Shrinks: A Self-Portrait of a Profession

Robert Whitaker
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After finishing Jeffrey Lieberman’s new book, Shrinks: The Untold Story of PsychiatryI was tempted to put it aside and not write anything, even though I had purchased the book with the intention of doing so. The reason was that I found it impossible to take the book seriously, and actually, I don’t think it is meant to be a serious book. Lieberman, who is a past president of the American Psychiatric Association, doesn’t present any scientific data to support his narrative, nor does it seem that he has relied on primary sources to document it. Much of what is told appears to be taken from secondary sources, and what is left is a kind of pop tale of psychiatry’s rise to glory. Even the publisher’s promotional copy basically acknowledges this, proclaiming it a “tale” that is populated by “true heroes . . . who dared to challenge the status quo.” That sounds like a blurb for an adventure story.

As for Lieberman having unearthed an untold tale, Shrinks relates a story that the American Psychiatric Association has been telling the American public ever since it published DSM III in 1980. The disorders in the DSM are real diseases of the brain; the drugs prescribed for them are quite safe and highly effective; and psychiatric researchers are making great advances in discovering the biology of mental disorders. Therapeutic and research progress are to be found at every turn.

But as I mulled over the book, it was the “heroes” reference, in both the publisher’s blurb and the text of Shrinks, that finally caught my interest. As part of my research for a new book I have coming out in April, Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform, which I co-wrote with Lisa Cosgrove, I reviewed all of the speeches given by presidents of the American Psychiatric Association at the organization’s annual meetings since 1980, and I was struck by how regularly they sounded this theme: Psychiatrists are true heroes. Which may or may not be true, but it is a bit unusual for a professional medical association to regularly remind its members of their own heroic specialness. And so it dawned on me: The revelatory aspect of Shrinks is that it serves as an institutional self-portrait. What you hear in this book is the story that the APA and its leaders have been telling to themselves for some time.

The cover of the book features a Freudian couch, inviting readers to sit back and listen. We can even play psychiatrist to Lieberman in his role as APA everyman, and ask this fanciful question: Is there reason, at book’s end, to make a DSM diagnosis?

The Doctor in the White Coat

Before reading Shrinks, it is useful to quickly view a video of Lieberman on YouTube in which he discusses his book. The words don’t really matter; what does is Lieberman’s presentation of himself. He is wearing a doctor’s white coat, complete with pen in the pocket. This is how he dressed for the camera. And with that visual in mind, we can turn to the introduction in Shrinks, where Lieberman recounts a story of a patient he calls Elena Conway.

Elena, 22 years old, had dropped out of Yale University a couple of years earlier when her grades mysteriously dropped. Thinking that their daughter suffered from “low self-confidence,” her parents, who were distrustful of psychiatry, hired “ life coaches and tutors,” and when that didn’t work, they turned to naturopaths, acupuncture and hypnosis, which also failed to help. Finally, Elena’s exasperated family doctor had this advice for her parents: “For Christ’s sake, take her to a real doctor!”

And so, Lieberman writes, they “came to me.”

What follows is an anecdote about a skilled doctor at work. Lieberman finds that Elena has grandiose ideas about saving the world, a symptom of schizophrenia. He orders Elena into the hospital, worried that she has gone untreated for so long, because untreated schizophrenia “gradually induces irreversible brain damage, like the engine of a car driven without an oil change.” Lieberman orders a battery of physical tests —blood tests, an EEG, MRI, and other neuropsychological exams—to rule out other possible causes of her grandiose thoughts and behavior, and then, with his diagnosis confirmed, he prescribes risperidone, “a very effective antipsychotic medication with only a modest potential for side effects.”

The reader knows what this anecdote of “real medicine” will bring: within weeks, Elena is much better. She is now “cheerful and intelligent, with a playful sense of humor,” and eager to return to Yale. Her parents, Lieberman reports, were “delighted to get their daughter back. “

At this point, the science-minded reader might recall how an anecdote is an “N of 1,” and thus can’t be taken as evidence of a therapy’s efficacy. What alert readers of Shrinks will also note, if they read the small print in the front of the book, is that this likely isn’t even a real anecdote. “In many cases I have created composites of multiple patients,” Lieberman writes. And so what we have in this introduction, along with the video of Lieberman, is a presentation of the psychiatrist as a skillful “doctor” in a white coat.

At the conclusion of his introduction, Lieberman writes that this is indeed the governing theme of Shrinks: “Over the course of this book, you’ll learn about a handful of renegades and visionaries who bravely challenged the prevailing convictions of their time in order to elevate their embattled profession. These heroes declared that psychiatrists were not doomed to be shrinks but destined to be a unique class of physicians . . . The world needs a compassionate and scientific psychiatry and I’m here to tell you, with little public fanfare, that such a psychiatry has arrived at last.”

 The Narrative

In medicine, artful diagnosis is the foundation for effective treatment, and Lieberman structures his book to reflect that relationship: first the story of diagnosis, then treatment. Both narratives tell of a past when psychiatry wandered in the desert, and then found the Promised Land.

Diagnosis

As a medical specialty, psychiatry got its start in the asylums that were built in the first half of the 19th century, and in those days, it had no diagnostic manual. Psychiatrists were caretakers of the “insane.” Then, in the late 1800s, psychiatry got its first glimpse of the guiding light of science in the work of German psychiatrist Emil Kraepelin. He separated psychotic patients into different diagnostic groups based on presenting symptoms and different clinical courses. But, Lieberman writes, the field soon lost its way, buffeted by the nonsensical ideas of various charlatans and, more ominously, the arrival of Freudians after World War II.

Psychoanalysis, Lieberman writes, became “a plague upon American medicine, infecting every institution of psychiatry with its dogmatic and unscientific mind-set.” Freudians came to dominate psychiatric departments at medical schools, and with their disdain of diagnosis and fanciful ideas about the unconscious, they opened the door to withering criticisms by antipsychiatry activists like Erving Goffman, R.D. Laing and Thomas Szasz, who mocked psychiatry as a pseudoscience. Psychiatry, it seemed, was headed to “extinction,” and it was then, at psychiatry’s darkest hour, that a small band of psychiatrists at Washington University in St. Louis, Eli Robins, Samuel Guze, and George Winokur, recalled the work of Emil Kraepelin and planted the intellectual seed that—as Lieberman writes—would “save psychiatry.”

As the Washington University group plotted their revolution, one person who took notice “was Robert Spitzer. Another,” Lieberman confesses, “was me.” The fight for “psychiatry’s soul” was on, with this small group of heroes taking on the powerful Freudians, and in Lieberman’s telling, it was this titanic struggle that gave rise to a new psychiatry. With Spitzer at the helm, the APA created a new edition of its Diagnostic and Statistical Manual, jettisoning old Freudian ideas and adopting a diagnostic approach modeled on Kraepelin’s work. This, Lieberman writes, “was the book that changed everything.”

In his YouTube video, Lieberman boasts that his book is the first ever to tell the “complete and unvarnished truth” of psychiatry’s history (a rather extravagant claim, one might think.) The problem with this history of the rise of scientific diagnosis is that the DSM III task force, as it created its diagnostic model, rejected the scientific framework that the St. Louis group had adopted for making diagnoses.

Robins, Guze, and Winokur, along with a psychiatric resident at Washington University, John Feighner, argued that in order for psychiatry to research mental disorders, it needed to identify individual illnesses based upon studies of presenting symptoms, the short and long-term course of the disorder, and genetic associations. After they reviewed the literature, they concluded that there was evidence of this sort for only 16 diagnoses, and even then, they considered these groupings of homogenous patients “tentative.” Guze wanted to apply this standard to DSM III, arguing that every diagnosis in the manual should be supported by this type of scientific information, but he was rebuffed.

“I couldn’t get that group to vote in favor of my suggestions,” Guze recalled. “The response that I was given was that they said we have enough trouble getting the legitimacy of psychiatric problems accepted by our colleagues, insurance companies, and other agencies. If we do what you are proposing, which makes sense to us scientifically, we think that not only will we weaken what we are trying to do but we will have given the insurance companies an excuse not to pay us.”

Having rejected the Guze model, the DSM III task force set about creating a manual that could provide a diagnosis—and thus insurance coverage—for everyone who came to psychiatrists seeking help. Psychiatry’s new “Bible” listed 265 disorders, with boundary lines for most drawn in an arbitrary fashion. Psychiatry told itself that it had followed Kraepelin, simply because it would make diagnoses based on “symptoms,” neatly forgetting the scientific details of his work.

In his book, Lieberman does not discuss whether DSM III and subsequent DSM iterations provide the reliability and validity that make a diagnostic manual useful in medicine. However, he does make this claim, which appears to be telling readers of its validity: “The Manual’s greatest impact is on the lives of tens of millions of men and women who long for relief from the anguish of mental disorder, since first and foremost the book precisely defines every known mental illness. It is these detailed definitions that empower the DSM’s unparalleled medical influence over society.”

Here is the scientific story of DSM III’s reliability. When it was published, Spitzer and the APA claimed that field trials had proven it to be vastly more reliable than DSM I and DSM II (meaning that two psychiatrists, when confronted with the same patient, would make the same diagnosis.) That is still an assertion made in conventional narratives of psychiatry. However, the reliability trials of DSM III that were conducted after its publication, including a large one funded by the NIMH, found that its reliability was in fact fair to poor, with NIMH investigators concluding that there was hardly any more agreement between psychiatrists “beyond what is expected by chance.” As for the field tests of DSM 5, the reliability scores were even worse.

