Addressed to:

Lisa Robin, MLA – Chief Advocacy Officer, Federation of State Medical Boards

Richard Hawkins, MD – President and Chief Executive Officer, American Board of Medical Specialties (c/o msteirer@abms.org)

Jesse Ehrenfeld, MD – President, American Medical Association

An Open Letter to the Medical Establishment

The Federation of State Medical Boards declares that its mission is protecting the public and keeping patients safe.  The American Board of Medical Specialties declares that it is committed to a higher professional standard to deliver better patient care.  The American Medical Association’s credo is to promote the art and science of medicine and the betterment of public health.

Among all medical specialties, there is one that is set apart in that it has failed its patients and the public by the standards your organizations have set forth.  That specialty is psychiatry. 

In this day and age, the world is consumed with mental health awareness but misinformed about the serious brain health disorders that psychiatry refers to as “mental illness”.  The medical establishment with its indulgence of psychosocial psychiatry bears some responsibility for this widespread ignorance.

There are divergent perspectives within the profession of psychiatry and there is a cohort which might be absolved of most of the criticisms that follow.  However, anyone with an MD credential, of the “biological school” that is at peace with a designation that broken down to its roots, translates to “healer of souls” has made a choice to coexist with the cohort that disbelieves in biogenesis of these disorders. 

What harm has befallen the patients of psychiatry for over a century after the advent of the neurology-psychiatry split?  They have become victims of two co-conspiring metaphors, “mental illness” and “mental health”, increasingly conflated due to strategic anti-stigma activism and ideological belief within the psychiatry and psychology communities.  The misleading term “mental illness” opens the door wide to conflation.

The medical (vs psychosocial) patients of psychiatry are homeless, unjustly punished, and prematurely dead.  It has become a cliché to assert that these persons are victims of a broken system.   However, the system is broken by design.   A system is destined to failure if the foundation and infrastructure of that system is built on the basis of false beliefs. 

What is Mental Health?   It is a metaphor that describes the problems of everyday living – death of loved ones, job loss, self-esteem issues, relationship problems and other adversities that can cause psychological and emotional damage at worse. Increasingly over time, this term has been misappropriated (out of ignorance and strategically) to talk about what are truly medical conditions.   However, the use of this metaphor has a long history in that government institutions from their inception have baked this conflation right into their agency names: NIMH, SAMHSA, and their counterparts at the state and local levels. 

The late D.J. Jaffe spoke to this crisis of conflation in an op-ed titled “Mental Health Kills the Mentally Ill”.  He had not yet turned toward rejecting the misleading term “mental illness” as many other advocates have, but as a former advertising executive, he recognized the adverse consequences of superimposing a term that refers to psychosocial wellbeing over what is truly physical, in that “mental illnesses” disorder the functioning of the brain’s semblance of mind.

As this letter is written, executive branch leaders in state and federal government are championing mental health parity and bringing their powers to bear to see that it is enforced.   It is difficult to discern what their concept of ‘mental health’ is.

It makes no sense to use the same terminology to refer to the oversharing jet set celebrity that chats up a late-night talk show host about how their mental health suffered after a divorce and someone that has become neurologically detached from reality (a disordered state of consciousness) to the degree that they are a danger to themselves or others.  This is nonsense and it needs to stop, but Psychiatry is not going to curtail what its practitioners are unable to see as a problem.

What is “mental illness”?   What does this term mean to the average person?  What does it mean to the media, to legislators, to judges, to prosecutors?   What are the implications of what this term happens to mean to most people?

When we use the term “mental illness”, not “brain illness”, do we put our patients in harm’s way?  …Drs. Mary Baker & Matthew Menken 2001.

Writing in the British Journal of Psychiatry, the late Dr. R.E. Kendell assigns blame to “medical opinion and medical impotence” for the concept of “mental illness” taking hold.  

Writing in a popular psychology journal, an MD (psychiatrist) castigates a former director of the NIMH for expressing disdain for psychotherapy, condemned for declaring that ‘psychiatric disorders’ in general are brain diseases — right now, no further proof needed’.  The psychologizers and subscribers to the “biopsychosocial model” in academics, research, and clinical practice, bristle at “the medical model”, and write emotionally charged treatises on the scourge of “reductionism”. 

In a 1996 Senate Hearing, Dr. E. Fuller Torrey made an appeal to Congress to be circumspect about the fact that the “mental disorders” targeted by the unscientific, politicized, and destructive IMD Exclusion were truly brain illnesses, that parity laws should not be necessary, that these illnesses should be covered under regular medical benefits rather than “mental health” benefits – like any other brain illness or disorder.  The full transcript of that hearing suggests that the hearing participants viewed parity as a means of addressing discrimination against a particular class of brain function disorders.  But in the years that followed, ‘parity’ came to mean equitable coverage of metal health (in its literal psychosocial sense) and it is questionable that the senators in that hearing intended for scarce tax dollars to be spent on interventions for psychosocial wellbeing (chief among them being psychotherapies).

