Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting


Psychiatry and the Business of Madness:

An Ethical and Epistemological Accounting
by Bonnie Burstow, PhD
Published April 1, 2015
by Palgrave Macmillan

This latest book by Bonnie Burstow, PhD critiques psychiatry, and effectively annihilates any claims that the profession might have had legitimacy.

Bonnie gives us a scholarly, but very readable, account of:

  • the history of psychiatry, ancient and modern
  • the significance and shortcomings of the DSM
  • the legal, ethical, and personal ramifications of involuntary “treatment”
  • the training of psychiatrists and the dynamics underlying their uncritical acceptance of their profession’s spurious concepts and destructive treatments
  • the ways in which non-psychiatrist mental health workers are co-opted into the system, and become, often despite good intentions, supporters and active participants in the psychiatric travesty
  • the role and tactics of the psycho-pharma industry
  • the stark, destructive, degrading realities of electric shock “treatment.”

In the final chapter, Bonnie offers us a glimpse of what an alternative approach might look like.

Normally when I write a book review, I include some quotes from the work to enable readers to judge for themselves the quality and content of the material.  With Psychiatry and the Business of Madness, however, this presented a problem, in that virtually every one of the 264 pages of text contains eminently quotable material.  Here’s a short sample:

“… the problems with this institution run so deep that what might be construed as ‘improvement’ is not and cannot be sufficient.” (p 21)

“… psychiatry consolidated its power and harnessed the newly acquired credibility of medicine not by being scientific but by mimicking the outward trappings of science and medicine.” (p 44)

“A timely reminder:  No biological sign has ever been found for any ‘mental disorder.’  Correspondingly, there is no known physiological etiology.” (p 75)

“The concepts of ‘open secrets’ and ‘bad faith’ have explanatory value here.  An ‘open secret’ is a truth that everyone knows but does not acknowledge publicly.  Everyone knows the secret; everyone knows that everyone knows the secret, but except for the odd ‘maverick’ who can readily be dismissed, everyone respects the secrecy.  Let me suggest that there are a number of open secrets in the mental health field.  Open secrets that suggested themselves to me as I interviewed practitioners – mainstream practitioners especially – include:  There is something wrong with the drugs.  There is something wrong with much of the research.  There is something wrong with the very way that we are all operating.” (p 163-164)

“All psychiatric drugs ‘work’ by obstructing normal brain function, causing dysfunction.  All substantially interfere with normal thinking and feeling.  All alter the brain’s chemistry and structure, to varying degrees, fundamentally damaging the brain.  All alter the size of the brain, making it (or some part of it) either expand in size or shrink.  All are addictive.  All work in ways that make withdrawal difficult, in some cases, arguably, impossible.  All cause dysfunctions (and in some cases disorders) in various parts of the body.  All work by ‘deactivating’ to some degree, though some primarily activate.  What is experienced as improvement, correspondingly, is invariably one or more of:  sedation, stimulation, and the placebo effect.  The drugs to varying degree inherently mask the very dysfunctions that they create.  They obscure people’s appreciation of their psychic state, and by extension, of the damage.  What goes along with this, there is a perilously close relationship between the purported ‘therapeutic effect’ and the ‘toxic effect,’ with the two at times being identical.  The toxic effect itself can manifest itself in mania and psychosis.” (p 195-196)

“…the pharmaceuticals are the kingpin, the mainstay of the regime of ruling.  Successfully problematize that and the edifice crumbles.  In this chapter, to an appreciable degree, that has happened, for in the final analysis, however much people may cling to them – and I am in no way denying that there are people who regard them as a lifeline – no medical credibility can be attached to a substance that is not medical, that addresses nothing medical, that gives rise to medical disorders, and whose modus operandi is dysfunction and damage.” (p 200)

“So what in point of fact does the research establish?  In short, that ECT is a profoundly injurious treatment that damages the brain, that substantially impairs memory, that gives rise to global cognitive dysfunction – and in the final analysis, it has no lasting efficacy.” (p 214)

“While in the final analysis readers must reach their own conclusions, what the logic of this investigation indicates – and indicates powerfully – is that not just parts of psychiatry, but the discipline and the regime as a whole is epistemologically flawed and ethically unacceptable.  Nor is it ‘fixable,’ for the problems are fundamental, at the core. My invitation, accordingly, is that we as a society do what may have once seemed unthinkable – that we acknowledge that our approaches to problems in living and to ‘problematic others’ are tragically misguided and muster up the courage to begin again.” (p 227)