As for the DSM’s validity, Spitzer and his co-authors acknowledged in their introduction to DSM III that the diagnoses should be considered “hypotheses,” and their thought was that future research would “validate” these constructs. But as any number of prominent psychiatrists have now publicly acknowledged, this has not turned out to be the case. Allen Frances, chair of the DSM IV task force, Tom Insel, director of the NIMH, and Nancy Andreasen, former editor-in-chief of the American Journal of Psychiatry, have all noted that the DSM diagnoses lack “validity.” Indeed, at a 2012 roundtable discussion of the DSM, which involved more than 20 experts in psychiatric diagnoses, the moderator, Yale Medical School psychiatrist James Phillips, concluded that “virtually all discussants” agreed that “most of the diagnoses fail the test of the original Robins and Guze . . . validators.”

Thus, we see the propagandistic aspect of part one of Lieberman’s book. He touts the creation of DSM III as a great leap forward for psychiatry, with the profession now having adopted a scientific mindset for diagnosing disorders, based on the work of Robins and Guze, and with that claim having been made, he subsequently relates, in every anecdote in the book, a tale of his making an artful diagnosis, which leads to the proper treatment for the disease. The anecdotes tell of a profession skilled in distinguishing between a myriad of disorders listed in the DSM, while a review of science, which is absent from his book, tells of a profession lost in a diagnostic wilderness, its “Bible” neither reliable nor valid.

Treatment

The narrative that Lieberman tells about “treatment” follows a trajectory similar to his narrative about diagnosis. First, he relates how psychiatry spent a long time wandering in a therapeutic desert. In the 1800s, Lieberman states, there were “no effective treatments for mental illnesses.” Then, in the first half of the 20th century, as asylums became ever more crowded with chronic patients, psychiatrists tried any number of desperate cures. Insulin coma therapy, metrazole convulsive therapy, and surgical lobotomy—all were popularized, but none stood the test of time. Serious mental illnesses—schizophrenia, manic depressive illness, and major depression—ran a chronic course, and there was little that asylum doctors could do to change that.

“Spontaneous remission—the only ray of hope for the mentally ill from the 1800s through the 1950s—was in most cases about as likely as stumbling upon a four-leaf clover in a snowstorm,” Lieberman writes.

But then comes the miracle of chlorpromazine. First developed for use as an anesthetic in surgery, chlorpromazine was introduced into asylum medicine after French surgeon Henri Laborit noticed that it induced a notable emotional lethargy in his patients. Chlorpromazine took European psychiatry by storm, but according to Lieberman, the American Freudians, with their psychoanalytic nonsense, had no use for this drug, deriding it as psychiatric aspirin. Finally, Smith, Kline and French bypassed the psychoanalysts and got the state officials that administered mental hospitals to try the new drug, which was marketed as Thorazine in the U.S.

“The results were breathtaking,” Lieberman writes. “All but the most hopeless cases improved, and many long-institutionalized patients were sent home . . . Like a bolt from the blue, here was a medication that could relieve the madness that disabled tens of millions of men and women—souls who had so very often been relegated to permanent institutionalization. Now they could return home and, incredibly, begin to live stable and even purposeful lives. They had a chance to work, to love, and – possibly—to have a family.”

The psychopharmacological revolution was underway. Next, the Swiss pharmaceutical company Geigy developed a derivative of chlorpromazine, imipramine, that proved—in Lieberman’s telling—as curative for depression as chlorpromazine was for the mad. “The entire profession was utterly transmogrified,” Lieberman writes. “Two of the three flagship illnesses, schizophrenia and depression, were reclassified from ‘wholly untreatable’ to ‘largely manageable.’” These were “miracle medications,” Lieberman writes, and then lithium arrived, and in the space of less than 15 years, all thee of the major serious illnesses in psychiatry had been tamed.

These drugs, Lieberman tells readers, were specific antidotes to these disorders. “What made chlorpromazine, imipramine, and lithium so different from the sedatives and tranquilizers before was they directly targeted psychiatric symptoms in a kind of lock-and-key relationship,” Lieberman writes. “Sedatives and tranquilizers produced the same broad mental changes in everyone, whether or not a person was suffering from a mental disorder, whereas antipsychotics, antidepressants and mood stabilizers reduced the symptoms of illness without producing much of an effect on healthy people.”

With these new miracle drugs in their toolbox, the stature of the psychiatrist changed. Lieberman and his colleagues “became receptive to the unexpected new role of psychiatrists as psychopharmacologists, as empathic prescribers of medication.”

In so many ways, this is the core of the narrative that the American Psychiatric Association has told to the public for the past 50 years, which has been embraced in its broad outlines by the public. The arrival of Thorazine in asylum medicine kicked off a “psychopharmacological revolution,” and today the profession has an array of effective therapies for the brain diseases it treats.

Although it would take a book-length treatise to fully deconstruct that governing story of psychiatry, even a fairly quick review can reveal that it is quite unmoored from science and history. The story that Lieberman tells is built on three assertions: spontaneous remissions are rare; the arrival of Thorazine and other antipsychotics made deinstitutionalization possible; and psychiatric drugs have dramatically improved long-term outcomes for schizophrenia, depression, and bipolar illness.

The natural course of major mental disorders can be difficult to assess precisely because societal treatment of the mentally ill has often been so abysmal, and thus treatment hindered the likelihood of “spontaneous remission.” But if we go back in history to the first half of the 19th century, we find that asylums practiced a form of care known as moral therapy, and historians who have studied the patient records of those early asylums have determined that “spontaneous remission” occurred rather frequently.

Moral therapy was introduced into the United States by Quakers, and their belief was that while they didn’t know what caused madness, they could treat their mad “brethren” with kindness and provide them with shelter, good food and daily walks in the countryside, and in this way “assist nature” in helping them to get well. Historians have determined that 35 to 80 percent of all first-episode patients in those early asylums were discharged within a year, and the majority were discharged as having been cured (which meant that their disturbing behavior and psychotic thoughts had largely disappeared.) In addition, a long-term follow-up study of 984 patients discharged from Worcester asylum in Massachusetts from 1833 to 1846, which was conducted in the 1880s, found that 58 percent had remained well throughout their lives. Another seven percent had relapsed but had subsequently recovered and returned to the community. Only 35 percent had become chronically ill or had died while still mentally ill.

This history of therapeutic success, and of the possibility of spontaneous remission, was forgotten in the second half of the 19th century, as communities began dumping all sorts of people—those struck by neurological disorders, end-stage dementia from syphilis, and senility in the elderly—into the asylums. Discharge rates plummeted, and moral therapy came to be seen as a failed therapy. Then, in the first decades of the 20th century, the United States fell under the sway of eugenic ideas about the “mentally ill,” which called for people so diagnosed to be segregated in asylums and kept there through their breeding years, lest they spread their bad genes. This social policy led to a buildup of the asylum population during the first 50 years of the 20th century, and the belief that these patients, since they were now spending decades in the hospital, were chronically ill.

Even so, studies by Kraepelin and others during this period of first-episode patients found that spontaneous remission was fairly common, at least for those ill with mania or depression. In fact, Kraepelin separated his psychotic patients into two types. Those psychotic patients who presented with a lack of affect (and difficulty in making willed movements), tended to deteriorate into early dementia, and thus were his dementia praecox group. Those who presented with affect, either mania or depression, could be expected to recover, with their illness running an “episodic course” over the long-term. This was Kraepelin’s manic-depressive group. “Usually all morbid manifestations completely disappear,” he wrote in 1921, “but where that is exceptionally not the case, only a rather slight, peculiar psychic weaknesses develops.”

Various long-term studies of patients hospitalized for a first episode of mania or depression prior to 1950 found that perhaps 50% would be discharged and never again be hospitalized, another 30 percent would suffer periodic episodes, but would recover to euthymia (e.g. an absence of symptoms) in between those episodes, and only 20 percent or so would become chronically ill. This understanding of the course of affective disorders—and thus the possibility of spontaneous remission—was oft repeated by leaders in the field during the 1950s and 1960s. For instance:

  • In 1964, Jonathan Cole, head of the NIMH’s Psychopharmacology Service Center, wrote that “depression is, on the whole, one of the psychiatric conditions with the best prognosis for eventual recovery with or without treatment. Most depressions are self-limited.”
  • That same year, Nathan Kline wrote that “one always has as an ally the fact that most depressions terminate in spontaneous remissions. That means that in many cases regardless of what one does the patient will begin to get better.”
  • In a 1969 textbook on manic-depressive illness, George Winokur wrote that “assurance can be given to a patient and to his family that subsequent episodes of illness after a first mania or even a first depression will not tend toward a more chronic course.

Although schizophrenia is typically seen as running a chronic course, studies of first-episode patients from 1945 to 1955 found that at least 60 percent of the patients were discharged within one year, and at longer-term follow-ups, 65% or more of the initial cohorts were living in the community. The diagnosis of schizophrenia was being applied to a diverse group of psychotic patients during that period, but, at the very least, this data shows that “spontaneous remission” was fairly common for this larger pool of psychotic patients.