Laws, government programs and regulatory policies continue to be informed by a metaphorical health concept.  Millions of dollars are now being dedicated to crisis lines and crisis centers with “calming chairs” – while the implication of anosognosia (a term rejected by the anti-medical model sect in psychiatry) is that afflicted persons do not know they are in medical crisis.  Medically necessary care is cast as coercion by activists who believe there is a right to be “psychotic” ( a neurological status with potentially catastrophic consequences). 

Does someone have the right to be “psychotic” if that translates to autoenucleating in a jail cell?

Legislative and social policies in effect today were largely shaped by the Mental Hygiene Movement – a mission that was hijacked and rebranded by psychosocial psychiatry, premised upon false beliefs about what caused “mental disorders”. Yesterday’s Mental Hygiene Movement is today’s Mental Health Awareness (traumatology) movement – and it is taking up an enormous amount of bandwidth in the media and societal discourse.

Peruse social media sites of the American Psychiatric Association and we find them posting about ‘mental health’ – that which is often depicted in glib sanitized pharmaceutical ads by snapshots of gleeful visages, people frolicking in parks, and serene yoga poses.  Meanwhile, people with “psychiatric” disorders are languishing on America’s streets, unhoused, and suffering in jails and prisons.

“The mentally ill are more likely to be victims than perpetrators”

Of the staggering 300 plus “diagnoses” in the DSM, which ones can involve “psychosis” – with its potentially catastrophic consequences?  How important is it that people understand that neurological detachment from reality can exacerbate into a medical emergency, that it’s not a “mental health” issue?

Neurology, while not the target of this letter has been complicit in the psychologization of medical conditions, writing off signs and symptoms to FND, the “conversion disorders” of neurology.   General medicine relegates neurological signs and symptoms such as delusions and hallucinations to “primary psychiatric” (whatever “psychiatric” is supposed to mean) when they cannot discover what psychiatry refers to “general medical conditions”.  The primary psychiatric construct is at the pinnacle of medical hubris – what little that science understands of the brain’s semblance of mind and consciousness even as we live within the trappings of modernity and technological advancements.   General medicine unjustifiably reserves what should be the most generic of terms, encephalopathy – which is a brain disease, disorder, or damage; temporary or permanent conditions that affect the brain’s structure or function. 

The construct of primary psychiatric needs to be banished, notwithstanding the critical importance of differential diagnosis.  Medical literature if rife with verbiage that implies that “psychiatric” disorders are to be contrasted with that which is medical and this corrupts the education of medical students.

Advances in neuropsychiatry are increasing our understanding of brain-behavior relationships. With this knowledge, the classification of illnesses as psychiatric and neurologic appears increasingly outdated – jscimedcentral.com

Psychiatry is attracting people to the profession that do not believe the genesis of their patients’ afflictions to be biogenic.  These beliefs in psychosocialspiritual causation, stress vulnerability, in transgenerational traumagenesis, have no place in medicine.  These beliefs and theories, bolstered by endless nature vs nuture studies since the dawn of psychiatry are holding back progress in research, misinforming public policies, and deranging the law and criminal justice.   

The medical establishment needs to expel Psychiatry from medicine as a standalone profession and establish a new credential as a subspecialty of neurology (and ‘neuropsychiatry’ would not serve the purpose of cleansing the taint of psychologization).   Let subscribers to the “biopsychosocial model” or those that have disdain for “the medical model ” relinquish their MD credentials.  Let psychiatry take its hideous, psychologized, misleading, stigmatizing lexicon with them and join in fellowship with their psychologist colleagues.  Biological “psychiatry” needs to have its own lexicon (What sense does it make to refer to situational depression and neurogenic “depression” by the same terminology…even inasmuch as there is clearly interplay of the two and that clearly mind-body connection cannot be denied across the spectrum of bodily afflictions)?   Psychology professionals have been emboldened to demand the right to prescribe pharmaceuticals – and been granted the right in some states.  If psychosocial psychiatrists can’t be MDs let them play doctor by prescribing powerful medications that can have serious side-effects and interactions. 

Let “forensic psychiatrists”,  call themselves criminologists – affixing “forensic” to a medical credential is detestable.  Let metaphorical health be tended to by non-medical practitioners and let disorders of the brain’s semblance of mind and consciousness be in the exclusive domain of medicine.

NASNIcares (nasnicares.org)

When we use the term “mental illness”, not “brain illness”, do we put our patients in harm’s way?   …Drs. Mary Baker & Matthew Menken 2001.

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