Rethinking Psychiatry


I was honored to both attend and participate in the recent Mad In America Film Festival. I was one of three psychiatrists who were asked to respond to the themes and questions explored in the festival. What follows are a lightly edited version of my remarks.

First of all, I want to thank Laura Delano for inviting me. She is a woman of great fortitude and bravery.

I also want to thank Robert Whitaker, our moderator and the inspiration for this festival. I first wrote to Bob on May 29, 2011. I had never written to an author before. I went back to look the first of a long and ongoing correspondence. This is how I concluded that first e-mail:

“I am almost immobilized at this point.”

Amazingly, Bob answered in the thoughtful and serious way which I have come to see is emblematic of him and this began what I have come to call “My Adventures with Whitaker”.

My response to Anatomy was in part the culmination of a long slide of disaffection I had for the major paradigms that have influenced modern psychiatry. I entered the profession enamored with psychoanalysis but by the time I ended my residency training I was disillusioned with that approach. I decided that it was a problem to have a branch of medicine in which the practitioner can not be wrong. If my analyst had said, for example, that my disaffection with psychoanalysis was rooted in my anger against our male dominated culture and I objected to her interpretation that response would have verified her observation, and if I agreed, well then she was also right.

I had a problem. By the end of my residency, I had decided that when it comes to problems of sadness and anxiety, the medical model was sorely lacking. I never found the DSM to be terribly helpful and I always thought most of these problems were highly complex and heterogeneous. Whereas early on, I thought psychoanalysis might be a way to approach that complexity, I had come to find that model to be seriously flawed. At that point, I would have left psychiatry if it hadn’t been for my fascination with extreme states – what psychiatrists call psychosis. To be honest, that was one area where I thought the medical model was valuable.

So I was that doctor who tried to convince people to take anti-psychotic drugs. I was fortunate to have come of age in the profession when judicious dosing was urged, but I nevertheless thought drugs were critical to the treatment of people experiencing psychosis.

By ~ 2000 though, I was utterly disgusted by the influence of the pharmaceutical industry and what I saw as the collusion of the leaders of my profession in the overselling of drugs.

Bob was not the first writer to influence me deeply. Marcia Angel’s book, The Truth about the Drug Companies gave the back ground information to what I saw happening right in front of me- the new anti-psychotics were grossly oversold. I do not think it is hyperbole to say that the entire data base of medicine is suspect especially when it comes to clinical trials.

But in the past 4 years, I have gone further to challenge some of my most basic assumptions.

What changed after I read Anatomy is that I basically decided that I would start over again and re-consider these problems from the ground up.

This has been a challenge because some notions are deeply embedded in my cognitive framework. But I decided that since I had been wrong so often I needed to drop a bit of my skepticism for at least a time and be open to other ideas.

So in this spirit, I have found Open Dialogue, the Family Care Foundation, the Hearing Voices Network, needs adapted treatment, and the many voices on Mad In America and the Critical Psychiatry Network. This is how I found myself at a Mind Freedom conference this summer; it is how I found myself in northern Finland and Norway.

This has been a deeply unsettling time for me and I still have many questions. I probably have more questions than answers.

But this is where I am today in my re-thinking:

In the current National Institute of Mental Health paradigm, we are wasting our time if we do not link behaviors to neural correlates. I reject that notion.

This is an issue of resource allocation. We are spending enormous resources on understanding brain function and I am no longer convinced that is required to figure out important ways to be of help to people.

But this is also an issue of a faulty paradigm. While the notion that we would identify compounds – drugs – that could improve mood and thought might have seemed reasonable in 1970, there is so much to suggest this is not likely to be attainable. Complex behaviors do not seem to yield so easily to the drugs we prescribe. The drugs we put into the brain have consequences – long-term ones – and we have not even begun to reckon with this. We need to be so much more cautious and humble than we have been over the past 60 years.

So is there a role for medicine?

Where I may part ways with some of my reformist medical colleagues is that I do not think one needs to be a physician in order to be helpful to people in the ways we learned about in some of the movies we viewed today.

However, the desire for psychoactive substances will not go away. It preceded psychiatry by thousands of years. We have been smoking and eating things to alter our mental states for a long time. Outside of this auditorium, people still want pills. Where there is demand, there will be supply. And while advertising has an enormous amount to do with this, this desire supersedes Madison Avenue and the modern psychiatric paradigms.