As for the assertion that antipsychotics made it possible to discharge chronic patients from mental hospitals and thus enabled deinstitutionalization, this too is belied by the facts. In 1955, there were 267,000 schizophrenia patients in state and county mental hospitals, and eight years later, during which time Thorazine was regularly prescribed, there were still 253,000 patients with this diagnosis in the hospitals. Deinstitutionalization was made possible by the enactment of Medicare and Medicaid legislation in 1965. It provided federal subsidies for nursing home care but no such subsidy for care in state mental hospitals, and so the states, seeking to save money, began shipping their chronic patients to nursing homes and other residential homes. Social policy, rather than a miracle new drug, prompted the discharge of chronic patients from state hospitals.

Lieberman’s third assertion is that psychiatric drugs dramatically improved long-term outcomes for major mental disorders, This was the very question that I investigated in Anatomy of an Epidemic, and a thorough review of the scientific literature reveals that, if anything, drug treatment increases the likelihood that major mental disorders will run a chronic course. That history of long-term outcomes took a book to document, but in order to provide a check on Lieberman’s  claims, we need only cite a few quick facts.

In a 1994 study titled One Hundred Years of Schizophrenia, Ross Baldessarini and his colleagues at Harvard Medical School reported that 35% of schizophrenia patients had favorable outcomes during the first third of the 20th century. They determined that a similar percentage had favorable outcomes in the post DSM-III era; outcomes today were no better than they had been a century earlier. Meanwhile, in the best long-term study of schizophrenia patients in the modern era, Martin Harrow and Thomas Jobe found that those off antipsychotics were eight times more likely to be in recovery at the end of fifteen years.

Depression is now understood to run a chronic course (as opposed to an episodic course,) and there are a small number of researchers writing about whether antidepressants have a depressogenic effect of the long-term. One who has done so is Rif El-Mallakh, an expert in mood disorders at the University of Illinois. He writes: “A chronic and treatment-resistant depressive state is proposed to occur in individuals who are exposed to potent antagonists of serotonin reuptake pumps (i.e. SSRIs) for prolonged time periods. Due to the delay in the onset of this chronic depressive state, it is labeled tardive dysphoria. Tardive dysphoria manifests as a chronic dysphoric state that is initially transiently relieved by — but ultimately becomes unresponsive to — antidepressant medication. Serotonergic antidepressants may be of particular importance in the development of tardive dysphoria.”

The same is true with bipolar disorder. This disorder now runs a much more chronic course that it did in the pre-lithium era, with patients so diagnosed showing much greater functional impairment. In a 2000 paper, Carlos Zarate and Mauricio Tohen wrote about this surprising downturn in outcomes: “In the era prior to pharmacotherapy, poor outcome in mania was considered a relatively rare occurrence. However modern outcome studies have found that a majority of bipolar patients evidence high rates of functional impairment.”

In sum, Lieberman recounts a story of miracle drugs arriving in psychiatry in the 1950s and 1960s, which brought hope to the hopeless and enabled people struck by serious mental illnesses to live fairly normal lives. That is a story that of course provides great comfort to the psychiatric profession. But, alas, it is belied by the science that can be dug out from psychiatry’s own journals.

In his book, Lieberman tells of other types of therapies in psychiatry, such as ECT and cognitive behavioral therapy, and of how the field is now embracing a more “pluralistic” approach to treating various disorders. All of these therapies are said to work well, with Lieberman waxing particularly enthusiastic about electroshock therapy. “I’ve seen patients nearly comatose with depression joyfully bound off their cot within minutes of completing their ECT.”

I read that line and my mind couldn’t help itself: Here was a modern-day story of Jesus, curing the lame, who could now throw away their crutches and walk.

Psychiatry’s Glorious Present and Future

In the last third of his book, Lieberman writes of a “Psychiatry Reborn.” He tells of research into the biology of mental disorders, and how imaging studies are finding all sorts of abnormalities in the brains of the mentally ill, and of advances in understanding the genetics of mental illnesses. This is familiar stuff, and there is no point in putting it under review, although there was one paragraph in particular that stuck out for me. Thanks to brain imaging studies, Lieberman writes, “we’ve learned that schizophrenic brains exhibit a progressive decline in the amount of gray matter in their cerebral cortex over the course of the illness, reflecting a reduction in the number of neural synapses . . . In other words, if schizophrenics are not treated, their brains get smaller and smaller.”

The implication here is that antipsychotics arrest this loss of grey matter, and thus preserve a more normal functioning. Lieberman, of course, knows this isn’t true. Although it may be that there is a decline in brain volumes of people diagnosed with schizophrenia that occurs independently of these drugs, there is abundant evidence, starting with Nancy Andreasen’s large study of this question, that antipsychotics induce a decrease in brain volumes. Lieberman even did a study of this type, finding a decline in volumes in patients treated with either haloperidol or olanzapine. More recently, German investigators, conducting a thorough review of this literature, concluded that it called for rethinking the use of antipsychotics, because the brain shrinkage appears to be associated with functional declines. But in Lieberman’s narrative, the image of the drugs as miracle agents must be preserved, and so he tells a story about how they arrest this pathological process.

And I have to confess, I found that sad.

Wearing the Black Hat

I should note that I make a one-sentence appearance in Lieberman’s book, as one of a modern group of antipsychiatry activists, and of course Lieberman lumps me together with the Scientologists, which has been psychiatry’s response to critiques of its narrative for some time now. The critics are anti-science cultish fanatics! I have to say though that even here Lieberman’s scholarship is rather poor, for he misspells my name and accuses me of taking a swipe at the creation of DSM 5, which is something I did not personally write about. But such mistakes are of no account; truth is, I was rather flattered to be wearing a black hat in this particular “untold story of the history of psychiatry.”

Through the Lens of the DSM

As I wrote in the beginning of this post, I think Shrinks ultimately provides a revealing self-portrait of psychiatry as an institution. Lieberman is a past president of the APA and he has reiterated the story that the APA has been telling to the public ever since DSM-III was published. And it is this narrative, quite unmoored from science and history, that drives our societal understanding of mental disorders and how best to treat them.

In Shrinks, Lieberman at one point diagnoses the Freudians, writing that if the psychoanalytic movement “had been able to lie upon its own therapeutic couch, [it] would have been diagnosed with all the classic symptoms of mania: extravagant behaviors, grandiose beliefs, and irrational faith in its world-changing powers.” Now we have in this book a story told by the biological successors to the Freudians, and it seems to me that turnabout is fair play. So what diagnosis can be made?

The symptoms that Lieberman saw in the Freudians—extravagant behaviors, grandiose beliefs, and irrational faith in its world-changing powers—seem present in this narrative, and I would think we might add that there is evidence of an institutional “delusion” too, the profession unaware of it own science. Psychiatry has a word for this lack of insight into one’s illness, but rather than spell it out here, I will simply note that anyone who has ever objected to taking antipsychotic medications will know it quite well, with psychiatry explaining this is why patients don’t like their drugs.

 

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112 COMMENTS

  1. Yes, I’m certain I don’t need to read that book either, but thank you for the critique of it, Robert.

    And I’d just like to point out the fact that the antipsychotics can, in fact, cause the schizophrenia symptoms in a previously healthy person. Proof that this is true from drugs.com:

    “neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

  2. Why do so many psychiatrists continue to embrace, support, and disseminate information that is absolutely provable as totally false? I wonder who the truly “delusional” people really are in al of this. Do you think that they actually believe what they’re saying or are they doing this with the thought that the American people are stupid enough not to catch on? What happens when they have to formally debate with people who know the real, scientific facts; how do they go about supporting their falsehoods?

    Am looking forward to reading your new book. I always appreciate when you write here on MIA because your writing is clear and concise and readily understandable.

  3. Thanks for the summary of Lieberman’s arguments (or lack thereof). I’m amazed that he has the temerity to call the book “Shrinks” in light of what his medications are doing to the brains of others. If heroes champion their own causes, I guess he’s a hero. But, in his claim to be a doctor, he is delusional. I’m sad too.

  4. For Lieberman, it is all about his quest for self-validation: he wants to feel like a “real doctor.” For those who abhor his message, the question is: how do we take him on and win? How do we change societal acceptance of the idea that psychiatric drugs are a safe and effective treatment? How does one teach the lesson of psych drugs to those who have not been burned by them? Is it even possible? The obstacles are daunting—Lieberman, Torrey, etc. get a platform in mainstream media; Bob Whitaker does not. But some obstacles are within our control. We should not fight their reductionist models with our own reductionist thinking. We should partner with psychiatrists who are open-minded, non-coercive, respectful and smart enough to ask questions. They are there; not nearly enough of them, but they exist. We need more success stories, more drug-free recoveries. It is not enough to curse darkness, we need to light candles. In the meantime, I can’t wait to read your new book.

    • “We need more success stories, more drug-free recoveries.”
      Do we? I mean this guy is producing miraculously recovered students at Yale on lobotomizers and “patients nearly comatose with depression joyfully bound off their cot within minutes of completing their ECT” and there will be people who buy it. The facts don’t matter when all you hear is propaganda :(. In fact MIA is one of a few beacons of hope.

      • B–

        do we need more success stories, more drug-free recoveries? Of course, we do. Otherwise, what is the point? Just to lament and let off steam? Thanks largely to Bob Whitaker, mainstream psychiatry has been put on the defensive; more people are ready to be persuaded that the current paradigm is ineffective and inhumane. The fact that more NAMI types flock to MIA to get information is a very good sign. But it’s not enough to say that the current treatments (shock therapy, drugs) are barbaric. We need a good answer to questions such as” “Well, drugs may be bad but it is the best that we have got.” We need to be able to point to effective treatment alternatives.

