Thread by @Altostrata

Let's unpack why @psychunseen publishes posts such as this one, seeking to delegitimize patient movements he's observed on Twitter. He's been doing this for more than a year. /1

First, everyone should be aware @psychunseen is a #psychiatrist who treats inpatients for the Veterans Administration in Los Angeles.

The target of the tweet is the "drop the disorder" people, but, ill-advisedly, he swipes at chronic Lyme & CFS patients as well. /2

@psychunseen has been working on this thesis for a long time: That patient campaigns on social media are driven by pathological psychiatric conditions, not the desire of patients for better care from doctors. /3

He is joined in his theory by @jonathanstea, a #psychiatry-oriented psychologist, & @tylerblack32, another psychiatrist. As shorthand, I call them the #ThreeBlindPsychs. They published this article medpagetoday.com/psychiatry/gen…

The #ThreeBlindPsychs derive their theories about how patients think & feel (&, one surmises, the actual condition of their brains) from what they see on Twitter. There is no sign they've visited Facebook, or even talked at length in person with "drop the disorder" patients. /4

They therefore have anointed themselves not only as experts in the behavior & psychoneurology of people they've never actually examined, but experts on the sociology of patient behavior on social media. Based on what they see on Twitter. /5

The assumption of such expertise by the #ThreeBlindPsychs would be considered hilariously & blindly ignorant in any field other than #psychiatry. But psychiatry itself is so constricted in its view of human behavior, they apparently make sense to their followers. /6

@psychunseen's "unpacking" of patient outrage over quality of #psychiatric care is done to delegitimize what patients have to say about their experiences with psychiatry. He & the other #ThreeBlindPsychs are defending #psychiatry from the very potent complaints of consumers. /7

#Psychiatry calling its critics crazy is not a new idea, & it looks creepy. So #psychuseen cloaks it in a Theory of Everything about patient activity on Twitter. Just to be safe, he throws in some obfuscatory blather about "delocalizing pathology from the brain, and the self." /8

That's why patients agitating for better medical care organize in communities on Twitter: To deny their problems are in their own brains. Tough sell to Lyme and CFS patients, but you do you, @psychunseen. /9

Now, #psychiatry has always had a vexed relationship with #psychiatric patients, having been criticized by them for misguided treatment modalities for more a century. @psychunseen is particularly troubled by seeing this continued on social media. /10

The #ThreeBlindPsychs have a brilliant solution to this. Out of vast privilege as #psychiatric caregivers & incisive parsing of Twitter, they have ascertained that complaints about #psychiatry are driven by complainers' unwillingness to address their own brain deficiencies. /11

Being experts, #ThreeBlindPsychs can say this with authority. This is not saying critics of #psychiatry are crazy -- no, that would be wrong. It's saying that criticism of #psychiatry is biologically based in brain dysfunction, "delocalizing pathology from the brain". /12

Patient critics of #psychiatry suffer from a biological brain pathology. Couldn't be clearer. They would benefit from a "therapeutic relationship" with some sort of unspecified mental health provider to learn how to cope with their disability. Same with CFS & Lyme patients. /13

What does this theory (entirely Twitter-based, btw) show about @psychunseen & the #ThreeBlindPsychs? What is their model of human nature? How do they understand patients who communicate to them in person? What assumptions about patients do they start with? /14

Do the #ThreeBlindPsychs represent only themselves, or do they represent attitudes pervasive in the mental health field? From my experience, the reasoning that patients with complaints are crazy is nothing new in medicine, across all disciplines, & it's not good for patients. /15