Charles Konia, M.D.
Introduction
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.
What happened?
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 facade 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.
Slowly, within departments of psychiatry a separate division focusing on psychopharmacology began to appear. By the late 1970s, the replacement of the psychotherapist by the psychopharmacologist in the departments of psychiatry across the United States was well underway. It was then a small step for the psychiatric profession to be taken over by big business in the form of the pharmaceutical and insurance industries.
Psychiatry thus came under the domination of the mechanistic approach of molecular medicine and brain research. By mistakenly equating the mind exclusively with the brain, and not with the whole body which includes the brain, the new generation of psychiatrists hoped to find a cure for psychiatric illnesses through an understanding of brain physiology. No longer did the psychiatrist have to understand the patient and look into his life's story that was giving rise to the particular symptom such as anxiety, depression, overeating, headache, insomnia, and so on. Instead, the patient was subjected to diagnosis by symptom checklist and given the appropriate medication. If that did not work, the patient was referred to the appropriate eating disorder, headache or insomnia clinic and put in the hands of the "expert" who dealt with these particular symptoms.
How Did it Happen?
The advent of psychopharmacology and an interest in brain research were not the major reasons for the collapse of traditional psychiatry, however. There were other factors having to do with fundamental weakness in the body of psychiatric, including, in particular psychoanalytic, knowledge and practice. These deficiencies were concealed just beneath the surface and they were far more serious.
The most important of these was the absence of an in-depth understanding of emotional functions and their relationship to psychiatric illness. From this lack of clinical understanding grew a diagnostic system that was inconsistent and often inaccurate. Psychiatrists from different schools of thought often came away with different diagnoses for the same patient.
Related to this lack of diagnostic consensus was insufficient understanding of the biological, bioenergetic principles underlying psychiatric illness. For example, what exactly does a symptom consist of and what is its function? What is the relationship of the symptom to the patient's illness? What is an emotion? Where do ideas originate from? What does a cure consist of? Combined with a lack of diagnostic reliability, failure to ask, much less answer, these questions led to confusion and uncertainty as to the correct course of therapy.
Finally, there was confusion as to an objective standard of emotional health and, as a result, the goal of psychiatric therapy was left vague and vulnerable to attack by the mechanistically oriented psychiatrist. Another consequence of this confusion was that it permitted every kind of deviant and indecent behavior to be tolerated and considered "normal," regardless of its destructive effect on the individual and on society. To further add to the confusion, this behavior was consistently supported by political activists, often arguing for protection under the First Amendment. Now, homosexual activists, for example, could argue that homosexuality was not a pathological condition but just a different sexual "orientation." This politically correct attitude and pressure from gay rights activists led the American Psychiatric Association to put the issue to a vote. With less than one third of its members voting, a majority elected to remove homosexuality from its official listing of mental disorders, a decision based on politics, not on the merits of actual scientific evidence.
These gaps in psychiatric knowledge eroded the rational authority of the psychiatrist and helped to usher in the emotional plague in full force during the latter half of the twentieth century. Almost every kind of deviant or indecent human activity, regardless of its harmfulness, was normalized. People felt free to do almost anything they wanted and personal responsibility was thrown to the wind. It was at this time that the phrase "different strokes for different folks" entered the vernacular. Freedom peddlers of every variety, such as free speech activists, argued that these offensive forms of behavior were not pathological but just different individual life style "choices."
These shortcomings in diagnosis and treatment and the decline in moral standards were the underlying reasons responsible for the degradation of psychiatry that we see today. They were part of a more fundamental social phenomenon: the breakdown and transformation of the structure of society from an authoritarian to an anti- authoritarian form. This transformation had a biological foundation. It was based on the widespread breakdown of muscular armor along with intensification of ocular armor in the general population, manifested by impulsive and psychopathic behavior that was often exacerbated by drug use. Hatred and destructive impulses broke through and were primarily directed toward authority figures in every area of social life, as a benumbed public stood by and watched helplessly. The resultant social chaos was referred to by some as "the sexual revolution."
Because the emotional plague underlying the breakdown was not recognized, it could not be understood and addressed. Every social institution-the Establishment-was challenged, from the government, military, and police, to schools and universities. Under the relentless assault of public opinion dominated by the politics and policies of the political left, many parents of adolescents fell victim to the emotional plague and lost the will to assert their rational parental authority. Thus, the degradation of psychiatry was part and parcel of the generalized breakdown and transformation of the authoritarian social order.