        • It’s not about how many “success stories” you have – it’s about the reach of your message. Guys like Lieberman can invent bs like the “schizophrenic Yale student who got better” (I’m not buying this story for a minute) and there will be people who believe them. It’s a propaganda war and it does not matter the truth is on your side if all the public can hear is someone else’s lies. We already have enough successes but so what?

          • B–
            I do not buy Lieberman’s contrived story about the schizophrenic Yale student either. But I disagree that the reach of our message can be separated from our ability to show that people can and do get well without drugs. I would love to see Big Pharma held accountable through a tobacco company-type settlement, but we are not anywhere near that point. To mount an effective human rights campaign, we need a critical mass of support from the society at large. We are very, very far away from that…we do not even have that type of support from the majority of those directly affected mental distress, such as the NAMI families. The fact that Lieberman wrote his opus shows that Bob Whitaker and the antipsychiatry movement really got to him. Good. But to win this this thing, we have to show alternatives that work. It cannot be just about cursing the darkness. We do need to light the candles and show the way.

  5. My computer keeps eating my comment, but I will try again.

    This is nothing new from Lieberman, and as Bob so well points out, both he and his profession of psychiatry are emperors without clothes. How do they get away with this? Because the mass media give virtually no exposure to psychiatry’s critics.

    One thing about our approach is that while it is extremely valuable and necessary for folks like Bob to expose how scientifically invalid the claims of psychiatry are, the average person on the street is not going to get excited about that, even if we were able to get these ideas more exposure.

    When we write about how much damage the practices of psychiatry causes, this is not an abstraction. These are severe human rights violations,and we should be saying so. Other movements for human rights, like the civil rights movement of the 1960’s, were able to get their message out, because they made themselves very visible.

    We can and should be doing that too. Elsewhere on MIA, I have written about the demonstrations against shock treatment in dozens of cities which will happen on May 16. This is the kind of action human rights movements do. I have already been contacted by a journalist connected with the New York Times about this, because the media take this kind of action seriously.

    Of course, shock treatment is only one of many abuses. But it is an abuse that the average person on the street knows in their hearts is wrong, and a first step in breaking the myth that psychiatry is a benevolent institution. I urge everyone reading this to participate in, or organize, a May 16 demo in your area. If we want our rights respected, we have to fight for them!

  6. Lieberman’s recent defensive reaction to the recent New York Times article was in stark contrast to reality. He does beg a diagnosis, but since Im boycotting DSM 5, Ill refrain. Clearly anosognosia is part of the problem.
    On the other hand “narratives” can be easily examined. Lieberman is seizing a position I call “two kinds of special” . He declares himself a “hero” but embraces the posture of “victim”. Its a neat trick because in either case (hero or victim) he is entitled to exceptions from normal social expectations. (By repeating words like “stigma” he can justify misrepresenting facts. It becomes ok to mislead people or even lie because his cause is noble and his intentions above reproach.)
    If he was my client Id help him understand that the only real difference between a hero and a victim is that the victim defines himself by whatever happened, while a hero defines himself by how he responds to whatever happened.

    • I love this comment, I think it’s pivotal in this debate.

      This is how I frame it: a “victim” sits in and operates from resentment, never owning their role in their development, by allowing the reactions and responses to trauma to shift, soften, and enlighten over time. Therefore, every challenge becomes traumatic, keeping one stuck in victim/blame mode.

      Whereas a “hero” would see the value in their experience, regardless of anything, process it and move on, resolving inner conflicts, growing, and creating fulfilling things from it. That’s empowerment over victimization, and tends to lead to better experiences in life, rather than repeating the same trauma over and over. I think it’s a good example of how our perception of ourselves really dictates the foundation of our respective realities. The reality of a ‘victim’ would be quite different than the reality of a ‘hero.’ That’s subjective reality.

      Thanks for this comment, I think it’s a really vital discernment as we continue to argue about who is ‘right’ and who is ‘wrong’ in this debate about the perception of mental health care, practices, and issues in the world, and to me, in the USA, which is the only system with which I’m familiar, and which I know is in deep trouble, and for good reason.

      • To put it in psychological terms, I’d say the victim has an external locus of control–that is, “something on the outside must change for me to feel better”–whereas a ‘hero’ has an internal locus of control–“my reaction to this guides me and my response is what shapes my reality and life experience.”

        That is why I feel this particular aspect of this topic is critical in this debate. What is it we’re looking to change, the outside or ourselves? Are we ‘victims’ or ‘heroes?’

        Again, just my perspective, but to me it rings totally true, and perhaps where a good and positive shift in perspective might be warranted, from a space of ownership and self-responsibility. Personally, I think it’s the best path to resolving any conflict and shedding light on truth for the purpose of resolving complex and highly controversial issues such as these, as it first ends our own internal suffering to make this shift, so in turn, we can better influence this end of suffering in the world, as we have seen past outs at this stage, by shifting our self-identity, and ACTING on it, be refining our responses to life’s challenges, into something more purposeful and useful.

        My 2 cents about this, anyway.

        • I had more to say once, but I keep getting busted by the language cops. I guess that’s why I’m not an MIA blogger (sob, sob). Just can’t seem to keep those mental patient gloves on.

          I’m with about anti-psychiatry, Fred. Repeal that loophole in the law called mental health law, and we’d have our rights back, our citizenship rights. The presumption of “sickness” would not hold. Nurse Ratchet and Dr. Josef Mengele could go take a hike, or worse, be prosecuted.

          • Take…well I lose count.

            I’m with you about anti-psychiatry, Fred. Repeal that loophole in the law called mental health law, and we’d have our rights back, our citizenship rights. The presumption of “sickness” would not hold. Nurse Ratchet and Dr. Josef Mengele could go take a hike, or BETTER, be prosecuted.

          • Good point and note (I just read in article via FB, can’t find right now) that there ARE psychiatrists being held accountable, sued for medical malpractice such as some cases involving prescribing psychotropic meds to children who were then harmed. Of course unnecessarily harmed.

            So take heart, some of the fighting and hard work of all the conscious objectors here (folks from what I understand have been fighting this fight for decades) has not gone without victories.

            Let’s work towards more victories as we work for massive systemic change.

  7. Regarding the “Hero” role . The last psychiatrist (Dr.Chris Ballas) likely also thinks himself a Hero.

    “Was Charlie really going to die in the water? Was he really going to get hit by lightning? Is Desmond actually saving him, or is it all– wishful thinking?… The action wasn’t just heroic; it was heroic and defining.”

    http://thelastpsychiatrist.com/2007/02/lost_tv_series_desmonds_fear_a.html

    The psychiatrist predicts the (bad) future, where no one knows the future. The psychiatric drugs do affect the brain. The family of the patient does believe the man in the white coat , and will help the doctor any way they can to save their loved one. A psychiatric diagnosis and treatment is self fulfilling prophesy.

    Forced psychiatry is fraud.

    Looking forwards to the new book

  8. After reading parts of the delusional rambling of Mr Lieberman I’m starting to believe that there’s some validity in the concept of mental illness…

    But seriously – how ignorant and full of oneself can one be?

    “Psychiatry has a word for this lack of insight into one’s illness, but rather than spell it out here, I will simply note that anyone who has ever objected to taking antipsychotic medications will know it quite well, with psychiatry explaining this is why patients don’t like their drugs.”

    I have nothing to add.

  9. Recovery?? I miraculously became “well” when I tapered off the psychiatric poly drugging. My story might be twisted as a recovery but it wasn’t. I was drugged into oblivion by a psychiatrist who had ceased to see me as a person. To him I was a mental patient.

    Thank you for your article. I hope one day to post my psych journey on MIA. I’m always amazed that off the drugs I was told I was not mentally ill.

    • Yes, that’s my experience as well. Not only was it reflected back to me (outside of the mental health world) that I was perfectly healthy, clear, and sane and reasonable in my perspective, but that is also how I felt, once I recovered from drugs toxicity and walked away from ‘mental health care’. It’s night and day, two different realities. Although within the walls of the mental health world perception, I always feel a bit off, at least this is how I am mirrored back, which I really don’t accept, but I do witness this. I guess it’s them, not me, which is a much better feeling and self-affirming truth to me than theirs. That speaks volumes.

  10. Once again, mega-Kudos, Robert! Thanks so much for your persistent calling out of the repeated false story-telling of mainstream psychiatry. Their fabrications would be laughable if it weren’t for the virtually unchecked power these folks have over the unfortunate souls who fall under their “care”. Of course, they will always parade before the public those for whom their drugs and electric shocks have had a positive effect (although sometimes even this is rather misleading, since the benefits may be only for a relatively brief time). Sadly, it appears that even some of the brightest, most talented and perhaps initially well-meaning psychiatrists have become shills for Big Pharma, whose profits make the income of the illegal drug cartels look like “chump change”!

    Lieberman’s book and your review touch again on what I have come to believe is the most pernicious of the falsehoods that have been successfully promoted by psychiatry and the pharmaceutical companies: that mental illness (or at least schizophrenia in particular) is a progressive brain disease that if left “untreated” (i.e., undrugged) will result in continuous brain deterioration. This drives both the practice of heavily drugging the brains of individuals experiencing first-episode psychosis, and then failing to consider discontinuation of those same drugs once the person is “stable” (it appears that “stability” trumps recovery almost every time). While making these unsubstantiated claims about progressive brain disease underlying psychiatric symptoms, they ignore or deny that which has actually been proven: that brains exposed to the drugs they prescribe (particularly neuroleptics) decline in size in proportion to the dosage and duration of the drug.

