Psychiatry 2099
Commerce Without Conscience = Practice Without Prudence  

— Gary L. Tischler, MD & Boris M. Astrachan, MD —

Archives Gen. of Psychiatry - Vol. 56 No. 12 - December 1999

We present a day in the life of 3 psychiatrists, members of an American family in 2099.

They and their practice are shaped by the world in which they live.

The confluence of capitalism triumphant,1 the rapid burgeoning of technology, enhanced access to information and globalism2-4 is reshaping the world, and with it medicine and psychiatry.5

The pace of change seems almost beyond our capacity to absorb.

It is a time for medicine and public health to join in a search for complicated answers to complex questions.

If we cure disease but fail to provide the basic skills required to survive in an ever more complex world, we increase dependency, foster hopelessness, and ultimately add to social costs.

If we tolerate a world in which a “me-first” ideology ignores the needs of the many living at the margin, we build a world that will forget how to care.

Fortunately, choices exist. If we make them wisely, our morality tale can have a different ending.

He awoke on a glorious day.

It was early May 2099 in New England and Herman Maier was home after a conference on rehabilitating cybergenopaths on the Afro-Sino Space Station.

Herman was the director of INTERN-A-HAC (the International Agency for Habituating and Acculturating Cybergenopaths). INTERN-A-HAC went boldly where others had never gone before.

Its mission: to identify and habilitate deviant individualists who sought to disrupt the lifeblood of global interaction and commerce, limit genetic technology, and destroy the stability of world markets and information flow.2, 6

Herman had developed sophisticated psychological screens for identifying potential cybergenopaths.

The project, now in its best practices intervention phase, involved team members from each of the major task areas of the new psychiatry.7, 8

The Medical Section’s Sigmund Nagajima was the first to report. From Kyoto, Japan, he related the cloning of embryological neuronal material.

When transplanted into the deviance center of cybergenopaths’ brains, hostility ratings decreased 73% and social relearning skills increased by 64%.

There were minimal side effects. Willowy Runanywhere, head of the Rehabilitation and Reeducation Section, interrupted from her Ethiopian workstation.

She boasted that intensive virtual reality flooding followed by a daily 24-hour group work program controlled cybergenopathology.

She insisted her methods would resocialize cybergenopaths without the need for costly and intrusive medical procedures.

Caramel Softie, chief of Human Development, commented from Basel, Switzerland, that her group’s psychotechnic approach, transcendental cybernetics, was a more humane and equally effective method for transforming cyberdeviants into well-integrated, motivated, content, and productive societal contributors.

Pleased with the reports, Herman began considering how to integrate the approaches.

He then turned to family matters and went visual with his mother, Tanika Maier, under a virtual earthlit sky on the tiny moon colony.

The two reminisced about the extraordinary changes witnessed over Tanika’s lifetime. Her grandfather immigrated to the States from India in 1987.

An efficiency expert, he contributed to the PAX COMMERCICA through restructuring medical practices and prospered as medicine entered the competitive, information-driven age of market worship, techno-innovation, and globalism. Akita, Tanika’s mother, was born in 1999.

The family’s first psychiatrist, she was among the last group of physicians based primarily in offices or hospitals.

She graduated from medical school in 2025, the year molecular treatments for major psychiatric disorders were first introduced.

Her skill with computer-enhanced molecular diagnosis and therapeutics was such that many believed she was one of the first recipients of a direct computer-interface implant.

By 2040, Akita was overseeing a psychiatric core care complex.

It was a period during which the market functioned as though “no one was in charge” and professional oversight was nonexistent.

When competitive pressures impaired the complex’s profitability, the board and the investors invariably demanded change.

Akita’s frustration with an unregulated market that constantly redefined medical practice led her to leave the complex and found the World Commission Overseeing & Monitoring International Standards for Health (World-COMISH).

Under her leadership, World-COMISH evolved into a global enterprise responsible for developing disease management standards, supervising and regulating all health care practices, and, when necessary, disciplining and re-educating professionals.

When Akita’s daughter, Tanika, graduated medical school in 2055, almost all major psychiatric disorders could be managed efficiently.