There is a role for a judicious, thoughtful medical expert on psychoactive drug use. I am not talking only about marijuana or LSD. The distinction between drugs used for recreational experiences and those prescribed by doctors to treat symptoms is an arbitrary one. Ketamine – special K – which historically has been given to rats to model psychosis and used recreationally is now prescribed for depression.

I am influenced by Joanna Moncrieff’s drug-centered approach. Some of these drugs may have advantages for some people at some times. But this is not because these individuals have a particular disease or disorder but because they have brains.

It is a worthy goal for some branch of medicine to understand what drugs do to the brain and offer people sound advice.

But physicians have a way to go to win your trust.

  • We need to disengage ourselves from commercial interests.
  • We need to do studies that are designed to understand drug effect – good and bad, short and long term – rather than to gain market share.
  • We need full transparency in analyzing research and data need to be open to researchers who have no conflict of interest.

Mainly, psychiatry needs to step aside. We do not need to be the main players in the general process of helping people to recover.

You are the ones who lead the way – in a humane, person-centered, respectful manner.

Thank you!

* * * * *

Psychiatry Panel at MIA Film Festival.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


  1. Very good Dr Steingard.

    I find myself wondering about the Open Dialogue program and the culture from which it emerged in Finland.

    This is a nation that outlawed the beating of children more than a hundred years ago, and my Finnish friends tell me that it has taken this long for the effects to be seen in their culture. As an 8 year old child I remember being made to touch my toes in front of the class and be beaten black and blue with a blackboard ruler by my teacher because I was an “annoying child”. I dared to correct her on my spelling exam by bringing the label of a sauce bottle to demonstrate that I was correct in my test.

    Do you think it possible to ‘transplant’ this model into a culture that has only recently banned things like the public flogging of children in schools, or are those deep cultural aspects likely to cause problems with the model?

    Kind regards

  2. Understanding a problem is critical for a solution; I appreciate psychiatrists for leading a medical investigation of mental distress but their premise is fundamentally flawed. Mental distress is not a medical problem- not a “mental disorder;” mental distress is normal emotional suffering from distressful experiences. Mental distress is not a biological dysfunction; it is the normal neurobiology of distressful experiences. I oppose psychiatry because it is a medical profession that assumes that emotional suffering is a medical problem. Most of the harm caused to emotional sufferers by the mental health care industry stems from this basic misunderstanding of the nature of mental distress. The erroneous assumption that emotional distress is a mental disorder is based on its painfully irrationality that is inconsistent with our assumption of a neo-rational mental process. Natural Psychology explains this paradox.

    Natural Psychology explains human psychology including mental distress with elemental empirical neuroscience. Natural Psychology also identifies and solves anomalies of the scientific principles that support the current paradigm. I hope that you will consider Natural Psychology at; I would appreciate any comments.

    Best regards, Steve Spiegel

    • Steve: in 1989 I was burning the midnight ad was becoming frustrated with what I felt was the ritualistic behavior of my companeros. One of my housemates called my mother from out of state. The stress of all of this did induce a degree of spiraling out of control, but after reading Szasz, Breggin, and the authors from Ethical Human Psychology and Psychiatry, I began to question the diagnosis. I am currently at an impass in trying to communicate with relatives about this manner.

    • I am sure you meant you wanted comments from Sandra Steingard, M.D. but I will comment.

      You wrote “psychiatry… assumes that emotional suffering is a medical problem”.

      I would say psychiatrists are forced into that position, when they get a patient, they have to treat them.

      There are two different psychiatric patients, the voluntary and the coerced. Shrinks can not perceive the difference between the two.

      Antipsychotics/neuroleptic are to make the patient too stupid to be “mentally ill” , as in, if you do not have a brain/mind you can not be psychotic. Similar to the idea of a lobotomy.

      The latest spin of psychiatry is making the mentally ill person smarter, too smart to think psychotic. “A neurobiological approach to the cognitive deficits of psychiatric disorders” Dec 2013
      I don’t think this will work, because they say you can’t fix stupid. The cognitive deficits are from previous psychiatric treatment.

      “Mental illness” occurs when a persons feelings are stronger than their intellectual capacity to function.
      This emotional event is usually a temporary situation, but a psychiatrist and their drugs-medicine and jail-hospital make it a permanent lifelong illness.

  3. Dr. Steingard,
    I really enjoyed the opportunity to see and hear you. I also continue to agree with you to an incredible degree. It is rare to find such agreement with another psychiatrist. I know you wrote me a while back about these things. I’m just writing here to let you know that I continue to admire your courage and your ethical reflection on your practice, and especially your persistence and energy in putting the message out.