    Thanks again, Robert, for this sorely needed antidote to the delusions of conventional psychiatry. To borrow on the phrasing of Lieberman himself in one of the quotes you include in your article above, “if shrinks are not treated with such truth injections, their brains get smaller and smaller.”

    • What strikes me about his tale of the Yale student is that most patients aren’t dropping out of Yale and the psychiatrist they see does NOT order “a battery of physical tests —blood tests, an EEG, MRI, and other neuropsychological exams—to rule out other possible causes”. They don’t test for so much as an iron or B deficiency or thyroid problems, and most of them don’t converse with the patient.

      It’s a very privileged tale.

  11. It is interesting, hey we can call it delusion right, but you can’t argue that it isn’t lucrative delusion. The way western society works, hell the way psychology even works is that if it gets you money, “success” then it it’s a belief worth having right ? Throw out all those pesky “unhelpful” beliefs and ethics that don’t get you the bucks.

    I like the hierarchy of svengali too, so you have your local svengali who thinks the nation svengali is a hero. Putting out these little pamphlets full of complete nonsense with pet arbitrary “diagnosis” and poisoning, oops I mean “treatment”.

  12. I’m a medical student exploring my interest in psychiatry ahead of the upcoming application cycle. I’m trying to better understand your position and some of the arguments in the anti-psychiatry movement. I certainly wouldn’t want to embark on a career where I may be doing harm or raising the anger of of people unknowingly where my only intention is to help those in our society who have become marginalized and have no advocate. I agree with some of the concerns raised in regards to the safety of psychiatric treatment, let us assume that they are correct, but what is your proposed alternative??

    If we did not have Risperidone on the market, we would have to increase the size of our prisons tenfold and lose many friends and family members to suicide and homicide. There is no better alternative at the present time, it’s not 100% safe and it has side-effects, but guess what? So do every other drug on the market that save millions of lives. Risperidone doesn’t work for everyone but when it does work, it’s miraculous and gives people their life back. With time, better medications and further advances in neurology and psychiatry WILL allow psychiatrists to better cater their treatments. 50 years ago, many of the current treatments for cancers, diabetes and heart disease may have been viewed as medieval and diabolical, yet today they are accepted as standards of care. I just don’t see the point in this method of criticism as it’s not constructive and no better alternative is being proposed. Join medicine and help progress of psychiatry because there are people who truly need help and modern medicine currently does not have a solution for them. Psychiatry is our only hope and needs a united front.

    • Your rationalization is a problem for me in two ways.

      Mentioning prisons implies that this isn’t really so much about doctoring but law enforcement. Social control etc.

      As far as i’m aware there is still no proof that psychiatric illnesses actually exist as discrete medical conditions. Therefore the treatments can not be justified.

      Psychiatrists swore an oath to do no harm, things like chemotherapy treat actual illness even though they cause damage in the process. With psychiatric treatment, there is only harm because it is not doctoring in the first place.

      As for the specific drug you mention, in my opinion it takes a particularly sick individual to prescribe and enforce compliance of that drug, particularly to males. If you want to talk about suicide that drug is a good way to induce it, man boobs, no orgasm, zombified, weight gain, looking forward to an emotionless existence with an early grave…….

    • Regarding: What is your proposed alternative?
      Start with the truth. There is no brain chemical imbalance. No prescribed chemical is fixing a brain chemical imbalance.
      No one should be put in prison BEFORE they commit a crime.
      No child should be drugged for behaving like a child.

      “I just don’t see the point in this method of criticism” you want to go back to judging witches on wither they float or not? http://en.wikipedia.org/wiki/Dunking

      Like the water test, modern psychiatry can only perceive success in its actions when it drugs someone.
      If psychiatry does NOT drug someone , and the person gets better, how is psychiatry to get the credit?

    • I disagree wholeheartedly, psychiatry is not our only hope.

      I’m an ex-patient/survivor who works in the very hospital I was held in and I can tell you that the psychiatrists are not the hope of the people who are held there against their will. I see people being drugged with multiple drugs in order to force them to behave and believe a certain way. Why is it that people are forced to give up their delusions, delusions which do not hurt them nor anyone else? Why is so much time spent in forcing people to believe the way that they psychiatrists want them to believe? Why not let people go on with their lives without forcibly treating them with drugs and holding them against their wills as long as their delusions are harmless. It’s all about controlling the way people believe and it’s simply wrong. No, psychiatrists are not the only hope.

    • Gavanshir,

      Though there are, for me, several points of concern in your post, I’ll limit myself to your last sentence: ‘Psychiatry is our only hope and needs a united front’.

      I know of nothing that is not informed (often for the betterment of it’s own agency or optimal potential) from external signification. No body of function, from the microscopic-or smaller!- to entire nations or people, politics, etc., throughout history, are exempt. I personally am troubled by the mere suggestion that a ‘united front’ is critical to the advancement of psychiatry. In fact, however flawed opposition may seem to be-and is likewise framed to be; it has historically proved to be the single most constructive, evolutionary human endeavor.

      I wish you best in your choice of careers.

  13. Thanks Robert W., for the required reading and the exegesis that spares us the firsthand frustration. I am not actually against psychiatry, although that might seem contradictory to my apparent negativity about how it usually turns out. What is unworkable about it at the theoretical level is just about the whole focus of academic critiques, and, of course, those typically find ways to help the profession adjust at that level the ideal of psychiatry as medicine. But what I know about going wrong happens in hosptials where drudgery and the sharp division of the subjects and the over-seers cancels all the therapeutic pie in the sky intended by “correct diagnosis”, with compliance and lifelong drug maintenance getting seen as the whole and only significant need, and where submissiveness and confessions of ineptitude whenever not acting the part of the good mental patient are the most approved of behaviors, by far. So, whatever happens to the data on these many, many cases of psychosocially caused nervous dysfunctions produces a very contorted version of scientific explanation of “outcomes”, indeed. Thanks for your work and leadership.

    • My experience with involuntary commitment in a private hospital was that the idea that I knew myself and experience better than anyone on that ward (or at all) was evidence that I was a problem child. Ignoring their prescriptions and diagnosis was one of the best things I’ve ever done for myself.

      I’m fine, thank you.

      But, the massive campaigning for bio-bio-bio psychiatry and the fact that so much of the public has bought into it makes it necessary for me to return here again and again to psychically fight it for my own good, though I know that I’m not bipolar and that I only had a brief reactive psychosis while suffering with very bad PTSD symptoms and a perfect storm of other stressors including an unprecedentedly long period of sleep deprivation.

      I’m still fine (thank you).

      It takes a continuing effort just to let myself know what I know about myself and my experience, and it wouldn’t tick me off so much if I were just a rare and unfortunate exception. Institutional abuse totally rubs my fur the wrong way; it’s the stuff of dystopian nightmares.

      • W., Off topic, but take the war on drugs. Could it go on if behavioral healthcare took a stand? Obviously not. But once you obtain the perspective on psych hospital treatment, you understand that the whole industry thrives on just such nonsense as the war on drugs creates, and they won’t challenge the myths and stereotypes that keep their anti-drug and dual diagnosis programs mandatory and funded and seen as topnotch.

        The same thing again with so-called misdiagnosis. Lucy Johnstone is right that all psychiatric diagnoses are misdiagnoses, since they aren’t what the drugs treat as though the prescriptions are somehow medically therapeutic. They are drugs the same as street drugs for how they fit the subjectively determined need.

        Good work, wileywitch. Plus, I am glad you are careful to say PTSD symptoms.
        I am glad you are careful to say PTSD symptoms, because the best logic is to try look into the labels that exhaust your presenting symptoms but not to label yourself. Rather actually, knowing I’m like thousands, it is undeniable that for me I got drugs not recommended for my specific problems. The culture of the industry supported getting those disfranchised customers for life. So they have looked the other way from trauma however they could. They censor their verbal reports so that big words like transient mental illness and derealisation never get heard or thought of. They won’t turn to page xxx or page yyy for the disorders that point to your situation intead of your mind. But I finally see what I was doing to make my suffering better and worse in cycles. Besides really having to adjust to episodic flashbacks, I compensated for the stress by “staying up in my head” and barreling through anxiousness and panic until the aggressive attitude became second nature. Meanwhile, I couldn’t rightly notice symptoms under the influence of meds and eventually feeling numb turned into my constant emotional state. I had to get out of putting myself into a state of shock when waking up to the hyper-sensorium, and get out of suppressing the reaction, too. Now what really is wrong with me in terms of post-traumatic stress has come to seem bad enough that I never think my mind is giving way to mania or delusion. It took noncompliance outright just to get all the facts available for working it out.

  14. Thank you Mr. Whitaker. Excellent. Keep up the good work, and keep speaking the truth in love. I look forward to reading Psychiatry Under the Influence.

    The conversation is starting to heat up, in part because more light is being shed. In the effort to generate more light than heat, it is good that people are beginning to ask more questions, even those who could potentially be led into the psychiatric trap, either as psychiatrists or as slaves of psychiatry.

