Psychiatry’s “Institutional Corruption”—A Chat with Robert Whitaker and Lisa Cosgrove

Bruce Levine, PhD
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What does psychiatry have in common with the U.S. Congress? “Institutional corruption,” concludes Psychiatry Under the Influence (Palgrave Macmillan, 2015), which investigates how drug company money and psychiatry’s own guild interests have corrupted psychiatry during the past 35 years.

Co-authored by investigative reporter Robert Whitaker and psychologist Lisa Cosgrove, the foreword for Psychiatry Under the Influence is written by Harvard Law School professor Lawrence Lessig, who helped create Harvard’s Edmond J. Safra Center for Ethics’ lab on institutional corruption (where both Whitaker and Cosgrove served as Fellows).

Whitaker and Cosgrove—as does Lessig—distinguish between “individual” versus “institutional” corruption, between a “bad apple” versus a “bad barrel.” In individual corruption, a politician takes an illegal bribe. But in institutional corruption, nothing illegal may be occurring when, for example, politicians raise campaign money via special interest political action committees (PACS). And just as elected officials develop dependency on special interests and become beholden to these funders instead of the citizenry, Whitaker and Cosgrove conclude that the same thing has occurred in psychiatry, which has had its social mission subverted by drug companies as well as by psychiatry’s guild self-preservation and expansionism needs.

Both authors responded to questions that I had about their recently published book.

Bruce Levine: The corruption of psychiatry by pharmaceutical companies has been widely known since the 2008 Congressional investigation of psychiatry, reported by the mainstream media including the New York Times; and this corruption has been bemoaned by major figures in medicine such as Marcia Angell, former editor-in-chief of the New England Journal of Medicine. But what you are saying is that there is a second corrupting “economy of influence” that is not as well recognized by the public but which is even more problematic. Can you speak about that?

Robert Whitaker: There has indeed been much public attention on the corrupting influence of pharmaceutical money on American psychiatry. But the public’s focus on pharmaceutical companies as the main problem distracts attention from the larger corrupting influence, and that is psychiatry’s own guild interests.

In 1980, when the APA [American Psychiatric Association] published the third edition of its Diagnostic and Statistical Manual [DSM III], it adopted a “medical model” for diagnosing and treating mental disorders. The APA then launched a public relations effort to sell this new model to the public, which meant informing the public that psychiatric disorders are real “diseases” of the brain; that they are under-recognized and undertreated; and that psychiatric drugs are very effective—and disease-specific-treatments—for these disorders. The APA has relentlessly promoted that message to the public for 35 years.

This is a narrative that has served psychiatry’s guild interests well. Pharma money flowed to the APA and to academic psychiatrists and their medical schools; psychiatry’s influence in society dramatically increased; and psychiatry was able to present itself, to the public and to itself, as a medical specialty that treated diseases of the brain. Money, power, a boost in psychiatry’s public image—that is a powerful mix of rewards from a narrative.

The problem is that mainstream psychiatric research was not showing it to be true. Research failed to validate the disorders in psychiatry’s DSM; the chemical imbalance hypothesis fell apart long ago; and clinical studies of the drugs, including studies funded by the NIMH [National Institute of Mental Health] have shown that their short-term efficacy is of a very modest sort, and that they may do more harm than good over the long-term.

But the APA and academic psychiatry haven’t told the public that story of science, and that is because it runs counter to their guild interests. And, of course, the public relies on the medical specialty—as opposed to pharmaceutical companies—to be a reliable provider of information, which is why this corruption due to guild interests is so problematic.

Lisa Cosgrove: I would add to what Bob said that there was a clear scientific impulse to the APA’s creation of DSM III. As we wrote in our book, the APA set out to redo its diagnostic manual in order to address issues of reliability. Spitzer, the chair of the DSM III task force, did have the public’s interest at heart. He wanted to have a more scientific, empirically based taxonomy. It also should be noted, as part of this discussion, that no medical specialty or professional organization is immune to guild interests.

Bruce Levine: Psychiatry Under the Influence attempts to understand psychiatry’s denial and refusal to accept blame for its failures. So, for example, Ronald Pies, editor-in-chief of Psychiatric Times, refuses to blame psychiatry for the dissemination of the disproven chemical imbalance theory of mental illness (which fueled the dramatic rise of antidepressant use). Pies claims that the chemical imbalance theory “was always a kind of urban legend—never seriously propounded by well-informed psychiatrists,” and he blames Americans’ widespread belief in it on drug companies. You attribute much of psychiatry’s denial and evasion of responsibility to “cognitive dissonance theory”—can you speak about this?

Robert Whitaker: Again, this is part of the “institutional corruption” lens we were using to study the institution of psychiatry and its behavior. The assumption is that individuals within the institution can’t see that their behavior has been corrupted by “economies of influence.” And so, when those outside the institution begin pointing out the corruption in it, those within it may construct a narrative that protects their self-image. In this case, psychiatrists need to protect their image as honest researchers and as physicians who put the interests of their patients first. Cognitive dissonance theory reveals that there are a myriad of ways that people protect themselves in this manner.

We can see that cognitive dissonance quite clearly in Ronald Pies’ claim that the “chemical imbalance” theory was always a kind of urban legend. The fact that psychiatrists, for a long period of time, regularly told patients that the drugs fix chemical imbalances in the brain represented a fundamental betrayal of those patients. So once the chemical imbalance story fell apart publicly, what does Pies do? Does he admit, even in his own mind, that psychiatrists told this false story to patients for decades? No, he says well-informed psychiatrists never said it, and places the blame on the pharmaceutical companies for telling that false story. Pies makes this argument even though it is easy to document that the leaders of the APA often told this chemical imbalance story to the public, and that, even today, many prominent psychiatrists serve on advisory boards of patient advocacy groups that continue to tell it to the public.

Lisa Cosgrove: One of my favorite quotes is by Carol Tavris: “Mistakes were made, but not by me.” None of us are immune to cognitive dissonance. It is part of the human condition to have implicit biases and remain blissfully ignorant of them.

Bruce Levine: You talk about the “social injury” caused by psychiatry’s institutional corruption, and I sense that you both are especially troubled by the injury incurred by young people, especially foster kids. Can you elaborate?

Robert Whitaker: This is one of the reasons that the institutional corruption framework can prove so useful. It requires an examination of the social injury resulting from the corruption, and when you do that in this case, you see how vast it is. We, as a society, have organized ourselves—both individually and as a society—around a false narrative of science. And what has been the resulting social injury? It has led to the pathologizing of millions of children, which is doing extraordinary harm; it has given us an impoverished philosophy of being, with its ever-narrowing boundaries of what is deemed normal; and it prevents us, as a society, from trying to create a more just society, since problems are located within the brain of the individual, rather than in poverty, poor schools, and so forth. Society gets a free ride with this model.

The injury done to children in foster care illuminates, with great clarity, this larger societal injury. Who are the children that end up in foster care? They are children who are born into families that are unable to provide for them. The children may be neglected, abused, and so forth—they in essence drew a short straw in the lottery of life. But what do we do in the post DSM III era? We don’t ask what happened to these children and try to create nurturing environments for them. Instead, we regularly diagnose them with a psychiatric disorder and medicate them. Of course the drugs—and this is particularly true of the antipsychotics—make it more difficult for the child to think and to experience emotion. And thus the social injury from this corruption: we as a society think we are providing medication to fix a disease the child has, while the child is now burdened with the stigma of a diagnosis and the burden of the medications.

Lisa Cosgrove: In order to fully address this social injury in marginalized populations, such as foster care children, we also need to understand that the way our healthcare system is structured deincentivizes prescribing providers from taking a more contextual approach. If you talk to clinicians on the ground, that is what they want to do, but they are incentivized to prescribe.

Bruce Levine: You describe institutional corruption as a problem of “good people” doing “bad things” because of a corrupted environment. I personally know a young politician who genuinely sought to do public good but quickly grasped the reality that candidates with the most money win elections, and he was compelled to either focus on raising money or not run at all. Is psychiatry really in that same situation? Psychiatry is not facing a big-spending opponent, and it has had every opportunity as the “incumbent” to gain public confidence by simply being honest and effective. And individual psychiatrists can reject drug company incentives and still make a good living, at least compared to most Americans—and some dissident psychiatrists do reject those incentives. Are you being too easy on psychiatry?