“Given that psychiatry is blatantly not the answer to life’s woes but indeed, one of the causes thereof, and given that there will always be some need for extensive emotional support, what do we put in its stead?  What we concluded is that tinkering will not serve us, that not only must we break with psychiatry, we have to rid ourselves of rule by experts, we need to stop ‘othering,’ we have to stop imprisoning, and beyond that, we need to fundamentally alter how we live with one another.” (p 264)

This book is scholarly, in the sense that it examines the issues, painstakingly, fearlessly, and with impeccable logic.  But, more than scholarly, it is human-centered and compassionate.   There are lots of stories.  Some are tragic; some are hopeful; all are instructive.  Bonnie has drawn on her own personal and professional experiences to bring the issues vividly to life, and to help us see that the victims of psychiatry are not just the people who have experienced physical damage from the drugs and the electric shocks, but all of us who live in this psychiatrically pathologized, and alienated, world of “us” and “them.”

Psychiatry and the Business of Madness reads seamlessly, and is a difficult book to put down.  I cannot think of a single issue in the psychiatric debate that is not covered – and covered thoroughly and convincingly – within its pages.  For those who wish to explore the various topics in greater depth, there are thirteen pages of references.

Please get a copy.  Read it, and tell others.  This book is a major milestone in the antipsychiatry effort, and stands as a monumental challenge to psychiatry’s continued existence as a branch of medicine.

. . . . . . . . . . . . . . . . 

Disclosure:  I have no financial links to this book or to any books/materials that I endorse.


  1. I am looking forward to reading this very much. I’m sure it will help me in my work. Also I want to say that I have very much appreciated Bonnie’s very helpful and well thought out writing on strategy for the anti-psychiatry movement.

    And Bob Whitaker’s new book Psychiatry Under the Influence is coming out this same month! I think there is some important intellectual momentum happening now.

    Looks like I am staying up late in the next few weeks to read the kind of books I can’t put down.

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  2. Thank You Philip for reviewing Bonnie’s book and Thank You Bonnie for writing it. I just ordered a copy and am looking forward to it’s arrival. Don’t you think if for starters if even 6 practicing psychiatrists threw psychiatry completely overboard (stopped practicing and renounced their” professional” license ) understood the meaning and cause of anti-psychiatry, worked as a team along with several other “of their assistant professionals ” that also threw it overboard ,along with some psychiatric survivors , did some well planned , civil disobedience actions, that came one after another planned as to appropriate time, place , message, and goal by best thinking within the anti psychiatry community.Proper steps being taken so that the element of surprise is preserved when deemed necessary. Really to at least have a better chance to get mainstream media attention and to at least do our level best to save generations of babies ,toddlers, and children from psychiatric assault and slavery and of course all others too including seniors in nursing homes. Also don’t you think Health Freedom should be an issue we should somewhere discuss through an anti psychiatry lens.

    Another thing that I see is that the history of psychiatry is even better understood if the history of medicine is studied cause I know that many parallels of corruption costing countless lives will be laid bare in such a study. There is another book I ordered yesterday of which free excerpts are available that touch on these issues and offer some do no harm alternatives. The link is below :;&source=bl&ots=R0u6RPoIZb&sig=KLwhy2wVzNFihJIxiv7TRYbjJMA&hl=en&sa=X&ei=K7MtVfX0O4XboASQxoDoDw&ved=0CCkQ6AEwAg#v=onepage&q=Healthy%20Gaians%3B&f=false

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    • In the description of the problems, maybe not. Perhaps the solutions are more clearly specified though: “We have to rid ourselves of rule by experts, we need to stop ‘othering,’ we have to stop imprisoning, and beyond that, we need to fundamentally alter how we live with one another.”
      All those kind-of come down to 1 thing: We have to take responsibility for our own lives and not look to blame anyone else (or our “defective brains”) for the aspects of life we don’t like. Too many of us don’t want to do that.
      So, either we blame other people and abuse them in a variety of ways, or we blame ourselves/others and become addicts (food, drugs, damaging behavior) in order to dull the pain, or we blame our brains (i.e. we blame G-d, or randomness, or evolution, or whatever) and drug ourselves, or we blame ourselves and sink into depression etc….
      If people don’t know about a different way to approach life i.e. how to constructively engage with their emotions, no amount of psychiatry-bashing is going to help them taper off, even if the drugs are making things worse.

