s anecdote also demonstrates why the public should be cautious about financing modern psychiatry. After describing his own fear of the patient, Dr. Klitzman declares, “I ordered Haldol for him.” In contemporary psychiatry, this is a reflexive act — when frightened by a patient, drug him.
His description of the patient’s treatment gives no indication that anyone tried to calm the disturbed young man through patient, empathic understanding. That is rarely offered in modern hospital psychiatry, which relies almost wholly on mind-blunting drugs. Tragically, most young psychiatrists are taught that a supportive human intervention is not effective in these emergency situations, when it is actually the best approach. Even the most violent patient is more likely to benefit more from a skilled, caring person than from a pill. Research has also shown that hospitalized patients value the few minutes of “talking therapy” they get more than all the drugs.
A news article on the same day reconfirms that the public should distrust institutional psychiatry. Its headline, “Court Reverses Practice of Allowing Research on Psychiatric Patients,” tells the grim story. It turns out that New York State has been allowing friends and family to give “consent” for mentally incompetent patients to be subjected to psychiatric experimentation. This practice is patently unethical and inhumane, yet your article notes that the Office of Mental Health may appeal the ruling. Time and again, psychiatry has fought against the rights of its own patients.
Modern psychiatry won’t deserve more public respect and financing until it implements higher principles of service by providing a safe, humane alternative that relies more on therapeutic relationships than on physical interventions into the brain.
PETER R. BREGGIN , M.D. Bethesda, Md., March 4, 1995 The writer, director of the Center for the Study of Psychiatry, is the author of “Toxic Psychiatry.”