Psychiatry and the Problem of the Medical Model – Part 1


Psychiatry is a branch of medicine. As such, psychiatrists apply the medical model to problems of emotion, thought, behavior, human relations, and living. This narrow gaze of the biomedical on problems that seem to transcend disease and disorder, brain and biology, has brought the field under severe criticism both from external commentators and from within its own ranks. Thomas Szasz, the libertarian psychiatrist, went as far as to argue that mental illness was in fact a “myth.”1 In contrast, the narrative of the history of medicine is one of technical triumphalism, with the historian Roy Porter titling his treatise on the topic The Greatest Benefit to Mankind.2

Many critics of psychiatry engage in “splitting.” They see psychiatry as an “all bad” object, mired by pseudoscience, pathologizing all of mental life, peddling quack treatments, often under coercion or control. So-called “real medicine” is idealized as the product of scientific advancement, with diagnoses and treatment precise, its diseases and treatments not influenced by sociopolitical, or economic fancy, and its practitioners portrayed as healers rather than agents of social control. Psychiatry aspires to be like the rest of medicine. Given that the problems that beleaguer psychiatry in particular, are true of medicine in general, it is a mistake to criticize psychiatry alone, and not locate it within a medical-industrial complex in need of dire reform.

Illness, Disease, and Slippery Syndromes

Many critics of psychiatry object to the use of the term ‘mental illness.’ These critics argue either that because the mind is a metaphor, it cannot be diseased (and thus conflate disease with illness), or wrongly believe the term implies such problems are biomedical in origin and warrant medical intervention.1 Illness is the subjective experience of being unwell, does not imply the existence of underlying disease, and labeling problems as illness never has led the majority of people to seek medical consultation. Medical sociologists have noted there exists an ‘illness iceberg’ whereby the majority of people in the community who identify as experiencing illness do not seek medical attention, and if they were the system would be completely overwhelmed.3 Instead, most people tend to consult a ‘lay referral system,’ seeking explanation and remedy of their problems from friends, family, and informal experts within their community, before seeking medical attention.4 Even with the creeping medicalization of everyday life and professionalization of helping, it is still the case that the majority of those who may identify as ill, ‘mental’ or otherwise, do not seek medical attention. Thus it is incorrect to state that ‘illness’ implies medicalization when it is a subjective experience that may or may not correspond with disease. Many of the individuals I see endure immense suffering and understandably see themselves as sick. I think it would be incredibly invalidating of me to say they are not ‘ill’ though they do not have disease.

The actual definition of disease is one of contention. I refer to the term disease to describe a clinical syndrome for which there is a well-described underlying pathology or pathogen. In this definition, schizophrenia, bipolar disorder, or major depression are not diseases. Alzheimer’s, vascular dementia, and frontal lobe syndrome due to traumatic brain injury do fall under this definition of disease. In other areas of medicine, it is clear that physicians cannot reach a consensus outside of infectious disease, which problems should be classified as ‘disease.’5 Epilepsy for example, in my definition could not be considered a disease. There also appear to be differences in definitions of disease between general practitioners, non-medical academics, medical academics and high school students.6

Psychiatry has rightly been criticized for the ever-expanding definition of mental illness, with the boundaries between mental health and mental illness (arbitrary as they are) becoming increasingly blurred. However this is true of medicine as well, where asthma is now diagnosed in children with minor wheezing and breathlessness, and diabetes expanded with a lower threshold of glucose level needed for the diagnosis. There is now even ‘pre-diabetes,’ a harbinger state of full-blown disease recognized as a condition.

With the increasing transparency of the body we are recognizing disease in those who are not ill. CT scans will routinely pick up lung nodules of unknown significance or early cancers in people who have no symptoms at all. These individuals are not ‘ill’ (they do not subjectively feel unwell) but through the medical gaze they do have disease, disease for which the significance may be entirely unknown and treatment cause more harm than good.


‘The medical establishment has become a threat to health.’ So begins Ivan Illich, social scientist and priest, in his book Medical Nemesis: The Expropriation of Health.7 He noted that with the professionalization of medicine, doctors had come to transform problems that were previously seen as social, moral or spiritual in nature into medical ones. In the process, physicians had created a new disease killing many: iatrogenesis. As such, medicine was doing more harm than good with the ill-conceived notion of treating problems that physicians had no business treating.

Psychiatry has particularly come under attack for transforming grief, shyness, hyperactivity, worry, and social suffering into mental disorders requiring professional intervention and quite rightly so. Given that extreme states of despair lie on a nebulous continuum with emotional states we all experience on a daily basis, it is no surprise that the mental health industry in particular has been particularly successful in increasing the range of human misery falling under its province. But it is a mistake to think that psychiatry alone is guilty of making us sick.

The menopause, once part of the normal reproductive trajectory of a woman’s life has been transformed into a sickness needing medical intervention.8 These interventions have now been shown to increase the risk of blood clots, strokes, and breast cancer. The urge to moves one’s legs about is now an increasingly diagnosed as restless leg syndrome9, and treated with drugs that can cause confusion, psychosis, dependency, or compulsive gambling. Pfizer has been successful in redefining the quality of an erection, leading many men to seek Viagra as a lifestyle pill, with the risk of blindness, deafness, and priapism.10 The American Medical Association last year voted to classify obesity as a disease, despite the evidence showing doing so is harmful by de-emphasizing the role of behavior and lifestyle in weight control. It is not by coincidence the emergence of obesity as a ‘disease’ occurred just as two new drugs for obesity appeared on the market.11 The pharmaceutical industry’s co-option of medicine neither begins nor ends with psychiatry.

Although obstetrics, a field once known as “man-midwifery” was denounced by the rest of the medical profession, today pregnancy is so entrenched in the medical model and so profitable, that the American College of Obstetrics and Gynecology continues to promote obstetric involvement in normal labor, despite the evidence that home births or midwife-led deliveries are better for uncomplicated pregnancies.12 In the same way, the American Psychiatric Association will never renounce any practice that would affect the earning of its members, regardless of the evidence base for those practices, no other professional organization in medicine or beyond would do so. Professional organizations by their very nature are self-serving. You do not bite the hand that feeds you. The profit motive has corrupted medicine and transformed it into a multi-billion dollar business – psychiatry is not the exception but the rule.

The Myth of ‘Objectivity’ in Medicine

Psychiatry by its very nature deals with subjectivity. Patients present with experiences; experiences that I can never know, nor ever see.13 The field has come under criticism for lacking objectivity, and not having blood tests or imaging or other confirmatory markers for the existence of illness or disorder. In a misguided attempt to look more scientific and objective, psychiatry has turned to the ridiculous task of looking for blood tests or biomarkers for depression and other such mental states. Quite apart from just how absurd it would be to ‘diagnose’ someone with depression or psychosis from a blood test or brain scan, the reliance on so-called objective indicators of disease is a hermeneutical nightmare. The technologization of medicine has led to spiraling healthcare costs, the devaluing of relationships and narratives, and the deskilling of doctors.14

Take the example of hypertension. This is a risk factor rather than a disease, but it is ‘objectively’ measured and thus the point at which blood pressure is considered hypertension in need of treatment should be uniform based on the scientific evidence. Yet if you live in the US and had uncomplicated hypertension, you would be treated when your blood pressure is above 150/90mmHg.15 In the UK, you would be treated if your blood pressure is above 160/100mmHg.16 What constitutes hypertension in need of treatment cannot then be based on science alone. It is constrained by interpretation, an act which itself is constrained by the surrounding social, political, and economic space.

