Why I Stopped Being A Psychiatrist

My journey to the shadow side of psychiatric diagnosis and treatment

I felt called to attempt to spell out my journey so far. It’s an attempt, that like my path, is a work in progress. There are many tantalizing tangents and rabbit holes that I only touch on. There are important counter-points and counter-perspectives. Nevertheless, here goes…

In medical school back in the 90s, I really tried to keep an open mind about all the specialties, but I kept getting drawn to psychiatry. I felt, naively perhaps, that in that field you could treat everything from the molecule to the community and that imbalances in the psyche were at the root of all diseases.

In residency, I wanted to learn everything, and be really precise at diagnosis and treatment. The phrase 'keeper of the faith' comes to mind. But there were early signs that the edifice might have cracks in it. Dr. Charlie Nemeroff (infamous now as I assume you know, more below) came to visit and I put my foot in my mouth by naively asking about the revolving door between the FDA and pharma. (This was before the big scandals about him came out.) Also, I was fortunate to get involved in the University of New Mexico's Rural Psychiatry program and developed a long-standing collaboration with a Navajo-tradition-based substance abuse treatment center in Gallup, NM. I learned a lot there and tried to help them address the needs of a mostly homeless, severely addicted population. I never wrote a single psychopharm prescription while I was there, for several reasons. It wasn't appropriate within the treatment model and the population was so rough and hard to follow that medications didn't have a safe role. I took a friend and mentor who at the time worked in a famous addiction treatment center in New York there when he visited and he said "So that's your 'non-prescribing' rotation." That phrase made me aware of a seed that had been invisibly geminating in my psyche.

A couple other experiences: Once while being a resident or attending at the Mental Health Center of the University of New Mexico, I was walking down the hallway and in a waiting area, saw a client I had worked with on a prior rotation. I asked him how he was doing. Drooling, very drowsy, almost falling off his chair, he said, "Terrible...I'm still feeling something." I was saddened. Numbing all feelings wasn't the goal of psychiatric medication management. I don't think it was this gentleman's 'initial' complaint either, but he had become a willing patient, who had bought into a particular model of psychiatry.

Later, while working at the VA, I saw a client who was a veteran (obviously) and big biker and had the classic look (long hair, handlebar moustache), jeans and leather. During one appointment, he told me he was really sad. He was almost crying. I asked him why. He told me that his neighbor, a woman he loved, was moving out of state and he had never told her that he loved her and wanted to be with her. He said to me "I just want to hop on my Harley, ride to her place and ask her to marry me." I asked him, "Why don't you?" He replied: "Well, tomorrow I have an appointment with my cardiologist. Two days after I have an appointment with my PCP..." The list went on. He had become a professional patient. It was so tragic that in his life, being compliant with his medical care, with his appointments (including his appointment with me), was more important than this really epic soul journey, riding on his Harley to ask the woman he loved to marry him. Both these events happened years ago, but the human tragedy of being a patient like that, being programmed to be compliant to the behavioral health care system, still stick with me and still fill me with a sense of tragedy.

Subsequently I opened a private practice. I somehow became known (morphogenetic field? 'If you build it, they will come'?) as a specialist in helping people come off psych meds, both the practical protocols and the soul journey this entails. It's interesting that dealing with the withdrawal effects of many medications, not just benzos, but of course SSRI's, SNRI's, atypicals, isn't taught in psychiatry residencies. And when a 'patient' experiences withdrawal symptoms of such meds, it's often mis-framed as a recurrence of the underlying disorder, and 'proof' that they need to stay on the medication. Which is a profound flaw in logic.

Incidentally in my private practice, I started offering ketamine in 2011. I didn't know anyone else who was doing it then. I had read the Zarate and Krystal studies and I had clients who I thought might benefit, and who did. This was before ketamine maintenance was a thing...a ‘thing’ that reenforces the perpetual patient status. (more below)

While in my private practice and meeting more and more 'survivors' of the behavioral health system and seeing the acute and chronic 'side effects' and often permanent damage these medications would cause, something else was building inside me, as yet unknown to my conscious ego.

