In the last decade or so psychiatry has received a great deal of criticism. The fundamental point of contention is psychiatry’s insistence that an ever-increasing range of problems of thinking, feeling, and/or behaving are in fact illnesses that need to be aggressively treated with drugs, intracranial electric shocks, and other somatic interventions. It is further contended, by those of us on this side of the debate, that this spurious medicalization of non-medical problems was not an innocent error, but rather was, and is, a self-serving and deliberate policy designed to expand psychiatric turf and to create an impression of psychiatry as a legitimate medical specialty.
Psychiatry’s much-touted “diagnoses” have also been the subject of adverse comment. It is argued that the simplistic checklists in successive editions of the DSM are no more than loose collections of vaguely defined behaviors and feelings, and do not produce meaningful or helpful information about clients or their problems.
In fact, it is widely asserted that the pseudo-diagnoses generated by the DSM taxonomy are intrinsically disempowering and stigmatizing. Problems, the resolution of which was, in former times, considered well within the ability of individuals and families, are now seen as requiring psychiatric intervention, and dire warnings are issued as to the expected consequences if this intervention is not pursued. In former times, society’s general message to youth was: you can succeed. Today this message has been significantly diluted by psychiatry’s message: your brain is broken; you need pills.
For decades psychiatry supported this disempowering message by promulgating as fact the chemical imbalance theory, even though it was known that this theory was false.
Psychiatry has also been criticized on the grounds that the drugs and electric shocks that constitute the bulk of its “treatments,” far from correcting any anomalies or abnormalities in the brain, are actually destructive of neural tissue – and this destruction is cumulative with continued use.
Finally, psychiatry has been criticized widely for its corrupt and corrupting relationships with pharma. Because of these corrupt relationships, psychiatry routinely and knowingly compromised ethical standards in both research and practice, and reduced its profession to little more than organized and legal drug-pushing.
Psychiatry has taken little or no corrective action on any of these matters. The chemical imbalance lie is still being told to clients. New “diagnoses” are still being created. Diagnostic thresholds are still being lowered. And pharmaceutical largesse is still finding its way into psychiatrists’ pockets, though, thanks largely to the efforts of Senator Charles Grassley, perhaps not as unstintingly as before.
The fact is that the criticisms directed against psychiatry are valid and founded. They are also extremely serious. Psychiatry is intellectually and morally bankrupt, and has no meaningful response to these criticisms. The vast majority of the human problems that psychiatry claims to address are not medical in nature, and are not amenable to a medical approach. Conceptualizing these problems as illnesses is the fundamental flaw which has derailed modern psychiatry since its beginnings.
Psychiatry and its spurious ideas and practices survived in former decades for two reasons. Firstly, because psychiatrists confined their attention to a relatively small section of the population, and secondly because, in general, there was less questioning and challenging of establishment ideas and practices. But today, psychiatry’s inane claim that fully a fifth of the population have a brain illness cannot withstand the scrutiny of a more educated public that has found its voice through the Internet and other media.
Psychiatry is dead, but, perhaps understandably, they won’t sign their own death certificate. They won’t acknowledge their errors. They won’t back down. And they won’t stop, or even curtail, their destructive practices. They will not even seriously debate the issues.
Instead, they’ve gone on the offensive. This offensive is two-pronged. Firstly, they attack those of us who speak out against them, and secondly, they are actively developing links to the media in the hopes that this will encourage reporters to portray them in a more favorable light.
Attacking the Critics
An example of the former appeared in the Lancet Psychiatry on May 27, 2014: Attacks on antidepressants: signs of deep-seated stigma? by Nutt DJ et al. Here’s the opening paragraph:
“Psychiatry is used to being attacked by external parties with antidiagnosis and antitreatment agendas. However, the recent disclosure that a doctor (Professor Peter Gøtzsche) had joined a new group, the Council for Evidence-based Psychiatry, whose launch was accompanied by newspaper headlines such as ‘Antidepressants do more harm than good, research says’ and ‘Psychiatric drugs are doing us more harm than good’ in The Times and The Guardian plumbs a new nadir in irrational polemic. What is especially worrying is that this doctor is a co-founder of the Nordic Cochrane collaboration, an initiative set up to provide the best evidence for clinical practitioners. What is the truth about antidepressant efficacy and adverse effects, and why would Professor Gøtzsche apparently suspend his training in evidence analysis for popular polemic?”