Turning to cancer, which most people would consider a diagnosis made through objective means, the story is even more frightening. One test that has been used in the US until recently to screen for prostate cancer is the prostatic specific antigen (PSA). Screening identifies cancers in people who are not ill, do not need or benefit from diagnosis and are ultimately harmed by treatment. Overdiagnosis of prostate cancer is as high as 50% in those diagnosed with prostate cancer. In one of the largest studies of its kind involved 182000 men, 1410 men had to bee screened and 48 unnecessarily treated in order to prevent one death.17 Complications of treatment of prostate cancer routinely include impotence, urinary incontinence, and radiation proctitis. The largest study of its kind to review the effects of mammography for breast cancer found that over a 30 year period 1.3 million women were unnecessarily diagnosed and treated for breast cancer, with 70 000 women in 2008 alone unnecessarily diagnosed with breast cancer.18 Mammography routinely identifies disease in those who would never become ill (have symptoms), or where the cancer would never pose a threat to life. The use of objective tests in medicine is rife with their own problems because they need interpretation. Where there is interpretation, there is error.

Diagnostic tests in the majority of cases were never meant to ‘make’ a diagnosis but to support a diagnosis, which is made from carefully listening to the history of the illness and through physical examination. As medical practice has become more litigious and we have become more reliant on tests to make diagnoses, doctors spend less time listening to their patients, and no longer trust their clinical skills. I went into psychiatry because of the focus on subjectivity, narrative, meaning and relationships. Because these are no longer valued in medicine, they are also less valued in psychiatry.

Coercion and Control 

One of the biggest criticisms of psychiatry is that ‘treatment’ often involves coercion and that psychiatrists are agents of social control. I don’t believe any meaningful treatment can occur within a coercive setting, and find it troubling how often force is used, and how comfortable psychiatrists seem to feel with its use. As a lowly intern, I found myself accused of “insubordination” for refusing to write an order for compelling intramuscular neuroleptics for a patient. Involuntary ‘treatment’ and drugging occurs far too often and is often avoidable. For almost 60 years, we have known that the organization of psychiatric units which foster an “us” and “them” mentality between patients and staff leads to inappropriate use of force and can be re-organized for the better.19 Non-hospital residential alternatives to hospitalization such as Soteria House have also successfully shown than in the majority of cases, violent behavior can be managed without recourse to coercive practices.20 Unfortunately, there do not appear to be models of care that have successfully avoided coercive practices in those who are actively dangerous to themselves or others altogether.

Some critics of coercion in psychiatry seem to ignore the reality that coercive practices occur in all of medicine, and in many occasions more often. In the institutions where I have worked, mechanical and chemical restraint of patients overwhelmingly occurs in the emergency room or medical wards, with no psychiatric involvement. Although there have been some recent studies exploring use of restraints in the medical (as opposed to psychiatric) setting, including identifying racial biases21, the use of coercion in these settings comes under far less scrutiny or study than in psychiatric settings, despite these patients not being involuntarily detained.

Similarly, physicians in all fields are agents of social control. In addition to caring for patients, physicians have the sometimes conflicting task of protecting the public. This includes determining safety to drive, fitness to care for children, and control of infectious diseases. Those who refuse treatment for TB can be detained against their will and forced to have treatment against their will or face legal repercussions.21 In the recent Ebola panic, Kaci Hicox was inappropriately quarantined in a misguided attempt to protect the public from a disease she did not have.23 In the case of the HPV vaccine for schoolgirls, Rick Perry as governor of Texas tried to force all school girls to have the vaccine, which appears to have been motivated from kickbacks he received from Merck, the makers of the vaccine.24

In the United States the overwhelming majority of psychiatrists are not involved in civil commitment or forcibly drugging their patients. For many, this facet of psychiatric practice is extremely uncomfortable. However, it is misguided to pretend that coercion does not occur in the rest of medicine, when it routinely does with less accountability than in psychiatry. We need to critically examine the use of control and coercion in all areas of medicine so that it is truly a rare occurrence and always of last resort.

The mental health industry has a lot to answer for. The psychologization of everyday life has eroded the range of human experience seen as normal, disempowered people to manage their own life challenges, professionalized helping relationships and undermined the already decaying support structures through which people found meaning and connection, stigmatized people through psychiatric labeling, led to iatrogenic misery from harmful treatments and traumatized already vulnerable individuals through excessively coercive practices. It is not because psychiatry is distinct from the rest of medicine that it has done so much damage. Rather it is precisely because it is a part of medicine and aspires to the medical model, a model that outside all but the most acute problems has been an abject failure, that it has done so. If our approach to problems of emotion, thought, behavior, human relations, and living is to be radically altered, we must take a closer look at what is wrong with medicine as a whole.

* * * * *


  1. Szasz T. The myth of mental illness. American Psychologist 1960; 15:113-118
  2. Porter R. The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. London: Fontana Press, 1999
  3. Hannay DR. The ‘iceberg’ of illness and ‘trivial’ consultations. Journal of the Royal College of General Practitioners 1980; 30:551-554
  4. Friedson E. Client control and medical practice. American Journal of Sociology 1960 65:374-382
  5. Smith R. In search of “non-disease”. British Medical Journal 2002; 324:883-885
  6. EJM Cambpell, Scadding JG, Roberts RS. The concept of disease. British Medical Journal 1979; 2:757-762
  7. Ilich I. Medical Nemesis: The Expropriation of Heath. London: Caldar & Boyars, 1975
  8. Moynihan R, Cassels A. Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients. New York: Nation Books, 2006
  9. Woloshin S, Schwartz LM. Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick. PLoS Medicine 2006; 3: e170. doi:10.1371/journal.pmed.0030170
  10. Lexchin J. Bigger and Better: How Pfizer Redefined Erectile Dysfunction. PLoS Medicine 3: e132. doi:10.1371/journal.pmed.0030132
  11. Pollack A. A.M.A. recognizes obesity as a disease. New York Times, June 19th 2013, B1
  12. Bennhold K, Saint Louis C. British Regulator Urges Home Births Over Hospitals for Uncomplicated Pregnancies New York Times, December 4th 2014, A6
  13. Laing RD. The Politics of Experience. Harmondsworth: Penguin Books, 1967
  14. Kleinman A. The Illness Narratives: Suffering, Healing and the Human Condition. Cambridge: Basis Books, 1988
  15. National Institute for Health and Clinical Excellence. Hypertension: Clinical Management of Hypertension in Adults. London: NICE, 2011
  16. James PA, Oparil S, Carter BL et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Reprot from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). Journal of the American Medical Association 2014; 311:507-520
  17. Schröder FH, Hugosson J, Roobol MJ et al. Screening and prostate-cancer mortality in a randomized European study. New England Journal of Medicine 2009; 360:1320-1328
  18. Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. New England Journal of Medicine 2012; 367:1998-2005
  19. Cameron JL, Laing RD, McGhie A. Patient and nurse; effects of environmental changes in the care of chronic schizophrenics. Lancet 1955; 269:1384-1386
  20. Mosher LR, Menn AZ, Vallone R, Fort D. Treatment at Soteria House: A manual for the practice of interpersonal phenomenology. 1992, unpublished monograph.
  21. Zun LS. A prospective study of the complication rate of use of patient restraint in the emergency department. The Journal of Emergency Medicine 2003; 24:119-124
  22. Centers for Disease Control and Prevention. Module 9: patient adherence to tuberculosis treatment reading material. (accessed 12/20/14)
  23. Hartcollis A, Fitzsimmons EG. Tested negative for Ebola, nurse criticizes her quarantine. New York Times, October 26th 2014, A1
  24. Colgrove J, Abiola S, Mello MM. HPV vaccination mandates – lawmaking amid political and scientific controversy. New England Journal of Medicine 2010; 363:785-791


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. Thanks for the post. I’m in total agreement. I believe that taking the money out of medicine might go a long way to correcting things, although certainly it would not correct all misguided behavior on the part of physicians. I’m encouraged because of the occasional story on doctors getting kick backs for prescribing the more expensive pill. On 60 minutes, there was a story on cancer drugs. When a big HMO refused to buy the more expensive pill, the pharmaceutical house gave a kick back to the doctors, but Medicare was continued to be charged the more expensive price. Given that economists keep saying that the cost of medical care will soon exceed, as I recall, 20% of GDP, someone might decide to reign things in. But, they did not do reign in the defense industry, so maybe the standard of living in the US will just continue to deteriorate.