Robert Whitaker: Perhaps, but that too is part of the of the institutional corruption framework: any path to reform must start with a generosity of spirit, which avoids condemnation of individuals—regardless of whether some individuals within the institution deserve such condemnation—and instead focuses on how “economies of influence” have created an environment where “corrupt” behavior has become normalized and unrecognized. The point is that the framework seeks “understanding” rather than “condemnation,” with the thought that such understanding will have two effects. First, in the absence of condemnation, leaders in the institution may be better able to see how the economies of influence have corrupted their behavior. Second, it will focus public attention on how to neutralize the economies of influence as a solution to the corruption, as opposed to stirring public anger toward individuals within the institution.

Lisa Cosgrove: I think this question points to a problem with the societal discussion we have been having. To me, this question of whether we were too easy on psychiatry is close to asking, are you “antipsychiatry” or “pro-psychiatry?” And I think when we pose questions or answers as dichotomies, we undermine the potential for solutions. I am not antipsychiatry; I am not pro-psychiatry. I hope that our book provides data that enables people to think critically about these issues. In my work as a researcher, I try to do empirical work that fosters such critical thinking, and helps people make more informed decisions about their mental health issues.

Bruce Levine: In your subsection on “Psychiatry’s Self-Image,” you had quotes from the 12 past American Psychiatric Association presidents who address psychiatry’s low professional self-esteem, upset that psychiatrists are not seen as real doctors and suffer demeaning jokes in medical school—and exalting APA members to “change the way the world thinks of psychiatry and the way we think of ourselves as psychiatrists” (Jeffrey Lieberman, APA president through 2014). In addition to trying to pump up psychiatrists’ self-esteem, a major role of the APA president is apparently to attack psychiatry’s critics—as Lieberman recently called you, Bob, “a menace to society.” Is there any hope of reforming American psychiatry?

Robert Whitaker: This is the bottom-line question, and unfortunately, when you apply this institutional framework to psychiatry, the answer becomes clear: American psychiatry, as an institution, is not going to reform itself. The guild influence is too strong; so too the cognitive dissonance. Lieberman is an example of this: He called me a “menace to society,” but what had I done? I had written and spoken about research that reported better long-term outcomes for unmedicated psychiatric patients, compared to those taking medication. But Lieberman can’t acknowledge that this could be the case, and so he needs to kill the messenger to protect his profession, and to protect his own beliefs. That is precisely why psychiatry can’t be expected to reform itself. The field, as a whole, is too invested in a narrative born of guild interests, and it has shown little sign of the introspection, as an institution, that could lead it to seriously reform its ways.

So what is a possible solution? It must come from an informed public that will see the need to strip psychiatry of its authority over this domain of our lives, and instead demand that the authority be vested in a multidisciplinary group of professionals, philosophers, and “users” of psychiatric care. Psychiatry could be a part of this multidisciplinary group, but not the ruler of it. But can this really happen? I am rather pessimistic, and yet, at the same time, the public is increasingly becoming aware that our society has organized itself around a false narrative, and that this is doing great harm, and so perhaps this will lead to society putting its trust in a more diverse, multidisciplinary group. I hope so, because this is a case of institutional corruption that is doing great harm to our society.

Lisa Cosgrove: What we were trying to highlight in our book is the harm that can be done when norms and incentive structures develop that undermine reflexivity and critical thinking. Although it is easy to vilify a few people, to effect real change, members of that organization will need to be willing to address the ways in which their guild interests took precedence over their public health mission.

In addition, the framework of institutional corruptions gives us tools to identify solutions and to think big. If we want to effect change, we need to change our current healthcare system. We have a society that thinks there is a pill for every ill, and a system that incentivizes the prescribing of pills. So there needs to be a paradigm shift, as well as public policy initiatives, that will foster an appreciation of the socio-political grounding of emotional distress.

 

106 COMMENTS

  1. I believe that psychiatry would be a safe, healing, and medically sound field of medicine today if deinstitutionalization had not been hampered by pill-pushing psychiatrists who wouldn’t stand up to the so-called “families of the mentally ill” groups and community mental health models that attempted to replicate long-stay hospitals (i.e. sheltered workshops, congregate housing, forced drugging, etc.). If only Mad people had had enough time to establish themselves as full and free citizens before we got pummeled by sanism 2.0. For the last 35 years, Mad people have been living through our Jim Crow era. I hope with all of my heart that I’ll live to see this era end.

    • Agreed on what you wrote. I have been through all that; sheltered workshops, psych0-social rehab, vocational rehabilitation, day hospital, even the regular mental hospital route include the drugging and the therapy sought to pry and invade into my mind; rather than assisting me in finding out my real uniqueness; my strengths and challenges which all would have helped me smile more each day. They are all demeaning and demoralizing and made me actually “sicker.” and of course in their eyes needing their illegitmate help even more. It was actually vocational rehabilitation that sent me down the road three times into the void of psychiatry. The first was when I went through a normal youthful career/identity crisis. It was the second two that really caused me the ongoing intentional pain. The second time was when I had just moved from one city to another and was looking for gainful employment. The second time was when I was again a client of Vocational rehabilitation and my sister passed away. I had been dismissed from a previous psychiatrist even though I was heavily medicated and needed to be monitored; because she was afraid she would not get paid since I had a high deductible insurance plan with my employer. I did leave that employer. I probably was on the way out of the system and eventually even off of the drugs for the second time; when the vocational rehabilitation figured I needed therapy because I had just lost my sister; who was also my best friend and roommate. You know, all I needed was someone understanding to talk to; not drugs and prying therapy. I got so messed up on the drugs that I became so paranoid in job interviews that I thought they already knew I was “mentally ill” and that’s why they were not hiring me or would ever hire me. I ended up on disability; which I still am on. I am no longer taking the toxic drugs and I won’t to get off disability and live the life I was meant to live. This probably started with the psychiatrists in about 1980 and has now grown into probably a billion dollar industry taking advantage of those when they are most vulnerable. I always remember when I was directed by my therapist in winter of 1991/1992 to see the psychiatrist for my first med review. She with great foresight said, “I don’t want to lose you.” She was exceptionally concerned at the prospect of a med review and being prescribed medications. I Lost her to cancer in 2002. And she did say; that may be the drugs worked a little in dampening some of my moods; but, she many times would not let me travel anywhere alone; because she would describe as “loopy” because of the drugs, I know. Still, I think in her little intuitive voice, she spoke for many loved ones who found those they cared about sentenced to a lifetime of unnecessary, toxic, addictive, fatal drugs. You do die twenty-five years earlier if you are on these drugs; yet others have to the death disagreed with me that it was not the drugs; but the effects of the “disease.” you see; the whole mental illness prison/conspiracy could be considered an urban myth like alligators in the sewer or blowing up a cat in the microwave; if it didn’t hut, maim, kill, destroy lives, dehumanize and demean people until all that is left of them is the rags and tags of being the walking dead. But, like the beautiful great American quilt is made from what made be considered rags and be reborn and resurrected into something worthwhile and esteemed; so can the person affected by the mental illness criminal conspiracy. As they say; what does not kill you makes you stronger. Thank you.

    • Montreal Gazette . Feb 26 , 1960 “Drug Manufacturers Brainwash Doctors”. Page 2 Top left

      https://news.google.com/newspapers?nid=Fr8DH2VBP9sC&dat=19600226&printsec=frontpage&hl=en

      Washington Feb 25 Dr Haskell J. Weinstein, a former research director for a big drug

      manufacturing company, today said doctors are being brainwashed by the drug industry.

      And his predecessor on the job with Charles Pfizer and Company – Dr. Martin A. Seidell

      – told the Senate Antitrust and Monopoly Subcommitte in a prepared statement that he

      resigned in protest against the firm’s “perverted marketing attitudes.”

      Weinstein aimed his testimony at the drug manufacturing industry in general, rather

      than at Pfizer. He said he had never met Seidell before Wednesday and that they were

      acting independently in their testimony.

