Society and Psychiatry: History, Fads, and the Future
(In)Stability of Psychiatry
I’ve been surrounded by psychiatry for as long as I can remember, longer than I even understood it. Beginning in elementary school, my dad coached my softball teams, starting at little league and ending in high school. He drove us to tournaments around Michigan and between listening to 80’s and 90’s alternative music, he talked with me about various things spanning from U2’s social and political commentary to docuseries about brainwashing or cults that were always on at our house. My dad was particularly interested in these documentary shows chronicling how people became entrenched in these controlling and abusive organizations.
As a family, despite my initial protests, we became particularly fixated on Leah Remini’s show, Leah Remini: Scientology and the Aftermath, that documented her and former members' experiences with the Church of Scientology. For those of you who aren’t aware, or didn’t grow up watching these shows, Scientology is a religion that was founded by L. Ron Hubbard in 1952. The Church of Scientology makes it nearly impossible to leave because members are isolated from criticism of the church and are solely dependent on the church’s social network. When people want to leave, they face difficulty financially, as much of their income goes to the church, and their social support system has been destroyed.
There are many off-putting aspects of the church, one of which is a cruise ship, manned by their “Sea Org,” where the church was housed in the 1960s after being criticized by the US, and kicked out of England (Burke, 2019). Although the church claims that the ship, the Freewinds, is where Scientologists can reach the highest level of spiritual attainment, this has been highly criticized by many individuals, including Leah Remini. Former members have claimed that the church invites individuals aboard for vacations, which turn into years-long indentured servitude, allegedly lasting over a decade (Burke, 2019).
Even though my siblings and I complained about the show, there was something haunting and captivating about the horrific treatment of people at the hands of the religion that caused us to sink into our seats and watch episode after episode. Scientology is saturated by celebrities like Tom Cruise and John Travolta, and even if I liked their movies, whenever I realized they were part of the church, I disliked them for their association.
Beyond this, Scientology has many interesting beliefs, and I am still particularly interested in their claims surrounding mental illness. They offer pseudoscience treatment for medical and psychiatric conditions and denounce the field of psychiatry.
Scientology does not allow for clinical assessment and treatment of many health issues, instead the church prescribes a variety of other treatments, like “detoxification,” a practice of diet and saunas prescribed to John Travolta’s son, Jett (Nichols, 2009). Although Jett exhibited symptoms of autism, the church believes that people with disabilities can cure themselves by working harder on the teachings of the church. Individuals with autism, potentially like Jett, also have a significantly higher risk of seizure disorders which can be treated by medication, something that would be discouraged by the church, but encouraged by clinicians (Nichols, 2009).
Jett died after having a seizure and hitting his head in 2009. Although the Travolta’s claimed that Jett was not autistic, his death was surrounded by speculation by medical professionals who thought that his death could have been prevented if the family had rejected Scientology’s theories on medicine (Nichols, 2009).
On Leah Remini’s show, they described another interesting treatment for mental health issues through the church– going to the “E-Meter,” a device that supposedly measures mental state and change of state that assists in the process of auditing (What Is the E-Meter and How Does It Work?, n.d.). Auditing is a concept created by Scientology’s founder, L. Ron Hubbard, with the purpose to restore beingness and ability by helping individuals rid themselves of any spiritual disabilities and increasing spiritual abilities (What Is the E-Meter and How Does It Work?, n.d.).
The E-Meter, also known more casually as the Cans for members of the church, incited great fear for those being “audited” because they were under constant subjection and could be manipulated by the auditor (the person performing auditing). These tools, along with other invasive measures, are used to manipulate people and keep them in the church (What Is the E-Meter and How Does It Work?, n.d.).
My parents don’t like Scientology because they are psychiatrists. Psychiatry is the field of medicine concerned with the study, diagnosis, and treatment of mental illness. Both psychologists and psychiatrists play important parts in mental health care, but psychiatrists are medical doctors who prescribe medication, whereas psychologists may offer therapeutic treatments, like Cognitive Behavioral Therapy (CBT), or talk therapy. Once, when my dad was attending a psychiatry conference, we received a selfie of him in our group chat with a line of protesters from the Church of Scientology, protesting and rejecting psychiatry.
