If my arm would get torn off in the accident, then, if I could, I would call an ambulance. I would trust health system to take care of me, and treat my wounds. I'm not going to entrust psychiatry with my body, behavior, thoughts, or feelings. Or at least not voluntarily. My consent still counts, right?
There are no defined borders in patient-/client-psychiatrist relationship. No defined variables. When I go to a prostitute, me and a prostitute both know what to expect, kind of. We both know what we are giving and getting. I give money and want sex, she gives sex and wants money. We can define in more detail what kind of sex it's going to be, what is allowed and what isn't. Relatively simple. The only thing I know that is defined in psychiatry is money. I'm assuming a client wants to feel better, and pays the therapist expecting him figure out how.
I have a few issues with psychiatry (I'm theorizing here, I have no practice with it) that I want to share and see what you guys think.
1. There are important undefined variables in client-psychiatrist relationship.
It's not clear whether the therapist (T) has what his client (C) wants.
It's not clear what C wants in the context of therapy.
(I'm assuming the C wants to feel better but it's not clear to C how the therapy is going to help him, and what it would take to get what C wants.)
T knows what he gets (money gain from sessions and drugs and how much), and has an idea of what it takes (loss of time and effort, and how much) to secure them.
C has only expectations, hopes of what he might get from therapy, or how much of therapy is needed to get what he wants (feel better), and only knows how much it would cost (in money and time).
2. Potential conflict of interest. Kind of rises from the previous point.
The best outcome for C is to get the most utility from therapy, which is to feel the best (feel good minus feel bad) and spent the lowest amount of money and time.
The best outcome for T is to get the most utility from therapy, which is to feel good for being helpful to your clients and/or get the highest amount of money from sessions and drugs with the least amount of time and effort spent.
It wouldn't be much of a problem if, for example, the usefulness of therapy for C would be defined (good feelings and problems solved, per therapy sessions), but it's not, so T, as far as I know, has no obligation (nor incentive, if T doesn't care about being helpful) to provide even a modicum of that. The more useful your therapy without resorting to drugs, the more problems are solved and feel-better levels restored, the less juicy dollars C will spend on sessions and drugs.
On the other hand. The better the quality of T's therapy, the better T's reputation is going to be maybe, and maybe T will get more clients, and more clients will be willing to pay more.
And if T's reputation is bad, then maybe he will have less clients, or maybe they would be more willing to abandon his therapy.
It's not clear to me how quality of T's therapy affects T's reputation. It's easier with positive comments because they're good for both clients and T, but if it's a negative response? T wouldn't want those to show up. Maybe there should be a place where therapists can't influence what responses show up and what don't, and where people wouldn't be able to smear therapists undeservedly. Something like: this comment is coming from someone who has been in therapy of this dude, and spent that much time or so.
3. Wide prospects for abuse.
С comes to seek psychological help that C can't seem to provide for oneself, so C comes from a position of psychological vulnerability.
T is trained at influencing the perception of his clients, so T is likely to be proficient at manipulation. It is part of T's job to affect the minds, and C expects it will be used in good faith, with the intention to help, and not harm.
It pertains to the nature of covert manipulation to be subtle, artful, evading the eye. The damaging effects of such manipulation are difficult-to-impossible to trace back to whoever inflicted them, let alone bring the manipulator to responsibility for said damage, or even to prove the malicious intent of the manipulator.
Putting pieces together, I see the environment where a psychologically vulnerable person can be exploited by a person skilled in manipulation, with remote risk of being caught red-handed.
(Turned out longer than I expected. At this point, I'm not sure if I should respond here or start another thread. But I'm not a big fan of starting threads, so I guess I'll leave it here for the time being.)