      Weinstein criticized promotional activities by the drug industry, which he said

      sometimes gave physicians less than a full picture of the effect of new drugs.

      He charged that the result is that “the patient … is often exposed to drugs which

      have been incompletely evaluated and which not infrequently are hazardous.”

      “He (the physician) has been taught, one might almost say brainwashed, to think of the

      trade mark names of the drug at all times.

      “Even new disease states have been invented to encourage the use of some drugs..
      “He (the physician) has been exposed to remarkable little information concerning the

      efficacy of the drugs he is asked to prescribe. Instead he is seduced with gimmicks of

      all sorts in an effort to make him loyal to a particular product or a particular drug,

      with relatively little attention being paid to the specific merits of the drug”

      The Pfizer Company issued a denial of the allegations of both men.

  2. We’re expected to believe doctors but my own experience is that the
    “chemical imbalance” and the “chronic mental disorders” are not true.

    A person can end up in a psychiatric unit for any reason, if they are distressed they mightn’t be making much sense (and this can continue if they are not helped). It’s possible though to make complete recovery through normal human means.

    My experience is that it’s the medical treatment that causes the disability and long term problems, and it’s very difficult to get away from the drug dependency because of the drug rebound and withdrawal syndromes.

  3. I agree that the corruption of the medical profession (and psychiatry) by the influence of pharmaceutical companies has been ongoing since the 1950s, as was laid bare in the Kefauver hearings (quoted above I believe.) And psychiatry, as a guild, started protecting its “drugs are great” story at that time. But, if we look at our current conceptions of psychiatric disorders, and the great expansion of diagnoses and the use of psychiatric drugs, that has occurred since 1980s, when the APA published the third edition of its Diagnostic and Statistical Manual.

    • And yet the corruption of the medical profession has been ongoing and growing more entrenched ever since Pasteur first looked into a microscope and immediately misinterpreted the significance of what he saw . Although Royal Rife and Antoine Bechamp tried with all their best possible efforts and scientific evidence to correct his misinterpretation and plagiarism the formation of the AMA around a root core of pseudo science jugernauted forward blinded by the good intentions of unlimited profits . Of course the American Dental Association and the American Psychiatric Association, with the American Medical Association having by example shown the way to the greatest profit procurement, could only try their best to emulate a soaked in pseudo science profit making machine like no other , the AMA Big Pharma Combination. Read Robert Young’s book “Sick And Tired” for real scientific explanation of what really happened. Also study Rife and Bechamp ,scientists so real and accurate they have been taken out of history to protect ongoing profits .

  4. The most important parts of this article that I took out were:

    1) “(APA has informed) the public that psychiatric disorders are real “diseases” of the brain… and that psychiatric drugs are very effective—and disease-specific-treatments—for these disorders. The APA has relentlessly promoted that message to the public for 35 years.”

    The influence of these outright lies are why I react negatively to almost any item on MIA’s “Around the World” and “In The News”: because life problems are not illnesses, and medications should not be a part of helping most distressed people. Nevertheless, almost every article in the mainstream media overflows with lies about distinct “mental illnesses” existing, with the illusion that “schizophrenia” or “ADHD” are real and reliable, and that medications should be a front line treatment.

    2) “problems are (falsely) located within the brain of the individual, rather than in poverty, poor schools, and so forth. Society gets a free ride with this model.”

    Also right on point. It should be widely acknowledged that abusive parents and trauma of all forms frequently cause “schizophrenia” and other false-disease labels. APA needs to stop lying about parents not causing schizophrenia, and understand that identifying parents as causes of distress is different than blaming them. Further,”mental illness” does discriminate by social class and ethnicity, which is why more black and poor people experience psychosis, because they are more frequently exposed to the societal stresses that are the primary causes of getting a mental illness label. Is there any sentence which is more full of bullshit than “mental illness does not discriminate by social class or ethnicity?”

    3) “We don’t ask what happened to these (disadvantaged) children and try to create nurturing environments for them. Instead, we regularly diagnose them with a psychiatric disorder and medicate them.”

    Agree. This is not only true of children but distressed people of every age. Until or unless long-term individual psychotherapy, group therapy, peer-support groups, job training, and affordable housing are available, it is unlikely that this situation will change. There is no other “cure” or way of effectively managing severe distress and stunted personality development apart from nurturing relationships over a long period. As Robert Whitaker rightly stated, psychiatric drugs only stymie the ability to process and move past difficult feelings and experiences.

    4) Lastly, regarding Jeffrey Lieberman – this sad figure is the prototype for many psychiatrists who unconsciously make the following deal with the devil:

    “I will lie to my patients about the causes and validity of mental illnesses, offer them neuroleptics which reduce their long-term chances of recovery, and in return I expect the following: freedom from having to understand distressed people in depth, a high salary, false prestige and power, fancy cars, a big house, and the illusion that I am doing good by “treating mental illness”.

    This is the equation for far too many psychiatrists, who in my opinion are nothing more than pathological liars and parrots for a false, damaging ideology.

    I am similarly pessimistic to Bob Whitaker about the potential for change within psychiatry as a profession. and that is why I encourage everyone in distress to educate themselves and be as aggressive as possible in protecting themselves against the predators who masquerade as psychiatrists and in refuting the false disease model perspective. In my opinion, only if enough consumers educate themselves and actively reject the APA and psychiatrists’ poisoned offerings will large-scale change be seen.

    • “It should be widely acknowledged that abusive parents and trauma of all forms frequently cause “schizophrenia” and other false-disease labels. APA needs to stop lying about parents not causing schizophrenia, and understand that identifying parents as causes of distress is different than blaming them.”

      I agree completely. Abuse, oppression, toxic family dynamics are, by and large, denied as critical factors that create the phenomenon we call ‘mental illness.’ Why? Because these are repeated in therapeutic ‘relationships.’ An alliance between psychiatrists and parents can be a stonewall for the vulnerable client. It’s over the top and insane-making, but that’s the way it is these days.

      Oppression is oppression, and it is passed down generationally until someone is brave enough to speak their truth, which will cause resistance and discomfort to others, and begin a process that will change the system. There will be attempts at sabotage along the way, by the ones whose power is challenged.

      That’s a hefty responsibility, but it has to start somewhere. Abuse of one’s position of authority leads to the oppression of others, and chronic fear. This will eventually lead to confusion and feelings of helplessness, aka suffering.

      The drugs cause problems, but lack of integrity, deceit, power abuse, and lack of empathy is what is epidemic and insidiously toxic. This can start in the family, and repeat in psychotherapeutic treatments, as well as dealing with social services. How do we change that?

  5. “And what has been the resulting social injury? It has led to the pathologizing of millions of children”… Just released, “The Australian Child and Adolescent Survey of Mental Health and Wellbeing” Almost one in seven (13.9%) 4-17 year-olds were assessed as having mental disorders in the previous 12 months. This is equivalent to 560,000 Australian children and adolescents. ADHD was the most common mental disorder in children and adolescents (7.4%), followed by anxiety disorders (6.9%), major depressive disorder (2.8%) and conduct disorder (2.1%). Based on these prevalence rates it is estimated that in the previous 12 months 298,000 Australian children and
    adolescents aged 4-17 years would have had ADHD, 278,000 had anxiety disorders, 112,000 had major depressive disorder and 83,600 had conduct disorder. http://youngmindsmatter.org.au/ http://health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/$File/child2.pdf

    Sadly our predominant model in Australia is also KOL psychiatrist led, with GPs doing most prescribing, including to kids, encouraged by KOLs. And as in the USA, “our healthcare system is structured deincentivizes prescribing providers from taking a more contextual approach. If you talk to clinicians on the ground, that is what they want to do, but they are incentivized to prescribe.”

  6. I will be short about this-again Robert Whitacker falls on his own sword, on his own site.
    Cognitive dissonance is the inability to hold two contradictory beliefs. Robert Whitaker , while railing against the very flawed institution of psychiatry, provides NOTHING to replace it.

    It is his dearth of understanding about what makes people unhappy, that allows him to rail against windmills.