I came across the book "The Alchemy of Healing" by Edward Whitmont, MD, a Jungian analyst and homeopath. The first part of the book was very theoretical, I assume based on homeopathic concepts and I just couldn't get into it. One day, assuming I'd never get into the book and perhaps never complete it, I decided to skip to the second half. There's an interlude chapter, the story of Godfather Death, who becomes godfather to a physician, with a haunting conclusion. Drawn in by that fairy tale, the subsequent chapters on the healer's wound and related topics were a breeze to read, but hit me hard and deep inside. I describe the experience like being forced to stare in a cold, harsh mirror. I literally flung the book across the room, because what I was reading about was describing what I was doing, and it horrified me. In brief, Whitmont explicates that even when a healer, a psychiatrist, wants to be the best and always be there for their clients (and I was certainly guilty of that), they unconsciously are trying to treat an unloveable part of themselves and are keeping the client trapped in the client role, by projecting that unloveable part of themselves onto the client. I realized I was keeping my clients trapped in the client role. Even though I had left behind academic psychiatry and the systems that turn people into professional patients, I was still keeping them trapped.  

I decided I had to close my private practice. That was in 2015. I knew I couldn't keep practicing in the way I had been, as part of the behavioral health system, because I was still contributing to making people professional patients.

A presentation I had attended by the Jungian analyst James Hollis, also about the healer's role, in which he showed a diagram of the conscious and unconscious relationship between the analyst/healer and the client and the healer's shadow (the wounded healer/healer’s wound) and the client's shadow (their own inner healer) made much more sense after that shock of awareness from Whitmont. Those in the healer role who pretend that they don't have a shadow, an inner wound, as if there was a brick wall between their conscious and unconscious, send this message, mostly unconsciously to the client, that their own inner healer doesn't exist, or is hidden under a brick wall, inaccessible. I didn't want my clients to feel trapped, so I realized I had to look at my own woundedness first. Interestingly, Hollis admits he adapted this diagram from Jung and later I found the original diagram in Jung, and the changes or distortions Hollis introduced, introduce a power differential. There's no analyst and client in Jung's diagram, who instead uses 'adept' and 'soror' (alchemical terms for the adept and his sister). Hollis's distortion unconsciously repeats the very power differential that Whitmont explicated and that I felt I could no longer ethically perpetuate.

Around the same time, although honestly it probably started before then, I started questioning psychiatric diagnosis. The history of the DSM is fraught with arbitrariness and the egos and dehumanizing tendencies of those who authored it. One sarcastic joke about the DSM-V was that they tried to remove the diagnosis "Narcissistic Personality Disorder" from it, because so many of the great minds in psychiatry who were involved in it were narcissists. Less funny is the story of why Complex PTSD wasn't included, in spite of the advocacy of experts. Bessel van der Kolk addresses this briefly in one of the chapters of "The Body Keeps the Score." The bottom line is the DSM, and the entire framework or enterprise of psychiatric diagnosis is weird, almost a pseudoscience, self-reenforcing, arbitrary, not linked to actual pathophysiology. Another joke is that if internists used something akin to the DSM, there'd be a 'runny nose, fever, malaise, cough, congestion syndrome', when internal medicine simply says it's a viral upper respiratory infection. Causality was specifically excluded from the DSM, except for one glaring exception.

When the DSM-V came out, there was a book review in 'The New Inquiry' (https://thenewinquiry.com/book-of-lamentations/) that interpreted it as a dystopian novel. Basically there's no way out. All the DSM-V contains is diagnoses. There's no 'normal.' There's no way out or forward or towards growth. Incidentally, that's why the Jungian model speaks so deeply to me, because there it offers a way forward. Being incarnated as a human gives us the opportunity (rarely pursued at all or with any persistence) to individuate, to become fully ourselves. Jungian individuation is very different from individualism. But unlike the DSM, it's a positive definition of health, i.e. something we can strive for, instead of 'health' simply being the absence of disease.

