Medical Nemesis Revisited: Physician-Caused Anger, Despair & Death

Bruce Levine, PhD
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Regaining power over our own health—power that has been taken from us by uncaring bureaucracies and arrogant authorities—was the goal of Ivan Illich’s 1976 book Medical Nemesis, which detailed an epidemic of physician-caused death and illness. Unfortunately, this epidemic continues, and so does an epidemic of physician-caused anger, despair and crazy-appearing behaviors.

It is today not news that American medicine is killing us in huge numbers. Even the American Hospital Association now admits to 98,000 deaths per year caused by hospital mistakes, and recent research shows this total is far higher. In 2013, the Journal of Patient Safety reported that, at the lower limit, 210,000 deaths per year are associated with preventable harm in hospitals, and that the “true number of premature deaths associated with preventable harm to patients is estimated at more than 400,000 per year.” That makes it the third leading cause of death in the United States (behind heart disease and cancer). And this total doesn’t include outpatient treatment errors, which research shows include a similar amount of malpractice.

Among the lengthy list of preventable medical errors resulting in death, it is especially drug use errors, communication failures and diagnostic errors that result in another medical nemesis: They can make us appear—and sometimes feel—like we’re “crazy.”

Investigative journalist Robert Whitaker, in his 2011 book Anatomy of an Epidemic, has brought attention to the research showing that psychiatric drugs, for many patients, can result in mild and episodic emotional problems becoming severe, chronic, and disabling ones. For example, an adverse effect of antidepressant and ADHD stimulant drugs is mania, which can result in a bipolar, psychotic diagnosis.

While I’ve seen several examples of these psychiatric drug adverse effects that Whitaker reports, what I’ve heard even more from patients in my three decades of clinical experience is that many of their doctors’ routine communications, diagnoses, and standard treatments can be invalidating and infuriating.

An American Journal of Medicine study (February, 2015) about the effects of doctor communications on a small sample of pain patients reported that a lack of understanding and acceptance can create anger and distress. Invalidated patients reported feeling dismissed and disbelieved, resulting in hopelessness and anger. In an interview with the study’s lead author Maddy Greville-Harris, she stated, “Our earlier work too, suggests that receiving non-understanding feedback can have very powerful effects.”

A generation ago, the idea that invalidating, incongruent, catch-22, and double bind communications from authorities—be they military commanders, doctors, or parents—could be “crazy making” was mainstream discourse among my fellow psychologists. However, Big Pharma drug sales benefit from a strictly biochemical view of mental illness, and a major agenda of the National Alliance on Mental Illness (NAMI) is to abolish “parent/authority blaming” with regard to mental illness; drug companies have funded NAMI, which has successfully made it politically incorrect to discuss communication by authorities as one potential cause of disturbing behaviors.

How Diagnosis Can Render Us “Crazy”

My experience is that, when it comes to medical interactions, there is no bigger source of resentment, anger, helplessness, depression, and behaviors that are deemed “crazy” than the experience of not being taken seriously. Such invalidation can be caused by doctors’ misdiagnoses in two major ways.

One way is that when physicians can’t figure out an organic cause for a patient’s physical suffering, many of these doctors become frustrated and even angry with patients—and label them with psychiatric diagnoses. This is the subject of Chloe Atkins’ book 2010 book My Imaginary Illness.

When Atkins was 21 years old, she developed serious motor skill problems and at times couldn’t walk. Doctors could not figure out what was physically wrong with her, and so they declared that it was “all in her head,” and she was given psychiatric diagnoses such as conversion hysteria. For the next 20 years, her physical symptoms were not taken seriously. Finally, Atkins found a physician who did take her physical symptoms seriously and diagnosed her with a form of Myasthenia Gravis for which she was successfully treated.

But Atkins remains afraid that, given the psychiatric labels that remain in her medical records, she is still vulnerable to once again being stigmatized as a “head case.” Such fear makes Atkins appear mentally ill to those authorities who equate a fear of doctors with paranoia.

Atkins is not alone. I recently consulted with a woman who, after years of misdiagnosis, figured out on her own that her physical and psychological symptoms were caused by pernicious anemia, a physical condition that can be treated with B12 injections, a simple and relatively inexpensive treatment which continues to be successful for her. But her medical records include diagnoses such as “somatic pain” and “somatoform” (which means that symptoms cannot be traced to any physical cause), as well as multiple other psychiatric diagnoses. These psychiatric diagnoses create a great deal of anxiety and anger for her because for any physical problem she may have, many doctors will not attempt to get to the root physiological cause; instead, based on the psychiatric diagnoses in her medical records (that she has so far been unable to have expunged), her physical complaints are dismissed as psychiatric issues. Her fear and anger seem quite reasonable to other people in her situation, but for doctors and even for some of her family members, she appears paranoid.

