Medicating the Mind (Part 3 of 3)

Coercion, Psychotherapy and Psychiatry: Can A Mind Be Made To Reason?

Sally Satel, a physician who wrote a book entitled ‘P.C., M.D.: How Political Correctness Is Corrupting Medicine,’ likewise fails to see the point about her profession. On the one hand she decries the paternalistic attitude of the psychiatric profession, but at the same time she appears to favor medication as a first resort and has even advocated coercive psychotherapy for drug offenders.

So much for opposing political correctness. Satel wants to use the force of government to make people stop using drugs. Instead of doing this in jail cells, as we presently do, she wants government reeducation programs, run by psychiatrists, to do the job. She must see a different kind of patient than the ones I see. The patients I see— e s p e c i a l l y those who abuse drugs—resent being told what to do, even when they clearly know what’s good for them. So how does Satel expect a government concentration camp for drug addicts to do for them what they won’t do for themselves? You’re either ready to stop a drug problem or you’re not. If you’re ready and willing, coercion is not necessary; if you’re not ready and willing, no amount of coercion will do the trick. In fact, coercion will just make things worse.

The same, of course, would apply to forcing people to take medications like Prozac and Paxil—a step which Satel (as of yet) does not advocate but which would be entirely consistent with her underlying premise that government can and should coerce people into psychiatric health. In reality, government would never achieve its goal of changing the character and personalities of people no matter how hard it tried. Even more, by what moral or political right does Dr. Satel initiate such force against drug a b u s e r s ? Conservatives such as herself claim to support the individual’s right to choose—and take responsibility for—the course of his or her life. This is anything but apparent from the kinds of positions they often take on personal lifestyle choices.

The core issue is this: can a mind be made to reason? Anyone who has struggled with a difficult, unreasonable person—a teenager, a boss, a client, a divorcing spouse—knows the answer to this question. Reason can only be initiated by the reasoning self.

Reason represents a choice to take a certain attitude: An attitude in favor of looking at outside reality and assessing what makes sense, as opposed to flailing about in blind devotion to emotion. Until or unless an individual chooses to adopt such an attitude, external intervention is irrelevant. Coercion is not the answer. Pills are never going to be the answer either.

The answer is the one that doesn’t sell very well these days but is still the truth: Good thinking, right choices, and a commitment to both personal responsibility and personal happiness. Happiness, after all, is the goal towards which all self-responsible efforts should aim.

Personal Responsibility: Not a Bad Idea

Not everything is your fault. Sometimes people around you are irrational. You shouldn’t blame people for your own unhappiness if others aren’t the primary ones responsible for it. At the same time, you shouldn’t absolve guilty people of blame either. Sometimes wives and husbands are abusive towards each other—perhaps physically but more often verbally and emotionally.

If you determine that a spouse or someone else important in your life is abusive, there’s no point turning yourself into a permanent victim whereby you constantly seek revenge. It’s better to identify them as they are, calmly tell them that you think this and why, and determine if they will change. If they won’t change, then you should take steps to reduce contact or eliminate this person from your life. At a minimum, refuse to take any more abuse for even a moment. Feeling emotionally upset about all of this is understandable and natural. But don’t fool yourself into thinking that taking a pill to numb your anxiety or depression is going to change your situation—or the individual responsible for most of the problem. Seriously abusive people usually don’t change and you will have to accept that change on your part is necessary.

Let this become your motto and guiding principle: Change, not pills.


Honest errors in judgment

If you made deliberately bad choices and you suffer emotional consequences, then this seems fair; but if you make honest, unintentional errors in judgment, the emotional consequences will be just as bad. It’s important in such circumstances not to condemn yourself but instead to simply ask, ‘What did I do wrong and how can I fix it?’ Take a solution-oriented approach rather than one that blames or condemns.

Doesn’t a solution-oriented method mean evading blame and personal responsibility? No. Personal responsibility is achieved through observing reality and acting to find solutions; it is not achieved by beating up on yourself and damaging the morale required to find solutions. That’s why I become amused when people tell me I’m harsh and moralistic for encouraging people not to take psychiatric medication. I’m not harsh and moralistic at all. It’s just that proponents of psychiatric medication can’t conceive of any other means of correcting errors in judgment, or other problems, aside from either popping a pill or condemning yourself. Given such a false alternative, popping a pill is clearly superior.

To proponents of conventional psychiatry, life is a series of biochemical reactions and nothing else. How sad for them. Yet this is the unstated ideology governing many mental health professionals and psychiatrists. Are these the sorts of people from whom you plan to accept guidance and direction?