Over a Thanksgiving break, my family was visiting Florida and we just so happened to be driving through Clearwater, the global headquarters of the Church of Scientology on our way to a beach. As we drove through the area of town owned by the church, which was eerily devoid of people, in our rental car, my parents gave my brother, sister, and me a warning to never be vulnerable to an organization that could harm us like that and to not get sucked in.
I don’t see myself, or many others getting sucked in—in fact, just last week I was in a class, making small talk with a peer, and I mentioned this project. She was surprised that I knew about Scientology and told me that she had worked for a dentist who was part of the church. She explained how when employees refused to attend events related to the church, his attitude toward them deteriorated, and many of them, including herself, quit because things became so bad.. Among the people I interact with, I believe few of them would be lured into the church with its false promises and dangerous views on medicine, but I could see how some more vulnerable or isolated people could be tempted with their promises of hope and community.
The key difference between Scientology’s pseudoscience mental health treatment and what I’m actually interested in, is that Scientology’s beliefs about mental health are not endorsed by the scientific community, whereas psychiatry is. This is not to say that psychiatry has not been wrong before, having endorsed other pseudoscience treatments that have been later proven false, but this means that Scientology can attempt to claim some sort of legitimacy and attempt to denounce psychiatry because of its susceptibility to both social and scientific trends.
The field of psychiatry and treatment for mental illness has progressed significantly from where it began, but considering early psychiatric hypotheses and treatments can explain some of the current skepticism and fear that some have of the field. For this reason, a brief overview of treatment of mental illness is of utility.
Records of treating mental illness began around 7,000 with the practice of trephination, or removing a small part of the skull to relieve mental illness, headache, or even what was believed to be demonic possession (Concordia St. Paul, 2020). Ancient theories about mental health were the result of the belief that supernatural causes, like demonic possession, curses, sorcery, or a vengeful god, were behind strange symptoms (sun). Trephination was thought to release the evil spirits that were occupying the head of the person. The treatment was initially done with the use of stone instruments, which were eventually upgraded to skull saws and drills for this purpose (Editorial Staff, 2022).
Beyond violent treatments like this, priest doctors used rituals to try to remove the demonic spirit like prayer, atonement, or exorcisms (Editorial Staff, 2022). Sometimes if these methods were ineffective, people would resort to threats, bribery and punishment. Although these treatments were common at the time, not all mental illness treatment was violent or abusive. Ancient Egypt, for example, offered more humane treatment, allowing patients to engage in recreational activities to aim towards normalcy (Editorial Staff, 2022).
Between the 5th and 3rd centuries BCE, Hippocrates, Galen, and Socrates pivoted to thinking that instead of supernatural causes, mental illness was caused by natural imbalances of the four essential elements to the human body (Editorial Staff, 2022). These elements, called “humors,” included blood, bile, black bile, and phlegm were said to cause mental illness when out of balance. Treatments included laxatives, leeches, cupping therapy, emetics (inducing vomiting), and specialized diets (Editorial Staff, 2022).
The responsibility of caring for mentally ill people typically fell on the family, and the first recorded mental hospital was founded in 792 CE in Baghdad (Editorial Staff, 2022). In Europe, having custody of a mentally ill patient was seen as shameful and humiliating so families hid them in cellars, caging them, delegating them to servants’ care, or abandoning them on the street. This stigma is still prevalent, especially in countries where there is a strong emphasis on family honor, and a mentally ill family member could suggest dishonor and cast doubt on the social standing and viability of the family. When that didn’t work, the churches offered workhouses (basic room and board in return for work), which helped the mentally ill until the need became too great (Editorial Staff, 2022).