  2. Dr Datta,
    I believe you have missed some key contributions that psychiatry has made– or rather how this *medical specialty* has led the way for what you are conclude is a matter of what is wrong with medicine as a whole:

    Here is a brief synopsis posted by a psychiatrist:

    “It’s common to dismiss psychiatry as the Cinder Ella specialty. A recent past-president of the Royal College of Psychiatrists, Dinesh Bhugra, at a meeting in Hay-on-Wye in May, delivered the typical unthinking mantra when he said that psychiatry was attempting to join mainstream medicine and would get there sometime soon. We’ve been supposedly about to join the rest of medicine since the introduction of modern psychotropic drugs in the 1960s. In fact psychiatry was the first to have specialist hospitals, and the first to have specialist journals. With Philippe Pinel in 1809 psychiatry was the first to outline the principles of evidence based medicine. Starting from the most complex clinical problems there are, Pinel was the first to show that differential diagnosis counts and other early psychiatrists followed up by distinguishing among mood disorders and psychoses in a manner that quite astonishingly stood the test of time when more specific treatments were later introduced. The form of the randomized trial now most widely used in medicine was first used in psychiatry and psychiatry was the first branch of medicine to submit most of its treatments to controlled trials. The talk at the moment is of Future Hospitals which will be in the community – closing the big old behemoths. Psychiatry led the way on this and on working in multidisciplinary teams forty years ago. The rest of medicine is catching up slowly. More recently it has been the first branch of medicine to have substantial amounts of its literature ghost-written. It was the medical arena in which pharmaceutical companies first developed their abilities to sell diseases. It was the first to have professors in jail for putting non-existent patients into clinical trials. It has provided the poster-boy for medical conflicts of interest – Charlie Nemeroff. “- See more at:

    I think you are side stepping the significance of a *biological*/medical model adopted by MD’s who turned the medical model upside down, corrupted the scientific process–and got away with based on their granted authority as MD’s. –psychiatrists, MD. The greater violation of the medical model occurred with the dismissal of patient’s complaints of adverse effects of psychotropic drugs, and the concept of *unmasking* serious mental illness as the explanation for the adverse effects, as in diagnosing the adverse effect of SSRIs, *mania* as *unmasked bipolar disorder*. I witnessed this. I have total recall of the absence of medical model thinking that ruined the lives of countless adolescents. The *doctrines* of Dr. Joseph Biederman prevailed over medical model scrutiny and common sense. As this scourge has not been properly exposed and the perpetrators punished, the doctrines of Dr. Joseph Biederman continue to… prevail.

    You contend: “Even with the creeping medicalization of everyday life and professionalization of helping, it is still the case that the majority of those who may identify as ill, ‘mental’ or otherwise, do not seek medical attention. ”

    How do you explain the psychiatric lexicon employed by professionals in our public schools and those who encounter the children ensnared in out foster care system ? Where did teachers, social workers get the idea that a disruptive child, one whose behavior is beyond their ability to manage, is in need of *psychiatric treatment*, that always includes psych drugs? Why do social workers assume that a child whom they know has been neglected or abused, is behaving in a manner that is best explained by a psychiatric diagnosis , and will benefit from a psychiatric diagnosis and psych drugs? Who propagated this nonsense? Do you think that the medical model is employed when it determined that it is okay to subject a child to harm if this is what it takes to make those *professionals* who deal with him more comfortable? How is it that you fail to note who is responsible for leading the crusade to dehumanize the *patient* who is little more than a victim of psychiatry,MD?

    If you discount that psychiatry led the way for exploiting the suffering of vulnerable people for obscene profit, as apparently you do, I suppose it is convenient for you to draw on the corrupting of medicine as a whole as some kind of validation for this being a socio/cultural/political forces- trend. It is a rather pitiful argument that begs the question: who amongst medicine as a whole will rise to the challenge of putting things right.

    Are we to accept that the most educated amongst us will do no more than appeal to the prevailing socio/cultural/political forces– rubber stamping whatever nefarious goals the ruling class devises to control the masses? – That Medical Doctors will abdicate their commitment to their patient’s best interest and well being and assume the role of strong arm for the *ruling class* ? Well, then we might need to rethink the authority we have granted to these bottom feeders.

    What may have been the beginning of a medical model for psychiatry, replete with evidence of various practices, treatments, ended long ago (1809)with the work of psychiatrist’s like, Philippe Pinel.
    It seems that though you are adept in describing the deplorable academic preparation psychiatrists in training receive, you have failed to perceive the goal of the training that has replaced medical model education. Psychiatry exists to control behavior with poisons prescribed by dim wits who have no clue what they are doing to the brains and lives of vulnerable people, especially children.

    Your profession has now laid claim to another group of vulnerable people,who just happen to be the high end users of health insurance, those with complex medical conditions, or those diagnosed by other medical specialists with disorders that cannot be supported by quantifiable diagnostic tests. Psychiatry has succeeded in establishing their own non-quantifiable diagnosis as superior–and psychiatry can exert their extra bit of power to remove children from parents who don’t believe the *subjective opinion* of a psychiatrist. Outrageous !

    You claim:” Some critics of coercion in psychiatry seem to ignore the reality that coercive practices occur in all of medicine, and in many occasions more often. In the institutions where I have worked, mechanical and chemical restraint of patients overwhelmingly occurs in the emergency room or medical wards, with no psychiatric involvement. Although there have been some recent studies exploring use of restraints in the medical (as opposed to psychiatric) setting, including identifying racial biases21, the use of coercion in these settings comes under far less scrutiny or study than in psychiatric settings, despite these patients not being involuntarily detained. ”

    The laws that govern the use of mechanical restraints draw a distinct difference between “medically necessary” and “behavioral restraints”. Medically necessary restraints are employed in situations where a patient is at risk for removing or disrupting that which is considered “life saving”, for example, endotracheal tubes, IV’s and the like,- or are in need of *life saving* care, as in the treatment of gaping wounds–In other words, most medical professionals understand that there are instances when a patient, driven by fear, will act out in a manner that threatens his own life.
    “Behavioral restraints” are to be employed as a last resort, for containment of an individual who is posing an immediate threat of harm to himself or others. I have never seen or reviewed a mechanical restraint of a *psychiatric patient* that did not include the forced drugging of that person with powerful psychoactive drugs. I have often seen and reviewed mechanical restraints in psychiatric settings where the use of mechanical restraint was the *punishment* for breeching the comfort level of the staff, and mostly as a means for administering the psych drugs that the person was adamantly refusing. There is no comparison between the coercion employed in medical vs. psychiatric settings– especially in an ED, where being labeled *psychiatric patient* is a sure bet mechanical restraints will be used for any sign of noncompliance.

    The real life, real time scourge of psychiatry speaks volumes regarding from *whence it came*. I think that so long as you discount all evidence of psychiatry,MD pioneering the movement to violate all that medicine as a whole stands for, and ignore how psychiatry,MD is continuing to advance on a path that looks more like predatory behavior than the noble pursuits of medicine, you miss the mark in interpreting the history that is ripe with reasons for eliminating psychiatry from medicine as a whole.

    • Vivek,

      As someone who was misinformed when initially put on psych meds (starting with a supposedly “safe smoking cessation med” / actual mind altering antidepressant) by a PCP who wanted to cover up her husband’s “attending physician” role at a “bad fix” on a broken bone of mine, since that PCP was paranoid of a potential (albeit non existent) malpractice suit. I absolutely agree both mainstream medicine and psychiatry are corrupt.