By 2063, the primary challenge confronting psychiatry was problems with dependent and deviant populations.

It was this trend that made Tanika encourage Herman to enter psychiatry.

She viewed his rehabilitative work and focus on the socially deviant as a moral enterprise.

Her faith was not shared by Rachel Ellen, who Tanika called after chatting with her son.

The family’s third and youngest psychiatrist was attending a meeting on the Minority Group Diagnosis Section of DSM-L (Diagnostic and Statistical Manual of Mental Disorders, 50th Edition). Minority status was no longer depicted as a function of race, religion, or ethnicity.

Rather, with the ascendancy of the market and globalism, it was now defined in terms of instrumental skills and socioeconomic status.

The Section concluded that the well-documented association between limited instrumental skills, lower socioeconomic status, learning difficulties, and amotivational states more than justified its inclusion as a psychiatric disorder.

Rachel Ellen described how Dr I. M. Jungmann, author of the top scoring cybertext, Dreams and Misdemeanors, captured the day.

He and his disciples advocated mandatory reconditioning for parents of children lacking technical skills.

Presenting evidence of higher prevalence rates in adolescents subjected to severe parental neglect in the first 3 years of life, Jungmann argued for reinstating the guilt-induction modalities of the previous century as primary treatment for cyberpathogenic parents.

His call to arms was: “Let me be the first to cast the stone!” Rachel Ellen expressed her concern about the uses to which psychiatry was being put.

With the conquest of most diseases, technology was increasingly being used in the service of social control.

Tanika reassured her that the overall goals of medicine and of psychiatry had not changed. Rachel Ellen, however, persisted.

She was both saddened and concerned at her brother’s role in the social control task area.

Two weeks previously, the DSM-L cybersite had been compromised.

Thousands protested the labeling of these outcasts of the information age as “mentally impaired.” They argued that societal reparations, not treatment, were needed. In an unprecedented live demonstration, thousands had massed and burned the INTERN-A-HAC logo chanting, “Reparation, Yea! Rehabilitation, Nay!” Tanika reminded her daughter that Herman’s work was clinically relevant and morally correct.

Not only did it interrupt deviant careers, it reinforced the profession’s democratic heritage by emphasizing the right of each person to treatment in a caring society, whether they wanted it or not. She continued, “His work is the epitome of medical function directed at individual patients, delivered with scientific precision, attentive to personal needs, and respectful of each person’s dignity.

“Rachel Ellen quietly broke the link still unconvinced that the third of the world living in poverty would find a place in the global economy. She wondered whether our capacity to cure would ever be matched by our willingness to care.

Rerefences

1.
Yergin DA, Stanislaw J.
The Commanding Heights.
New York, NY: Simon & Schuster; 1998.

2.
Friedman TL.
The Lexus and the Olive Tree.
New York, NY: Farrar, Straus & Giroux; 1999.

3.
Fukuyama F.
The great disruption: human nature and the reconstitution of the social
order.
Atlantic Monthly.
May 1999:55-80.

4.
Miller J.
Globalization widens rich-poor gap, U.N. report says.
New York Times.
July 13, 1999:A8.

5.
Tischler GL, Astrachan BM.
A funny thing happened on the way to reform.
Arch Gen Psychiatry.
1996;53:959-963.
MEDLINE

6.
Shaw E, Ruby K, Post J.
Insider Threats to Critical Information Systems: Characteristics of the
Vulnerable Critical Information Technology Insider.
Bethesda, Md: Political Psychology Associates Ltd, 1998.

7.
Astrachan BM, Levinson DJ, Adler DA.
The impact of national health insurance on the tasks and practice of
psychiatry.
Arch Gen Psychiatry.
1976;33:785-794.
MEDLINE

8.
Astrachan BM, Tischler GL.
Normality from a health systems perspective.
In: Offer D, Sabshin M, eds. Normality and the Life Cycle. New York, NY:
Basic Books Inc Publishers; 1984.

• • • OISM Newsletter • • •
Subscrine to OISM Newsletter and you’ll always be kept up to date via eMail on the news in the field of mental health and the struggle against psychiatry... CLICK HERE TO SUBSCRIBE!