Note the offensive tone from the outset: “Psychiatry is used to being attacked by external parties with antidiagnosis and antitreatment agendas.” The implication being that those of us on this side of the issue who criticize psychiatry’s spurious nosology and draw attention to the destructiveness of its treatments are simply people with “agendas.” And Dr. Gøtzsche’s criticisms are not to be taken seriously, but simply condemned as “a new nadir in irrational polemic.”
The article then pushes the claim that antidepressants are efficacious and safe. The authors concede that there are some adverse effects, but contend that:
“…the new antidepressants, especially the selective serotonin reuptake inhibitors, are some of the safest drugs ever made.”
They grudgingly acknowledge that there might occasionally be “extreme” adverse effects, but immediately offset this admission.
“The incentive of litigation might also distort the presentation of some of the claims.”
In other words, those clients who report that the drugs are helpful should be believed; but those who say that the drugs harmed them are just angling for damages. How convenient!
The authors then launch an attack on psychotherapy, but first they prepare the ground:
“Antipsychiatry groups usually claim that depressed patients should be treated with exercise and psychotherapy instead of drugs.”
This is actually a caricature of this side of the argument. Most anti-psychiatry material, including my own writing, conceptualizes depression not as any kind of brain illness, but rather as the normal (and even adaptive) response to loss, negative life circumstances, or counter-productive habits. Successful amelioration of depression involves recognizing these precipitating factors and working collaboratively with the client towards resolutions. This is a highly individualized endeavor, and is not adequately embraced by any simplistic formula such as “exercise plus psychotherapy.” Indeed, it is a central tenet among us that simplistic solutions (e.g. eat these pills and you’ll be fine) are generally unhelpful.
Dr. Nutt et al then speculate as to what motivates these attacks on antidepressants and on psychiatry in general. They don’t, in this context, acknowledge even the possibility that our motivation could be founded on a rational assessment of the situation. Instead, they suggest:
- firstly, that GP’s (who prescribe most of the antidepressants) don’t really want to do this kind of work;
- secondly, because there are still strong remnants of mind-body dualism in our society, there may be some deep-seated resistance to treating something as ethereal as “the mind.”
- thirdly, that “… the anti-psychiatry movement, although now long in the tooth, has revived itself with the recent conspiracy theory that the pharmaceutical industry, in league with psychiatrists, actively plots to create diseases and manufacture drugs no better than placebo,” and
- fourthly, that “… anti-capitalist flavour of this belief resonates with anti-psychiatry’s strong association with extreme or alternative political views.”
So there it is: we’re a bunch of politically extreme conspiracy theorists! Such enlightened discussion!
The authors conclude:
“Whatever the reasons, extreme assertions such as those made by Prof Gøtzsche are insulting to the discipline of psychiatry and at some level express and reinforce stigma against mental illnesses and the people who have them. The medical profession must challenge these poorly thought-out negative claims by one of its own very vigorously.”
So those of us who, like Professor Gøtzsche, dare to “insult” psychiatrists by voicing criticism of its concepts and practices are expressing stigma against people who receive psychiatric attention. In response to which I can only invite my readers to decide which is the more stigmatizing thing to say to a client:
“Why are you depressed?”
“You’re depressed because of a chemical imbalance in your brain.”
And, incidentally, Professor Gøtzsche and two of his colleagues have invited Professor Nutt and his co-authors “to a public debate where these views can be properly aired.” To the best of my knowledge, this invitation has not been accepted.
And also incidentally, according to the disclosure information at the end of the Lancet Psychiatry article, Dr. Nutt and two of his co-authors have received grants, personal fees, and other payments from multiple pharmaceutical companies.