    Dr. Whitacker, my suggestion to you if you want to be constructive, is provide a paper ,science based, on what should supplant the agreed mis handling of mental illness propagated by psychiatry.
    You have not, and likely will not. It is easier to knock down a house, than to build one-which you have not.

    TS Monk.

    • Here are my answers, Theloniusmonk, for what should supplant the agreed mishandling of “mental illness”:

      Free or low-cost long-term psychotherapy, peer support groups, job training, and affordable housing. And promotion of the idea that with sufficient resources, the most serious developmental-life problems (“mental illnesses”) can be overcome or largely ameliorated.

      In other words, hundreds of billions of dollars shifted from overmedicating and providing disability checks to the “mentally ill”, redirected towards restorative psychological-social support at large scale. Basically, things that are politically impossible for today’s leaders so long as corporate interests and lies about biological/genetic causes for life problems predominate.

      If we think in a common sense way about what enables young people to become psychologically healthy, it is: Loving, reliable parents, supportive peers, good mentors and teachers, safe homes and neighborhoods, good education, enough food, etc. The lack of good relationships and basic security causes “mental illness”, along with physical abuse, sexual abuse, war, and other traumas. If we accept this, it follows that love and hope, plus sufficient food/housing/education, translated into various psychosocial programs as outlined above, should be the new “house.”

      What house would you build to replace today’s failed psychiatric efforts, Theloniusmonk?

      Or do you have no answer, just as you accuse Whitaker of lacking one? It’s ironic that you criticize him for not providing a solution, but you don’t provide anything yourself. Hopefully you’ll have the courage to put yourself out on a limb instead of just taking pot shots.

      • I want to add that Theloniusmonk has a point that Whitaker is not in general discussing many ideas for replacing or improving the way psychiatrists “treat” life problems. Without something to plug the emerging black hole, attacks on medication/diagnostic-focused approaches won’t gain traction. On the other hand, that was not really the point of this article.

        But Whitaker could say more about the potential of psychotherapy, peer support, crisis respite centers, and other low or non-medication approaches. Maybe he is aware of the evidence but doesn’t think the data is that strong yet; I don’t know.

        If more encouraging data on non-medication psychological approaches for “madness” is needed, here’s some:

        Why Schizophrenics Do Twice As Well with Psychotherapy as Without (full paper): http://psychrights.org/research/Digest/Effective/BGSchizophreniaMeta-Analysis.htm

        Long-Term Psychotherapy Shown To Have Large Effect Sizes in Dozens of Individual Studies (full paper): http://www.centerforselfdevelopment.com/pdf/000004-effectiveness-of-long-term-psychodynamic-therapy.pdf

        The Helsinki Psychotherapy Study Showing Various Advantages for 3-year Over 6-month Psychotherapy Study (abstract only, I have the full paper if anyone wants it): http://link.springer.com/chapter/10.1007/978-1-60761-792-1_5

        To me, these stats are eye-popping – 67% of schizophrenics improving with an average of 2 years’ psychotherapy versus 34% improving without psychotherapy, across 2,600 clients (Gottdiener), medication plus psychotherapy having no advantage over psychotherapy alone for schizophrenics (Gottdiener); dozens of effect sizes in the 0.75 to 1.50 (large) range for long-term psychotherapy covering 1,000+ clients in 23 studies (Leichsenring), 350+ clients on average doing much better on various depression/anxiety measures in long-term 3-year psychotherapy than only short-term 0.5 year therapy, in a randomized study (Knekt).

        When you think about it, long term human help ought to blow long-term meds out of the water most of the time. People develop in human relationships, not on pills – only relationships can heal.

        Current studies showing that “medication and psychotherapy work about equally well” are a bunch of bullshit, because medication quickly dulls symptoms, whereas working through emotional conflict and learning to love take long periods of time. If these simplistic comparisons were extended from periods of a few weeks into periods of years, human love, understanding and support (concretized as psychotherapy, peer support groups, etc.) would decimate medications.

        I hope some billionaire will fund a study comparing the results of 2x/week psychotherapy for 3 years for depressed or psychotic clients, with medication only for those same clients for 3 years. Because the clowns in our government will not fund this. Those results could be very damaging to Big Pharma and psychiatrists.

        • Hi bdtransformation,

          I agree with you on the psychotherapy front.

          In the early 1990s I went to ‘MIND’ in London and they provided me with a ‘trainee’ psychotherapist (for free). He said he wasn’t qualified to discuss diagnosis with me, but to tell him about my situation right now. He said that he wasn’t going to give me his “recipe” for life because this mightn’t work for me.

          He told me that it sounded like there was a type of battery attached to me and instead of getting rid of the battery I could maybe learn how to keep it detached. He told me there was probably a lot of good ways to deal with the situation.

          (I was suffering from psychotropic withdrawal syndrome – and I had to learn to deal with the kind of problems I never had before).

          I found lots of good ways to deal with my ‘Problem’ but the supportive and insightful psychotherapy was very helpful.

          • Hi Fiachra,
            I am glad that you found help through therapy, or rather through a trusting relationship and exploration of what led you to be distressed, which is what happens in a good psychotherapeutic relationship.

            Being very general, psychotherapy in my opinion is the mirror image of medication in terms of efficacy – i.e. psychotherapy more often than not provides significant relief and help over the long term (i.e. 6 months plus), whereas zombification more often than not damages, discourages, and worsens long-term functioning. On the other hand, a small minority of people are helped by long-term medication, and a minority of people are damaged or get no help from psychotherapy.

            The short-term BS studies that psychiatrists put out comparing medication with 4 or 8 weeks of psychotherapy are pathetic and should be laughed at. “Medication and psychotherapy are equally effective” – what a bunch of horsecrap! This type of lying really upsets me. Psychotherapy is way better than medication over the long term of years for most, not all, people.

            To me the point of advocating against these misrepresentations is to undermine the flimsy house of cards that is American psychiatry, cause its eventual collapse, and provide the impetus for provision of far more psychotherapy and peer support programs for people in distress.

            I have this image of Jeffrey Lieberman saying, “On this sad day, a day on which I am selling my Mercedes and the McMansion I bought through lying to patients about the causes of their problems, I admit that my whole career has been one big lie. Psychatric diagnoses are not valid or reliable, medications are mostly ineffective over the long term, and it’s tragic that I lied to myself and the public for so many years about what really helps people in severe distress – understanding, empathy, long-term loving relationships, and basic needs for security, housing, friends, and work. Only now in my old age do I realize that I have essentially acted my whole life as a shill for corporations that played me like a puppet. Yes, I ruined thousands of lives by lying to people that their life problems were illnesses and prescribing brain damaging medications, while lying to myself that I was doing good. That is the legacy I leave, as a lifelong liar not even aware that he was telling lies, to my eternal shame.”

            That would be the day. What are the chances that someone would admit that to themselves?

          • Thanks bdtransformation

            My main problem in treatment was the medications, and then the dysregulation I experienced on withdrawing. My underlying problems would have been more understandable to a psychotherapist, but the withdrawal syndrome was the imminent.

        • Can you send me the studies showing psychotherapys effeciancy in treating schizophrenia? Norway has mandated that patients are to recieve drug free treatment if professionally ethical and if i can prove psychotherapy is at least as effecient in treating schizophrenia as drugs (even though id agree with you that its probably more so) i might get drug free treatment july 1 next year. Heres my email: [email protected]

      • Thank you for the thoughtful, constructive reply.

        Let me say (having just come from a meeting with a college on developing biomarkers for stress that could be inexpensively obtained), that as a psychiatrist, most of my treatments are-talk.

        Talk has its limits. Medications have their limits. I am agnostic, and have spent 30 years as a neuroscience researcher trying to come up with an answer to your question.

        In brief-we are getting closer to developing a more comprehensive understanding of how the mind works, and the underpinnings of what it means to say-its not working. It is not far from Freud’s original declaration of love and work.

        That said-and having taught this for years, what should be replaced with Robert Whitaker’s somewhat helpful and often abrasive and misdirected book is an educational system that teaches what I taught. To that I was met with great resistance from colleagues on “both sides of the isle”. Pharmacologists and cognitive therapists who got paid a lot of money to practice what they preach-without understanding hardly anything about what they were doing.