    It is interesting to note that the conversation is heading in a direction that is too often ignored, namely, answering the question “What is mental illness?” Even if we understand that psychiatry is a sham, a fraud through and through, and even if we learn that psychotropic drugs are dangerous and potentially lethal, we will eventually need to confront the questions that Dr. Thomas Szasz addressed decades ago. We need the scientific proof that psychiatry is a hoax (and there is plenty of that), but we also need to provide well reasoned responses to the question “What is mental illness?” No one has answered this question more accurately and with more clarity and power than Szasz.

    Of course people will continue to evade the truth by categorizing Szasz and others who are critical of psychiatry as “antipsychiatrists” or as “scientologists.” In reality, Szasz and those who carry on his legacy are pro-liberty, pro-responsability and pro-truth. Psychiatry, on the other hand, is pseudo-scientific lie built upon a foundation of sand. No amount of propaganda or apologetics can save the psychiatric edifice from its inevitable collapse.

    Let us graciously and kindly continue to Slay the Dragon of Psychiatry.

  15. My premise is the psychiatric drug made me less able to function and I’ve loss count of the people who have said ,”Good God you were messed up on those drugs” to me now that I’m psych drug free. They saw an individual barely functionally, mumbling, stumbling and it was obvious I was heavily drugged. They have said I’m “normal” (for what that’s worth).

    Am I “anti-psychiatry”? Any group that takes your life away, makes you zombified, has no clear idea of what the drugs they are prescribing do and then ignores the toxic side effects, would make someone be “anti”. I wish I had known what I know now before I walked into the psychiatrist’s office.

  16. I too read Shrinks this past week with an eye to reviewing it, but I think Mr. Whitaker’s discussion above renders the effort unnecessary. Anyone who does read the book will see that Dr. Lieberman makes no attempt to distinguish between a patient who asks for his help from a person whose relatives bring her to him asking for his help. Which is, I would have thought, a significant distinction.

    I will, however, cry foul on one assertion that you make in the book, Dr. Lieberman. You write (emphasis added),

    Dr. Fuller Torrey, a prominent schizophrenia researcher and leading public spokesperson for mental illness, told me, “Laing’s convictions were eventually put to the test when his own daughter developed schizophrenia. After that, he became disillusioned with his own ideas. People who knew Laing told me that he became a guy asking for money by giving lectures on ideas he no longer believed in. Same with Szasz, who I met several times. He made it pretty clear he understood that schizophrenia qualified as a true brain disease, but he was never going to say so publicly.”

    Lieberman, Jeffrey A. (2015-03-10). Shrinks: The Untold Story of Psychiatry (p. 113). Little, Brown and Company. Kindle Edition.

    I do not believe you. I wonder if by “he made it pretty clear,” Dr. Lieberman, you mean “he said.” Can you please explain what you meant?

      • If you read carefully (I’m assuming that’s a direct quote from the book), it’s only stated that someone heard from other people, who said they knew another. And what kind of people are this, being friends of Torrey who wanted to deliver the goods about Laing to him?

        And you can imagine what making it “pretty clear” means.

        Again, they simply make it clear how they make assumptions, what their sources are, and it’s about what they or others think about another, not about finding out what’s going on, or even respecting truth and how you find out what is the truth.

        So and so said that so and so said to me..

        Or

        To say someone “made it pretty clear” is a statement about what another thought was being said, it says nothing other than that.

        And beyond that, where’s the evidence, for those statements or that it’s a brain disease?

  17. This is a sad review… at the same time it is fascinating how psychiatrists can remain willfully unaware of how their viewpoint distorts the causes and nature of human emotional problems / “madness”.

    It is ironic that the author of this book denigrated psychoanalytic treatment in relation to schizophrenia/severe emotional problems. If one researches the literature in detail, psychodynamic treatment (based on psychoanalytic principles) can greatly help people diagnosed with schizophrenia. There are some incredible books about the healing process in therapy for psychotic patients… for example, Ira Steinman’s Treating the Untreatable, Murray Jackson’s Weathering the Storms, Bryce Boyer’s The Regressed Patient, Vamik Volkan’s The Infantile Psychotic Self, and MIA’s own Paris Williams’ Rethinking Madness. These are just a few of dozens of such books describing how formerly psychotic patients can become quite emotionally well if they get sufficient support for long enough.

    Ironically, current psychiatric practice ensures that millions of “schizophrenics” will not get the opportunity to fulfill even a fraction of their true potential for emotional wellness, functionality, and satisfying relationships. In that regard, people like the author of this book are indirectly responsible for snuffing out the ability of millions of traumatized people to recover, and turning them instead into nonfunctional zombies. If effective psychosocial treatments were used in combination with much less medication, such people would have a much better chance of doing well.

  18. “I’ve seen patients joyfully bound off their cot [sic] within minutes of completing their ECT.”
    PRAISE LIEBERMAN! It’s a MIRACLE!!!
    LOL! LOL! I agree with you, Mr. Whitaker, there seems to be an allusion here to the gospel story of Jesus healing the paralytic. (Mark 2:1-12). Intentional? Very likely, I think, as Lieberman’s book, “Shrinks,” isn’t just a self portrait of a profession, it’s a self portrait of psychiatry suffering from a messianic delusion!
    Another laugh-out-loud moment was Lieberman’s quote about how the “entire profession [of psychiatry] was utterly transmogrified.” Leiberman appears not to understand the meaning of the word “transmogrified,” which means “to change or alter greatly, and often with grotesque or humorous effect” or “to transform or change completely, especially in a grotesque or strange manner.”
    Yes, the trade of psychiatry certainly is grotesque and strange, so much so it would be humorous, except that the killing, stealing, and maiming it commits is no laughing matter.

    Thanks, Mr. Whitaker, for the good, hard laughs at the expense of this monstrosity called psychiatry. With the anniversaries of my son’s birth and death coming up in the next few weeks, I could use a laugh or two. Good therapy.

  19. Hi Bob,

    I find this article very astute. I’m looking forward to your new book as well.

    I myself, object to the term ‘schizophrenia’, because it suggests an illness attached to the way a person behaves when they are very stressed. This ‘illness diagnosis’ then justifies the ‘medical treatment’ that eventually turns a person into a longterm psychiatric patient. The disabling effects of the drugs with their mental illness withdrawal syndromes ensure this.

    When I came to the Maudsley Hospital (London) in 1980: What I was looking for was help to find a better way to deal with life – but I was given ‘templated’ mental illness and disabling drugs instead.

    I recovered in 1984 though, through not taking my medication (carefully) and accessing the non drug help I had asked for to begin with.

    In my opinion ‘schizophrenia’ is a false and exploitative term that should be outlawed.

    • Regarding the word schizophrenia. As long as people believed in witches, they named people witches. As long as there are slave owners, they will name their slaves, as slaves.

      If you can’t name someone “schizophrenic” then you can not forcibly control them, such as jailing them(call it a hospital) or forcibly drug them (call it medicine).

      “sane behavior is attributed to reasons (choices), insane behavior to causes (diseases)”, Thomas Szasz. http://www.academyanalyticarts.org/szasz.htm

      • Markps2, yes. I haven’t read Szasz and from what I’ve read of his thoughts, I’m not sure I agree with all of it. I think many people diagnosed with schizophrenia have something wrong in their body, for instance. Stress hormones, metabolism, HPA axis, etc. On the other hand, these diagnoses, drugs and other techniques are also often used as tools of behaviour control. For instance, labelling someone with “schizophrenia” often is similar to labeling someone as a “witch”. I also got labelled as having “schizophrenia”, and it was only then that I realised how hazy the real clinical world of psychiatry was. Much of it has to do with behaviour control.

        • To elaborate, psychiatrists, psychologists and other people, even lay persons often use diagnoses and other technical terms such as anosognosia, bipolar, schizophrenia, lack of insight, etc, as tools of behaviour control. It’s true that some persons hear voices, have mental problems, etc, and that is related to whatever happens in their body. At the same time of course these diagnoses and other descriptions of patients are often used as kind of tools in behaviour control.

  20. it never ceases to amaze me how disingenuous both the leadership of the APA, as well as the extremists of the anti psychiatry movement, want to villainize the other with glee and complete overgeneralizations.

    There are people who have legitimately been injured by poor treatment, and there are physicians who are being slimed by this narrative that are in fact honest sincere appropriate doctors.

    Let’s have a moment of candor, can we knock off this brutal assault on both extremes of this argument and try to find some moderation!?

    Joel Hassman MD

    • First of all, I apologize for my previous comment which I expect will be rightfully removed. Anyway, again addressing Dr. Hassman’s point about moderation, let me relay my experience.

      Thanks to feeling like 15 years of my life were wasted taking psych meds, not only did I develop a big distrust of psychiatry, it transferred over to other doctors for good reason. Not to justify that but I think Dr. Hassman, that is called being human.

      Anyway, last year that distrust led to cancel a minor surgery and it wasn’t until I found a great surgeon this year that I greatly trusted who listened to my concerns and treated me like an individual and not a robot patient who must obey all doctor orders, that I am decided to ahead with it. To make a long story short, I am having a fantastic recovery.

      Because of this experience, I now have more faith in medicine because I now know there are doctors out there who do listen to patients. But if someone like you Dr. Hassman, had told me that I have to be moderate in my position when all my experiences indicated differently, I would have rebelled big time. As they say, actions speak louder than words.