Extreme as it is in the condemnation of its critics, the Nutt et al article is by no means an isolated example. On May 20, 2013, the very eminent psychiatrist, and then President of the APA, Jeffrey Lieberman, MD, wrote DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice, which was published in Scientific American. Here are some quotes:
“[Anti-psychiatry groups]…are real people who don’t want to improve mental healthcare, unlike the dozens of psychiatrists, psychologists, social workers and patient advocates who have labored for years to revise the DSM, rigorously and responsibly. Instead, they are against the diagnosis and treatment of mental illnesses—which improves, and in some cases saves, millions of lives every year—and ‘against’ the very idea of psychiatry, and its practices of psychotherapy and psychopharmacology. They are, to my mind, misguided and misleading ideologues and self-promoters who are spreading scientific anarchy.”
“Being ‘against’ psychiatry strikes me as no different than being ‘against’ cardiology or orthopedics or gynecology—which most people, I think, would find absurd. No other medical specialty is targeted by such an ‘anti’ movement.”
“This relatively small ‘anti-psychiatry’ movement fuels the much larger segment of the world that is prejudiced against people with disorders of the brain and mind and the professions that treat them. Like most prejudice, this one is largely based on ignorance or fear–no different than racism, or society’s initial reactions to illnesses from leprosy to AIDS. And many people made uncomfortable by mental illness and psychiatry, don’t recognize their feelings as prejudice. But that is what they are.”
So, those of us who dare to criticize psychiatry are “…misguided and misleading ideologues and self-promoters who are spreading scientific anarchy.” We “fuel” prejudice and stigma against psychiatry’s clients, although research suggests that the broken brain theory, which underpins almost all psychiatric activity is inherently stigmatizing. Our attitudes are “…no different than racism…” and we – poor deluded creatures that we are – don’t even recognize our prejudices.
Again, enlightened discussion!
Psychiatry and the Media
The second prong of psychiatry’s offensive is the development of close ties to mainstream media.
The World Psychiatric Association is an association of national psychiatry societies from 117 different countries and represents about 200,000 psychiatrists.
The WPA’s Action Plan 2008-2011 was adopted by their General Assembly in September 2008. According to the 2010 WPA document WPA guidance on how to combat stigmatization of psychiatry and psychiatrists, one of the goals of this plan was “…an improvement of the image of psychiatry and psychiatrists in the eyes of health professionals, the general public, health decision makers and students of health professions.”
According to the 2010 document, the plan first identifies the shortcomings in the image of psychiatrists. These include:
“The public opinion on psychiatric facilities has been consistently negative during the past decades…”
“Five misconceptions about psychotropic medications were found to be prevalent in the general population. They are perceived as being addictive…, a ‘sedation without curing’ …, an ‘invasion of identity’…, merely drugging patients…, and ineffective in preventing relapse…”
“Negative attitudes about electroconvulsive therapy (ECT) were often observed.”
“Perceived low prestige and low respect among other medical disciplines have been among the main reasons mentioned for not choosing psychiatry as a career…”
“Medical students also perceive psychiatry as lacking a solid, authoritative scientific foundation…. This attitude is partly based on uncertainty concerning the nosology and diagnosis of mental illnesses, which is mentioned among the reasons for medical students not to enter psychiatry…. The classification of mental disorders in the DSM and ICD categories has been subject to criticism because the majority of these diagnostic categories are not validated by biological criteria…, thus reinforcing the image of psychiatry as not being ‘real medicine’. One aspect of this discussion includes the question as to whether research using diagnoses that are not validated as inclusion criteria ‘is equally invalid’….”
“Medical students were often less skeptical than the general public towards psychotropic medications…. However, psychotropic drugs were criticized for not targeting the actual cause of the illness…. Psychotherapy was rated more positively in some instances….”
“The general depiction of psychiatry in the news and entertainment media is predominantly negative. In a media commentary, psychiatry was portrayed as ‘a discipline without true scholarship, scientific methods, or effective treatment techniques’…”
“They [psychiatrists] are ascribed a low status among physicians…, academicians…, and mental health professions….”
