A Shrink in Obamaland: Vanity Musings

Recent and accelerating changes in America’s social and political landscape have me pondering my chosen profession these days.

I’m not talking about the rumored craziness of the upcoming new DSM-V, the Diagnostic and Statistical Manual, Fifth Edition. Shrinks must struggle to come to grips with each one of these committee-generated monstrosities as they appear, even though their actual usefulness in practice grows increasingly suspect.

Neither am I talking about the new, Byzantine complexities of the CPT billing codes that have come down on us like a plague of locusts as ObamaCare begins to work its transformational magic.

I am also not referring to the unchanging fundamental gist of this medical specialty - the diagnosis of and attempt to treat people with some very devastating brain disorders, personality styles and life-style choices, using a combination of talk and chemicals (and occasionally electromagnetic currents or fields) capable of causing as much harm as good.

The goals of the doctor-patient relationship are also not much on my mind at this time. These are fairly well-defined on the individual level by the Hippocratic Oath I took back in medical school. The proper role of the doctor - and of the patient - in my specialty often requires a bit more thought than it does in more straightforward branches of medicine, but the bilateral responsibilities, limits and expectations are things I’ve mostly sorted out years ago.

No, my musings lately are focused on my supposed responsibilities to the State, especially with regards to the ways they may conflict with my responsibilities to my patients. But first, some clarification is in order.

By “State,” I am not referring merely to the other members of society, but to our leviathan government. Sometimes, as in the case of a doctor treating someone for a dangerously communicable disease, there are times when, for the sake of the “greater good” of other people, I might need to quarantine, so to speak, a patient against their will. Of course, there are also times when I might need to do this, not for the well-being of others, but for the patient’s own well-being instead, such as with a highly suicidal or a dangerously agitated or confused patient. I may even need to rely on agents of the State to effect such protections, and protocols are in place for such things. Having worked in many forensic and involuntary settings over the past quarter century, the morality of such decisions has been worked out in my profession in a way that sits well with my own conscience.

What I’m considering are some additional roles the State seems to want me to play as we sink into our brave new, post-Costitutional world. The State - at this point in our history, unfortunately - seems to be moving in the direction where they will need and perhaps demand someone with the “cover” of credentials like mine, to act primarily as their agent, and not as a doctor whose primary intended tasks are the diagnosis and treatment of illness.

This is a very slippery area. One only has to understand the role psychiatrists have played historically - willingly or under duress - in many totalitarian regimes. Already in our country there are some forensic psychiatrists who play this role to a greater or lesser extent in the legal system, with greater or lesser fidelity to their oaths, in my opinion. However, several recent topics in the news have me increasingly concerned.

People may or may not be aware of reports (of ? validity, as far as I can tell) of cases where the DSM-IV diagnosis of Oppositional Defiant Disorder (which must be made by age 18) has been used to justify psychiatric detention of adults who are considered right wing extremists. There has also been talk of a proposed DSM classification specific to such political positions. I am reminded of the use of the Soviet gulags in such a manner, and I quote from a salient 8/29/12 post by “phaed” at the link below:

“Psikhushka (Russian: психушка) is a Russian colloquialism for psychiatric hospital. It has been occasionally used in English since the Soviet dissident movement and diaspora community the West used the term. In the Soviet Union, psychiatric hospitals were often used by the authorities as prisons in order to isolate political prisoners from the rest of society, discredit their ideas, and break them physically and mentally; as such they were considered a form of torture.[2] The official explanation was that "no sane person would declaim against Soviet government and communism".

“Psikhuskas were already in use by the end of the 1940s (see Alexander Esenin-Volpin), continuing into the Khrushchev Thaw period of the 1960s. On April 29, 1969, the head of the KGB Yuri Andropov submitted to the Central Committee of CPSU a plan for the creation of a network of psikhushkas.

“The official Soviet psychiatric science came up with the definition of sluggishly progressing schizophrenia, a special form of the illness that supposedly affects only the person's social behavior, with no trace on other traits: "most frequently, ideas about a struggle for truth and justice are formed by personalities with a paranoid structure," according to the Moscow Serbsky Institute professors (a quote from Vladimir Bukovsky's archives). Some of them had high rank in the MVD, such as the infamous Danil Luntz, who was characterized by Viktor Nekipelov as "no better than the criminal doctors who performed inhuman experiments on the prisoners in Nazi concentration camps".