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      • There has always been people been pointing out what the problems & solutions are.

        Goes into areas of a lot of controversial debate, & no one really can agree.

        i’d agree that the masses need to take more personal responsibility – But i’d also think the systems we have need transformation – especially the economic, political & religious systems.

        Of course the blame needs to be let go of – It’s a blame culture – this web site seems to blame psychiatry? along with this book.

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        • Babies and toddlers and some children are too young to blame anyone for the IndustrialElectricPsychoPharmacaustArchipelagoComplex .Who are we if we leave them trapped there. But somehow the escapees understand, but the battle to escape 40 years long in my case, has not left me with the billions in funds to more easily help facilitate the escape of so many others trapped and continuing to be trapped by those primary profiteers of the above mentioned complex.

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          • RE: Cpuusage “How do ‘you/we’ change the system then???”
            Who has the power now? The doctors. As long as legitimate doctors of science support psychiatry, psychiatry will continue. The “scientific” studies do prove lobotomy and chemical lobotomy stop unwanted behavior, but (chosen) behavior is not and has never been a medical disease.

            The doctor has a need to help their patient. The doctor himself/herself needs to be patient and do nothing for the “mad”.

            The tradition of giving or forcing drugs on the “mad”, has to be stopped. Drugs only lead to more drugs.

            Call stupid people stupid, not mentally ill in need of medication.
            Call drug addicts as drug addicts, not mentally ill.
            Call (too) angry people angry, not mentally ill.

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    • It actually does. For example, it maps work processes of psychiatric professionals step by step–something never done in any book before, looking concretely at psychiatry rule as it operates through the activation of texts, for example. You would have to take a look at it, though, to understand what I am getting at.

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    • “Doesn’t seem to be saying anything new or different to hundreds of other books on the subject?”

      That’s exactly what I thought. AFAIC there are only three books that are currently really important regarding psychiatry/drugs:
      Mad in America (2002)
      Anatony Of An Epidemic (2010)
      Deadly Medicine And Organized Crime (2013)

      With perhaps some honorable mentions:
      The Emperors New Drugs (2009)
      Bad Science (by Ben Goldacre, 2008)
      Blaming The Brain (1998)

      I think that many professionals who know of these problems but otherwise feel trapped to either work in or around that system, feel that they need to write a book just to get things off their chest, and then of course their colleagues will read it and congratulate them. All part of a social activity that is probably just a coping mechanism.

      But considering that most people, even those interested in the subject, are probably not readers, it makes no sense to burden them with 100 titles of mostly parakeeting books. Always recommend the most relevant and acclaimed to any newcomer.

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      • Read the book, and my guess is that you would no longer think that it is not different. It is actually profoundly different than any other book out there–as everyone who has agreed read it to date agrees.

        In this regard, we can make vague guesses on the bases of reviews–but in end, however well done the review, that is all that we can do.

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      • i’ve Not seen or read anything that shows this book is saying anything new or different to reams of other stuff out there? Not to say it isn’t a good book – i’m sure it is.

        I don’t disagree with people – i largely agree with everyone – mass drugging is bad, & there are better alternatives, in most cases. But it always comes back to the same things – namely How do ‘i/we/you’ change the system? i haven’t found/seen/heard a genuine answer to that? & a million books won’t change the facts/realities of it all.

        i’d also contest the illness denial – people are to varying degrees & in various ways unwell. Some people ideally need a lot of help & support. i do agree with critics of the system, but don’t really agree with denial of illness, & i don’t really agree with more extreme Libertarianism.

        i’d love to see a far more humane/better treatment of the ‘mad’ – But i think it is very debatable how ‘we’ get there?

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        • Actually the book is very clear that people are in all sorts of emotional turmoil. That is not the same as “having an illness”. Nor is objecting to the medical terminology an issue of denial. It is an issue of the meaning of terms like “disease” and the science or lack of it involved.

          What is important to take here here, almost no one who takes an antipsychiatry in any way denies the very real distress in which people find themselves. to think that they do is to totally misunderstand the nature of the position. And while of course you can object to the position regardless , you can only object to it on the basis of what people are actually saying.

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          • “Actually the book is very clear that people are in all sorts of emotional turmoil. That is not the same as “having an illness”. Nor is objecting to the medical terminology an issue of denial. It is an issue of the meaning of terms like “disease” and the science or lack of it involved.