I just came across this: https://www.pchtreatment.com/dsm-5-issues/ which summarizes some of my doubts about the DSM, although I came to many of the same conclusions on my own, long before I read this.

It does mention something I remember, back in 2013, when Tom Insel, then director of NIMH said that the NIMH was going to ignore the DSM-V and use 'research diagnostic criteria' or something like that instead. That caused a huge shitstorm, because someone at the center of the 'scientific' enterprise basically, in an Emperor's New Clothes moment, stated that the DSM-V wasn't scientific enough to be used for mental health research. The shitstorm meant that Insel subsequently had to walk back his statements a bit, but the truth he exposed remains. The DSM-V isn't very scientific.

My perspective was also influenced by Robert Whitaker, whose journey somewhat paralleled mine, going from a faithful journalist reporting on psych med trials to questioning the whole industry in his books "Mad in America" and "Anatomy of an Epidemic" and subsequently via madinamerica.com. One figure from “Anatomy of an Epidemic” (it’s a figure quoted from a study and it's also paraphrased here: https://robertwhitakerbooks.com/anatomy-of-an-epidemic/) shows that as the number of psychiatric prescriptions rose and continues to rise, the number of people on disability for psychiatric diagnoses (not even everyone who is diagnosed) also has continued to rise. Contrast this with the chart for the prevalence of tuberculosis, which, after effective treatments starting with streptomycin were introduced, plummeted as the number of prescriptions grew. The latter would suggest that effective treatments decreased the prevalence of tuberculosis. The figures for mental health disability and number of psych prescriptions written suggest that either the medications don't work, or worse, actually contribute to the disability from mental health issues. There are several other 'anti-psychiatrists', though not everyone likes that term that I learned from. (Just to be clear, I do NOT subscribe to the views of the Citizens Commission for Human Rights, which is supported by or part of Scientology.)

There are some that say that the term schizophrenia should be abandoned, because it is unscientific and the label keeps people trapped. (https://www.bmj.com/content/352/bmj.i375) Psychiatric diagnoses are different than other diagnoses. They fundamentally change, or disrupt our sense of self, which I would argue, hypertension or diabetes don't. Psychiatric diagnoses are the only diagnoses that allow someone's rights to be taken away. That's how disruptive to our sense of self they can be. A psychatric diagnosis, once applied, has a fascinating 'stickiness.' It can never be taken away. I've had several clients who have been diagnosed with bipolar disorder tell me, "I think I'm happy, but what if I'm manic?" Their diagnosis has made them unable to trust themselves and enjoy basic human emotions. Everything can be questioned, everything can be diagnosable.

Allen Frances, a psychiatrist who was actually a contributor to prior editions of the DSM, had a similar awakening, realizing there were inherent, fundamental problems with the DSM-V. )Here's an interview: https://www.psychotherapy.net/interview/allen-frances-interview ) There are also several youtube videos of his lectures. He's another former keeper of the faith who woke up and asked “What are we doing?"

In brief, I realized the entire edifice of diagnosis that psychiatry is built on is very suspect, non-scientific, and contributes to people being trapped by rigid labels they can never escape from. While also supporting a multibillion-dollar research and treatment industry.

I mentioned Charlie Nemeroff above, and he was at the center of a scandal some years back, in which he was in charge of putting together articles for a journal, and presentations for conferences, that reenforced the pharmaceutical model. The authors and presenters were paid handsomely for perpetuating the psychopharmacological industry. Of particular note was such a letter he wrote to himself, addressed 'Dear Me', promising him an honorarium for his work. He was clearly benefitting greatly from the war chest of the pharmaceutical industry and was rewarded for perpetuating their products and world view.

In parallel, a similar scandal engulfed Jeffrey Biederman at Harvard, who basically invented the concept of childhood bipolar disorder and advocated and popularized pharmaceutical treatment for this condition, which became the de-facto standard of care, even though there were no controlled studies on the benefits and risks of these medications in children, some of them extremely young.

So in addition to my "What are we doing?" journey, questioning diagnoses and medications, I was also appalled by the profiteering by "authorities in the field" at the cost of medicating and diagnosing countless people and keeping them trapped.