        It is very very hard, and laborious task to understand mental life, and mental illness. The path was paved by Freud in scientific psychology. I have the good fortune to have been befriended by the top neuroscientist in the country. I initially trained in Eric Kandel’s lab.

        Do people want to hear the complexities of this issue? Not on this blog, as I have offered on multiple occasions to debate Dr. Whitaker on the points he presents. Not in academia where drug money or the rock stars of psychotherapy teach (though Becks recent paper on the need to understand the basis of CBT was refreshing).

        No, the only people who care are the patients I have helped, either directly, or by clarifying misinformation often in the lay press, and often (tyhoug by no means always), on this site.

        Again, thank you kindly for asking the pointed question-if not this, what?

        Monk.

  7. Hi Bob.

    I think you meant to add something to this sentence?

    “But, if we look at our current conceptions of psychiatric disorders, and the great expansion of diagnoses and the use of psychiatric drugs, that has occurred since 1980s, when the APA published the third edition of its Diagnostic and Statistical Manual.”

    What do we see since the 1080’s? IMO we see evidence of criminality– we see fraud, harm done, absence profits made– and it is psychiatry that, IMO is where the buck stops.

    When I met you April 2011, I shared my experience as a whistle blower on Boston Children’s Hospital’s pedi psych unit Bader 5. I , having no credentials as journalist and no chance to wrk in my profession after being blacklisted (Traitor to Harvard)– asked for your assistance to expose Bader- Harvard Child Psychiatry– in depth. Now, as well as 4 years ago, I realize that what I was asking is tantamount to asking someone to be willing to lose everything they have worked for –with no guarantee any good will come of the sacrifice. Though the kidnapping and torture of Justina Pelletier -2 years later– might have been prevented?? I worry about such things having been an insider –on the front lines; knowing the psychiatric clinicians who grabbed Justina — AND how reluctant so many professionals are to attack the root of the problem here head on.

    There is a link on Psych Rights web site to a 86 page document outlining the *conflict of interest* issues in the case against J&J– like you cited in your book, “Anatomy”, the ethicist David J. Rothmans, PhD,cites in his “Expert Witness Report” EMAILS exchanged between Allen Frances and J&J– you cite emails between Joseph Biederman and J&J– The evidence of disease mongering for profit is so clearly stated , one, like ME, has to wonder– WHEN are these psychiatrists going to face criminal indictments??

    Anyone serious about abating the scourge of child psychiatry , is talking about protecting kids from serious harm. We know that criminal indictments would be the first real statement about psychiatry– removing claims as– the ruler of treatment —.

    I understand why you could not *write my story* or personal investigate Bader 5 in 2011– but considering ALL that has happened since– I do not understand why the topic of psychiatry reform is even still on the table–.

    Best,
    Katie

  8. Hi Bruce, Robert, Lisa;

    Robert says:

    “So what is a possible solution? It must come from an informed public that will see the need to strip psychiatry of its authority over this domain of our lives, and instead demand that the authority be vested in a multidisciplinary group of professionals, philosophers, and “users” of psychiatric care. Psychiatry could be a part of this multidisciplinary group, but not the ruler of it. But can this really happen? I am rather pessimistic,…”

    I’m not sure if you mean that you’re pessimistic about the overall prospects for keeping patients from being harmed or specifically about the formulation of a multidisciplinary group and removing the authority of psychiatry. I’m very optimistic myself. My impression (partly from watching one of the major mental health web sites steadily for about 10 months) is that things are already changing a lot. Word is getting around. One big sign of progress this is very powerful media stories like this one:

    http://www.cnn.com/videos/us/2015/07/25/ptsd-new-approach-costello-dnt.cnn

    What veteran, after seeing this story, is going to just defer to their pdocs and take whatever they are given?

    From the interview, I have the impression that you two think psychiatry can’t reform itself, so the only hope is that public pressure will cause someone to “neutralize the economies of interest,” thus causing the currently corrupted institutions and individuals to become uncorrupted and thus stop harming people. Isn’t it a better strategy to simply bypass psychiatry entirely? Isn’t it enough to convince PCPs and the general public? Some people do need drugs (for instance the many, many people who have already been on them for years), but PCPs can take care of that. Psychologists and non-harming Psychiatrists can handle the therapy. Alternative and better treatments can be developed.

    I am sure that many here are decades ahead of me, but wouldn’t it help to have informed consent laws, for, say anti-psychotic drugs where, by law, a patient has to be shown the actual risks and the actual long term prospects of taking particular drugs? I think that this could have a huge effect on both MDs who might prescribe things casually and on patients. For children in foster care, one measure might be making sure that each person in charge of these facilities gets the same informed consent information in a way that can’t be denied after the fact. I’ll bet that a step like that would make a major change.

    The other wonderful thing happening is developing effective alternative ways to treat mental problems. I’m especially thinking of Functional Medicine and new organizations like ISEPP (http://psychintegrity.org/, advertised on MIA). I think that most people with mental problems first go to their PCPs. If you put effective alternatives with some track record of success in the hands of PCPs, I think many will be happy to use them.

    ———— re: Cognitive Dissonance ————

    Even though I think your book is truly wonderful, I still have a hard time buying into cognitive dissonance theory as an explanation and as a way of finding solutions. For instance, you say

    “So once the chemical imbalance story fell apart publicly, what does Pies do Does he admit, even in his own mind, that psychiatrists told this false story to patients for decades? No, he says well-informed psychiatrists never said it, and places the blame on the pharmaceutical companies for telling that false story.”

    Maybe, as you say, Dr. Pies really is unaware of the truth and he is suffering from “cognitive dissonance,” visible on MRIs (p. 176). However the facts also seem compatible with the old fashioned explanation that Dr. Pies is just lying. Couldn’t the MRI tests in your book be interpreted as lie detector tests? Or is “lying” and “cognitive dissonance” the same thing? [ I was struck by the irony of reducing psychiatrists to helpless victims of their brain function, just as psychiatrists do to their patients! ].

    I also think that CDT as you explain it in your book, just can’t (at least by itself) explain the institutional behavior of the APA. The problem is that even if each person is unaware of their own dishonesty and corruption, as you say in P.U.T.I., they can still clearly see dishonesty and corruption in others (p. 177). Thus, even if all the psychiatrists in APA were afflicted by CD, they would still see corruption all around them.

    Also, at just a basic level, at some point it becomes hard to believe that corruption is really unconscious. Can it really be true that academic psychiatrists put their names on ghost written papers and it never occurs to them that this violates the most basic scientific ethics? Ethics so basic that if they were students turning in a paper, they could expect to be failed and/or expelled from their University? Surely Prof. Biederman *noticed* that Janssen Pharmaceutical paid him $1.6 million (p. 41). Can it really be true that Prof. Biederman never wondered if Janssen was doing that to buy his influence? Maybe I’m mis-interpreting, but Lisa’s “we are all vulnerable” answer above suggests that these people should not be blamed because any one of us could do the same thing. If that is what you mean, Lisa, I disagree. I’m in physics, not in a medical field, but I would never do something like this and I can’t even think of a single case like that in my field.

    I understand and am very sympathetic to the idea that you want to prioritize reform over blaming victims or institutions, but I also have doubts that CDT inspired solutions are going to work. When I think of corrupted institutions, the examples that I think of are a corrupted police department where, say, bribery and stealing is common and the institution of slavery in the U.S. I am sure that what you would describe as cognitive dissonance would be rampant in both cases, but is “neutralizing economies of influence” really a way to reform these institutions, or do they have to be condemned first and then rebuilt or abandoned?

