Charles Konia, M.D.
Reprinted from the Journal of Orgonomy, Vol. 41 No. 2
The American College of Orgonomy
Psychiatry is not the only branch of medicine that has declined in stature. The entire medical profession and the whole of society have suffered degradation. However, today I will focus only on the decline of psychiatry.
Psychiatry in 1960 and Psychiatry Today
In 1960, when I started my psychiatric training in a psychoanalytically oriented residency program, the psychiatric profession was at its zenith. Psychiatrists were highly respected members of the medical community. Rightly or wrongly, they were considered the exclusive authority by all on matters of mental health and illness. The organization of mental health professionals was seemingly well ordered. Psychiatrists were in charge of treating psychiatric patients, clinical psychologists dealt primarily with psychological testing, while social workers mainly handled matters of patient disposition to psychiatric and non-psychiatric facilities.
Contrast that situation with the current state of psychiatry. Psychiatrists who have been in practice for many decades watch with amazement and alarm at the steady decline in the social standing of the psychiatrist and the quality of psychiatric care. Today, the understanding and treatment of psychiatric patients has been degraded into a mindless, cookbook approach to patient care. Psychiatric hospitalization is largely devoted to medicating and releasing patients in assembly-line fashion. The practice of prescribing medication for children’s emotional disorders, unthinkable in past generations, is a matter of daily routine and to make matters worse, there is little or no attempt made at understanding the underlying source of the patient’s condition. For example, the number of children and adolescents treated for bipolar disorder, a catch-all phrase applied to almost any explosive, aggressive child, has increased 40-fold from 1994 to 2003. After children are classified, they are treated with powerful psychiatric drugs that have few proven benefits and potentially serious side effects like rapid weight gain (New York Times).
Finally, the psychiatrist is no longer the primary caretaker. He is now trained in a mechanical fashion to dispense psychotropic drugs that seek to eliminate the patient’s symptoms. This approach, erroneously called biological psychiatry, is his exclusive function. The primary therapist in charge of the patient’s emotional and mental care are now psychologists and social workers.
The traditional physician-patient relationship, where the psychiatrist is the one in charge of the well-being of the patient, has become a thing of the past. To further complicate the situation, insurance companies have become responsible for paying for a large part or all of the patient’s treatment. As a result, the psychiatrist has come under the direct control of insurance companies and is, in effect, working for them. Big business now dictates treatment by watching over the psychiatrist’s work, offering alternative “low cost” options, pushing medication as the treatment of choice and establishing “guidelines” for the type and duration of treatment. As a result, the rational authority of the psychiatrist has been eroded to the point of being non-existent.
Before looking at the ways to alter this course, it is first necessary to understand how this degradation occurred.
Around 1960, the most prestigious psychiatric residency programs, like the one I was trained in, placed a strong emphasis on Freud’s ideas, and the various schools that had splintered off from psychoanalysis. Despite its strictly Freudian emphasis, the residents in my training program were expected to have more than a passing understanding of the various schools of psychiatric thought other than psychoanalysis. This acceptance of eclecticism was the rule, with one notable exception: Except for the first part of his book, Character Analysis, Wilhelm Reich and his ideas were considered off-limits in every psychiatric residency program. In my psychiatric training, not only was any discussion of Reich’s ideas not tolerated, but there were several occasions when I heard his name smeared by members of the psychoanalytic teaching staff. Entire lectures were devoted to slandering Reich and his work with the sole purpose of making sure that no resident even thought of looking seriously into his psychiatric contributions. The chairman of psychiatry, who himself had been analyzed by Reich in Europe, once said that if he ever heard any resident mention Reich’s name that person would be dismissed from the program. Since I had started my training in medical orgone therapy shortly before, I kept my mouth shut and simply learned as much traditional psychiatry as I could. Later, when the residency director offered me a position on that hospital’s staff, I declined, knowing that I would not be able to practice psychiatry the way I wanted to.
The reason I mention these events now is that it will help to clarify later developments in psychiatry. I will show that the exclusion of Reich’s contributions to psychiatry and sociology from the main body of psychiatric knowledge were the pivotal factors that resulted in the degradation of psychiatry during the following decades. It prevented psychiatry from being placed on a natural scientific, biological foundation. Instead it is based on sterile, mechanistic principles.
Even in the early 1960s, however, there were signs indicating that the façade of psychiatry was cracking and conditions were not as robust as they appeared. For one thing, there were many psychiatric disorders such as psychoses and depression that were not amenable to psychoanalytic treatment. Another was the discovery of drugs that could be used to suppress the symptoms of anxiety and panic resulting from psychiatric disorders. These drugs were effective in eliminating the distressing psychiatric symptoms, but they certainly could not be considered a cure and, moreover, they had disturbing, sometimes life- threatening, side effects. Nevertheless, the practical advantage of these medications was that in many cases the length of psychiatric hospitalization could be reduced dramatically with great overall savings. The effectiveness of drugs on symptom reduction, although doing nothing to alleviate the underlying emotional problem, was a welcome alternative to psychiatrists with a mechanistic orientation. Psychoanalysis could not stand up to the symptomatic benefits of medication therapy.
To read the full article, please reference the Journal of Orgonomy Vol. 41, No.2.