            What is important to take here here, almost no one who takes an antipsychiatry in any way denies the very real distress in which people find themselves. to think that they do is to totally misunderstand the nature of the position. And while of course you can object to the position regardless , you can only object to it on the basis of what people are actually saying.”

            Some people deny mental illness – to say it’s all distress/emotional turmoil i think is about as accurate & polemic to say it’s all chemical imbalance – & no more explains the nature of madness/peoples experiences.

            i think there are physiological, psychological, social & spiritual factors involved – in various ways & to various degrees/weightings.

            Anyway – lets see what this book changes? Lets see what MIA changes? i’m pleased that at least some kind of dialogue has been started.

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  3. Thanks Paul, for the review, and Bonnie for writing the book!

    I have just ordered two copies, one for me and one to share.

    Here in Australia the “mental health” system has just come under some really heavy fire in an official report around waste of money and damaging the people it is supposed to help , so there might be significant interest in such a book. I am hoping the publisher has distributed review copies to major national newspapers here (The Age, The Australian and the Sydney Morning Herald).

    That Bob Whitaker’s book will come out very soon is wonderful too – again, I hope it gets sent to and reviewed in the national newspapers.

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      • Have you seen the TV ads Kim?

        Mental Health is costing Australians 10.6 Billion per year?

        Love to put it alongside the poster from the National Socialists in Germany. This person is costing Germany 60,000Dm per year.

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    • Publishers like Palgrave (both mine and Whitaker’s new book) only allow to you specify a small handful of places to send free review copies (in the case of Palgrave, 10). After that,the only way a paper or a journal will get a review copy is if the person in charges of reviews writes the publisher, states they are going to do a review, and asks for a complimentary copy. So as you can see, unless someone has contacts with any of the national newspapers who came impel them to make such a request either to the publisher directly or indirectly through the author, they in fact won’t end up with review copies. All and all, a difficult conundrum.

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      • Yes…difficult.
        I’ll see whether I can get someone to either request a copy or review my spare copy given the current interest in the subject here in Oz.

        My copies are two to three weeks away, sadly, as they have to come from the US.

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  4. Thanks Philip,
    I think the descriptions in the excerpts are excellent, and I support the inclusion of the word ‘Business’ in the title.

    “Given that psychiatry is blatantly not the answer to life’s woes but indeed, one of the causes thereof, and given that there will always be some need for extensive emotional support, what do we put in its stead?” – Good solutions actually do exist in the present day community. Its well known that lots of “diagnosed schizophrenics” recover completely, independent of Psychiatry. Its just that we don’t hear much about them.

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  5. I WILL buy this book. Vindication and honesty is priceless. Thank you, Doctor Burstow.

    Everyone knows the secret; everyone knows that everyone knows the secret…

    And yet so many psychiatrists and other mental health professionals remain haughty and attack people who have been harmed by diagnoses and medications when they talk about it as if they were attacking the psychiatrists personally. Psychiatry needs to grow up, look at itself, and stop treating patients and ex-patients like they’re the ones behaving like children when they simply speak the truths about their experiences .

    Recently I saw an article asserting that the Placebo Effect is primarily a relic of RCTs, and the improvements are primarily either naturally occurring or the result of implicit biases in evaluations. I have no opinion on this, but find it interesting. Even the worst sort of depression— melancholia— generally lasts no more than three months for those who survive it. I don’t doubt that there are certain states that are worthy of the term “depression”; but the assumption that it requires constant and lifelong medication or other treatment is pure bunk.

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    • I wouldn’t disagree with you that it is like a malignant tumour. However, it is not the only tumour, and so while I see getting rid of psychiatry as essential, I would not agree that this would suffice for “health to blossom”. My take on this? We need a far more major societal overhaul.

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      • Totally agree Bonnie since about 80% of psych meds are now prescribed by non psychiatrists because they are now drinking the mental illness cool-aid. In all types of medical settings, including some that you would least expect, one is asked typical mental health screening questions that could easily lead to meds if you didn’t answer “correctly.”

        Additionally, in our current health care system where meds are the answer to everything come heck or high water, I definitely don’t see getting rid of psychiatry as leading to health blossoming. I agree it takes a much greater overhaul.