    Please keep me in the loop, and let me know of any ways that a person such as myself can help.

    Gene Combs

  4. Boans – re your comments about Open Dialogue, here’s an excellent outline of its methods by a couple of its originators. Thanks to Will Hall and Ron Unger for making it available.


    IMHO, Open Dialogue and similar programs are the way of the future. I just don’t see how insurance companies and taxpayers can continue to waste so much money on traditional psychiatric programs and lifelong disability payments while the Open Dialogue methods get 85% recovery rates and close down mental institutions for lack of long term patients!

    Best regards,
    Mary Newton

      • Thanks Mary, I am going to look into this a lot more.

        I did watch Daniel Maklers movie and have passed it on to others to challenge their thinking about our current model/system. In addition to my comments above about Finnish culture, it also struck me that when Daniel asked the professionals about concerns over their registration, and their responses.

        When I first met my Finnish friend I was often thinking that he tended to be rude to people. After a while he explained to me that they do not have a Finnish word for sorry. The attitude being that I didn’t mean harm, and therefore why should I be sorry?

        It’s worth looking at that part of Daniels movie again, with this in mind.

        Once again, thanks

  5. Thank you for recommending our paper, “The Key Elements of Dialogic Practice in Open Dialogue.”
    The link you have is actually the next to last version. I’ll let Will and Ron know.

    The final version of the document–September 2, 2014, Version 1.1–can be downloaded at:
    There are only a few variations between the two; but the most recent version is the one we’d like to make available.
    Again, thanks.

  6. Open Dialog wonderful .Truly , and yet do we need psychiatrists to administer it ? and titled authorities over us as the have not unlabeled us. ???

    The other 15% ?……and maybe some of even the other 85%….. Need more than the MD or Phd. or progressive APA, One Trick Pony .
    They need, honed in the fires of the 400 year holocaust of psychiatry ….the deep wisdom of psychiatric survivors that see from the inside out and the outside in that have come out the other side, psychiatry free . Who’s input is still not respected (reduced to a thousand words or less) as it deserves, whose discoveries are still ignored to the point that some of us stay silent.
    Humble your selves and study at our feet if your concerns are to help relieve humanity’s suffering and don’t tie the help you offer to first solidifying your reception of the top dollar incomes you receive while victims of psychiatry languish on incomes of less than $750 a month if they are lucky. Look to the example of Mahatma Gandhi who chose not to live on an income higher than the poorest person he wished to lead out of slavery.
    Ask us for solutions for extreme states than give credit where credit is do even if the solutions come from those untitled but permanently labeled as non-people by others with the same titles you yourselves wear that truly sicken us in more ways then one . Unlabel us and set us free if you can .
    “One fool can throw a rock into a well and a thousand wise men can’t get it out.” Said by my Grandmother to my Mother my Mother to me , I never met my Grandmother , my Mother was forced to watch my grandmother came out in the form of smoke out of the smokestacks of the crematoria soon after one of them was forced to the left and the other to the right upon arriving at Auschwitz after enduring together 5 years as confined tortured prisoners in the Lodz Ghetto in Poland. 40 % of psychiatrists in Germany joined the SS . What have they joined here in America ? the worlds hotbed of Eugenic’s ? Educate yourselves read the book “War Against The Weak” by Edwin Black and you will see how eugenics evolves here with psychiatry in the lead funded by ……READ THE BOOK . And we should trust you all FURTHER ???? Are you kidding ?
    Look for real help also to Traditional Naturopathy, Energy Healing systems like, also Homeopathy, Herbs that help www. and other natural therapy’s, Hoffer and Linus Pauling Otho Molecular supplements modality, My improvement (ask me) Niacin delivered along with minerals delivered non invasively non coercively absorbed by the skin in a mineral bath with hot water and a self rub down with a Swedish luffa.( ask what it does and it’s power) yes even in extreme state if 32 oz. of fresh made green veg juice according to Fred’s (me)guidance is voluntarily drunk in 2 servings. Doc’s 9 herb formula made into an extract to help in extreme states . Fred Abbe’s Gem stone combo formula for sleep aid . All these with no side effects and no shortening of life in the quest for equilibrium .All ignored on the alter of preserving the system’s power and cash flow above all.
    Hal Huggins Advance Dentistry….STUDY IT….REALY YES.
    Ask me and us the labeled but untitled and un “decorated with degrees ” whose level of wisdom exceeds and leaves your partial picture of understanding looking like a 3 year old child’s but most of you with out the child’s open mind to really investigate something that comes from outside the “sacred halls of your formal education ” mesmerized by your own titles while you hand out labels to people more brilliant then yourselves lol if it wasn’t so tragic and devastating to so many.Then so much torture comes with the labels you still have no idea .WAKE UP.
    I offer my knowledge for free , you have only to ask and to try first do no harm natural psychiatric survivor recommended strategies that work . Show interest and the details I can customize for an individual for free according to what their personal situation requires and their voluntary desire to proceed exists .I have arrived to be able to do this after 39of study in first do no harm modalities and decades as a prisoner of psychiatry . You must use your own best judgement which should be something that improves over time .

