What the Hell is Wrong With Modern Psychiatry?

Table of Contents

My personal experience with modern psychiatry

During my internship in psychiatry, I saw few patients improving and many were given, in my opinion, harsh and senseless drug combinations, such as the ones listed above.

I also have one encounter with psychiatry as a patient.

When I first tried moclobemide, I got quite agitated and anxious in a way I had never been before. However, because I had upcoming med school finals, I chose to continue taking it out of fear that a potential withdrawal would prevent me from studying properly for the exam, which was only a week away.

A friend, who was interning in psychiatry at the time, suggested that I speak to one of the psychiatrists there for guidance on how to proceed. After only 10 minutes of talking to me, he prescribed me a massive dose of an atypical antipsychotic (aripiprazole, 15mg), and a dangerously high dose of a potent sedative (lorazepam, 5mg).

Obviously, I discarded the prescription as soon as I got it.

After my exam, which went well, I approached the head of the psych department to complain about my experience as a patient. He apologized and acknowledged the faults in the sometimes rushed and suboptimal treatment of patients. Unfortunately, a rushed and suboptimal choice of psychiatric meds to an “I trust the doctor!” person can do serious harm to one’s health, career, relationships, and future.

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What the hell is wrong with modern psychiatry – and what could be better?

Mental health is the strongest predictor for life satisfaction and explains twice as much as the second strongest factor (physical health). Given that the human brain creates every aspect of human experience, unfortunately, most but not all psychiatrists I have met knew disturbingly little about brain biology.

Many just seemed to follow blindly what they were taught by their seniors. Furthermore, many seemed to be somewhat detached from other disciplines, therefore blind and deaf to everything that is not “mental”, such as lifestyle, hormones, metabolic health – and how these influence the brain & mind.

Unfortunately, in practice, psychiatry has a lot of issues:

  • Diagnosing too many people with too many “disorders” and medicalizing what are non-medical problems. For example, someone who is burned out sees a psychiatrist and leaves with separate diagnoses of depression, anxiety, and ADHD. This is “accomplished” by ticking off the patient’s (perceived) symptoms and attaching multiple labeling diagnoses, followed by the prescription of a drug (or multiple drugs) but not looking at the essence of the problem, which would perhaps require meaningful life changes instead of medication.

  • Assuming that mental disorders are clear-cut pathologies, even though they are just made-up, arbitrary, culturally determined, social constructs. I discuss this issue in more detail here.

  • Neglecting trauma.

  • Confusing etiology and pathophysiology of mental disorders. “Pathophysiology” usually means the biological changes associated with a disease, whereas “etiology” refers to the underlying cause of the disease, which is an important distinction. For example, the pathophysiology of depression in person X is changes in the brain, whereas the etiology of depression in person X may be the death of a loved one. Unfortunately, our treatments are almost exclusively targeting the pathophysiology (though, it would presumably be much more effective to target etiology!).

  • Assuming that a second episode of depression, psychosis, or mania, invariably means medication for life.

  • Settling for the “good enough” after an initial “response” is achieved and not trying to change or augment treatments to get a more complete resolution of symptoms. For example, many people achieve a limited remission on SSRIs but the remission remains partial.

  • Giving out quetiapine to almost everyone for sleep.

  • Giving out antipsychotics too easily and for too many conditions. Due to this, probably millions of people are taking antipsychotics unnecessarily.

  • Assuming gabapentinoids (pregabalin & gabapentin) do neither cause psychological nor physical addiction.

  • Tending to always add drugs instead of simplifying. When I interned in psychiatry, many patients were taking harsh and senseless drug combinations such as:

    – Patient #1: 450mg moclobemide, 300mg bupropion, 450mg pregabalin, 400mg quetiapine. I did bring up the fact that moclobemide should not be combined with bupropion, but the head of the psychiatry ward dismissed it despite the patient having had a blood pressure of 180/110 mmHg (he was given a triple antihypertensive therapy instead).

    – Patient #2: 90mg duloxetine, 300mg bupropion, 45mg mirtazapine, 5mg aripiprazole, 400mg quetiapine

    –Patient #3: 450mg bupropion, 300mg modafinil, 5mg aripiprazole, 2mg alprazolam

    – Patient #4: Sertraline, bupropion, brexiprazole, trazodone, hydroxyzine, and lithium. This patient commented that he believed that he was on too many drugs. On the same visit, they added Adderall to his regimen. (Unlike patients #1-#3, I have not personally met this particular patient, but I came across his story on an internet forum – so I do not know whether this is actually true. But my personal experience with psychiatrists leads me to believe that it is.)


There is a reason why groups like r/antipsychiatry exist, and it is in part related to the above.

A lot of people blindly trust their doctors in the same way little kids blindly trust their parents before realizing that parents often do not really know what they were talking about.

Sources & further information

Disclaimer

The content available on this website is based on the author’s individual research, opinions, and personal experiences. It is intended solely for informational and entertainment purposes and does not constitute medical advice. The author does not endorse the use of supplements, pharmaceutical drugs, or hormones without the direct oversight of a qualified physician. People should never disregard professional medical advice or delay in seeking it because of something they have read on the internet.

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