Upfront Disclaimer: I originally decided to read Daniel Carlat’s Unhinged: The Trouble with Psychiatry — A Doctor’s Revelation about a Profession in Crisis as the logical followup to Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Thus, it’s almost impossible for me to think about this book without comparing it to the Whitaker (the Reading Responses for which are here, here, and here). All that being said, I’ll do my best.
Carlat’s Unhinged is an amazingly fast read, mostly because it’s written the way a person would speak. This works for the book, because at its core it’s a first-person account of realizing that what you do for a living may be just a little mediocre (and sometimes unethical) in the grand “Am I doing all I could be doing with my training and for my patients?” scheme of things. The major takeaway for me was less about having learned something new about the god-awful practices of the pharmaceutical industry and less about the solutions he’s offered in his concluding chapter. The takeaway point that made reading it worth it was NOT that “sadly, psychiatry itself has become unhinged, fractured by scandals, by debates, and by the skepticism of an increasingly informed public” (186). Instead, it was a very specific form of audacity within the psychiatric field.
Carlat is not audacious. (For that matter, neither is my psychiatrist who practices with talk therapy and meets with me for an hour.) But given the broad-brush description I’ve just finished reading, I’m wondering at what point a profession may put its ego aside and realize that what they know of the brain is minimal and what they know of the mind is less. And although Carlat doesn’t come out and point-blank say it for me, it’s always refreshing to hear the honest “I don’t know.” Through the years I’ve seen my fair share of doctors who seem incapable of admitting what they do not know. With every rule comes its exceptions, but right now I’m beginning to wonder To what extent are we (the patients) complicit in allowing a profession we rely on to work toward its own self-preservation even if or when that need for validation conflicts with our best treatment?
So, here: Regardless of your chosen or recommended treatment methods, how many questions do you ask of your mental health professionals? How many questions do you ask of their responses? What kinds of answers to do you receive? To what extent are you satisfied with those answers? My thinking here is that when we are sick in some other way, we ask our doctors a lot of questions. We get second opinions. We talk about alternative treatments. We ask all kinds of questions regarding what to expect from our treatments. We know the histories of the medications available. We know the histories of our doctors (e.g., the number of patients they’ve seen with similar conditions). After a few months of running this forum, I’ve been surprised more than once at the responses I get when I say that we have the right to self-define all those terms used to define us. Further, I personally have a hard time swallowing the idea that a diagnostic rubric can categorize any human mind in any conclusive way. I am comfortable with my diagnosis now, because it’s been a decade and Time has shown me that it fits. But that rubric has failed me before. Different treatment methods have failed me before. And I largely blame myself for not being empowered to ask the questions I needed to ask. I didn’t advocate for myself. I didn’t interrogate when necessary. I trusted an authority that, at different times, either forgot to earn my trust or flat-out made up the reasons I should trust it. How many times in your path(s) of treatment have your practitioners reminded you that all the authority they have is that which you give them through your trust? This is the thought I kept having while reading this book: the audacity of believing a profession has some legitimate preexisting authority when it can honestly claim none.
And still, sometimes, the world is confused when I ask the questions I ask today…and I’m afraid they are confused because they think my brain can’t be trusted. Honestly, they wonder, how can her brain know better than mine? The answer: Because I am in here.