In psychiatry, the hatred was directed most strongly against the authority of the father of modern psychiatry, Sigmund Freud, his teachings and his followers. This antipathy ultimately turned toward all psychiatrists. In the intervening decades, one book after another appeared attacking Freud and his theories, sometimes even written by psychoanalysts themselves.
The central psychoanalytic premise consistently attacked and rejected was that conflicts originate from within the individual, and that these unresolved conflicts are responsible for people's psychiatric symptoms and illness. Instead of looking at the underlying sickness in the individual, at the disturbances in the person's character that determine neurotic behavior, the focus was turned outward toward authority figures in the real world. In effect, people's hostility was projected outward onto society in general and authority figures in particular. Nothing productive, certainly no advances in under standing the cause and treatment of psychiatric illness, ever came out of these attacks.
In the absence of a coherent, unifying understanding of the origin of psychiatric illness, the psychiatric profession turned its attention and focus to the patient's symptoms, to the endless variety of human suffering that emotional disorders can manifest. It was hoped that this would make possible a more satisfactory system of diagnosis. By standardizing definitions and providing a clear set of criteria for each and every psychiatric disorder and condition, it was believed that this new descriptive way of classifying mental illness would solve the problem of diagnostic reliability, that different psychiatrists would be able to arrive at the same diagnosis. This resulted in the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which remains the official listing of all mental disorders recognized by the American Psychiatric Association.
First published in 1952, the DSM originally listed 106 categories of mental disorder and was 130 pages long. In the following decades the list has grown and the most recent revision, DSM-IV published in 1994, contains 297 categories and is 886 pages long. This attempt at standardization, by simply adding every conceivable symptom to the list, produced many new diagnoses, such as academic skills disorder, pathological gambling and pre-menstrual dysphoric disorder. These additions only complicated matters and served to further mechanize the diagnostic process. As could have been expected, the degree of reliability and agreement using this symptom-based set of criteria in clinical practice proved to be no better than the old, and in most cases was worse. Furthermore, the new diagnostic criteria in effect threw out the significance of psychosexual developmental factors in the causation of psychiatric illness, knowledge that had been painstakingly gained through many decades of clinical work and research. This paved the way for the triumph of a mechanistic-behaviorist approach to psychiatric treatment, to treat human beings as if they are a machine. By effectively negating the importance of the emotional life and of psychosexual factors, it was a triumph of the emotional plague. Commenting on some of the defects in the current use of the DSM classification, the editor in a recent issue of the American Journal of Psychiatry wrote:
One, we have lost the patient and his or her story with this process; two, the diagnosis, not the patient, often gets treated; three, surprisingly, the study of psychopathology is almost non-existent; and four, the strict focus on diagnosis has made psychiatry boring. This never seemed to be a problem in our field before. (Tucker)
Further destructive consequences followed necessarily born of this shift to a symptom-based method of diagnosis. It led to the "pharmacologization" of psychiatric practice: Each symptom has a recommended drug that is purported to eliminate it. Psychiatrists were often mandated to follow these diagnostic and therapeutic guidelines. By focusing on symptoms, and not on the underlying emotional condition of the patient, most psychiatrists and eventually the vast majority of those in the mental health field accepted the idea that pharmaceuticals targeting the brain was the correct method of treatment for psychiatric disorders.
Why Did it Happen?
Was this degradation inevitable or could it have been prevented? Was it simply a matter of ignorance on the part of psychiatrists, or was it due to a flaw in the psychiatrists themselves? The answer: If the psychiatric discoveries of Wilhelm Reich had been utilized, the degradation of psychiatry could have been prevented. Reich's discoveries were available to be applied, but they were not. Not only were they not used, but they were avoided "like the plague."
We can trace the origin of this reaction to the fateful event that occurred at the 13th International Psychoanalytic Congress in 1934 in Lucerne, Switzerland. The significance of this event went unnoticed by almost all, at the time and since. At that Congress, Wilhelm Reich was expelled from the International Psychoanalytic Association (IPA). Reich had been a highly respected psychoanalyst who made many valuable contributions to psychoanalytic theory and technique: But he went much farther than that-and that was the problem. He provided a biological basis for Freud's psychoanalytic theories and the world of psychiatry was not prepared to accept that.
Among Reich's important contributions to psychiatry are the following:
• The discovery of a real energy that lawfully governs biological functioning, including psychic (emotional) functioning. This gigantic discovery placed Freud's libido concept on a solid physical foundation.