In 1406, the first psychiatric hospital was founded in Spain, marking the creation of asylums that were not places for treatment or comfort, but instead forced patients to live in inhuman conditions and subject them to abuse while ostracizing them from their communities (Editorial Staff, 2022). In asylums patients were subjected to bloodletting , vomiting, dousing in very hot or cold water, neglect, physical restraints, straitjackets, and threats. Because of this horrible treatment, a call for reform began resulting in the movement for moral treatment in 1792. This was marked by hospitals starting to center care around kindness and improving conditions through emphasizing time outdoors, fresh air, and not using restraints (Editorial Staff, 2022)..
Once the moral treatment movement reached the US from Europe, the focus shifted to helping patients by focusing on their social, individual, and occupational needs which was the first time that the idea of rehabilitating patients back to recovery and reintegration to society was introduced (Editorial Staff, 2022). When that movement died out, because people believed patients depended too much on caretakers, Freud’s strategies, including psychoanalysis emerged and became commonplace. This occurred through talk therapy, which Freud thought would open the unconscious mind to grant access to repressed thoughts or feelings that may impact mental instability (Editorial Staff, 2022). Most of this phased out in the mid 1900s, due to lack of verifiability and falsifiability but some of Freud’s strategies are still used today.
Next, the biological model of mental illness emerged, suggesting that mental illness is caused by chemical imbalances in the body and should be treated as a physical illness, like by doing surgery on the brain (Editorial Staff, 2022). In the 1930s, psychosurgery became popular– hammering a medical instrument through the top of both eye sockets to cut the nerves that connect the frontal lobes that regulate behavior and personality. This was thought to calm patients with schizophrenia, manic depression, and bipolar disorder. Patients left psychosurgeries, like lobotomies, with undesirable side effects like issues with mood and becoming lethargic and immature, but this didn’t cure the illness (Editorial Staff, 2022).
Psychosurgery was controversial from its introduction, so psychiatry moved on to the current era of psychopharmacology. Lithium was introduced in 1949 and was able to control symptoms of mental illness, and now modern psychiatry has a host of other medications that are offered for depression and other mental health disorders (Editorial Staff, 2022).
Although many of these trends seen throughout time have dissipated, some of the concepts can reemerge and return to being commonplace. Although this is a brief history, psychiatry has made errors in endorsing treatments like lobotomies or trephination that would not occur today. Because psychiatry is part of medicine that is still being explored and the mind is very complicated to understand and therefore treat, it is highly vulnerable to making these mistakes due to the beliefs and values of society at that time.
The Memory Wars
As I began this project, one story from my dad’s training drew me to consider the vulnerability of psychiatry. As a young doctor in the late 1980s and 1990s, he began working with psychiatric patients that came in with what I assumed would be an uncommon complaint; repressed memories of childhood sexual abuse.
At the time though, there were widespread claims of these repressed memories that were amplified by the media. Psychologists and psychiatrists offered treatment for this, and validated these claims. Later, in the 1990s, the claims of sexual abuse ended up in court where they were eventually retracted.
I wondered why these claims were accepted without question, and why there was such an emphasis on widely treating something without exploring how prevalent the issue was? Beyond that, I wanted to know who or what institution was responsible for taking this too far, and more alarmingly, what new fad is being embedded in modern psychiatry, and the potential repercussions.
These repressed memories occupy an argument known as the “Memory Wars” in the literature, showing a tension between two different camps; memory scholars asserting that there is no credible scientific evidence that repressed memories exist and clinicians who claim that these memories do exist (Otgaar et al., 2021). There have been instances where individuals go to therapy, just like the patients my dad saw, and claim to have recovered memories of abuse that was unknown to them prior to therapy.
From these claims, clinicians concluded that the abuse was a repressed memory that therapy had helped recover, whereas memory researchers asserted that therapeutic interventions may be inherently suggestive and lead to the creation of false memories of abuse. It is also noted that repressed memories could also be explained by ordinary forgetting, because it is normal for people who experienced a traumatic event to not remember all the details of that experience (Otgaar et al., 2021).
Although researchers extensively studied how false memories are created and whether repressed memories exist, there have been questions about the validity of that research. Because this topic is controversial and contested to this day, I wanted to understand what evidence there is for repressed memories. I found a literature review that aimed to thoroughly examine what science says about the phenomenon of false or repressed memories (Otgaar et al., 2021).