      Regarding psychiatry, unlike many people on this board, I don’t consider myself anti psychiatry. Well maybe anti biological psychiatry. Anyway, because I know people who had a great experience with one when they were suffering big time withdrawal symptoms which you have disregarded, my opinion isn’t as negative about psychiatry although it admittedly isn’t still that positive. Again, I think they call that being human.

      By the way Dr. Hassman, since you are about brutal candor, let me ask you this question. If you had a female rape victim who hated men, would you insist that she moderate her position because not all men are rapists? I hope that would gently try to make her realize that not all men are evil but I sure hope you would show alot more sensitivity that you have shown to people on this board who feel they have been brutalized my psychiatry.

    • Joel (Therapyfirst)

      You want to retain your power to lock me up and drug me and yet you complain that I am being unreasonable if I object by coming on sites like this to advocate for my human rights and dignity using just my pen? You and your colleagues can inflict the very worst of torture and yet if I object to your having that power, I am sliming you?

      I can’t see why any honest sincere appropriate doctor would ever want such power over another human being.

      If you’re decent, then why won’t you relinquish the power?

      Uhhmmm…..why don’t you get it? Lack insight do you?

      Forced drugging and involuntarry treatment is no more about medical care than rape is about a loving sexually intimate relationship.

      While you reserve your right to rape me, I reserve my right to treat you like slime. Decent people do not reserve their right to rape others, either sexually or chemically.

    • Moderation does not save theories built on false assumptions and outright lies. Moderating falsehood only serves to perpetuate falsehood. False theories must be discarded, something the liebermans, biedermans, fullertorreys, hassmans of psychiatry will not do, since their lucrative careers rest on perpetuating/moderating falshood. The unscientific quasimedical speciality of psychiatry is discredited by APA high priests like Lieberman and his nauseating disciples, hot on the global trail of Big Pharma money and the public purse.

    • Hi, Joel,

      I didn’t really see anything in the article sliming honest and approprate and sincere doctors. I saw a critique of a MODEL OF THINKING, which is being promoted by Lieberman as if it were scientifically proven truth, when in actuality, increasing evidence shows it to be lacking in credibility on almost every level. This is not to say that drugs have no utility in mental/emotional distress. It is to say that LYING to clients and the public about what is known and not known, and PRETENDING that we’re making progress toward a goal that looks to be a false one in the first place (to treat all mental/emotional distress as a “disease of the brain”) is wrong and evil, and for Lieberman to go on a national radio station and proclaim this “truth” to millions is quite reprehensible. While the comments section will, of course, contain more extreme views, as in ANY comments section of a controversial issue, the article does not appear to me to do anything but juxtapose the statements of one APA-invested arrogant thought leader against the actual known facts regarding the long-term history of the APA and the DSM. It doesn’t look like demonization to me. I’d be interested to hear where you see this occurring.

      Given your username, I assume we’d agree aboout a lot of things. There are a lot of people who area angry at psychiatry for very good reasons and need to vent their frustrations, but Whitaker has never been an abolotionist. I suggest you really take a good look at what you are terming “antipsychiatry” really looks like, lest you do a bit more demonizing yourself than is really appropriate. We could use your wisdom and experience if you can find a way to appreciate that people here come from a variety of viewpoints, many of which aren’t nearly as extreme as you seem to assume.

      — Steve

    • Joel

      Only if psychiatry will agree to quit brutally assaulting people that it likes to label as “mentally ill” so that psychiatrists can stroke their egos for being “real doctors” and so drug companies can make billions of dollars in profit off of the American public and those who experience emotional and psychological distress and dis-ease!

      • Assault is legal? Well, it is where psychiatry is concerned, and it is the law that needs changing. Psychiatry could not legally assault people without mental health law, the law that makes it legal to assault certain people in the name of “medicine”. What am I saying? Blaming psychiatry alone is rather simplistic. You’ve got what claimed to be a “public safety” issue here, that’s the way it is posed, and so that brings in the attitudes of the public and the politicians who would represent them. Psychiatry doesn’t “brutally assault” people on a whim. It does so because it is sanctioned to do so by law. “Mental illness” is not “real” because some psychiatrist says it is “real”, “mental illness” is “real” because it has been legislated so. If they’d legislated “witches” into being, we’d have a “witch” infestation, as is, our present day “witches” are people labeled by psychiatry. There are three groups involved in this mental patient hunt, the general public, the politicians a certain amount of that general public votes into office, and psychiatry. More if we are to include economic interests, such as those of drug companies. We have a chemical, you name it, straitjacket, prison, holding cell, etc., now for what pre-crime, or “mental illness”, how convenient, especially if you feel a need to scapegoat (or enwitch) a certain segment of the population.

        • I have seen people destroyed by psychiatric treatment. I have seen people literally killed by psychiatric treatment. I don’t consider any “injury” by “poor treatment” “legitimate”. Allen Frances makes an argument similar to yours, Joel. The problem is the extremists. Like I said, I have seen people literally killed by psychiatric treatment. The people treating them didn’t see anything extreme in their so called medical practice whatsoever. Extreme is not the problem. Harming people in the name of “helping” or “healing” them is the problem. If opposing that injury is extreme, so be it, I’m going to oppose that kind of injury anyway.

    • The comment about “extremism” reminds me of a Jules Feiffer cartoon from many years ago at a time when black schools were being bombed in the South. It was a parody of President Eisenhower saying that he was “against extremists on both sides, those who want to bomb the schools and those who want to keep them open.” There’s nothing extreme going on here except the extremely damaging way people like me are treated by the profession of psychiatry.

  21. First of all, I want to be again candid and note I will not be commenting here further, as I don’t see the point of trying to dialogue with those who only monologue here, albeit there are some commenters who do seem to understand the concepts of moderate and not generalize to the 99th percentile. To those, my apologies I won’t be back to debate honestly.

    So, let’s address who did wallop, er, weighed in. As always, the inconsistencies with AA speak volumes, the first comment being censored, and for the editors to do so, I can only assume “WOW”, it must have been ugly.

    Which the Berit was quick to support. Then AA’s second comment ends asking me to be sensitive to the commenter’s issues, but, where was AA’s sensitivity to the first instinctual response? Lucky for you, AA, the comment was gone before I read it, could have given me more ammunition to my point about antipsychiatry attitude outwardly??

    As to Kim, well, your comment for me exemplifies my point to the overgeneralizing that goes on at sites like this as an overall commentary about psychiatry.

    Then Berit’s second comment lumps me in with the Liebermans’ et al and yet, what have I published in the press or in psychiatric literature that gives me some position of influence or authority to then make such an unsubstantiated claim Berit offers? Oh, I forgot, my MD after my name makes me complicit. Again, thank you for the validation as a representative of the standard antipsychiatry commentary.

    Finally, to Steve, while you were certainly fair and respectful in your comment, Whitaker does not note in the post, unless I missed it, that there is a sizeable percentage of psychiatrists OUTSIDE the Lieberman box (or to me, the coffin), who do not embrace nor echo his and his failed legion of “medicate until proven otherwise”. So, the absence of such a disclaimer is a loud point to me, especially since the point of this site is to document the failings of mental health care as the overall theme.

    Also, Whitaker is a primary player to this site, and for what I have read in past posts and to me some of the most heinous threads about psychiatry allowed printed on the Net, I believe one is associated with a following or group that speaks around such person. Unless, the person realizes the following is NOT speaking the message that is intended, and would at least distance by some disclaimer or showing some more effective censoring that would drive the zealots and extremists away for not being able to smear and demean with pleasure and reckless abandon.

    So, while I thank the editors here for allowing my first comment to be printed, and hopefully this one as well, and also sparing me the harsh attitude of at least one commenter, I respect Dr Whitaker has issues with some of psychiatry’s poor insights and judgments but he seems to just flame the fires of hate and disdain for ALL in the field, until future commentary says otherwise. If Mad In America wants to be seen as a consistent and viable voice in the honest debate about mental health care failings, it starts with moderation and avoidance of extremism. Yes, there are commenters here who are fair and respectful, but, if I wrote here with regularity, I would call out on some commenters who just don’t get it.

    At least so readers know I have boundaries and abilities to work on resolution, not absolution and dissolution. Be well and safe to all, but, be tolerant to those who are noting there are grays out there, if you can.

    Sincerely,

    Joel Hassman, MD
    (and again, when I first logged in here, I was given the illusion I had to have an alias to be a commenter, so why “therapyfirst” is my lead, I ALWAYS sign my name at the end of all my comments, so end this agenda allegation, please)

  22. Thanks for the review it has saved me reading time. I’m a wiser man today that I was yesterday that’s for sure. I don’t believe any of the drugs were originally designed for long term use but that is where we are today. We have no one to blame but ourselves because we demand the quick fix these days.

    If you have rode the wave of suffering behind days of no sleep and uncontrollable fits of a misguided spirit you know more than any doctor. The fact is many doctors won’t diagnose you because they don’t want to tell you they can’t cure you because they know that’s what you come to them for.

    When you take a magic bullet like Zyprexa and find that the next day you appear suddenly normal then why wouldn’t everyone think that a miracle has happen. This is reality! But you have just sold your soul to the devil because the fleeting moments of a cure are coming from within and are often lost in the soon to appear hopelessness of all the side effects.

    The doctors need to tell the patient that here are a few days of pills take them only if you must to get you some sleep and maybe get yourself to a place of peace. Give you some hope by telling you to have faith in your own body that like a bad illness this will in time pass.