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        • AA,

          On October 14, 2011, the Centers for Medicare and Medicaid Services (CMS) issued a “Decision Memo for Screening for Depression in Adults (CAG-00425N)”

          Here’s a brief quote:

          “The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is adequate to conclude that screening for depression in adults, which is recommended with a grade of B by the U.S. Preventive Services Task Force (USPSTF), is reasonable and necessary for the prevention or early detection of illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

          Therefore CMS will cover annual screening for depression for Medicare beneficiaries in primary care settings that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment and follow-up.”

          The memo is standard psychiatric fare, and is the primary reason that we are seeing these so-called screening questions in primary care settings. Medicare and Medicaid will pay!

          CMS has also produced “Screening for Depression” (February 2013)

          This is a 13 page user-friendly document with lots of hyperlinks. On the cover there are three beautiful color photographs, presumably of models – our tax dollars at work.

          It’s about selling drugs, and it’s nothing short of a disgrace.

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  6. “A timely reminder: No biological sign has ever been found for any ‘mental disorder.’ Correspondingly, there is no known physiological etiology.” (p 75)

    The evidence is all around us, including on MIA, that this is not so. Numerous studies have shown that deficiencies of key nutrients (e.g., Vitamin B12, Vitamin D) are implicated in mental illness. The emerging science of epigenetics shows that environmental insults (physical or emotional trauma) change gene expression (not DNA structure), and those changes survive cell division and are transmitted to future generations. And the person with altered gene expression becomes more vulnerable to other environmental insults (e.g., bullying, childhood deprivation, drugs, toxins and who knows what else). What is inborn and what is experienced in one’s lifetime become fused. Acknowledging the obvious is not to embrace the drug-based paradigm — I yield to no one in my loathing for coercive psychiatry and the use of neurotoxins — but it leads to better, more effective interventions than talk therapy.

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      • If your “depression” is actually an iron or B-12 deficiency, then yes it’s medical. If your psychiatrist diagnoses you with some endogenous depression assumed to be caused by some natural defect and prescribes antidepressants that he/she expects you take for life while your body is starving for oxygen, for instance, it’s medical malpractice and bulls*it.

        This ain’t rocket science.

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      • I had a vitamin deficiency in my teens which mimicked depression and it was resolved by taking vitamins.
        Others may have thyroid or other hormonal issues that can also cause depression.
        You don’t treat an underactive thyroid with antidepressant but goodness knows the pdocs sure try.

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        • engineer,

          Yes. There is a great need to distinguish between depression that stems from a genuine biological pathology (e.g., thyroid problems), and depression that stems from adverse life events or from a joyless, treadmill kind of existence. The former is a genuine symptom of a genuine illness. The latter is not an illness, but is constantly so presented by psychiatry.

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  7. Cpuusage,

    please make an effort to understand posts that you are responding to. The operative word is epigenetics. The environment changes biology (the expression of one’s genes) and those changes are passed on. Is it inborn is it it one’s life experience? It is clearly both.

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    • i have no trouble taking a genuinely integral/holistic view on these matters.

      There are epigenetic effects within genetics – but that doesn’t explain their entire function – no – far from it – there is gene mutation at conception & numerous other genetic ‘mechanisms’ at play. We’re hardly scratching the surface in our understandings of genetics & especially how that relates to the brain/neurology/CNS/physiology, in combination with consciousness.

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  8. Thank you, Bonnie Burstow, Ph.D for writing this book, and Phillip Hickey, Ph.D for letting me know about it on Mad in America. This would be a great article to share with my mom, who does not trust my experientially-based feelings about psychiatric medications or psychiatry in general and who seems to trust my psychiatrist’ beliefs more. I don’t know if I could convince her to read this, as she does not like to read, and she especially may not want to read an opposing opinion to my “Doctor’s,” but if I could get her to read it it may be of so much value to me in helping her to understand where I am coming from, as I have failed in that regard. I’m not good at facts. I’m not particularly interested in them, and I’m even worse at retaining knowledge of them. The fact that you are a Ph.D and wrote a well-researched and scholarly book about this subject, coming from a different perspective from mainsream Psychiatry would do a lot toward prying open her brain to consideration of what I consider my own truth/reality, and maybe start a change for me. (I’m on meds, and I’ve always lived with her).

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    • Good luck with what you are confronting, Linda Ale. There are sections in my book that particularly and very deliberately speak to parents, and it just might come in handy with your mom. If she would agree read it to the end, while I cannot promise her mind would change, for it could just anger her, there is also a possibility that she would seriously reconsider her position.

      All the best.

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