When researchers attempted false memory implantation, they invited participants to elaborate on events that were suggested to have actually happened to them (Otgaar et al., 2021). For this study several of these situations happened, and one had not. These researchers were able to implant false events, like being lost in a shopping mall, going on a hot air balloon ride, bumping into a punch bowl, and even being abducted by a UFO. Around 30% of participants can be swayed into remembering a false autobiographical memory (although studies varied with reports ranging from 0%-70%). This is a concerning percentage especially because when the correct conditions are met, like those that may be met in therapy, like probing guided imagery and repeated suggestions over time, people may be even more susceptible (Otgaar et al., 2021).
As it pertains to the recovered memories of childhood sexual abuse, it is not ethical to experiment with implanting that memory, but the literature highlights that negative and stressful events, like being accused of copying, are more easily implanted in children than neutral events, like moving to another classroom. Also, repeat events were just as easily implanted as events that happened once (Otgaar et al., 2021)..
When looking to understand “repressed memories” in the context of childhood abuse, it is important to look at how these claims compare to how traumatic memories are typically processed. The forgetting of traumatic incidents have been hypothesized to be due to victims not wanting to discuss the abuse and it may result in forgetting the event, “forget-it-all-along” effect where some people who claim to have forgotten the event are found to have disclosed the traumatic event to someone but forget the disclosure, or individuals didn’t interpret the event as traumatic as it happened but reinterpreted as being abusive in retrospect (Otgaar et al., 2021).
Despite this, the article states that most traumatic experiences are generally well-remembered. Instead of repression, the authors highlight that suppression, which is a conscious repression, or motivated forgetting, might be plausible as when people are told not to remember something, they don’t remember as many details. The review stated that evidence for this isn’t as strong as that of the implanted memories. Unconscious repression of memories doesn’t align with how most traumatic memories are stored and retrieved, but other plausible explanations include reinterpreting memories, which should be considered within the repressed memories debate. The unconscious belief of repressed memories is much more controversial than the conscious suppression of memory (Otgaar et al., 2021).
Although scientific evidence does not generally support the unconscious repression of memories, two small studies of therapists found that over 70% of them believed in unconscious repression and multiple student studies found that over 50% of students believe in unconscious repression. The belief rate increases from between 59%-67% to 80.9% when asking about unconscious repression of traumatic memories (Otgaar et al., 2021).
Not only are these beliefs entrenched in the general population but also the clinical context despite little evidence (Otgaar et al., 2021). The article concludes with a warning that the work done by memory scholars can extend into therapeutic and legal settings. There are implications for not educating these stakeholders educating these entities may mean that fewer false memories of abuse could arise in clients, preventing false accusations from sticking in court (Otgaar et al., 2021).
In my dad’s first week as an attending psychiatrist, a woman came in with not only claims of repressed abuse, but with claims of Sexual Ritual Abuse, or SRA. This person and her family claimed that they wanted treatment for SRA, which is not provided at the hospital that he worked at. Her claims were concerning, stating that her church kidnapped and harmed her, but some of the finer details seemed highly implausible.
According to the US Department of Justice in 1993, Ritual Sexual Abuse is abuse that may have religious overtones and can be difficult to prosecute. They highlight the difficulty that children may have in perceiving and remembering reality makes it easy for offenders to commit acts that confuse and intimidate them. They state that there are several different kinds of SRA, and that many victims don’t report it for fear of their safety or that they will be labeled crazy (Bradway, 1993).
They also stated that individuals who experience SRA often develop multiple personality disorder (now known as Dissociative Identity Disorder) among other psychological symptoms such as suicidality, eating disorders, substance abuse, etc.. The article explains that the abuse is often initiated by family members or day care providers. Because of these factors, they note that the prevalence of such abuse is difficult to estimate because many child victims and adult survivors do not publicly acknowledge that they were abused (Bradway, 1993). The article concludes, saying that therapists may be able to help.
I don’t doubt that a therapist could help… so long as they don’t falsely implant memories.