On to psychopharmacology or prescribing. Again, it's really a pseudoscience. The serotonin theory of depression (that low serotonin causes depression), which is the supposed foundation for the development and prescribing of the most popular classes of antidepressants (SSRI = selective serotonin reuptake inhibitors, SNRI = serotonin norepinephrine reuptake inhibitors), has been called 'one of the most debunked theories in all of science.' There's really no evidence. Here's just one paper: https://www.nature.com/articles/s41380-022-01661-0 There are many more.

Robert Whitaker, who I mentioned above, tells a story about inquiring about the rationale for prescribing serotonin-targeting medications, often explained in analogy to diabetes and insulin. The experts he interviewed said to him, "We know these medications don't really work this way, we just tell people, so there's a rationale to taking these medications." The gist is that it's ok to lie, to misrepresent 'how' these medications work, so that people are more willing to take them. Pseudoscience.

I had a similar experience personally. Many years ago, when I was still at the University of New Mexico, I was invited to participate in a conference called "Future Leaders of Psychiatry." The name now to me sounds of an indoctrination camp. One of the presentations, I don't remember by whom, was to study the effects of some SSRI in an in-vitro system of neurons the serotonin receptors of which had been removed by gene splicing, to see what other targets these medications might have. This was done long after most SSRIs had been FDA approved. They were approved, widely prescribed, and then afterwards there's an effort to research how they really might work. Disturbing.

The withdrawal syndrome that SSRIs and SNRIs and even atypicals cause is really 'a feature not a bug.' I met countless people who told me 'Yeah, I stopped being depressed a long time ago, but if I try to stop my SSRI or SNRI, I experience the most awful withdrawal syndrome. I just can't do it.' Another lifelong customer. I was lucky to help a number of people come off SSRIs and SNRIs and ameliorate their withdrawal syndrome with a regimen I came up with. I've told this regimen to many people and colleagues, but I never did a controlled study. Many who don’t know the protocol remain trapped, having to keep taking these medications, because the withdrawal syndrome is intolerable.

The entire act of medicating certain conditions is already suspect. You may have heard of Eugene Bleuler and Emil Kraeplin, two German 19th century psychiatrists. In texts and chapters on the history of psychiatry, their history is usually boiled down to the factoids that Bleuler offered the '4 A's' of schizophrenia (associations, affect, ambivalence and autism), an attempt to formalize the diagnosis based on criteria, and that his term for the condition, i.e. schizophrenia, is the one that stuck. Kraeplin's contribution was to distinguish the time course of schizophrenia, or as he called it dementia praecox, which was permanent, from what came to be known as bipolar, or manic depression, which was cyclical. But that is quite an oversimplification of history. Their real difference was that Bleuler believed that the locus of illness, the determinants of disease, for schizophrenia, was in the interpersonal, social realm. The 4 A's all have to do with human interaction and how a person’s capacity for those is impaired.

I've had several clients with schizophrenia tell me "Don't take away my voices...They're my only friends!" To me this speaks of two tragedies: First, that the target of 'treatment', i.e. medications, is to get rid of hallucinations, i.e. voices, because that's what the medications do and that's what's 'alien' about schizophrenia, even though the person with schizophrenia may not agree that that's the most important thing to treat. (Which incidentally might explain why people with psychosis use methamphetamine, which can cause or exacerbate psychosis. The psychosis is not an unacceptable deterrent to the use of meth. And then there's Bruce Alexander's rat park that the opposite of addiction is connection. For another time…)

The second tragic implication of that statement is that the real suffering of people with severe mental illness, such as schizophrenia, is their social isolation. They have no friends. And antipsychotic medications, which kill drive and motivation and cause visible side effects, including but not limited to the abnormal movements of tardive dyskinesia, akithisia and others, actually profoundly isolate people who take them and contribute to and exacerbate their social stigmatization.