Beyond the misdiagnosis of physical illnesses as psychiatric ones, doctors often diagnose a person with a psychiatric disorder when that person’s so-called symptoms are actually normal human reactions.

So, suppose the love of your life suddenly dies and you find yourself having difficulty concentrating and making decisions, having difficulty sleeping, lacking any appetite or interest in once pleasurable activities, lacking any energy, and pretty much immobilized. And suppose you happen to have your annual physical exam three weeks after this death, and you report how you are doing to your doctor. Does your doctor simply assure you that you are experiencing a very normal grief reaction? If your doctor follows the American Psychiatric Association’s latest diagnostic manual, the DSM-5, your symptoms indicate that you have the mental illness of depression, and that doctor will likely prescribe antidepressant medication. If you reject medication, you may be labeled in your medical records as treatment noncompliant.

“Diseasing” normal reactions is especially common with children and adolescents who are rebelling against oppressive environments; doctors simply label them with mental illnesses. When our inattention, depression, anxiety, and distrust are quite normal reactions but are instead deemed mental illness, this can be enraging—and then that rage, too, is determined to be a “crazy” reaction.

The Case of Ernest Hemingway

In the last years of his life, Ernest Hemingway became extremely depressed and ultimately committed suicide in 1961. The origins of his depression are uncertain—one of many possible causes may have been ongoing severe pain from the physical damage caused by multiple injuries. What is certain is that not only did doctors not help his depression, but, by Hemingway’s own words, doctors made him more hopeless.

Hemingway’s doctors leaped to diagnostic conclusions of paranoia about what we now have evidence were Hemingway’s very valid fears. And these diagnostic conclusions resulted in his depression being viewed as psychotic depression, which led to multiple electroshock treatments (ECT) that resulted in Hemingway feeling even more depressed, hopeless and suicidal.

By 1960, Hemingway was depressed and sounded deeply paranoid to those around him. His friend and biographer A.E. Hotchner recounts how Hemingway and another friend (Duke) met Hotchner’s train in Shoshone, Idaho, for the drive to Ketchum, Idaho. When they did not stop at the bar opposite the station as they usually did because Ernest was anxious to get on the road, Hotchner asked Hemingway, why the hurry? Hemingway replied, “The feds . . . It’s the worst hell. The goddamnedest hell. They’ve bugged everything. That’s why we’re using Duke’s car. Mine’s bugged. Everything’s bugged. Can’t use the phone. Mail intercepted.”

But was Hemingway actually experiencing delusions? Later, Hotchner discovered the FBI had in fact placed Hemingway under surveillance, and Hotchner believes that it is likely that Hemingway’s phone was tapped. Hotchner wrote:

Decades later, in response to a Freedom of Information petition, the FBI released its Hemingway file. It revealed that beginning in the 1940s J. Edgar Hoover had placed Ernest under surveillance because he was suspicious of Ernest’s activities in Cuba. Over the following years, agents filed reports on him and tapped his phones. The surveillance continued all through his confinement at St. Mary’s Hospital. It is likely that the phone outside his room was tapped after all. In the years since, I have tried to reconcile Ernest’s fear of the FBI, which I regretfully misjudged, with the reality of the FBI file. I now believe he truly sensed the surveillance, and that it substantially contributed to his anguish and his suicide.

Hotchner feels guilty for misjudging Hemingway’s fears, but it was psychiatrists’ arrogant certainty that Hemingway was paranoid and thus psychotically depressed which resulted in treatments that, by Hemingway’s own words, made him more hopeless and suicidal. According to another Hemingway biographer Jeffrey Meyers, Hemingway was treated with electroshock (ECT) as many as 15 times in December 1960, then in January 1961, he was “released in ruins.” Hotchner reports in Papa Hemingway that Hemingway’s loss of memory caused by the ECT made him even more depressed and hopeless, as Hemingway stated, “Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business?” In July 1961, soon after Hemingway had been given still another series of shock treatments, shortly before his 62nd birthday, he committed suicide.

Can the Medical Nemesis Be Abolished?

What can halt this epidemic of physician-caused death, illness, anger and despair?

Medical Nemesis author Ivan Illich clearly acknowledged there are valuable aspects of modern medicine, but he knew that much of it is deeply problematic. And while Illich greatly admired dissident, whistleblowing physicians, he knew that there are not enough of them in places of power to transform healthcare, and so he warned, “What is dangerous is a passive public that has come to rely on superficial medical house cleanings.”