As I looked further into this phenomenon, this patient’s case was not unique, instead occurring in the context of many other similar instances and complaints in the 1980s and continuing into the 1990s. The Satanic Panic, which was a moral panic and fear of satanic cults committing mass abuse occurred in a time where women began joining the workforce, causing them to turn to daycare centers for childcare (Yuhas, 2021).
In 1980, Michelle Remembers, a book about murderous Canadian satanists was released, and although the claims in the book were challenged, it was a bestseller (Yuhas, 2021). This book, written by a psychologist and their former patient about their memories of child abuse at the hands of satanists, sparked a moral panic in an unstable America.
Sociologists explain that as more women joined the workforce out of necessity and due to the women's rights movement, conservatism and the religious right became a strong voice prioritizing the nuclear family. Good daycare was difficult to find and parents felt guilty for depending on it. At the same time, the public was beginning to address the issue of sexual abuse, particularly involving children (Yuhas, 2021). The book was a spark to place the blame outside of the home, and although these claims were challenged, they managed to spread mass fear.
Shortly after, in 1983 Manhattan Beach, California, a woman accused her son’s daycare of abusing him. The police sent a letter to 200 families asking them to help with their investigation (which the article states is not the appropriate way to approach the issue from a lawyer specialising in child abuse cases). They had therapists interview hundreds of children, questioning them for hours at a time and asking suggestive and leading questions (Yuhas, 2021). Although this alone didn’t jump to satanism immediately, the interviews began stating that “something weird or elaborate” happened. The lawyer interviewed in the article stated that they were ill-equipped to deal with a situation like this (Yuhas, 2021).
In 1986, prosecutors charged 7 daycare employees with over 100 counts of child molestation and conspiracy, although a week later the charges were dropped for 5 of those individuals and all stated that they were innocent. At that point there was weak evidence, and “fantastical claims” from the interviews including a “goatman,” bloody sacrificing, and an employee who could fly. The trial didn’t end for years and dozens of other similar cases sprung up throughout America (Yuhas, 2021).
They state that credible authorities, the police, prosecutors, psychologists, and the media put pressure on others to act. In 1985 America tuned into the 20/20 news program on a segment on Satan Worship, and in 1988 20 million Americans tuned into NBC’s special featuring child testimony of abuse. Over the course of the panic, almost 200 people were charged and dozens were convicted. Many of these individuals were eventually freed but sometimes after years. The FBI stated that they were skeptical of the satanic abuse claims, and in 1994, the National Center on Child Abuse and Neglect could not substantiate any of the near 12,000 accusations of group cult sexual abuse based on satanic ritual (Yuhas, 2021). Law enforcement, lawyers, therapists, and the broader population all reinforced and amplified these unsubstantiated claims.
For my parents, they noted that it wasn’t just the patients that were suffering from the results of these complaints of SRA, but also the families. My dad’s patient’s family came in, belligerent, demanding an extended psychiatric stay for treatment of SRA on the inpatient unit, protesting when the hospital asserted that an inpatient unit is not used to treat SRA and is only used to stabilize patients who are at risk of harming themselves or others.
It isn’t just one person that buys into this, but communities and relationships suffer as a result as well. While my dad seemed astounded by the improbability and the implausibility of these claims as he told me this story, my mom chimed in saying that so many claims during this time were unsubstantiated and that many relationships, particularly parent-child relationships, were ruined as a result.
They acknowledged that deciphering what is real about SRA is very difficult, and nat people may have experienced horrible abuse, but that it may not be at the hands of a cult or church. They hypothesized that some other individuals they saw citing a history of abuse might now be considered to be trafficking victims by today’s standards.
My mom said that the whole thing was very sad because some patients would cut off their parents because of either “repressed” or unsubstantiated memories of abuse. Part of practice now includes mandatory screening questions, so if a mental health professional is searching for something in particular, people could easily fill in the blanks to confirm an assumption. There is also a big focus on open ended psychotherapy and if therapists are searching for these things and offering leading questions, they may actually be the one traumatizing patients.