  7. Hi Sandy-thanks for the post and the comments at the film festival. Surprisingly, I do think that the body influences mood and behavior, but focusing on the brain and the neurotransmitters misses the big role on how what we eat, exercise and infection influence mood. For psychosis, I’m convinced that antibodies to NMDA receptors and inflammatory factors play a big role. Seems to me that if someone presents with psychosis, the first thing to check should be for NMDA antibodies and/or infection. Next would be for whether the psychosis might have been precipitated by a change in sleeping and eating patterns-since the clock genes keep coming up as associated with bipolar. When will psychiatrists really practice medicine rather than thinking that the brain is not attached to the rest of the body?

    • Jill: As someone involuntarily committed with the diagnosis for bipolar, I make a concerted attempt to keep to a regular sleep pattern, but I need to upgrade my diet as I fluctuate between ten pounds and forty pounds over weight. Also I would like to get back into the habit of riding the spin bike and lifting weights.

  8. Respected Neuro- Surgeon Russell Blaylock M.D. retired talks and has tried to present at congressional hearings that he has found inflammation of the brain in autopsies caused by too many vaccinations given too close together to our children starting from the Simsonwood secret meeting about vaccinating policy where Doctors recommending vaccinations for the general population do not intend to give them to their own children. Plus Robert F. Kennedy did a privately financed investigation into this. I advise avoid them altogether at all costs use Homeopathy as needed instead.

  9. Hi,

    Sandra, this was your best talk yet!!! I am so deeply appreciative of your courage, persistence and professional honesty.

    My teenage son continues to do well in college three months after he came through a 2 week period of what could be called – from a medical model perspective – a ‘psychotic’ experience. We worked to keep him away from traditional providers and the hospital…we were so lucky to find an Open Dialogue trained psychiatrist in the NYC area that helped us offer 24/7 support and connection to him as he worked through his extreme experience. We all agreed that his experiences were related to his life, both past and present.

    I found my fear of losing him to the medical model, mental health system worse than my motherly concern over what he was going through…this speaks so loudly to the need for true alternatives in the US. Thank you Sandra, Bob, Laura and all of my MIA community.


  10. Sandra and others,
    Relative to other recent liberation efforts, The Civil Rights Movement, The Women’s Rights Movement,The Gay Rights/Pride Movement , this effort to liberate ourselves the people from psychiatric oppression( who unlike the others ) are denied the right to bear arms and seems to have relatively no funding , an inability so far to create huge demonstrations , A most intense propaganda machine demonizing us. Even a DSM book like Mien Kampf telling and justifying what they will do to us , a total pseudo science pseudo bible and yet it still flies . The entire juggernaut moving forward at high speed engulfing more and more younger and younger victims even invading the womb and homes now. Into nursing homes upon occupants unto death .
    To all employees on the inside from survivor peers , to social workers ,to therapists, to psych nurses , to psych nurse practitioners, and nurses aides , and orderlies ,especially to physicians and physician assistants,and especially to psychiatrists and their assistants, to pharmacists and their assistance to big pharma and all employees from secretaries to CEO’S , and all government officials world wide from the highest to the lowest , and mainly all the people “we need help at another level from all.”
    If you did not see the movie “Dances With Wolves” see it , because if the human beings oppressed by psychiatry, considering how drugged and under pressure so many still are, receiving a level of action support in real life, comparable to that which the Kevin Costner character had the courage to offer even to join the fight for freedom with the Indian peoples in that movie , with many more psychiatrists dedicated in that manner we may yet survive.

  11. Thank you, Sandra. I admire your courage and ethical curiosity to continue seeking multi-level, multi-directional orientations to making sense of our growth and healing towards wholeness. You help lift us from the mire of either/or, absolute assumptions, fear-based rush to control and thereby promote our moving toward accepting complexity and contradictory truths.