    – Saul

  9. A major problem in psychiatry has not been the adoption of the “medical model” but the corruption of the medical model. This model, as it applies to medicine, and should be applied to psychiatry, is that one uses symptoms to lead to an understanding of aetiology. One can then only state that something may be a disease if one does know the underlying cause. In psychiatry, this would mean that the underlying causes of distress would often be trauma and social situations. The “diseases” would not lie in the brain but in our society. In psychology, the medical model has come to mean something entirely different: that despite no evidence one assumes a biological cause.
    The DSM III acknowledged that it was not aetiologically based, but the psychiatric industry has highly promoted a biological model. The DSM system in making research easier has led to a circular argument: if a biological treatment appears to work than the aetiology must be biological. This “empirical evidence” has created a monster.
    I strongly disagree with the point that Spitzer had the public interest at heart. He has always been on a strong campaign to remove all indications of emotional roots and psychodynamics from the DSM. He is largely responsible for the direction that DSM and psychiatry has taken.
    I have always treated people according to the true medical model Without understanding the cause of someone’s pain, and with only looking at symptoms and a superficial analysis of research, one cannot truly help someone. Psychiatry has abandoned basic principles in medicine.

  10. TS Monk’s question about solutions, and whether I should be offering one, has made me think I should write a blog about this. But here is what MIA and I are trying to do on the solutions front.

    The first thing is this: what is clear is that we have a paradigm of care in the United States (and increasingly this is true globally) that is organized around a false narrative of science. A first step toward change is documenting a scientific narrative that reveals that to be so, and the harm it is causing, and that is something I believe my writing has helped to do, and this website has helped to do (by fostering a forum for such critical discussion on psychiatry.)

    Next, once society comes to see that the prevailing narrative is false and doing harm, the obvious question becomes, what now? And that is a question to be answered in a collective fashion by society. It would be presumptuous and ridiculous of me to posit an answer to that profound question, and in fact, I think it is my particular challenge–and the challenge of MIA–to help foster a societal discussion about that question and provide information about initiatives related to developing a new paradigm of care, but doing so without saying we favor any particular solution. We should not be seen as having our own “horse” we are backing, so to speak.

    So how are we trying to do foster such a discussion? One is through MIA: our news section is designed to help publicize research into psychological aspects–such as trauma–related to emotional distress/difficulties, etc., and also help publicize research into non-drug treatments (or treatments that use drugs in a much more limited manner). We also urge bloggers to write about initiatives for change, whether it be the hearing voices movement or efforts to adopt open dialogue type practices (or any other type of alternative.) MIA also started a non-profit continuing education organization, Mad in America Continuing Eduction, that is putting up online courses that are designed to help professionals and others learn about research into long-term outcomes with drugs, and research into alternatives as well.

    I like to think that MIA and Mad in America Continuing Education are contributing to the search for solution, and doing so by serving as a reliable source of news and as a forum for dissemination of information and discussion around this entire subject. But MIA –and me personally–should not be in the position of saying, in any way, here is the answer! My own personal belief is this: We, as a society, don’t know the answer , but need to commit ourselves to creating a new paradigm of care, one that respects civil rights, treats people with dignity, and helps people have full, meaningful lives.

    As for the question of my pessimism, I do think that there is a great deal of new discussion occurring about what to do differently, and ultimately about the failure of our current paradigm of care. That is good. But I am pessimistic that psychiatry, as an institution, will be stripped of ts authority over this domain of our lives, or that it will reform itself in a way that provides for a real rethinking of the current paradigm of care. So I guess I am of two minds on that, optimistic and yet pessimistic at the same time.

    • Robert,
      I agree with most of your comment, which is carefully articiculated and not jumping to conclusions, as is your normal style.

      Regarding these statements, “We should not be seen as having our own “horse” we are backing, so to speak,” and “We, as a society, don’t know the answer , but need to commit ourselves to creating a new paradigm of care.”… I think this vein of thinking – of standing for nothing, and/or being overly cautious and noncommital – can be problematic. Why?

      Generally, there appears to be growing evidence that psychological and social approaches – individual psychotherapy, family therapy, peer support groups, jobs/social skills training – which use low or no medication are much better for “mad” people in the long term than doing nothing or using long-term medication. I linked the three metaanalyses above as examples of this kind of research. So I would suggest that a variety of primarily long-term psychosocial approaches would be the stable of horses to get behind for helping “mad” people.

      There is no one horse. But it’s clear that the majority of people on this site support a shift toward less and shorter-term medication combined with more intensive psychological and social programs.

      And the idea that we “don’t know the answer” (not that there is one answer) but “have to create a new paradigm of care” is a bit dissonant… we cannot create a new paradigm of care without building some greater degree of conviction about where to go. Most psychiatrists have a very strong conviction that illusory diagnoses and brain damaging medications are the way to go. Perhaps an equally strong conviction that something better can be offered to mad people is needed to fight that.

      • I think there are probably lots of different routes to full recovery and the process doesn’t have to be very difficult or expensive.

        I found “CBT” to have beneficial longterm effects because it helped show me how my anxiety worked in simple terms (but “CBT” mightn’t be everyone’s choice).

        But I think the Psychiatric system in place is a dead loss. The treatment only works through disabling.

    • Hi Dr. Whitacker. Nice to cyber meet after all this time.

      So, some thoughts (pardon my jagged writing style, as I spent more time studying music than english).

      It is hard to define a false narrative in science when only selective data are being used. As you know, this has been my point of contention about this blog, and your book (which I believe was helpful in the narrative it stimulated-though I stand by my opinion that it was misleading to the general public. Perhaps a friendly fire sort of thing).

      I will push back on you in the sense that the “damage it is creating” is something you can not clearly define. I am a staunch opponent to reckless use of medications. That said I use them both frequently -and judiciously in my practice. That psychiatric medications can be harmful is both factual and something I agree with-totally. Why I read the book. I can also add I have written one of the few papers on their mechanisms of action. The fact that they likely work in part on altering gene expression is interesting, enlightening, yet sobering and concerning.

      On this I also disagree.Society is not to answer the question about correctness of science. The obvious historical reference is Germany in the 30’s. No, science-at its most beautiful is a political, and bound only to creative destruction (to use Schumpters economic phrase). Thus on this point I would firmly disagree.

      As far as your MIA author population-some have been gracious, informative and downright friendly to me for my persistently and pervasively
      pointed disagreements. That said–you have no authors who are proponents of the essential need of psychiatric medications for many whose lives have been saved. That is a clinical fact, and one only needs to ask the patients who they have helped. That the side effects are so unpleasant, and people insist on staying on them is suggestive of the importance of these medications in a subset of patients lives. By not making this abundantly clear in MIA, I believe you diminish the important work that you are trying to do.

      So yes, psychiatry has in many circles been utterly corrupted as an institution by its ability to charge 350 for a xanax prescription . One of the reasons I left academia after 25 years .
      On the other hand, psychotherapy has been equally corrupted by teaching people how to reframe their misery-only to encourage them to lead a tolerably miserable life. Or to say patients are not motivated to change, or given labels that are terrible, poorly understood and destructive. To include the vast literature on the perils of psychotherapy on this site I think would make it a more balanced blog.

      I do not hear the equally important, and prudent railings against psychotherapy on this site, a form of treatment that is even less well understood , has its dangers present in a more pernicious fashion, and has been shown in many papers to be potentially dangerous-too.

      Thank you kindly for the book, and the nod. If you are in NYC would be glad to discuss over a beverage.

      TSM

      • TSMonk,

        I have a comment about your views on psychotherapy. First we should remember what psychotherapy is – a structured human-to-human relationship, ideally intended to help improve functioning and lessen distress, extending for a longer or shorter time. Psychotherapy is a person to person relationship. It is not a concretized thing, like a pill.

        So when the fact that it’s a human relationship is kept in mind, yes of course psychotherapy relationships can be damaging. Human to human relationships can sometimes be devastating even when started with the best intentions. This can be especially true in psychotherapy when abusive or neglectful past relationships (of the client) get replayed and acted out with the therapist in the present, even more so if the therapist doesn’t know how to handle such projections.

        But I think looking at the big picture – as I tried to do in the 3 metaanalyses I posted above – it shows that people more often than not benefit from psychotherapy, i.e. an ongoing relationship in which another person tries to help them. Not all benefit, and some are harmed, but the data clearly indicate that a significant majority do benefit on a variety of functional and symptom control measures. You didn’t present any data to contradict that, although perhaps you don’t disagree.

        I agree with you that neuroleptics can be helpful for some people; I’ve read accounts where clients feel it to be very helpful. But the doubtful question remains as to whether a majority of people benefit from neuroleptics long term. Many people on this site are still waiting to see the data showing that a majority of people benefit from long-term use of neuroleptics. Where is that data?