Illich instead hoped that “The crisis in medicine could allow the layman effectively to reclaim his own control over medical perception, classification, and decision making.” Recognizing the enormity of uncaring bureaucracies, greed-driven institutions, and arrogant doctors, Illich believed that change will not come from inside the medical establishment, and so he instead urged the public themselves to regain power, “My argument is that the layman and not the physician has the potential perspective and effective power to stop the current iatrogenic epidemic.”

Why then has the public not yet stopped this epidemic of physician-caused anger, despair and death? While many Americans have been touched by it and are keenly aware of it, my sense is that much of the public feels helpless to change it. Thus, the job of dissident healthcare professionals is to:

  1. Validate the public’s perception of this medical nemesis,
  2. Encourage patients, when it makes sense, to challenge authorities, and
  3. To energize the public by describing how in fact they do have power.

Patients can demand to be taken seriously, and all of us—patients and dissident professionals together—can help one another to be taken seriously.

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23 COMMENTS

  1. Yes, I will respond to uncaring bureaucracies and arrogant authorities.

    https://www.madinamerica.com/2015/04/stay-psychiatric-hospital/#comment-64163

    8 hospitalizations

    1) 2 months – 15 years old
    2) 1 week – 15 years old
    3) 3 days – 19 years old
    4) 1 week – 29 years old
    5) 1 week – 31 years old
    6) 1 month – 32 years old
    7) 1 week – 32 years old
    8) 1 week – 38 years old

    In the first hospitalization I learned by getting my ass kicked that you are NOT allowed to talk about your problems (specifically, sexual abuse). I learned suppression and brainwash, and control by drugging.

    In the second hospitalization I learned that psychiatric detention is imprisonment and punishment.

    In the third hospitalization I learned that staff could do absolutely nothing for me, my troubles and my sufferings.

    In the fourth hospitalization I learned the idiocy of staff as they failed to recognize me.

    In the fifth hospitalization I learned the sadism of a wholly ignorant nurse.

    In the sixth hospitalization I learned the horrors of both the ill and the staff, and the mindlessness of drugging. Note: I also learned the backwards morals that psychiatric detention is more business, less care.

    In the seventh hospitalization I learned that my dire ill-health would forever go unrecognized, uncared for and untreated.

    In the eighth hospitalization I ascertained my eternal nightmare.

    Hemingway was trapped in the same dimension I’m trapped in: it IS Hell.

    It’s like this is a movie instead of reality. Makes me sick to death.

    • Bruce,

      I always appreciate reading your posts, both here and elsewhere on the internet, thank you for all that you do. And given my medical records show proof I dealt with both a “Dr. #22” and a “double bind.” And “A generation ago, the idea that invalidating, incongruent, catch-22, and double bind communications from authorities—be they military commanders, doctors, or parents—could be “crazy making” was mainstream discourse among my fellow psychologists.”

      I hope you will add the clergy to your unethical “authorities” list. Especially since it’s been confessed to me by an ethical subsequent pastor, who was kind enough to look over my chronologically typed up medical records and research, and confessed that I’d dealt with the “dirty little secret of the two original educated professions.” Apparently, any time a doctor or pastor wants to cover up easily recognized iatrogenesis or medical evidence of child abuse, the psychiatric industry’s “crazy making” maltreatment is their answer.

      Especially now that “Big Pharma drug sales benefit from a strictly biochemical view of mental illness, and a major agenda of the National Alliance on Mental Illness (NAMI) is to abolish ‘parent/authority blaming’ with regard to mental illness; drug companies have funded NAMI, which has successfully made it politically incorrect to discuss communication by authorities as one potential cause of disturbing behaviors.”

      This has, however, also made it extraordinarily easy for the “authorities” to cover up child abuse, as my ex-pastor did. His neighborhood had the highest suicide rate at his local high school in the nation (US), by the time my child was in high school. And, of course, he was heading up the committee to point out the “at risk” children to the psychiatric industry. And all the kids who killed themselves, from my understanding, had been psychiatrically defame and drugged.

      And given John Read’s research on the number of schizophrenics who have dealt with adverse childhood experiences and the absurdly large number of children admitted with medical evidence of child abuse who’d been also been diagnosed as “psychotic,” although I do understand why doctors don’t want to deal with this problem. And the medical proof the antipsychotics actually cause the symptoms of schizophrenia from drugs.com, and iatrogenically turning people into “mental” patients can be highly profitable for the medical community:

      “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.”