• The discovery of armor. Armor is defined as the typical characterological and muscular attitudes that an individual develops as a block against the breakthrough of emotion, in particular, anxiety, rage and sexual excitation. It results in bodily rigidity and lack of emotional contact. Armor interferes with the spontaneous movement of bioenergy. All the signs and symptoms known in psychiatry depend on the location and severity of armor, and the time of its formation during infant and child psychosexual development.
• The discovery that the therapeutic removal of armor restores the spontaneous movement of bioenergy and makes possible the capacity for pleasurable work and the establishment of a gratifying sexual life. By eliminating character neurosis, armor removal eliminates the energy source of psychiatric symptoms and this is an objective indication of an individual's progress toward health.
Thus, Wilhelm Reich succeeded in placing psychiatry on a bio energetically, not chemically, based biological foundation. He showed that the biochemical alterations accompanying disease are themselves the result and not the ultimate cause of illness.
Tragically, neither Freud, his followers nor the overwhelming majority of psychiatrists could grasp the crucial importance of these fundamental discoveries. They continued to remain stuck in the more superficial psychological realm. Unable to follow him, many psychoanalysts turned against Reich and began a vicious emotional plague attack against him, starting rumors that he had gone mad or was a psychopath.
One example of their limitation was their inability to grasp the fact that more important than the patient's symptoms are the disturbances of character, since the energy of the neurosis is held in the character armor. The symptom is simply a partial discharge of energy through the character armor. Effective treatment requires an understanding of the bioenergetic, as well as the psychological, functions of character.
With this understanding of character, Reich went further and showed that it is not only the individual who is sick. He concluded from his clinical studies that since everyone suffers from a character neurosis, society as a whole is sick. He was the first to emphasize that the source of the sickness in both individuals and society is the way children are raised from the very beginning of their lives. Therefore, there have to be fundamental changes in childrearing practices. This was another revolutionary idea that was unacceptable to Freud and the other psychoanalysts who believed that the individual had to be made to conform to society's rigid authoritarian standards.
Thus, the exclusion of Reich and his contributions from mainstream psychiatric thought was not based on rational considerations but rather was a manifestation of the emotional plague, the destructive social behavior of people. This reaction has had a lasting destructive effect on the practice of psychiatry. Instead of having an effective diagnostic system and a practical technique of therapy to access the underlying bioenergetic disturbance of the patient's neurotic character and restore natural functioning, psychoanalysis and all subsequent therapies are today largely psychologically oriented and separated from the physical, biological body.
The consequences of this emotional plague attack on Reich's good name and his work have been devastating for psychiatry and the public. Power and influence in the profession has been polarized between the mechanistic biologists (psychopharmacologists) who believe that "chemical imbalance" is the cause of mental disease and the mystics who believe that these illnesses are primarily a result of environmental (psychological/sociological) influences. Neither group will ever be able to provide a satisfactory understanding of and a solution to the problem of mental illness.
Without the insights given to us by Reich of the orgone of emotional disorders from chronic armoring, there can be no functional bridge to integrate these divergent views, or the mind-body duality, or to provide any possibility of prevention.
Thus, the current problems and limitations confronting modern psychiatry can be directly traced to the past and present-day consequences of the psychoanalytic community's rejection of Reich and his pivotal contributions to psychiatry, that began back in 1934. These ideas were rejected because the psychoanalysts and the psychiatrists at large were and still are, themselves, unable to comprehend and utilize them in their clinical practice. Their personal limitations set in motion an emotional plague campaign whose destructive social consequences are being felt to this day. The destruction is in the form of a tyranny of the masses where everyone's medical opinion and brand of therapy is as good as anyone else's.
Some 50 years after Reich's death, almost all in the scientific community, like their predecessors, have failed to understand and continue to ignore the deep significance of his bioenergetic discoveries. Incredibly, overt plague attacks against Reich's reputation and work are still heard from time to time.
Once thing is certain. Before psychiatry can regain the stature that it must have in order to survive as a natural scientific discipline, it must first recognize and address the emotional plague campaign against Reich's crucial discoveries. This step consists of exposing the existence and the operation of the emotional plague, and its use of distortions and slander to silence public interest in his work.
In conclusion, the emotional plague's effective destruction of Reich's good name and work has been the underlying reason that the psychiatric profession has been turned into an emotional desert. The members of the American College of Orgonomy and the faculty of its training programs in medical and social orgonomy are dedicated to opposing the emotional plague by training qualified therapists and by insuring that the knowledge given to us by Wilhelm Reich is established as the biological foundation of a living psychiatry and sociology.
References
The New York Times, September 16, 2007.
Tucker, G. 1998. Putting DSM-IV in Perspective. American Journal of Psychiatry. February 2:155.