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More Psychiatrists—More Problems

Posted on 12 Nov | 2 comments
More Psychiatrists—More Problems

Just from the name, I would have assumed that the International Journal of Law and Psychiatry was a journal dedicated to the undoubtedly severe mental health issues of lawyers.

Apparently, I’m wrong. Indeed, a recent study published in that journal showed that countries with better mental-health systems—as measured by the number of psychiatrists and mental health beds—are significantly associated with higher national suicide rates.

“Significant positive correlations between suicide rates and mental health system indicators (p < 0.001) were documented,” the study notes. “After adjusting for the effects of major macroeconomic indices using multivariate analyses, numbers of psychiatrists (p = 0.006) and mental health beds (p < 0.001) were significantly positively associated with population suicide rates.”

Well, now that seems worth talking about.

The study’s authors have no clear explanation for why the number of psychiatrists should correlate so strongly with a nation’s suicide rates, but do speculate a bit. One thing they suggest is that “population-based public health strategies may have greater impact on national suicide rates than curative mental health services for individuals.” Countries with better mental health systems may also be better at determining whether a death is a suicide. Yet another idea is that nations with fewer psychiatrists “may have better family cohesion and social connectedness.”

This last point is almost certainly true. As legendary Saybrook faculty member Art Bohart demonstrated in his 1999 book How Clients Make Therapy Work, much of what drives people to therapy is a failure of their capacity to heal themselves. A successful therapeutic intervention “re-starts” their ability to self-heal. That capacity is, in many cases, just as well supported by supportive friends, community, family, or religious figures—exactly the kinds of strong social connections that existed prior to mass privatized mental health care. It is precisely a symptom of modernity that such bonds have frequently broken down … and it may very well be that the public/private system of mental health we’ve brought in to replace it (therapists, social workers, and suicide hotlines) don’t do the job as well. I wouldn’t be surprised.

But there’s another possibility, one not mutually exclusive.

The study’s focus, after all, was on the number of psychiatrists as a reified representation of a “mental health system.” And as has been widely noted, the trends in psychiatry are:

•    Providing more psychoactive drugs, while;
•    Spending less time diagnosing patients, and;
•    Spending almost no time talking to them, getting to know them as people.

Should we be at all surprised that when you take individuals who are suffering to the point of suicide and put them in a system like this—where no one has the time to talk to them and then goal is to shuffle them on and off medication—that they don’t respond well? If suicidal thoughts are in any way a cry for human contact, then a system based on more psychiatrists is designed to fail.

Indeed, there is significant evidence that going through the psychiatric system—where you are treated as a series of symptoms to be cured rather than as a person who must be listened to and respected—is itself traumatic and dangerous.

There will always be a distinction between an organic support network and a privatized support network—between people who are offering support, insight, and time just because they care and people who (however exceptionally trained) are there because they’re paid to be. But what this study strongly suggests to me is that our mental health care system is best when it most closely resembles the organic system: when the people in it and the systems that make it up behave as though the patients are unique individuals that they actually care about.

One of the downsides of the other approach, where people are put on a kind of pharmacological conveyer belt, has now been documented.

-- Benjamin Wachs

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Comments and Discussions

Thanks for posting this -

Thanks for posting this - very interesting article, indeed. There are a few points I would be interested in seeing further research on, after reading the original article. First of all, the authors themselves mention the need for a longitudinal investigation. Second, since the efficiency of suicide records will vary so much between the 191 countries, I wonder if replicating the analyses by clustering countries who have similar levels of efficiency in the reporting would alter the results. This is a design issue because if countries with lower GDP are tend to under-record suicides as the authors suggest (and also happen to be the countries with fewer psychiatrists), this will influence the results.

I agree that the trend to medicate clients after spending 15 minutes to establish their diagnosis is alarming and, personally, reminds me of the "soma" in the Brave New World. We are basically there (in some countries, at least). This is why I am particularly attentive to making the research designs that examine this issue as strong as possible - so that we can demonstrate that this model is not effective.

Now, that's putting it out

Now, that's putting it out there, Benjamin. Simplicity is the greatest profundity:
If suicidal thoughts are in any way a cry for human
contact, then a system based on more psychiatrists is
designed to fail.

People need others to be their strength encouragement and comfort when they are weak, downcast, and alone. I can only imagine the depth of such pain, and going to a psychiatrist only to be sent home - alone again - with a bottle of pills, but no hope.

Thank you.

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