      And as someone who had the further misfortune of having that proactive malpractice suit prevention inspired psychiatric assault further covered up by being medically unnecessarily shipped to an internist, V R Kuchipudi. A man who has now been arrested by the FBI for having lots of patients medically unnecessarily shipped all over Chicagoland to himself, “snowing” patients, and performing unneeded tracheotomies for profit, resulting in numerous patient deaths.

      According to my medical records, Kuchipudi had admitted me with a non-existent “chronic airway obstruction,” exactly what an unneeded tracheotomy would “cure.” But when the “airway obstruction” didn’t result in brain death (I’m off the organ donor list now), it magically turned into “bipolar.” And this unprovable and scientifically “lacking in validity” disorder was used as the rational for the “snowing” done by Kuchipudi’s psychiatric partner in crime, Humaira Saiyed,

      Now an ethical pastor was kind enough to explain to me, after reading my chronologically typed up medical records and corresponding medical research, that historically, and obviously still today, a major function of the psychiatric industry is covering up easily recognized iatrogenesis for the incompetent doctors. He also mentioned that the psychiatrists historically, and still today, cover up sexual abuse of children for the religions (I also have medical evidence of this issue in my child’s and my medical records.). He called these, apparently common, psychiatric injustices the “dirty little secret of the two original educated professions.”

      I agree, power and greed have corrupted the mainstream medical community, absolutely. But their corruption would not be nearly as easy, without all the unprovable and scientifically invalid DSM diagnoses, and without all of the psychiatric industries’ mind altering and toxic tranquilizers. My take on the situation is that psychiatry’s fraudulent ways are what are leading to the destruction of the credibility of all of mainstream medicine.


      Thank you for standing up for the patients, and speaking the horrid truth. It was decent nurses, disgusted by my corrupt doctors, that saved me. I’m very grateful to the decent and ethical medical professionals.

  3. When i read this article, I new right away, where it was heading. That being said, I believe that there are many sincere Psychiatrists, out who really want to help those with psychiatric illness.

    However, its been my experience, that the education they receive makes this practically impossible. Once they graduate from medical school, and take a psych residence their approach is usually set for the rest of their career. Only a handful in every given generation, become dissatisfied, and learn to take a different approach.

    Medicine, is not experimentation usually,. it has a set play book, of standards of care. People, patients are diagnosed and treated along those lines. First comes a diagnosis, then comes, the treatment. And since medicine believes that psychiatric illness is a result of some biophysical problem, that usually that means drugs of some kind.

    Other, models view treatment much different. In my on training as a psychotherapist, i learned to first listen to the patient, and use my clinical skills to get a feeling for what they are experiencing. The DSM was only after thought. Treatment consisted of psycho therapy, not medications. I learned quite early that medications, interfered with he healing process. One that I had experienced myself prior to becoming a therapist.

    Medicine on the other hand almost never gets beyond, the you are sick, I am well mentality. Doctors unlike therapists, are not required to go through therapy of their own, not encouraged to engage in personal growth to understand that what is happening to their patients is also happening to them.

    I have seen the you are sick I am well, mentality played over and over again, when patients come to their doctors, their feelings are anesthetized by medications, and remain unheard. They are considered to be problematic, if they don’t take their pills and go away quietly. To just do what they do.

    And of course now, especially in the USA, the insurance companies control treatment by what they will pay for. Its much more profitable to to pay for drugs, for them, than talk therapy. Which makes monetary considerations of the most important, yet ethically treatment decisions should never be based on those considerations. But ethical considerations no longer seem to matter, once prescribing psych meds whether the work or not doesn’t matters since they are so highly profitable. Consider the fact that now psychiatric medications, cause more fatalities than car accidents.

    Psychiatrists run mental health, through insurance companies. Their job is really to deny treatment, to ensure that the gargantuan profits for this companies continue.

    Psychiatry as it is now, is primary one of drug dealing, and addiction. Yes there are psychiatrists that are good and who care. but they have been trained, to work in a system, that is not based on science but on profit.

    There are cures for mental health issues, that don’t involve drug use, that involve instead, therapy, counseling, therapeutic relationships, and psychotherapy. And there are therapists, who help people get well despite everything, they have been fed by the medical model.

  4. Some interesting information there Dr Datta.

    Strange, but my experience with other areas of medicine have not been anything like the one with psychiatry. I even got to say no to a needle of dye when having xrays done one time. The word No in our psychiatric institutions constitutes an ’emergency’ and your right to consent is immediately removed, you will be restrained and drugged if that is what is required for patient management. Our Chief Psychiatrist who is responsible for ensuring the protection of consumers, carers and the public doesn’t even know what a burden of proof is, (and yes I have it in writing) so accountability doesn’t exist in our system, and a person can be detained by a community nurse because ‘tomato’.

    It is only in psychiatry that I have met people who make the guards at Abu Ghraib look like kindergarten teachers.

    Psychiatry is to medicine, what ISIS is to Islam.

  5. There is no doubt that the entire field of medicine has been corrupted by the drug and insurance companies and the pursuit of money rather than the healing of human beings. So, I won’t say that psychiatry is the only branch of medicine that has problems that need to be cleaned up and taken care of on a grand scale. Too many doctors, in all medical specialties, are arrogant tyrants who believe that they know more than I do about my own life and health. The doctors of this type, of which there are far too many, need to be taken down a peg and put in their place.

    But, I also believe that psychiatry should be done away with as a medical specialty. This so-called specialty of medicine is filled with misinformed and poorly educated people who know little more than how to write scripts for drugs that are dangerous and life threatening. Most of them, with the exception of the older ones, know nothing about doing talk therapy, and many are so afraid of real, human emotions that it’s not funny. Many doctors have not done their own work and taken care of their own issues and this makes them dangerous, but many psychiatrists are the worst about this. They do not understand the basic saying of “physician, heal thyself.” They set themselves up as the experts on other peoples’ lives and set about ordering “treatment” that destroys rather than restores life. There is no reason for this so-called branch of medicine to exist. Not every psychiatrist is bad or incompetent, but the ones that are seem to far outnumber the ones who aren’t. I believe it’s time to do away with psychiatry. And I’m sure that this will stir those people up who believe that we need to continue to try to dialogue with this group and to these people I will ask, just what has our attempted dialogue accomplished so far. I continue to see people dragged to the state hospital where I work and forced into treatment meted out at the hands of, what seem to me, to be incompetent psychiatrists. And the door in Admissions where I work has become a huge, revolving door.

  6. This article talks about coercion in psychiatry, then compares it to other medicine. The coercion Datta refers to is forced restraint, forced medication and so on. But in reality, in psychiatry, people are using somewhat more subtle devices such as diagnoses, “he has a lack of insight”, “he has paranoid thinking”, “he is psychotic”, “he has anosognosia”, etc, etc, as a form of restraint or coercion. In the current world, this kind of coercion is quite common in psychiatry. I know it, I’ve seen it, I have a proof of it in my psychiatric papers. I think that generally, there is a lot more of this kind of thing happening inside psychiatry than in general medicine, if only because psychiatry is maybe.. more vague or whatever.

  7. It seems the centerpiece of this well-argued piece is that psychiatry as a sub-specialty of medicine is part of a much larger movement toward promoting illness when none exists. The only conclusion I can draw from this is that including psychiatry as a medical specialty is a mistake and that it should be eliminated as such, leaving psychological/emotional/spiritual healing to the lay public and to agencies whose job is to care for people rather than just bodies.

    I appreciate the inclusion of childbirth as an area with a great deal in common with psychiatry, including warping of informed consent and the de facto use of force and unnecessary medical interventions on a routine basis.

    Yes, there is definitely something very, very wrong with modern medicine, especially in the USA, and it has a lot to do with financial incentives and corruption. It’s hard for me to imagine psychiatry, with its inherently subjective and socially-embedded definitions and dogma, to function in a truly helping way within the confines of the medical establishment you so aptly describe.