“Psychiatrists are accused of relying too much on medications….”
“Within the medical community, the status of psychiatrists is usually described as low. Some authors suggest that there is a ‘lack of respect among the medical community’…”
From this side of the debate, these criticisms seem founded, and suggest a major need for substantive and far-reaching reform. But the WPA’s recommendations for combating what it calls these “prejudicial beliefs” are largely PR.
“It [the Task Force] also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front.” [Emphasis added]
“Changing the depiction of psychiatry in the media is an important prerequisite for changing public opinion…” [Emphasis added]
“We were unable to identify any studies describing interventions specifically targeting the stigmatization and discrimination of psychiatrists. However, there were several recommendations on how to change their negative image, most of which focused on developing a positive relationship with the media. This includes active participation of psychiatrists in the flow of information…and provision of expert knowledge on mental health issues…and forensic cases….” [Emphasis added]
“The Quebec Psychiatric Association developed recommendations on how to improve the image of psychiatrists with the help of a communication firm. Their strategies include becoming more visible in the media, responding to public needs and critical events, and increasing the visibility of psychiatrists in the community….” [Emphasis added]
“Our review of the literature on stigmatization of psychiatry and psychiatrists produced only a very small number of articles on research concerning the development and evaluation of interventions aimed at reducing such stigma. The main results indicated the importance of close collaboration with the media.” [Emphasis added]
“Skills of presentation and communication, for work with the media and governmental offices, are of considerable importance in the development of mental health services as well as in any effort to change the image of psychiatry.” [Emphasis added]
“National psychiatric societies should seek to establish and maintain sound working relationships with the media.” [Emphasis added]
The American Psychiatric Association has also been active in this kind of activity. Their Workgroup on The Role of Psychiatry in Healthcare Reform produced its report earlier this year. Here’s a quote from one of their recommendations (p 59):
“The APA should develop a communications campaign that addresses how to best advance the APA agenda, internally with its members and externally with key stakeholder audiences. This campaign will likely require external communications expertise. Psychiatry’s value proposition for health reform is not self-evident to key policy/payer audiences and members. Moreover, a fully informed and educated membership will be essential to fulfill the demands for psychiatric services that the APA’s agenda embodies.” [Emphases added]
The APA already has a Council on Communications, currently chaired by J. Raymond DePaulo, MD. On the APA website it states:
“The council is charged with transforming public attitudes towards psychiatry by:
- Connecting the public emotionally to psychiatrists, ·
- Creating excitement about psychiatrists’ ability to prevent and treat mental illness, and ·
- Branding psychiatrists as the mental health and physician specialists with the most knowledge, training, and experience in the field.” [Emphasis added]
The APA also has a fairly sophisticated media office. They have a very user-friendly “Newsroom” tab, in which they “…offer a variety of resources to journalists including background materials and information on psychiatric disorders and other mental health topics.”
With the click of a mouse, a journalist can: Request an expert; Join the Media Database; Receive News Releases (archived back to 2009); and Receive DSM-5 Information. There are also links for the most recent editions of Psychiatric News and for twice daily emails of Psychiatric News Alerts. In short, they are putting out a red carpet for journalists, and they are making it very easy for journalists to produce articles favorable to psychiatry.
So if you’re seeing a great many sugar-coated articles on psychiatric topics in newspapers and magazines, as I am, it’s not a coincidence. It’s part of psychiatry’s strategy to improve their image without the inconvenience of having to make any substantive changes in their practices.
In the past fifteen years or so, psychiatry has been repeatedly and convincingly exposed as something flawed and destructive. Psychiatry has no defense to offer against these contentions, but instead has launched a massive smear campaign against its critics, and a tawdry PR campaign to whitewash its ever-deteriorating image. But chickens always come home to roost, and ultimately, when all the rhetoric is spent, psychiatry will be judged on its merits. Come the day!
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This blog first appeared on Philip Hickey’s website,
Behaviorism and Mental Health