Kraeplin's view on the other hand, was that schizophrenia was a neurobiological illness, which is the entire rationale for the idea that medications help. If there's an imbalance in the brain, medications which change brain chemistry have a justification. If that's not the main locus of illness, as Bleuler would argue, then medications don't really help people with schizophrenia, although they do help 'normal society' by marginalizing and stigmatizing the people who are often forced to take them. We live, as one paper I read a long time ago stated, in a neo-Kraeplian world.

There are many other psychiatric conditions that could be construed as being due to social factors, other people, including anxiety, depression, and especially PTSD. It has been proposed that our late-stage capitalist society is really bad for mental health (here's a presentation by Bennet Zelner, an economist, that among other things, explains this: https://p.widencdn.net/nofolg/2019-Bennet-Zelner) So how can we possibly justify prescribing medications for these conditions, if they are caused by social factors? That sounds a lot like the soma of Huxley's "Brave New World." It definitely doesn't sound like actual science, for actual human benefit.

So, that, in brief, is my journey to become an 'ex-psychiatrist,' which I sometimes joke is like being an 'ex-con,' meaning there's nothing 'ex' about it. I had my personal awakening that made me realize I had to close my practice and in parallel I saw the deep inherent flaws in diagnosis and psychiatric prescribing.

Where have I come to? First of all it's an ongoing journey. Another time, I will elaborate on the importance of the Wounded Healer, of committing to examining our own shadow, continually. It's by confronting and attempting to integrate our shadow aspects that we can take steps on the journey towards Individuation (Jung's term) or what I've come to call ‘living our personal myth.’ I can only support 'clients' on their journeys as far as I've come myself. I am committed to my clients not carrying my shadow, although, of course, every client constitutes a new constellation. I am committed to no longer prescribing. I am committed to no longer diagnosing.

I find there is healing in exposing and acknowledging the traumas we and our ancestors went through and how these traumas have been unconsciously inherited. But to me, that's very different than labeling someone with a diagnosis. One of the many gifts I received from Jung is to view 'symptoms' as messages from the unconscious. Instead of 'shooting (or medicating) the messenger,' these messages need to be honored as gifts, which is basically what Jung did by writing the Red Book. Once we acknowledge the power and wisdom of the unconscious, through the gifts it presents us with, even if the gift wrap is anxiety or depression or other symptoms, we also need to accept that the ego is not in charge, although it has tried to trick us into thinking its in charge. Only then can we take serious steps on the journey of Individuation.

I have written elsewhere about the Shadow side of psychedelic therapy, because I see a lot of the same issues I have attempted to touch on above in the current social construction of psychedelic therapies. Behavioral health professionals are getting into the field, new clinics are opening. This demands diagnoses and 'maintenance' treatments, which both contribute to a person's sense that they have a permanent, disabling condition, that requires external factors and experts who decide on treatment. Ketamine (and what's coming down the pipeline, i.e. psilocybin and MDMA) are just shiny new toys, promising new treatments, but the entire view of a person's journey hasn't changed. Instead of honoring a person's unique journey, individuation, awakening, whatever you want to call it, these new modalities are being colonized by the providers and companies that want to make money, which precludes questioning the entire system and forced people to accept having a diagnosis and buying into the world view of the system. The dominance of providers, academic centers and companies has also silenced the indigenous voices that have the living traditions of working with some of these sacred medicines, and also have a world view of what it means to be human as part of a larger-than-human environment.

So I am worried about the current, mandatory enthusiasm for psychedelic therapies. We have to ask much bigger questions about diagnosis, and treatment, and 'symptoms' and what it means to be human and how we can restore relatedness to ourselves, our unconscious, our ancestors and our ecosystem. How we can heal our disconnection, that is the core illness of modernity (for which some have proposed the term ‘wetiko.’ One aspect of this illness called ‘wetiko’ is denying that one is ill.)

And, if we look at the state of the world, the environmental and political crises (or what's sometimes been called the meta-crisis), these questions are urgent, can't be answered by the same system that created the crises (including the behavioral health system in a late-stage capitalist society that is fundamentally cut off), and will determine whether we as a species survive.