    — Steve

  8. Many critics of psychiatry engage in “splitting.” They see psychiatry as an “all bad” object, mired by pseudoscience, pathologizing all of mental life, peddling quack treatments, often under coercion or control. So-called “real medicine” is idealized as the product of scientific advancement, with diagnoses and treatment precise, its diseases and treatments not influenced by sociopolitical, or economic fancy, and its practitioners portrayed as healers rather than agents of social control.

    This is outrageous. How do you know that “many critics of psychiatry engage in ‘splitting'”?

    I don’t know exactly what to make of this. Is it an attempt to marginalize your opponents’ viewpoints by pathologizing their thinking processes? I’ve noticed a pattern of this among some of the reformist “mental health” professionals on MIA – that when they disagree with someone else over reform of psychiatry vs. abolition of it, they bring out terms like “splitting” or “black and white thinking,” which every one of them know are associated with so-called “personality disorders.” There was even a psychiatrist who flat out said that he thought the people who post here have “Axis 2 going on,” or some such nonsense. You know, rather than “splitting,” it might be that reasonable people can look at the same information about psychiatry and come to different conclusions about it. I expected sophistry (and was not disappointed), but this passage is just offensive.

    • Psychoanalysts would not necessarily regard splitting as pathological, in fact we probably engage in splitting at some time or other. Although pervasive splitting behaviors are associatedwith borderline personality organization, I did not make that implication – if that were my intention, I would have spelt it out! I used the term because it seems the best description for the critiques of psychiatry which deride it all whilst idealizing medicine when all the problems with psychiatry can be traced to it being part of medicine.


  9. Dr. Datta,

    As Christian pastor and theologian, I would adamantly disagree with you that “psychiatry is (or ever ought to be, for that matter) a branch of medicine”. Herein lies the heart of the problem!

    Psychiatry (like psychology) was, is, and always will be essentially a branch of Theology and NOT Medicine! That is, psychology was, is, and always will be “the study of the soul” (Gk. psuche-logos). And likewise, psychiatry was, is, and always will be “the healing of the soul” (Gk. psuche-hiatria)

    As such, or quite naturally, my question to you, as well as to other medical doctors who are attempting to study and heal the soul, is what is the Medical Art doing in my jurisdiction? That is, the jurisdiction of the soul? And how did the Medical Art (historically) get here?

    The answer, it would seem, is to be found, in part, with the following statements (or clues) that you made above:

    “psychiatrists apply the medical model to problems of emotion, thought, behavior, human relations, and living. This narrow gaze of the biomedical on problems that seem to transcend disease and disorder, brain and biology, has brought the field under severe criticism … ‘The medical establishment has become a threat to health.’ So begins Ivan Illich, social scientist and priest, in his book Medical Nemesis: The Expropriation of Health. He noted that with the professionalization of medicine, doctors had come to transform problems that were previously seen as social, moral or spiritual in nature into medical ones. In the process, physicians had created a new disease killing many: iatrogenesis. As such, medicine was doing more harm than good with the ill-conceived notion of treating problems that physicians had no business treating … It is not because psychiatry is distinct from the rest of medicine that it has done so much damage. Rather it is precisely because it is a part of medicine and aspires to the medical model … If our approach to problems of emotion, thought, behavior, human relations, and living is to be radically altered, we must take a closer look at what is wrong with medicine as a whole.”

    It is in your last statement that the key, I believe, is to be found. That is, “If our approach to problems of emotion, thought, behavior, human relations, and living is to be radically altered, we must take a closer look at what is wrong with medicine as a whole.”

    To begin with, the “professionalization of medicine”, in the modern period, was NOT the real cause behind the transformation of “problems that were previously seen as social, moral or spiritual in nature into medical ones”. That is, professionalization was more of a historical “conduit” rather than a historical “cause”. The real historical cause was the major paradigm shift that took place within medicine (and Western thought and culture) as a whole in the late 19th century. That is, the paradigm shift that ultimately took place, within medicine, as a result of the enormous influence of Ludwig Feuerbach, and especially Ludwig Buchner, in the philosophy of science.

    As I have mentioned elsewhere, theologian, Hans Kung, in a series of lectures given at Yale University, in 1979, discussed Feuerbach’s and Buchner’s relationship to, as well as their sway over, the medical profession. Together with their overt hostility toward Christianity, the supernatural, God and the soul, these two philosophers of science have undoubtedly helped to establish the terms of endearment between Science and Faith ever since. Professor Kung, in this regard, is definitely worth quoting at some length:

    “Feuerbach prophesied another successful revolution, which would be speeded up by the natural sciences … the natural sciences had ‘long before dissolved the Christian world view into nitric acid’ … (Feuerbach) insisted that philosophy should be linked no longer with Christian theology but with the natural sciences … It was Moleschott, together with Carl Vogt and Ludwig Buchner among other young natural scientists, and supported by Feuerbach’s philosophical criticism of religion and immortality, who brought a specifically natural scientific materialism to fruition in the nineteenth century … it was clear that religious persuasions had no place in questions of natural science or medicine … religion had nothing to do with science and if it counted at all was a private affair … Ludwig Buchner, a doctor, produced his Kraft und Stoff (Force and Matter). More than twenty editions of the letter made it the militant bible of the new scientific-materialistic world view. According to Buchner, the world as a whole, and also the human mind, are explained by the combined activity of physical materials and their forces. God is superfluous. It was mainly the epoch-making progress of the two basic medical sciences of anatomy and physiology (including pathology) that favoured a kind of medical materialism … For Ludwig Feuerbach, at any rate, it was clear at this time that the medical man was by nature and training a strict materialist … In fact medicine in particular was of the greatest importance for materialistic atheism in the second half of the nineteenth century.” (Kung 3-6)

    Thus, Ludwig Feuerbach and Ludwig Buchner, together with a host of others, helped to utterly destroy Christianity, and especially the holy doctrine of the soul (i.e. the human “being” as a wholistic and interactive substance dualism of “spirit and matter” and not a strict physical monism of “force and matter”), as thee foundational worldview for doing medicine in the modern period; while, at the same time, establishing a naturalistic-atheistic foundation in its place.

    And so, or as we can clearly see, from just a very brief examination, it is natural human reason alone, informed by the observable, natural, physical laws of “force and matter” (and not “spirit and matter”), under the authority of a natural science philosophy, which determines virtually all medical pronouncements. At a core level there is no room, whatsoever, for the supernatural, God, theology, the soul, faith or divine revelation to inform medical decisions, its uses, and limits. At a fundamental level the Medical Art has not considered the knowledge of God, and particularly the knowledge of the soul (i.e. out of the Revelation of His Holy Word), worthwhile, let alone foundational, to how we “choose” to do medicine today. Historically in the West, this was not the case. And it was not the case for centuries.

    For example, in the “preface” of Rev. Dr. John T. McNeill’s 1951 textbook, “A History of the Cure of Souls” he describes the traditionally long-held Christian world view (in the West) as it pertains the “essence of human personality”:

    “The soul is the essence of human personality. It is related to the body, but it is not a mere expression or function of the bodily life. It is capable of vast ranges of experience and susceptible of disorder an anguish; but it is indestructible and endowed with possibilities of blessedness within and beyond the order of time. The cure of souls is, then, the sustaining and curative treatment of persons in those matters that reach beyond the requirements of the bodily life.” (McNeill, p.7)

    This “healing of the soul” (or the true “psychiatry”) “in those matters that reach beyond the requirements of the bodily life” can be, clearly, seen in just a sampling of historical-theological works:

    1. Rev. Dr. Johann T. Beck’s 1843 textbook, “Outlines of Biblical Psychology”:

    “The human soul is, in its essence and origin, neither a spiritual and supernatural being nor a sensible and merely natural one. It is a being created by the supernatural in-breathing of the Spirit of God; and, accordingly, it combines in its breathing powers a two-fold life. While its vital force is spiritual and supernatural, it is revealed in a sensible form and sensible modes of action (Gen.ii.7: ‘God formed man of the dust of the ground, and breathed into his nostrils the breath of life;’ cf. Eccles. Xii. 7, iii. 21; Isa. Lvii. 16; John xx.22; Job xxxiii.4). Man is not a spirit, for the spiritual element in him is interwoven with the sensible life. He is not an animal, for the sensible element in him is interwoven with the higher spirituality. Even in its dealings with the sensible world, and amidst all the joys and sorrows incident thereunto, the soul of man partakes in a supernatural divine influence. It can pass beyond the world of sense, and stand in communion with God. This is a communion which lays in the soul’s own proper substance the foundations of a life different from its existence in the world of sense, – a supernatural life, a life whose health or disease depends upon man’s moral conduct.” (Beck, pp. 7,8)

    2. Rev. Dr. Franz Delitzsch’s 1855 textbook “A System of Biblical Psychology” Section II (“The Ethico-Physical Disturbance”):

    “The spirit which was breathed into man was, indeed, the condition of life to his body. But life, light, and love, are throughout the whole of Scripture, ideas that are interwoven one in the other. Departed from the love of God, the spirit had thus become incapable of being the principle of life and of glorification for the body. Instead of the life that aspired to glorification, had appeared a life that was sinking back downwards to corruption. But the spirit itself cannot possibly die in the manner in which perishes the bodily form of dust. Such a death is contrary to its nature, and contrary to its origin. It cannot be dissolved into elements, for it is not composed of elements. Moreover, it cannot be annihilated, for it is of immediate divine origin.” (Delitzsch, pp. 151, 152)

    3. Prelate Magnus F. Roos’ 1769 textbook (and which I am, presently, translating from Latin to English), “Fundamentals of Psychology Collected from the Sacred Scripture”:

    “It is obligated of an individual intending to search out the nature of the human soul to first of all consider carefully when it lives a life on this earth, which part is itself in common with the brute beasts and which part is of the nobler nature, and abides eternally. Thereupon he may give consideration to, the vast number of realities a living human being is able to desire or to loathe, with some to be delighted in, with others to be overthrown. Ultimately he should weigh it carefully, not for the reason that all these realities may be attributed to an individual person, insofar as one may bear a fleshly body, but that a part of it may exist as a being having been separated from the body, however much this being may have been formed at union with the body, and with that union may constitute together a single person. This becomes then the first stage of psychology, how the expressions ‘nephesh’ and ‘psuche’ are disclosed to us.” (Roos, p.1)

    4. Rev. Dr. George Bush’s 1845 textbook “The Soul: An Inquiry into Scriptural Psychology”:

    “Anthropology is the appropriated term for ‘the science of man’. Its two grand divisions, founded upon the twofold distinction of man’s nature, are ‘physiology’ and ‘psychology’, the first relating to the body, the second to the soul.” (Bush, p.2).

    And so in light of the historically established boundaries between the physicians of the body (doctors) and the physicians of the soul (clergy), I ask, once again, what is the Medical Art doing in my jurisdiction of the soul? And why is a medical (i.e. physical disease-based) model being applied to the soul?

    Reverend Haynes

    • Beautifully stated, Reverend Haynes. I too, hope and pray the psychiatric industry will get out of the businesses of claiming people are “mentally ill” for questioning a dream about being “moved by the Holy Spirit” and believing in God.

      I don’t have time to comment on all that you’ve addressed here, but I will say the quantum physicists are coming to the conclusion that the strict belief in “medical materialism” does not mesh with their findings.

      Merry Christmas.

  10. My first take on Part 1 of Dr. Datta’s blog on the medical model is that – so far it divides very sharply into two distinct viewpoints.

    On the one hand it is a great exposure of everything that is wrong with conducting science, medicine, and all forms of caregiving under a profit (capitalist) system. The following quote:
    “The profit motive has corrupted medicine and transformed it into a multi-billion dollar business – psychiatry is not the exception but the rule.” ; this cannot be repeated too often; this has been a constant theme in almost all my written blogs here at MIA.

    Datta provides numerous examples of how the profit motive corrupts the medical model bringing up forms of corruption and distortion of medicine that I have never even thought of. Every time I see my own PCP he complains about what he describes as “the war on doctors.” In my area there is an all out war between competing “nonprofit” hospitals and medical groups that would rival the most cut throat competition of any warring capitalists. All this puts various forms of coercion and control on the role of formerly independent doctors who are now forced under the strict control of various hospital groups and their narrow economic agendas.

    Competing medical nonprofits in a capitalist system are very much subjected to the same “expand or die” economic laws and practices that guide “for profit” corporations. In the end medical care for the masses is thoroughly degraded for those lucky enough to even have access to it. And this will only get worse.

    Now on the other hand I believe Datta’s Part 1 analysis devolves into a form of moral and political relativism when he makes the following statement:

    “Many critics of psychiatry engage in “splitting.” They see psychiatry as an “all bad” object, mired by pseudoscience, pathologizing all of mental life, peddling quack treatments, often under coercion or control. So-called “real medicine” is idealized as the product of scientific advancement, with diagnoses and treatment precise, its diseases and treatments not influenced by sociopolitical, or economic fancy, and its practitioners portrayed as healers rather than agents of social control.”

    The problems within the medical model under a profit system are not all “relative” or “equal” where everything is more or less the same and we cannot determine some definitive or more absolute truths about the present state of affairs of modern psychiatry in comparison to the rest of medicine.

    There is very much a QUALITATIVE difference in comparing the problems inherent in Biological Psychiatry as compared to the entire practice of medicine with all it present day distortions. The entire foundation and edifice upon which psychiatry is built is based on faulty and “spurious” (as Hickey would say) notions of science.To not recognize this qualitative difference is a form of “relativism.”

    When “relativism” is applied to analyzing psychiatry within today’s medical model it leaves the reader to believe that those who single out or focus criticism on psychiatry are resorting to various forms of “subjectivism” in their approach. This is definitely not the case. The essence of most of the critical appraisals (at MIA and other forums) of modern psychiatry have represented a correct application of the scientific method and an advanced form of political analysis.


    • I agree 100% with your analysis. I would only add that in psychiatry, there is an element of intentionality that isn’t always present in other areas (like childbirth) that are plagued by mythology and perverse incentives. History tells us that psychiatry made a conscious decision to “sell” the concept that mental illnesses are biological and treatable by drugs. This was clearly a marketing tactic not based on even a warped misconception about what the science says or on some pre-existing traditions that conflicted with current knowledge. It was a marketing decision by a trade organization that was palmed off as science, at the very same time that scientific investigations were showing that the theories underlying the “message” were false. Given the subjective nature of psychiatric diagnoses, I consider the level of irresponsibility to be much higher when a political decision led to a huge change in how people were categorized and treated, which was knowingly embarked upon despite known contradictory findings. It is similar to the intentional suppression of nursing in the 50s in order to sell infant formula (and continued to this day in third world nations by Nestle Corporation, among others) despite knowledge that nursing is the superior option.

      While medicine as a whole is massively corrupted by money from Big Pharma, and some similar scams like “erectile dysfunction” have a familiar feel to those of us knowledgeable about psychiatry, the degree of systematic and intentional distortion around the entire field I think puts psychiatry on a uniquely unstable footing ethically, even in comparison to the general corruption of medical science. While I agree that there are plenty of practitioners who entered into this with an honest desire to help, the field itself is so corrupt in its very foundations that it is hard to see any way it can be salvaged, except, as I said above, by removing it from the field of medicine entirely, where it really does not belong.

      —- Steve

      • Steve

        Thanks for the validation. All the points you have raised in this thread I agree with, and I believe you have raised the discussion to a higher level.

        And we all owe a great debt to Philip Hickey who, in his search for the unvarnished truth, seems to make all of us delve much deeper into these vitally important discussions and debates.