        • Thank you kindly for you thoughts.

          Firstly-I do not understand what you mean”Psychotherapy is a person to person relationship. It is not a concretized thing, like a pill.”, or maybe we disagree.

          There is a very large data base regarding the neurobiology of human interactions, and the damage caused by their ruptures.Naomi Eisenberger,s wonderful work. There is Panksepps work as well.To my thinking, relationships are concrete things-albeit beautiful ones.

          As far as neuroleptics. As I have mentioned in the past-consider watching the moving interview of one of my idols-Tom Harrell by Charlie Rose. Tom is not the only person who will swear by the life saving (and affirming) aspects of antipsychotics.

          Tom is a paranoid schizophenic. He can not function without his mellaril–at all. He stops them-he does not function.There is little doubt about this to either him or those who know him. Also I suspect you know of “An unquiet mind”.Tom Harrell, Kar Redfield Jamison-thes are a few high profile cases of people who feel their life were saved in part by “toxic psychiatry”. I am sure you would agree, these are not the only people in the universe who have been helped by toxic pills.

          Yes, neuroleptics are toxic, to this I believe strongly. But as physicians, we get paid to look at a risk and benefit. It is not easy.Unlike psychologists, we have to live with our decisions to give toxic drugs to people when we know they are dangerous- and toxic. Because of that I use them always as a last resort. I often wonder if my conservative approach may even do harm.

          As far as literature-having done research for many years, I believe (as do many researchers) that the published data surrounding clinical trials are either misleading, or analyzed with improper statistics. That was the touchstone of this blog. If you wait for the literature to support or assuage your concerns, I don’t think that will ever occur. The problems in published literature are beyond this discussion.

          Might I suggest the alternative approach-to try and understand what the/an illness is that is being treated, and how all therapies (neuroleptics included) interface with the problem at hand. That seems to be the agnostic, rational approach to the problem. Again, just my opinion.

          Are there those in psychiatry who are reckless about prescribing psychotropic medications. Yes, I know them and try not to socialize with them because the ensuing dialogues make me uncomfortable.

          My disagreement with many on this site is the conflagration of poor diagnosis and reckless treatment by some psychiatrist, or perhaps even many, with the maligning of drug therapies. Its wrong, and harmful to people who are on the fence about the decision on to take, or not to take.

          About psychotherapy-I find it interesting that you feel bad outcomes are a result of the patients reenactment. How about the therapist reenactments? Lack of mention of the negative effects of talk therapy for me, is one of the “elephants in the blog”. Unlike medication where you can say “you gave me this, now I have tardive dyskensia” or “I took this and wound up with serotonin syndrome”-except the most abusive of situations (sleeping with patients and the like), patients have no recourse against the subtle acting out therapist. To me that is even more dangerous in ways, because it is harder to pin down.

          About psychotherapy research. In brief, a very frequently cited paper by DeRubeis which propertied to show that CBT worked as well as medication in severe depression-was misleading. When I discussed this with him, he said further clarification would come out in a subsequent paper. It never did. He needs to write, and there is enormous pressure to do so for many reasons. That said, I would consider being circumspect about any research regarding any therapies unless they pass a sniff test. Meta data and meta analysis are even worse. This is both my opining and an opinion shared by many (not most) in the research community.

          To close, I think that all the emperors in the field of mental health are standing naked-and I try to pay attention only to the child who sees it. As noted, my opinion is that science is the only child to be trusted at the table. As Feynman once said (paraphrasing)’ I spent a whole lifetime studying one tiny thing, and maybe got it partially correct”. I think to many over reach when positing positions about human behavior, mental illness, what is happiness, or how (or if ) to treat it. All I kind of know, is that most of what I read-seems wrong.

          Anger has no place in science, and serves only to distort logic. It saddens me to see the amount of anger driven messages on this blog. People have been harmed by psychiatrists. They deserve to be angry, as would I. Yet, he same is undoubtably is true about psychotherapists-again, rarely if ever mentioned.

          “Made in America”- would be my prefrence-a more constructive approach perhaps. I grew up listening to the Grateful Dead-I guess I am an optimist from it all.

          • Ok thanks, I agree with many of your thoughts.

            I do not know enough to say it’s not true that some people absolutely need a certain medication to function. If that is what they experience and evidence through their behavior, then they/it should be at its word.

            My bias on this comes from my father, who was so overmedicated by a poorly educated psychiatrists, for so many years, that he lost any ability to function. But he is only one case, and not all psychiatrists are poorly trained.

            About therapists, I think you may have misunderstood me. I meant that the clients brings negative expectations or “bad internalized objects” to use the language I like, to the therapy relationship. I didn’t mean the therapist cannot do this too. Yes the therapist, due to many possible reasons, may also contribute to the self-defeating or damaging dynamics.

            The client may push the therapist into the position of abuser from the client’s past. Or the therapist may be reminded of someone in their own mind who they did not like, and treat the client as if the client were that person. Or, the therapist may simply be immature or too weak emotionally to help the client.

            Any of these scenarios can mean that the therapist damages the client. It takes a good deal of skill to avoid these pitfalls on the therapist’s part and even the best therapist cannot always avoid them. But I am an optimist and believe that more often than not clients on the balance derive more benefit than harm from therapy relationships.

            There’s also a good quote about the pitfalls in treating people:

            Life is short
            The art long
            Opportunity fleeting
            Decision difficult
            Experiment perilous

            Regarding drug therapies, I think many more longer term trials are needed to see how medications or no medications affect functioning and wellbeing over the long term. So many of these trials only span a few weeks or months and it’s not long enough. There need to be more 3 or 5 or 10 year trials of on drugs vs off drugs. And the same for different kinds of psychotherapy.

            Lastly what I meant about psychotherapy is that each psychotherapy relationship is so variable; it changes minute to minute based on what is going on with the client and the therapist. It is less simple or concrete than a pill in that way. So saying that CBT is a reliable entity is a little problematic. Each therapist actually practices their own form of CBT. They also apply it differently to every client based on the client’s needs and what the therapist thinks they need. In this way it’s different from, say, giving various people Prozac, because hopefully each Prozac factory comes out of the factory with about the same chemical composition.

            My point was that concretizing or talking about psychotherapy as one reliable entity is more difficult than people think, due to the complexity and variability of each human to human relationship.

      • Self-assertion can hardly be said to provide more reliable evidence than can eye-witness reportage which is seen as notoriously faulty in a courtroom setting. I would suggest that many of these people who believe they have been helped by long term psychiatric drug abuse may have in fact been speaking under the influence of their emotions rather than from that of the facts. This is to say that the evidence is likely to say something entirely different, and this is especially true when we see these stats showing people in treatment for the most serious of disturbances dying at much earlier ages than the rest of the population.

      • That the side effects are so unpleasant, and people insist on staying on them is suggestive of the importance of these medications in a subset of patients lives.

        It could be because most of these patients are told by their doctors that they need to take the drugs for life or their conditions will get worse. It could be because they are afraid of what their psychiatrists will do to them if they do not take the drugs. It could be that the drugs themselves have caused medication spellbinding and the patients don’t truly realize how disabled they are becoming. It could be that they think the drugs are effective because of placebo effect. It could be because the patients’ conditions improved on their own but they attribute the positive changes to the drugs. It could be that the patients are rightly scared of withdrawal or have been told that previously experienced withdrawal was the return of their “original condition.” This list is obviously not exhaustive.

        There are many possible reasons for people electing to stay on the drugs despite the damaging effects. I don’t see how an argument for the drugs’ supposed efficacy can be based on the fact that people keep taking them.

        • Uprising, the reason one can make the argument that people stay on the drugs because of efficacy is because thats what they tell you when you ask them. Patients dropping out of clinical trials comparing drug to placebo are always asked why. Dropout rates are consistently higher in the placebo arm, and lack of efficacy is by far the most common explanation given by these individuals.

          • JohnSmith,
            But one also has to ask what “efficacy” means… if it is efficacy at suppressing symptoms, that may be helpful over the short term. Most of these trials only last weeks or months. So maybe neuroleptics do suppress anxiety, depression, and delusional thinking better than placebos.