      It strikes me as highly probably, given that there’s no genetic proof any of the DSM disorders are actually real “genetic” illnesses. That the most likely cause of schizophrenia, and perhaps all the “major mental illnesses,” today is likely doctors misdiagnosing children or adults dealing with child abuse issues as “psychotic,” then creating the symptoms of the “major mental illnesses” with any and all of the psychiatric drugs.

      Personally, my family is still dealing with a religious cover up of the sexual abuse of my child (with medical evidence of the abuse now handed over) by a religion known to be doing this.

      http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CB8QFjAA&url=http%3A%2F%2Fwww.virtueonline.org%2Flutherans-elca-texas-catastrophe-coming-lesson-episcopalians&ei=fkkrVamUB8HZgwS-m4SwDA&usg=AFQjCNFCLdn2fWTrsQEfb7pz44zbEXdOnw&bvm=bv.90491159,d.eXY

      I don’t believe the medical industry being in the business of covering up child abuse for profit with psychiatric stigmatization and torture is in the best interest of society as a whole, despite this being the easiest and most convenient way of dealing with such a deplorable situation.

      9, I pray to God you recover, and am terribly sorry for the psychiatric / medical cover up of the child abuse you dealt with. It makes me sick to death as well. I’m so incredibly sorry for what you’ve been through. My prayers are with you, I pray to God you escape, and recover. My best to you.

  2. …an adverse effect of antidepressant and ADHD stimulant drugs is mania

    Thats what happened to me and because its more important to cover up the liability of the malpractice by blaming the victim, I had a course of further malpractice and a ruined medical record. Its too bad that a person can fix their credit report and wipe away blemishes after 7 years but medical records can remain stained for life. Misinformation on a medical record can deny a person proper care in medical situations which can be life threatening.

    • S1w2f3,

      I had the common symptoms of antidepressant withdrawal syndrome misdiagnosed as bipolar, too. And I have found (hopefully) an ethical doctor who’s taken the bipolar misdiagnosis (according to the DSM-IV-TR) off my medical records. My prayer is I will be able to get appropriate medical care in the future, and it does seem this doctor is working with me to try to provide this.

      I switched doctors (get away from all psychiatrists), and brought all my medical research (and MiA is a wonderful source) in with me on my first appointment with him. And when he claimed I was wrong about one detail, I asked him if he’d like to google it, I knew I could prove I was correct. He eventually conceded to the reality that stigmatizing people with invalid disorders (according to the head of the NIMH) was defamation of character, and that defamation of character is technically illegal in this country, so took the misdiagnosis off my medical records.

      My second physical with him was just a couple weeks ago, and it was a two hour teaching physical, I would imagine he was hoping to get to know me a little better, since he was a little taken aback by a patient who knew more about the drugs than he did, on my first appointment (by the way, I chose a doctor I thought would be very self confident, the head of family medicine, at a nationally well respected hospital). The appointment seemed to go well, except the student was quite nervous. But she definately knew less about medicine than anyone in the room, and was kind enough to say she was impressed at my knowledge of medical terminology.

      I agree with Fiachra’s comment below, don’t complain too much, although if you complain too little, and say you’re just in for a physical, it confuses a medical student. But the medical and pharmacutical industries have oversold their actual knowledge, doctors don’t actually have answers and are currently very misinformed due to the pharmacutical industry publication bias. At this point, they just seem to have drugs that make you so sick your real life problems pale in comparison.

      But once you understand the etiology of your illness (hand your doctor a copy of Whitaker’s book “Anatomy …” if need be). And point out the misdiagnosis to an ethical doctor, you can get the psychiatric defamation off your medical records. At least, so far it seems to be working for me.

      I will mention I found the drugs.com drug interaction checker quite helpful in my medical research also. The bipolar drugs do cause the schizophrenia symptoms. And look at the “professional” information, not just the “patient” information, on that site. My best to you in correcting your medical records, and it is shameful the doctors are stealing people’s time in this manner. But not all doctors are appalling thieves and poisoners.

  3. Thank you, Bruce. You are one of the professionals who heal on this site, instead of causing pain to many of us.

    When I have my support system and research lined up, I’m challenging my diagnosis (given in 5 min. after a 20-hour encarceration in emergency room overnight) and I plan to use whatever happens as a basis for a class-action suit. 10-minute diagnoses that put the individual in peril for the rest of his/her life are unacceptable and should be, WILL BE if I have anything to do with it, illegal.

  4. Ah, Hemmingway – sounds like another psychiatric success story! I suppose once he killed himself, his symptoms abated completely – a total cure.

    It is disheartening to know that people are still so mesmerized by doctors’ aura of scientific exceptionalism.