  11. I think that some of the responsibility for the state of affairs lies with our legislators. Certainly here in Australia where our Acts have been described as a violation of human rights, a small ‘crack’ was opened up in the law to deal with a few very disturbed individuals.

    That ‘crack’ which has been opened up has been distorted and perverted beyond recognition, and what could have been a reasonable tool for dealing with these few individuals has been transformed into a weapon of abuse like none I’ve ever seen. A good example would be where saying “no” constitutes an “emergency” and makes the right to consent to treatment a myth.

    The spirit of the Act and the actual application of it are so far removed from one another as a result of fraud, heresy, violence and treachery being seen in this area as virtues. I’m sure that this spirit was intended to get help for people in extreme distress, but not as a means of getting someone to clean their house to their mothers standard.

    Have a think about what was intended by the Mental Health Act, and then take a look in any locked ward and see how it has been interpreted. The small crack has been turned into a grand canyon into which a lot of people are being thrown, and being severely damaged and in some cases killed.

    So I lay some of the responsibility at the feet of our legislators for not ensuring that the spirit of the Act is enforced, and allowed the rats to breed to a point where the infestation is doing major damage to the community. Though I don’t hold them responsible for the lack of honesty and integrity shown by those who work in our mental health services.

    • And further, I think that given our new Muslim Hygiene Act has the same spirit and intent that it won’t be long before we see the odd case of it being used as a weapon. If the right to bodily integrity and consent can be removed through the gaping loophole in our Mental Health Act, then I feel sure that attending a Mosque could be interpreted as an act of terrorism, and a person detained and tortured (or more correctly coercively interrogated [does that sound like ‘treatment’?]) for doing so.

      And given how effective Mental Health Services are at silencing any of their abuses and criminal negligence then there is little hope for the Muslim community. Shame really because I have met some nice Muslims over the years.

      • How does the law get perverted in such a manner?

        I know in my State that the person who is responsible for protecting the rights of the community, the Chief Psychiatrist, was prior to his appointment the head of the Royal College of Psychiatrists, where he represented the interests of psychiatrists. What better way to represent the interests of psychiatrists than to hold the position where he is charged with protecting the community, and then neglecting his duties.

        I have a letter from him where he even rewrote a section of the Act in order to remove a protection, and make what was a criminal act disappear. Very clever and I’d like to see more of his card tricks at some point.

        So, appoint the Grand Wizard of the Klan to protect the rights of African Americans and scratch your head about why the system is failing? Our Chief Psychiatrist has delivered carte blanche and zero accountability for his doctor friends. Well done.

  12. Many of the individuals I see endure immense suffering and understandably see themselves as sick. I think it would be incredibly invalidating of me to say they are not ‘ill’ though they do not have disease.

    They do not have disease, they are not ill, they are, therefore, perfectly healthy. How about telling them the truth? Could the truth possibly be invalidating? I see a lot of invalidating myself, but that invalidation is not due to the truth, that invalidating is due to the web of lies that you yourself are, in this instance, engaged in telling. This is where the typical hypocrisy begins.

    In the process, physicians had created a new disease killing many: iatrogenesis. As such, medicine was doing more harm than good with the ill-conceived notion of treating problems that physicians had no business treating.

    You’ve just captured in a sentence everything that is wrong with psychiatry. Chiefly, it is a matter of “treating problems that physicians” have “no business treating.” Further, when that treatment is a matter of injuring the patient, iatrogenesis is what you get, psychiatry “doing more harm than good”.

    Apologies, or no apologies, I’m not one to excuse psychiatrists for the excesses of their profession, excesses that include mass murder. In fact, considering that there is no scientific basis for the field itself, everything psychiatry does could be said to be excess, and that it is.

    You’ve made a good case in my opinion for getting rid of psychiatry altogether. Psychiatry is not medicine. There is no medical basis for the field. Should we be dealing with the excesses of medicine? That is another matter entirely. Physical wounds have been known to heal. Metaphysical wounds, on the other hand, can go on forever. The best person for a your “wounded soul” narrative is probably a novelist. The novelist knows his or her profession for the fiction that it is. How do you heal wounds made of words? Obviously, with salves made of words. Words, words, and more words. All of this eventually leads back to the body, a body beyond words, and beyond any need for them.

    • you seem to have missed my point about conflating disease and illness. most people with illness (‘mental’ or otherwise) do not have disease. many people with disease are not ill. I have no qualms gently confronting people who see themselves as sick or as victim where this is unwarranted. but people are often made unwell by their circumstances and I think it is important therapeutically to recognize that, while at the same clearly locating the source of illness or distress within the context that is generated it rather than medicalizing it.

      psychiatry is a broad field and many psychiatrists do see people with problems that they have no greater expertise in than anyone else or some other kind of mental health professional. but I think it is a step too far to argue that problems like delirium, dementia, traumatic brain injury, drug-induced altered states (like steroid induced psychosis etc) are not within the province of medicine or that psychiatrists don’t have a role in managing. especially when my colleagues in medicine and neurology often want nothing to do with anyone with any kind of emotional , reasoning or behavioral difficulties regardless of whether it is due to some clearly identifiable medical condition (such as cerebral lupus), trauma, or something else.


      • I disagree. Disease and illness are conflated by definition, and, either way, whether called “illness” or “disease”, non-medical problems have become, in this fashion, medicalized. There is a great deal of difference between saying a person is a victim of social injustice, or of bureaucratic callousness, or of alienation, and saying that a person is a victim of a disease or an illness. Disease and illness are much more accessible to a microscope lens. Discomfort, on the other hand, whether conceived of as “illness”, or otherwise, need not be medicalized. That physicians do hand off problems dealing with brain injury and so forth, with behavioral aspects, to psychiatrists, I don’t disagree. They only do so though because the option exists.

  13. Bravo, Dr. Datta. You appear to understand the fundamental flaw with the “medical” model – or, to call it precisely, *treatment* model.

    This flaw is the artificial opposition of two no-less-artificial sociocultural costructs – “health” and “illness”. And I mean not only “mental health” and “mental illness”, but “physical health” and “physical illness” as well.

    In fact, what we have, in the cases of both “physical” and “mental” illness, is concrete experience and empirical data we derive from it. The classification, interpretation and evaluation of this data is just a model. A myth. A metaphor. In a social context, it become a map to help our orientation at the existential-phenomenal territory. But map is not a territory, and no data is as itself and in itself a sign of “illness”. “Illness” is just a lingual-conceptual label we attach to some experienses which are perceived as distressful by us and/or undesirable by society – experiences we can eliminate by “treatment”.

    The problem is, the social authorities and dominant culture is the common source of “undesirability” labels, which gave them the power to devaluate and neutralize anything deviant by labelling it “illness”. Such tactics is indefensible, since no one can know what is desirable or not, what need to be “treated” and what does not.

    It is the person who should decide whether the experience is desirable or not. And, if (s)he would want to remove it from his/her existence, it would be not a “treatment”, but just a change, a moidification – which is neither good nor bad, but just producing difference.

  14. While I find Dr Datta’s response interesting, well research and well written, I also find it very troubling indeed, as he seems to excuse psychiatry’s behaviour on the grounds that all of medicine is based on poor science, is corrupt and other arms of medicine also use coercion.

    Well….some of this might be true to some degree, but my life has been saved on more than a few occasions because of antibiotics, vaccines, surgery and other science-based medical interventions. In none of those cases was kidnapping, incarceration and forced drugging deemed necessary.

    My physician and I recently had a discussion on statins, and I was quite free to refuse…she didn’t lock me up and force them on me, neither did she when I refused HRT or any other medciations we have discussed over many years. My surgeries were done after fully informed consent. I hardly think a surgeon would consider it appropriate to open up a patient and remove “bits” purely becasue they offended him/her. And they wouldn’t get away with it on the grounds that the patient was a danger to self and/or others. Fingers can pull the trigger on a gun, but they don’t remove fingers of gun owners or even convicted murderers on the basis that they are dangerous. Penises can rape…teeth can bite….feet can kick, yet surgeons don’t remove or disable them.

