Paternalism and psychiatry


It seems to me that many doctors who self-select to do postgraduate training in psychiatry are attracted to the profession largely in a quest for self-realisation. Once trained, they pride themselves as doctors who are compassionate listeners, unlike most of their colleagues in the medical profession who are doers and fixers. Psychiatrists like to get to the bottom of things, to see people as they really are. They believe they are best placed to interpret the words, actions and behaviours of their patients. Without any confirmatory tests, it will be the psychiatrist’s conclusions that will be the foundation on which a diagnosis is made. Psychiatrists see themselves as unique in possessing the wisdom needed to make such judgements and have become the experts on whom the world trusts, able to differentiate and define, motive and intention in complicated lives. Their opinion is so widely respected that the lay public becomes nervous, fearing that a psychiatrist can ‘read their mind’.

Psychiatrists also have powers which other doctors do not have. They can force their patients to have treatment and to be incarcerated, and detained under lock and key. Such patients have little recourse to advocacy or to lawyers. Once sectioned (detained), they have no entitlement to vote.

Many psychiatric patients have been in the system for years. Those who have survived the plethora of psychotropic drugs and treatment will have been or are still being harmed. Yet when these very same individuals attempt to make any retrospective claims, they have no way of proving that they have been hurt. Their medical record will always be written from the psychiatrist’s point of view. Psychiatrists will always have the safety net that their patients’ accounts cannot be validated due to the diagnosed mental condition they were ‘suffering from at that time’. Their doctors express their beneficence with a knowing shrug of the shoulders and shaking of the head. They can dissolve any argument without question by the psychobabble which predominates throughout their patient’s psychiatric record. All in all, psychiatrists have a golden ticket to sanctioned paternalism.

Take Jean. She has been drugged to the eyeballs over many years. Once she was slim, suffering from a problem which was first termed ‘anorexia’. But as is the psychiatrists’ wont, this morphed into depression and then ‘psychosis’. They gave her more and more drugs, and then deemed her incurable, spat her out of the system labelled her as having a ‘personality disorder’.  Like many she was thought of as a ‘hopeless case’, and in common with others when she self-harmed, the psychiatrists claimed it proved their point. In the defence of such diagnoses, psychiatrists never fail to mention how their patients exhibit outrageous behaviour such as self-harm or acts of aggression. Psychiatric patients have been forced into lives of boredom and dependency and such ‘behaviours’ are commonplace within a system where they are not listened to. For many patients, it is the only way that they can get any attention at all.  It is psychiatry that has made them dependent on the system and then they are punished for their dependence. After years of hospital treatment, years of medication, Jean is overweight. She has metabolic disorders caused by her medication and long-term sleep disturbance. She has no means of earning a living and like many who are discharged from care as a psychiatric success story, she is living as best she can out in the community and claiming benefits.  She cannot suddenly change her life. She has no chance of getting the last 30 years back.

When patients such as Jean who have spent the better part of their adult lives being ‘treated’ by psychiatric services are then informed that the drugs they took in the hope of recovery, were exactly what robbed them of the chance to lead their best life, their pain and loss becomes unbearable. It is Catch-22. Those patients whose lives have been destroyed have no way of answering back and so the wheel keeps turning.

Why is it that society is not rising to their defence? I suggest that ignorance is bliss and it is only in governments’ interest to care for citizens who they see as either productive or likely to win them votes.  They will take notice of certain vulnerable sectors of society like babies and young children because they are the future. They will take notice of the elderly because they themselves may live to become old. They will care for the disabled only if there are those to champion their cause. But there are few willing to advocate for those who have survived the excesses of psychiatry. Psychiatric patients, though vulnerable are not useful; they are victims who are seen as wasters. Many survivors have acquired long lists of psychiatric diagnoses. These labels stick like glue and along with drunks, addicts or the homeless, their lives are considered low value and easy to dispense with. This is humanity at the bottom of the barrel, forgotten.

The ‘mentally ill’ were euthanised even before the Jewish population in the horrendous mass extermination of the Nazi Holocaust. It is convenient to forget this fact, as much as it is convenient for Holocaust deniers to diminish the suffering of the Jewish nation, or for the empire to forget how she contributed to the vast destruction of indigenous communities and peoples across the globe.

We might say the right things, such as ‘a nation should be judged by how it treats its most vulnerable’, and of course, it is right to look at those within its population who are discriminated against, whose well-being must be preserved. Yet perhaps nations should be judged by how they treat those members of their society who are most despised within it. Even so, today’s Western societies like to think of themselves as more advanced, and less capable of committing the atrocities of the past. But our recent history says otherwise. Extreme opinions are commonplace, fake news is rampant and yet freedom of speech is curtailed. There are attempts to silence debate and stop the criticism of current healthcare practice including the prescription of medications that are thought to be causing, or have the potential to cause, catastrophic harm in the lives of individuals. Doctors can’t even talk about these things openly for fear of bringing the wrath of their regulatory bodies down on their backs. Not long ago a doctor whose opinion on the Covid-19 vaccinations was not in line with the official messages from the government was disciplined for voicing his opinions publically. Following this, the media publicised the fact that one of the vaccines was found to cause death in certain vulnerable individuals. Why silence the canary in the coal mine?

This is a pivotal time as big pharma has spread the net wide, hoping to increase their profit throughout the world. There are psychiatrists who are prepared to sacrifice themselves and their reputation rather than continue with the status quo. They seek to debunk the myths of chemical imbalance and overturn the diabolical lies when the pharmaceutical industry claim their drugs are safe as well as effective. We honour their efforts and their agreement to partner with patients. But it is critical that many advocates arise from amongst us, whether survivors, friends or family of loved ones.

There are still psychiatrists who are in denial when the harms their discipline has caused to patients and their families, is brought to their attention.  Thankfully it is not everyone and there are psychiatrists who are listening to the thousands of patients who are giving testimony about the suffering that has resulted from their psychiatric treatment. But can we allow psychiatrists to reform their own profession from within when they have been given enough time and have failed to put their house in order? It is serious when they are blinded by the mythology surrounding EBM (evidence-based medicine) and RCTs (randomised controlled trials.) They are not objective – perhaps it is not possible while they have vested interests in their own careers. Undoubtedly it’s a no-brainer that those who profit from the sale of their products are the last people to go to for independent evaluation.

Unfortunately, the psychiatrists who refuse to be open about their recent history, hold the prizes for arrogance and paternalism within their anachronistic profession. They sit under the umbrella of respectability, and even if they do not directly put financial gain or the nebulous concept of the ‘greater good’ above the safety of individual patients, they enable those who do. They are the wolves in sheep’s clothing, and while they present themselves as benign, truth-seeking, compassionate individuals, they are dangerous beyond belief. They have lost their way and lost their most valuable talents. They are no longer able to treat every patient as an individual with the time and care that they would want for the most loved member of their family.

I believe we cannot afford to wait any longer – it is time for us to stand up and fight for our rights and to prevent more irreparable damage to be forced on us by those who are old school, patriarchal, institutional, and self-seeking and whose primary goal is to preserve their notional expert status.



Editor’s Note: These posts are designed to serve as a public forum for a discussion about the mental health system and related interventions, critiques and alternatives. The opinions expressed are the writers’ own.


  1. I tend to think of “paternalism” as male practice but many female psychiatrists buy into the biological model of psychiatry. I don’t understand why this is unless they feel that they can only further their careers in this way. At the end of their careers do they feel that they have done a good job? Or am I expecting too much from women who I have always felt, on average, have more understanding of human distress and trauma?