    — Steve

    P.S. It is important to note that many of the deaths due to medical care are NOT due to accidents or malpractice – they are due to side effects of properly prescribed and properly administered medications. Remember Viiox…

    • Let’s ged rid of psychiatry… Let’s replace it in its entirety with psychotherapy, and psychotherapy alone.

      After all, the facts show that severe “mental illness” are based on trauma and emotional distress. CBT and other very popular treatments are “evidence-based” – they’re the new magic cures.

      In fact, a good therapist can help you overcome almost any physical condition. Physical conditions in the “mentally ill” are somatic – signs of underlying trauma, always.

      Talk, talk, talk… and more talk. That’s what works. Every time. Like magic.

      My apologies, but I had to get that off my chest.

      • The psychiatric industry has apparently placed all their cards in one basket, their belief the DSM disorders are completely “genetic” disorders. But the medical evidence has now come in showing the DSM disorders are largely either normal human behaviors and emotions medicalized (as in ADHD and depression), or completely iatrogenic illnesses (as in bipolar and schizophrenia).

        The “chemical imbalance” theory of “mental illness” no longer has any credibility, other than that drugs do create “mental illnesses.”

        Whitaker, and others, point out that doctors cause the serious symptoms of the so called “mental illnesses,” mania and psychosis, via the ADHD drugs and antidepressants themselves.

        http://www.alternet.org/story/146659/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america

        https://books.google.com/books?id=KMapbFl0ZZMC&pg=PA59&lpg=PA59&dq=iatrogenic+bipolar&source=bl&ots=wdK5ki8N3s&sig=JQn4ukuOkcxFJVya6WKIwH9e2fQ&hl=en&sa=X&ei=3G0sVYieHIe1sQSwkoC4Dg&ved=0CDYQ6AEwAzgK

        The serious “mental illnesses,” like the “childhood bipolar epidemic” and bipolar in adults itself, are actually caused by the ADHD drugs and antidepressants. And drugs.com points out the reality that the gold standard “cure” for bipolar and schizophrenia, the antipsychotics / neuroleptics, actually do cause the schizophrenia symptoms”:

        “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.”

        And the most common symptom of all “schizophrenics” today (since there’s no genetic correlation), according to John Read, a psychologist, is “adverse childhood experiences” or “child abuse.” But is it actually in society’s best interest for the mainstream medical community to continue to keep the child molesters on the streets, and cover up child abuse of children, by turning the victims of child abuse, into schizophrenics, via misdiagnosing and defaming the victims of child abuse with the neuroleptics / antipsychotics?

        I understand these crime are, and have historically have been, profitable for the medical community, however I personally find them morally repugnant. And I hope some day others will also find them unacceptable, as well.

      • CBT was not something I needed while in severe life crisis. Psychiatric drugs were also unnecessary and not something I needed.

        I had been attending an “outpatient day hospitalization” CBT program but eventually had to walk out and completely end my participation. I was lost and entirely caught up in all the bindings of domestic violence. I was unavailable to anything or anyone. The only thing that mattered was the marriage, which finally ended with me on my knees, praying to God, and covered in bruises.

        STOP MEDICALIZING LIFE, PLEASE.

  5. I feel a certain affinity with the Hemmingway case.

    Drugged with benzos without my knowledge, and then locked in a mental institution. The drugging documented, and as i had no mental illness the detention was an unlawful deprivation of liberty and kidnapping. However, the hospital hides the documents (quite possibly destroyed them) and I become delusional to anyone I speak to, and the trauma of the kidnapping is seen as evidence of an illness, and surely they were right in kidnapping me in the first place.

    Like Hemmingways biographer, I hope to copies of the documents demonstrating the drugging and kidnapping perhaps restore some of my destroyed credibility.

    Maybe not, God (tClinical Director) has spoken and we dont like that truth.

    Great article.

      • Hey chrisreed,

        I’m not what would be described as an optimist lol.

        But there has been something happen in my state that really got me thinking about your question. Our shadow Minister for mental Health is an openly gay man. Back in the 70s he was a mentally ill man according to psychiatrists and would have been treated very badly by these people. In fact, back then there would have been gangs waiting outside parliament to beat him up, and if he went to the police, they would have probably given him the same treatment.

        Today that has changed significantly (though whether it’s enough is debatable). I feel sure that he is aware of this history with the psychiatric industry, and given the power of government, may make some significant changes as a result.

        So, is it possible? Yes, but the community needs to stop placing these barriers in front of people, and then using peoples failure to achieve as evidence of their illness.

        Not very clear but…. I just hope that someone who has first hand experience of how stigma works, and the contribution of psychiatry to that might just make some changes that have a real effect, and not just this statistical juggling act we have at present.

        Regards
        Boans