    It is enough for a psychiatrist to claim “danger”, there need be no history, no proof, no action that even begins to look like violence for them to be able to detain and inflict irreversible brain damage.

    While I understand that sometimes forced drugging and restraint sometimes takes place, particularly in emergency situations where the patient has actually displayed violence, the patients are unlikely to be maintained long-term on those drugs, or to be forcibly detained for long periods without access to justice. Yes, it may happen, but not ROUTINELY and they are not subjected to the TORTURE that is psychoactive drugging known to cause brain damage and a whole range of pyhsiological disturbances.
    Much doctor-work does have a basis in biology/psysiology. This is clearly NOT the case with psychiatry.
    I sicerely hope one of the other wonderful MIA authors will fully address your post and show all of its weaknesses up for the obsfucations they are!

    • thank you for your response. I do not wish to absolve psychiatry of responsibility to get its own house in order, mainly to contexualize the problems within medicine as a whole as I believe these issues cannot be resolved unless we look at the whole system, rather than a narrow part of it.

      One problem is people seem to have a pretty skewed view of psychiatry. while the use of coercion is one of the most troubling aspects of the field and should not be minimized, the fact remains once they leave training the vast majority of psychiatrists are not involved in civil commitment or forcibly drugging their patients, and the overwhelming majority of mental health encounters do not involve involuntary detention or “treatment”. Similarly, while you may have not experienced coercion in other aspects of medical care, surgeons routinely operate of people without informed consent, and though it is exceedingly rare for someone to be operated on against their will, this is mainly because you are not going to drag someone kicking and screaming to the OR – I routinely get calls for surgeons who want to operate on patients who are refusing surgery, and in medical wards confused agitated patients are routinely drugged with haldol and/or placed in restraints. to claim this is not the case is to miss the point.

      I also think it is to miss the point to think that “doctor-work” has a basis in biology (which I will address in my next blog) as most medical consultations are the result of social or behavioral factors, and there is of course a biological basis to everything. the question is not whether there is a basis in biology, but whether this is the appropriate level to conceptualize and tackle the problem. And some psychiatrists, such as myself deal with problems that inarguably have a basis in “biology” such as neuropsychiatric complications of HIV/AIDS, delirium, dementia, traumatic brain syndrome, autoimmune disease and so on. This is a small part of of the field, but it a part of psychiatry nonetheless.


      • Thanks for your reply, Vivek..

        As far as addressing the whole of medicine is concerned, I suspect that is a little disingenuous – nothing would happen for a very long time as it in general, does a lot of good and addresses a lot of physical distress and illness. Trying to tackly psychiatry via more general medicine would result in almost certain defeat because of this, no matter what the approach. There are certainly aspects of medicine that require reform, but the whole lot does not need abolishing.

        While you mention a few genuine medical conditions with which psychiatry deals, you do not address the hundreds of made up non-medical (ie voted into existence) illnesses in the DSM and ICD (?) that form by far the greatest percentage of the work psychiatrists undertake and that psychiatric drugs are claimed to treat. Your own piece on homosexuality looked at one, and, by inference, at others.
        That surgeons wanting to operate against a patient’s will have sought your help to allow them to operate, they still had to come to you, a psychiatrist, to seek your power to overturn their patient’s human rights – they were not able, no matter how much they wanted to, to operate without using psychiatric force. That is precisely my point….psychiatry is the only specialty with that degree of power.
        As far as forced drugging goes….I don’t dispute that it happens, bit when it does, unless the doc is a psychiatrist, then they risk some pretty severe sanctions in my part of the world (Australia) if they can’t show good reason.
        Much psychiatry may occur outside the boundds of coercion….indeed, I have worked for a number of years with a psychiatrist to try and recover from the trauma of being detained and drugged and in that time have come off those bloody awful drugs and worked out some of the content of my (forced and medication-induced) psychosis. However, there are things I simply cannot/will not work on with him solely because I know that he has the power to lock me up. The mere existence of that power is an impediment to our work and as a psychiatrist there is no option for him to relinquish it, even should he want to. Perhaps psychiatrists should be allowed to “opt out” of that power. THAT would give patients a solid indication of the approach and, if you like, “character” of the person with whom a patient was placing his/her innermost being.
        The power imbalance inherent in the patient/psychiatrist relationshp necessarily precludes the meeting of equals that would help facilitate a meaningful and healing relationship. It precludes trust. It precludes mutual respect.
        Given no biological or genetic causes have yet been found for the very large majority of the DSM diagnoses, I believe it is spurious to argue for continued power abuse and drugging, and also for the continuation of the power currently vested in psychiatry. And lets face it, would this power, psychiatry would quite probably die a natural and very timely death.

        • you make some interesting assumptions which is not really correct. I actually do not have any power to detain anyone involuntarily (nor do any psychiatrists where I am) and I have no more power than any other physician to compel drugs involuntarily. Psychiatry still continues to exist in those US states where this is the case. It is also not correct that psychiatric power would allow surgeons to operate on people involuntarily, in the cases where psychiatry is involved it is to clarify that no such powers exist and that whether the law allows it (which varies), it never allows it under any mental health law.

          I would also add that most of those hundreds of diagnoses in the DSM are not used by most psychiatrists. They simply don’t see or diagnose patients with most of the diagnoses in the DSM. I myself, do not use the DSM unless there is some specific reason (and I can’t even think of a reason to do so).


  15. What a great article!

    It is good to contextualise the problems of psychiatry within broader problems of medicine.

    Although enshrined in law in Australia,informed consent is sorely lacking throughout medicine. It is simply the case that the end result in psychiatry is probably worse due to the length of treatment of patients and the severity of side effects. What is unique to psychiatry, however, is enforced treatment and a systematic lack of respect for the patient.

    Sadly, pseudo-science is also a pervasive feature of medicine. You simply have to look to the fact that ‘evidence based medicine’ is a very recent invention and is, moreover, one that is not universally accepted.

    Far and away the worst thing about psychiatry is that, in far too many cases, it fails to lead to the betterment of the lives of its patients. Putting aside highly questionable science, ethics and all the rest … it is simply bad medicine. It fails on its own terms: it causes more harm than good.

    • There is no right to informed consent in Australia.

      If you disagree with a doctor they simply invoke the “emergency” clause of the Mental Health Act and do whatever they wish, by force if necessary.

      I have had this done when I refused to take a fist full of pills I knew would do me harm. A “code black” was declared, and I was surrounded by a dozen security and nurses and told if I didn’t swallow the pills I would be injected forcefully. And this is perfectly lawful. As Dr Steingard pointed out to me I had just learned how subjective the term “emergency” is.

      Patients rights in Australia are an option, not a right.

      Of course if you have a few hundred thousand dollars you might be able to purchase your rights in court, otherwise lay back and enjoy the rape.

      These people are not worthy of the trust placed in them by the community.

      • “a person has a mental illness if the person suffers from a disturbance of thought, mood, volition, perception, orientation or memory that impairs judgment or behaviour to a significant extent. ”

        That is the definition of a mental illness in our mental Health Act. I could burn a person with a cigarette and they have a mental illness. The whole coutry is mentally ill by this definition, and therefore can quite easily be subjected to any ‘treatment’ a doctor wishes.

        You might like to argue that it is unreasonable to force someone to swallow battery acid and have belts of electricity to their brain, and if so, see you in court……in 6 years and when you have sold your home to enforce these no existent rights. Of course a good lawyer would know you would most likely lose because of the flawed Act. Save your money.

        • It makes me howl laughing to think that we are paying a large sum of money to a Chief Psychiatrist to protect the rights of consumers, carers and the public, when they don’t even have any. The Chief Psychiatrist is guarding an empty hen house. The foxes are laughing with me.