Electroconvulsive Therapy (ECT)
For the past several months I’ve worked as a psychiatric care tech in an Electroconvulsive Therapy (ECT) Unit. This has proven to not only be an interesting learning experience in regards to working as a team to try and make sure that the most severely depressed patients can receive necessary care to achieve remission from their depression, but also to have an inside view on one of the most stigmatized mental health treatments. By the time patients come in, they often have failed several medications, and it is common for them to begin ECT treatment on an inpatient psychiatry unit where they may be sick and contemplating suicide.
As it has been described to me, ECT essentially works to rewire or reset the brain to help with depression symptoms. Currently, ECT is not a violent or harmful procedure. When a patient comes in, they are put under anesthesia for about 15 minutes and given a muscle relaxant. While the patient is asleep, a short seizure is induced, usually lasting for under a minute. Contrary to popular belief, the patient is not shaking, they just appear asleep, due to the muscle relaxant medications. The only thing that you can see is their big toe moving, and after their treatment, they are monitored as they wake up and return home.
When I mention that I work in ECT right now to friends or school advisors, I am rarely met without trepidation and it often prompts a slew of follow up questions. At Easter brunch, one of my friends asked me about it, mimicking a seizure at the restaurant and asking if we electrocuted people at the hospital. On multiple occasions, the only way to explain that it is not a violent procedure is to show them a video. I’ve had to do this this past weekend, and also with one of my school advisors in the past year and even though a 10 minute conversation about it doesn’t help them fully grasp that the procedure is safe, after they see a video of it the vast majority of their skepticism and stigma seems to dissipate.
Beyond working in ECT, I’ve had two of my high school friends struggle with severe mental health issues, and they were treated with ECT which significantly helped them both. One of them was so grateful for it that she got herself a lightning bolt tattoo to commemorate it. Although I’ve never considered ECT to be problematic, I’ve only existed in a time and in a family where this has not been considered dangerous or stigmatized.
ECT has a tumultuous history, not only in how it emerged but in its portrayal in the Media. In the 1930s, ECT was invented in Italy after psychiatrists had discovered that inducing seizures could relieve symptoms of mental illness (Sadowsky, 2017). Prior to ECT, seizures were induced by using chemicals, typically one called Metrazol. However, patients reported experiencing a feeling of terror after taking Metrazol prior to the seizure, so researchers began searching for a safer, more humane, and less frightening method of inducing the seizures, settling on electricity to create ECT, which is used around the world (Sadowsky, 2017).
In the 1950s, ECT continued to benefit patients, however there is evidence from that time that ECT and threatening it was used to control patients and maintain order (Sadowsky, 2017). Additionally, ECT was physically dangerous at first, prior to using muscle relaxants to control the seizure and anesthesia to control the pain from electricity. Although these modifications (that are still used today) to make ECT more comfortable for the patient were quickly created, it took a while for them to become common practice. Currently ECT is considered to be “modified ECT” which means that it is done under anesthesia and with muscle relaxants.
In 1975 the film adaptation of “One Flew Over the Cuckoo's Nest,” an unruly patient is subjected to ECT as a punishment (Sadowsky, 2017). Although it was sensational in its showing of ECT, it was not completely unrealistic for being set in the 1950s. This, along with other media representations of the treatment often show it in this negative light, despite modern ECT being safe, comfortable, and relieving symptoms (Sadowsky, 2017). Despite the evidence that ECT was effective in the 1960s, it was still feared and its use continued to decline in the 1960s and 1970s during a revolt against medical authority of psychiatric illnesses. People seemed particularly opposed to physical treatments for mental illnesses, especially ECT, instead supporting talk therapy as a treatment. Since the 1980s, ECT has become much more common and there have even been positive portrayals of it by celebrities like Carrie Fisher and writers who describe it as bringing them back from a bad depression (Sadowsky, 2017).
The benefits of ECT cannot be denied, but neither can the history of it. Even now, in the Netflix Series, Wednesday, there was a mention of “Electroshock Therapy” in an attempt to be jarring that failed to reduce stigma of the treatment or accurately depict how it occurs today, particularly towards younger viewers. The popularity of ECT has ebbed and flowed as it has become much more humane, but the stigma and memory of its history remains.