“The sane individuals who were diagnosed as mentally ill were sent either to a regular psychiatric hospitals or, those deemed particularly dangerous, to special ones, run directly by the MVD. The treatment included various forms of restraint, electric shocks, a range of drugs (such as narcotics, tranquilizers, and insulin) that cause long lasting side effects, and sometimes involved beatings. Nekipelov describes inhuman uses of medical procedures such as lumbar punctures.

“Notable political prisoners of psikhuskas include poet Joseph Brodsky, dissidents Leonid Plyushch, Vladimir Bukovsky, Natalya Gorbanevskaya, Alexander Esenin-Volpin, Pyotr Grigorenko, Zhores Medvedev Viktor Nekipelov, Valeriya Novodvorskaya, Natan Sharansky, Andrei Sinyavsky and Anatoly Koryagin, politician Konstantin Päts, and whistle blower Larisa Arap .”

The issue of mental health clearance for gun purchase or ownership is also much in the news lately. Up to this point, an FFL form merely asks if one has ever been “adjudicated” mentally ill, in other words declared mentally ill by a court during a detention or commitment hearing, which, in most jurisdictions I’ve practiced in, is a pretty high standard. If this requirement is expanded to include a psychiatric evaluation for each person wishing to buy a gun, at what point would an increasingly totalitarian government require that doctors such as I participate in such evaluations, with or without the proposed “Right-wing Extremist Disorder” in the DSM to back up a denied request.

Another area of concern is the increasing requirement that all patient records be transparent to their insurance companies and the government. Many doctors are now asking their patients routinely about firearm ownership and presence in the home. I and most other psychiatrists ask this if there seems a reasonable risk that the person’s mental state puts them or others at risk, and I am currently bound to take steps to insure that the guns are removed if such risk exists. I have no problem with that. But in cases where my clinical judgement is that no such immanent and substantial risk exists, how will the State expect me to act as they tighten down on gun ownership. Will I be required to interface with, say, the DHS in turning in every patient for potential gun confiscation? Will I be required to turn in anyone who expresses any concern or dissatisfaction with the government or the way society is headed (a large part of my current caseload!)?

"...they will need and perhaps demand someone with the “cover” of credentials like mine, to act primarily as their agent..."

A very astute observation on your part, and perhaps the heart of the issue.

We saw that in the Soviet Union.

Somewhat with you on this.

I believe a psychiatrist would have a field day as he delved into the dark recesses of the mind of the occupier of the White Hut. I believe the psychological problems of this interloping phony, narcissistic sociopath are myriad and here we stand on the sidelines watching as he destroys this nation.

"...Another area of concern is the increasing requirement that all patient records be transparent to their insurance companies and the government.."

I often suffer from a dearth of imagination in some areas, but it isn't to hard to see how this will happen.

Your insurance, banking and the government databases will all speak to each other and be accessible completely by the government at least.

What could possibly go wrong there?

Psychiatry and its offshoots, psychology and social work have ALWAYS been used as a tool of conformist repression in this country. Shrinks are doctors, after all - is there a group more square and status quo than MDs? They all follow the trend. Most are leftists. A huge proportion are, like Freud, secular Jews. There isn’t one original thought among them.

Reading “Whores of the Court”.

A very chilling account on the power of one person to determine who is mentally ill or sane in our court system. It is the prelude to the gulag society. Very dangerous. Psychiatry is a suspect “science” at best. Used for child development or understanding human actions-—it is ok—but now that politics has taken over the APA and twisted their “science” to perverted agendas-—it is all “junk” science and being used to protect Vice and destroy character in children.

It is the Leftist tool to destroy Christian Ethics-—and twist Good and Evil and destroy moral development in children and create chaos in society.

I don’t know about any of that except to agree there appear to be a high proportion of leftists in the mental health field.

But I do know there are many professions that are co-opted by the government and do the bidding of the government, both willingly and unwillingly.

“... is there a group more square and status quo than MDs? They all follow the trend. Most are leftists.”

I agree with the rest of your comment, but not this. Of the 19 doctors in Congress, 18 are Republicans. I doubt if any of them are leftists. I know many doctors in urban practice in NJ, in a spectrum of specialties, and they are nearly all conservative.

The ones who are “conservative” are leftovers - status quo ante, so to speak. It’s doctors who are involved with public health, defining normalcy this way and that depending on which way the wind blows, participating in and endorsing corrupt globalist organizations like UNESCO and WHO.

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