    Read the warnings on the drugs and you will find that none are to be taken long term. Be aware that a drug in the short term and for safety reasons might be the only choice. Be aware that healing takes time and it isn’t going to happen on drugs. Faith and love and compassion and time will heal the spirit. I have witnessed it!

  23. Hi Robert W. and what an excellent write-up, gave me a fresher course on things I learned many (over 25) years ago (reasons for closing of asylums, etc.) and what a peach that Lieberman sounds like 🙂 Sad is the fact he thinks the American public is dumb enough to believe the story he is telling. I think it should be considered professional misconduct the fact he is intentionally distorting the truth and the facts – he obviously has access to the same information you, I and others do here – makes you wonder how he made it through medical school. That is a scary thought.

    All psychiatrists (on west coast so just got lucky?) I saw when suffering severe illness states of BP-1 disorder were not arrogant, insufferable arses but kind, competent, caring and ‘trying to help’ docs. Meds saved my life a few times (antipsych/tranquilizers whatever it was I was given) stabilizing me after a manic psychosis on a few occasions and keeping the few hospitalizations I had to no more than the legally required 14 day hold.

    I know how lucky I am, especially with some of the horror stories of the past, and even those going on today such as the case of Justina Pelletier, other Boston hospital case ‘Walpole couple’ and this one I learned of today of a Danish girl who had severe M.E. was forcibly removed from home, imprisioned in mental ward for 2 years, made worse (like Justina), family not allowed to visit, think she will die soon after being declared brain damage and moved to a nursing facility: https://www.facebook.com/JusticeForKarinaHansen.

    Absolutely horrific.

    One thing above really bothered me (sure I would come up with more but will not read it!)…. “whereas antipsychotics, antidepressants and mood stabilizers reduced the symptoms of illness without producing much of an effect on healthy people.” – quoted from book. What planet does this trained, licensed physician live on? What anti-psychotic or other psychotropic med would not affect the physical/mental state of anyone who took it normal or under distress? He should lose his medical license for stating such an untruth.

    But I have to add what bothered me as much was the following offered in your excellent critique:

    “Historians have determined that 35 to 80 percent of all first-episode patients in those early asylums were discharged within a year, and the majority were discharged as having been cured (which meant that their disturbing behavior and psychotic thoughts had largely disappeared.)”

    Yes, I am sure that is just what happened… as we know how good moral people do good things – please and spare me. It couldn’t possibly be that much rape, torture, adopting out babies of teen mothers (rape victims?) and much else went on while hospitalized for a year? Heavens no, these were religious folk. That many of the incarcerated were probably victimized by the rigid set of ‘moral behaviour’ they were suppose to achieve and put in an asylum for ‘correction’.

    Is as bad as Lieberman’s misleading rhetoric, and just as dangerous. In my book I just published on Amazon “Bipolar 1 Disorder – How to Survive and Thrive” I use the story of Frances Farmer to illustrate the difference between her horrendous 5 year incarceration and what I experienced. I actually even spent a couple of weeks at the same lovely hospital in Washington State, and was not tortured, raped, abused as she was.

    My bipolar was not being treated as a ‘moral failure’ like her Manic Depression was in the 1940’s – I was given medication and thankfully had a positive outcome. I am as against the long-term use of psychotropic meds but do not think all applications and uses are ‘evil’ or intended to harm, though of course misused, over-prescribed and patient’s not given adequate information on the damage they can cause.

    What is the religious-bias going on at Boston Hospital these days? What programming led way for the abuses that have occurred? My guess? Good Christian folks. Mormon? A mix? How are those who have committed the crimes above and millions of others from the past justifying their actions?

    They think they are doing ‘good’, no? They of course are good people as they are moral and therefore superior. God’s work maybe? That’s a biggie. Good Christian-convert George Bush reading his bible and hearing the ‘voice of God’ to illegally, irreprehensibly invade Iraq.

    I could go on, will stop, think my point is clear and a valid one. Hope it causes others who like to wax poetic about ‘moral’ values and the return back to times past to think twice about what they are saying and the validity of that idea.

    In respect, Molly

    • Apologies, was at a public computer and rushed, the above quote was incomplete, of course referring to your talk of ‘moral therapy, Quakers. spontaneous remissions, etc’ – the full quote would have made my following remarks a bit clearer. Ridiculous to use that as some wondrous time to follow or look at as an example of future changes.

  24. BAsically being weak and fighting back is a “mental illness” and being deprived of your freedom by those who actually made your life miserable , refusing to take drugs that you instinctively know do nothing but harm you physically and dumb you down is an aggravation of your “mental illness”. LEts be honnest, we all know it s a war between weak people and strong minded people.

    just like in communist countries those who criticized communism were labeled as “mentally ill”, just like the nazis considere deverything that was non white as “mentally, genetically abnormal” in modern days weak, hurt, abandonned kids, teens and young adults, and OLD PEOPLE who fight back against their oppressors , wicked family members are labeled as “mentally ill”.

    Fact is, if you re weak and criticize those who made you weak -parents, family-, or benefit from your weakness -young people preying on old people weaknesses- they will label you as mentally ill and throw you like garbage to cold, heartless, sadistic so called “scientists” known as psychiatrists and their staff. It s pretty easy to understand, its quite binary.

  25. Is there a single film made in recent times that has an actually good person as the psychiatrist? Or are they all like the one in Girl With A Dragon Tattoo? If I were a psychiatrist I would find this book an embarrassment. I would also find a better use for my medical degree — Doctors Without Borders perhaps.
    Although the bad doctor actually comes across as comic, he is also a criminal. ECT is cruel and unusual treatment clearly. The drugs are basically poison. This is all quackery. But then so much in America is fake, deceptive, dishonest and criminal that these men and women pass almost unnoticed unless one has a friend or relative who has had the bad luck to fall into their clutches.
    Well Hannibal Lecter was a psychiatrist. The author might have chosen the law or politics for his character but chose psychiatry! Hmmm.

  26. As a freshly graduated MD three decades ago, I was deciding between internal medicine and psychiatry, as career options. Psychiatry prevailed, because it seemed to be up-and-coming and was promising to explain disorders such as schizophrenia, mania, and depression that medicine did not understand. The “diseases” were difficult to treat, med school taught me, but now drugs existed that offered not only effective treatment, but also permanent cure.

    In training the emphasis was on teaching us, residents, how to “elicit” symptoms and observe signs of those diseases. DSM classification made the process appear scientific. Much later, a realization would come; in the absence of objective tests, little else other than my personal judgement and experience qualified symptoms and signs of illness that I was observing. I would decide if, and to what end, the observed and/or reported phenomena should be accepted as evidence of “mental illness” in the person before me.

    Trainee doctors were encouraged to talk to the “mental patients,” of course, mostly as a means of getting at all the symptoms that might be hiding under a thin veneer of pseudo-normalcy, waiting to be unearthed by well rehearsed (leading) questions. Empathic understanding of the patient on the human level, on the other hand, was secondary to the diagnostic enterprise.

    When sufficient “symptoms and signs” were collected and put down on paper, i.e., documented, settling on the “correct” diagnosis was not difficult. And once established, that diagnosis would remain on the record forever, seldom if ever revised downward, though sometimes upgraded, if the patient failed to develop “insight,” i.e., agreement with his psychiatrist on the nature of his illness.

    In my practice, general practitioners would refer patients, expecting me to manage their long-term care. There was a sense of empowerment, solemn responsibility, and accomplishment in this work. After all, I was protecting unfortunate individuals from the ravages of disease that had the potential to ruin their lives. I was eliminating their suffering, or so I thought.

    It did not take long for another realization to dawn on me (and most of my colleagues, I’m sure). The acclaimed psychiatric drugs produced effects that were short-lived at best, or nonexistent entirely once the placebo effect was discounted. Patients would improve, but their “symptoms” tended to return, usually as a result of medication “noncompliance” due to drug toxicity, referred to routinely as “side effects.” If they did comply fully, they could not function and were on the way to chronicity.

    Family or law enforcement agents would often enter the picture somewhere along the way, insisting that treatment be continued against the patient’s will, if necessary. Employers preferred to steer an employee, with psychiatrist’s help, toward a disability status, less likely to be challenged than outright dismissal would be. I soon learned that to stand up to the family and state agents in support of my patient’s autonomy was asking for trouble. Taking the family or government agency’s side was entirely problem-free, on the other hand.

    At some point, the scales of med school indoctrination started to come off from my eyes. Something I was led to ignore became obvious. The diagnostic system I followed was arbitrary and subjective; psychopharmacology had nothing to offer beyond sedative-like drugs for acute states and stimulant-like drugs masquerading poorly as “antidepressants.”

    Emotional suffering was real and had many forms. It responded only to genuine empathy. Time spent with the “patient,” listening and being a sounding board to him, was a form of treatment intervention better than most, I realized. It was liberating for this psychiatrist to “come in from the cold” – the diktat of DSM-style diagnosis and ineffective, toxic, biologic treatments, so called.

    It was liberating, except… Outside my office door, alive and well, lived the dogma that treatment by empathy was not scientific and/or sufficient, unless accompanied by a bottle of expensive pills of the “second generation,” preferably, prescribed as the actual remedy. My newfound freedom collided head-on with expectations of the medical powers that be: I should practice psychiatry “by the book.” Fending against accusations of unscientific practice became part of my own “Psychiatry Reborn” experience, unfolding still.