What's Next?
Where does this leave us? While I’m not sure exactly what will happen with psychiatry, and I don’t think anyone will truly know until we examine events in retrospect, I have an idea or two. First off, psychedelic therapies seem to be booming right now and it seems to be correlated with the influx of acceptance of recreational psychedelics in society right now. As of 2022, Oregon and Colorado have decriminalized and legalized psilocybin (mushrooms) for therapeutic use. Some other cities, including Ann Arbor, MI have passed measures that decriminalize these mushrooms and other naturally derived psychedelics, not making a distinction between medical and recreational use (Ollove, 2022).
At work, as I was waiting to transport a patient from an inpatient unit to our ECT unit, I began talking with one of the nurses about how they started working in Psychiatry and what they wanted to do moving forward. They began working on one of the inpatient units, and moved to doing ECT and assisting with a ketamine clinic that is open a few days a week. For the next chapter of their work, they really want to be on the cutting edge of psychedelic psychiatric care as the field continues to emerge. I didn’t know much about ketamine beyond that ECT and ketamine are both used to treat treatment resistant depression (depression that isn’t helped with other treatments like SSRIs).
Outside the clinical setting, in the past year one of my friends thought that she needed help for anxiety and instead of talking to her primary care provider or finding a regular therapist, she decided that she needed ketamine treatment. I think that this may have been influenced by music festival culture, where she has seen people use ketamine recreationally, and have to be carted off in wheelchairs when they take too much and enter a K-hole (where you become high enough on ketamine to experience a state of dissociation). While that might enhance the experience at a music festival, it hardly sounds safe to me.
The Ketamine clinic that takes place where I work is for a Ketamine study and just like ECT, patients have to experience very severe mental health issues to qualify (and usually fail other antidepressants). In that setting, they determine if the person is a good candidate for either treatment, and then proceed. If for whatever reason, let's say the person’s primary issue was some kind of personality disorder, they could decide that ECT would not be an appropriate treatment.
SSRIs and other antidepressants are one of the front line treatments for mental health issues, and about 55% of SSRI prescriptions come from primary care physicians, those that do not have specialty training in psychiatry (Cascade & Kalali, 2008). Although this is not inherently an issue, it may become one when physicians, and even psychiatrists, begin to offer treatments that they are not trained to administer, or offer treatments without proper procedure.
As my friend was seeking help, she found a private practice that offered ketamine and other therapies. Growing up around psychiatry, I’ve always been told that you begin with CBT, progress to medications if that doesn’t work, and then if issues are still unresolved move to Ketamine, ECT, etc. From her research, it sounded like this ketamine clinic likely was for people paying out of pocket, and had a shorter vetting process than had she sought ketamine out in another setting, like an academic hospital.
The likelihood of a treatment working may be decreased if the patient is not assessed and determined to be a good candidate for the treatment. Although I work in a hospital setting, I know that my workplace emphasizes oversight and continuing education to ensure that individuals providing care are not only trained within the medical specialty, but trained to provide specific treatments within that specialty, which may not be followed or regulated as much in a private practice.
For me, this raises concerns about safety and efficacy of treatment if the providers can alter their practice and treatment options based on what is popular in society. Just because there are consumers, or patients, asking for ketamine or other treatments doesn’t necessarily mean it is the right treatment for them. Ketamine is safe and helpful for some people, but offering it based on societal or consumer demand and ability to pay, could create unintended consequences. , or done in a zero to 100 fashion.
As I was trying to find the origins of psychedelic treatment for mental illness, I found that although the concept of treating mental illness with hallucinogens and dissociative drugs seemed new to me, this is actually a resurgence. Researchers first began studying LSD in 1943 and were interested in the therapeutic effects of LSD which alters perception, cognition, and mood (Dyck, 2005). In the early 2000s, there noted a new preoccupation with rediscovering therapeutic uses of psychedelic drugs, although the history of LSD has been controversial (Dyck, 2005).
In the 1950s there were several hundred articles on LSD published in scientific journals, none of which describe LSD in the context of addiction or abuse and they highlighted potentially promising information about LSD’s contributions to medical research (Dyck, 2005). In the early 1960s, academic articles remained positive despite a high profile firing of a Harvard Psychologist for “indiscriminate promotion of the drug.” In 1966, news articles about LSD increased, warning of the drug’s danger and coupled with medical research reporting that LSD caused chromosomal damage, fetal abnormalities, and potentially memory impairment. As LSD became central in a moral panic about drug use in the US, some researchers were hesitant to halt studying of LSD because they thought that it would eliminate one of the most progressive therapy options, but the US government banned the use of LSD (Dyck, 2005).
My friend who was originally seeking Ketamine just recently visited a primary care clinic for a physical. She had never been to this clinic before and when she returned she had a prescription for SSRIs. She quit therapy because they would not provide her with medications, but she was able to access them in her first and only visit to this clinic, she was provided medications.
I’m not sure that this is inherently wrong or dangerous, but I’m not sure there was appropriate time for assessment and for her to understand the side effects and process of starting these medications. She took the medications that day, and soon after said that she didn’t feel well. She didn’t have a prior relationship with this clinic, and the provider may not have known her history with mental health issues. There may not be fault here, but she likely didn’t research the implications of starting these medications, and the provider did not provide education.
My undergraduate major is Public Health and as a field that champions prevention and lifestyle changes I wonder if as a practice, psychiatry is overmedicating these issues instead of considering modifiable lifestyle changes that could help patients prior to medicating them. Potentially having the patient improve their diet, exercising, improving sleep, or trying cognitive behavioral therapy as a brief intervention may be a first step. Just like a best practice for depression treatment would be making sure someone has failed medications prior to giving ECT, it could make sense to try lifestyle changes first that wouldn’t come with potential side effects before prescribing medications.
Perhaps no one is inherently at fault that psychiatry as a discipline cannot be disentangled from the society that it exists in at the time. There are emerging challenges including the vast amplification of messaging through media as technology continues to improve. Societal strife seems to manifest in different ways depending on culture and time period, making it difficult to identify a treatment or panic that may not be useful, and at times could be incredibly harmful to patients.
Psychiatrists and other clinicians in this space carry a lot of responsibility, and should center their care on first doing no harm, which is in line with the Hippocratic Oath emphasized in their medical training. These trends are incredibly cyclic and as treatments and maladies begin to trend, providers should be on the lookout for emerging issues and think critically about the evidence for the intervention they want to do and the history. This is not to say that new treatments should not be explored, but they should be investigated in an appropriate and safe manner to study their effectiveness prior to offering the treatment to the general population. This also means that psychiatrists should make sure that they are practicing medicine appropriately, and following protocols like making sure that they are trained in administering certain treatments and by making sure that the patient is an appropriate candidate for treatments.
Beyond this, the US healthcare system operates like a business, so it isn’t just providers making decisions, although they make the final call as a prescriber, but the consumers seeking treatments out. Patients, or consumers, owe it to themselves to think critically about what treatments they are seeking and why to ensure that they are receiving the care they need to improve their health, not necessarily the most popular treatment at the time.
The media also plays a huge role in amplifying messaging surrounding psychiatry which has and can continue to spark panic. News outlets, including social media, as well as parts of pop culture like movies and TV shows, should be thorough and intentional about what they promote regarding mental health and treatment messaging which could help reduce the harm of emerging concerns before they are validated.
The media can play an active role in either exacerbating or alleviating the stigma or fear around mental illnesses, and often can play to the vulnerabilities in the population. As a practice, psychiatry is intertwined within society and just like an average American can be swayed by their priorities and fears, the field of psychiatry can be too. Although I doubt that trends in treatment will ever dissipate, all of us, care providers, media, and the public have a responsibility to each other to slow the cycle down, and think critically before jumping to new conclusions and potentially harmful treatments. By slowing this cycle, this can allow for time to research and adopt evidenced-based new treatments once they are proven to be effective and beneficial.