            But in the long term, this “efficacy” could be a barrier to recovery and achieving a satisfying life – because instead of facilitating a person facing their life problems and working out emotional conflicts, taking the drugs and effectively suppressing their distress could lead them not to work out feelings and life problems that they might be able to do off the drugs. That is why I think a number of these long-term studies are showing that neuroleptics don’t facilitate better long-term outcomes; in fact they likely cause worse long-term outcomes for most, not all people.

        • It is not because patients are told this. What happens in real life is that patients stop taking the medications (as any sensible person would do for all pills-they are a nuisance), feel much worse , then go back on them.

          It is only part of the “argument”. It is not an argument, it is a fact based upon 27 years in practice. Some people stop them, do fine, and don’t go back on them. Some people can not tolerate life without them. That is a clinical fact. To make assumptions on how those patients should live their life I believe is terrible. There is ample evidence about the problems these pills cause. To say a patient is brainwashed seems a bit of a stretch, and logic would seem to go against the point you are making.

          • You seem to have confirmed that your claim about drug efficacy as supported by drug popularity was indeed based on your own subjective “clinical experience.”

            I have not made any assumptions about how other people should lead their lives. Yes, there is ample evidence that psychiatric drugs are dangerous, but this evidence is not getting to the public, in part because of psychiatry’s institutional corruption. I think that if the broader public were aware of what the drugs really do to people in the long term, then there would be a huge decline in public toleration for both the drugs and for psychiatry in general.

            I did not say anyone was brainwashed. What I did was list SOME of the many possible reasons that that people might continue taking psychiatric drugs despite the horrendous negative effects they cause. I would not use the word brainwashed, but what they are is drugged. That would seem a strange point for you to argue.

            By the way, I took multiple psychiatric drugs for 15 years as directed and there was a period early on when I was very vocal about how they had “saved my life.” Very quickly I became blind to the deterioration of my health. I was indeed spellbound by the drugs for a long time, before they made me so physically ill that I had no choice but to consider that the drugs could be the cause of my ailments. (And they were.) So when I put medication spellbinding out there as a possible reason that people stay on the drugs, that is not intended as an insult to anyone’s intelligence or agency. One who takes mind altering drugs will have an altered mind.

          • It’s also no surprise that many many patients will come off a drug, feel much worse, and then want to go back on. Withdrawal symptoms alone can make that happen.

      • “That said–you have no authors who are proponents of the essential need of psychiatric medications for many whose lives have been saved. That is a clinical fact, and one only needs to ask the patients who they have helped. That the side effects are so unpleasant, and people insist on staying on them is suggestive of the importance of these medications in a subset of patients lives.”

        Many people insist on staying on their medications because, once they start, they cannot stop without getting much worse, (presumably due to oppositional tolerance) just as Robert describes in his talks and books. You can find many, many examples here, for instance

        http://forums.psychcentral.com/psychiatric-medications/

        Many people have been told by their “pdocs” that they are “searching for the right cocktail” and/or hoping that some new drug will help. Some wish that they could quit, but many also believe strongly in the path that they are on in spite of suffering side effects. In a way, this is understandable, because their only experience of relief may come from starting a new drug. They have signature lines like the following real one:

        “Diagnosis: Bipolar I, ADHD, C-PTSD, GAD, OCD, Social Phobia, Panic disorder, Substance Use Disorder
        Previous Rx: |Celexa|Sertraline|Lithium|Depakote|Buspar|Wellbut rin| Klonopin|Perphenazine|Cymbalta|Strattera|propranolol|
        Trazodone|Zyprexa
        current:|Seroquel XR 400mg PM”

        That’s what’s happening to people. Many, many people. The fact that many people choose to stay on these drugs doesn’t mean that they help in the long run.

        • Well, there are anecdotes, but clinical trials demonstrate that intermittent treatment with antipsychotics during periods of symptom exacerbation is less effective than continuous treatment and more effective than non-treatment, with a relative risk for intermittent treatment of 2.5 relative to continuous treatment and 0.37 relative to continuous treatment.

          If the lower dropout rates of people treated with active drug compared to those treated with placebo was due to a withdrawal syndrome when they stopped, one would expect intermittent treatment to be worse than continuous treatment. Its not.

      • There’s been plenty of railing against psychotherapy on this site, especially the ubiquity of CBT in its increasingly reductionistic form.

        I think the main reason you see more passion against psych drugs is because there is more long-lasting damage from their use, including serious physiological damage, including death. Psychotherapy just doesn’t have the scope and power to do that kind of damage. The other reason is that the chemical imbalance-chemical cure “story” has become the prominent explanation and justification for pulling more and more people into the realm of “mental illness” while spending less and less time trying to figure out what is really helpful to people in distress. Consider the millions spent on researching genetic causes vs. the paltry sum by comparison spent on the impact of trauma, when the association of early-life trauma with almost any mental disorder you could name is an order of magnitude higher than the most optimistic data on genetic associations.

        The third and perhaps most important reason you hear more against drugs is because the bulk of the money corrupting the influence of psychiatry comes from the direction of selling more diseases to sell more pills. It’s just as profitable to talk to people over weeks and months when you can drug them in 15 minute segments and make more money at it. Besides which, people who get psychotherapy sometimes actually GET BETTER, and this really cuts into the bottom line and forces you to have to look for new clients. The therapy business can get pretty shady, and I’d recommend extreme caution and assertiveness to anyone looking for a therapist, but dollar for dollar, it can’t hold a candle to the drug industry’s incredible corrupting influence over psychiatric research and practice.

        One thing to remember also: the patients you continue to see are the ones who continue to participate in the MH system. This creates a large bias, in that “dropouts” who are successful will almost never come to your attention. Reading this board, and looking at the WHO research and the prior research from the 50s on schizophrenia recovery rates, should convince you that there are a lot of such people around whom you would never, ever see in your practice, because they either don’t need your help or are terrified of getting enmeshed in the MH system. Look at John Nash as an example. He was still very symptomatic but intentionally flew under the radar to avoid being hospitalized again, and then he somehow came out of it again years later. Not a medication success story, but his story would normally never even be told, because no one in the system would ever hear about his recovery. They’d just say, “I wonder what happened to that guy? Must have either died or moved away.” He’d never get counted as a recovered client who recovered by escaping the system.

        I appreciate your efforts to be rational. I encourage you to look a little further outside your normal field of vision. There’s a lot of healing going on in the community that you will never see in the office or the clinic. Don’t dismiss it.

        —- Steve

    • Bob, your patience is admirable. And your response well-considered.

      Just for the record however I think I should point out that one’s articulately exposing the inherent contradictions of an oppressive system or practice is not negated by not simultaneously solving the problem. Very often the accusation that “you have no solution!” is a way of deflecting valid criticism.

    • BPD, you raise an interesting question, but I think it would be very difficult to design a study that would provide a clearcut, objective answer to your question. I suspect that if one could be designed, it would show examples of both.

      Frank, your response was not particularly helpful in terms of understanding your position. You don’t think the drugs used longterm help anyone. I think the stock market will be flat for the rest of 2015. Since we dont’ know each other well enough to know how to value each other’s opinion, statements like this are not helpful. Why do you think the drugs are never helpful long term and what evidence are you referring to?

      • I’m talking about outcomes before the development of modern psychiatric drugs and after. They’ve not improved. The story is there in Anatomy of an Epidemic and Mad In America. It seems that the drugs used are, in large measure, creating more problems than they are solving. Instead of health, what you’ve got are people being maintained on drugs, people who think their stability depends upon them. In some instances the use of one drug can lead to a further diagnosis treated by another drug, that is to say, where so-called “mental illness” is concerned sometimes the drugs used in the treatment of one disorder can be causative in the case of another disorder. Withdraw the drug and you’ve got another problem as now those people have developed a physical dependence upon certain drugs. The drugs, as has been pointed out many times before, don’t fix any chemical imbalances so much as they create them. The outcomes for people given scizophrenia diagnoses in particular are notoriously bad, and some of us, myself included, believe that over reliance on neuroleptic drugs has a great deal to do with why those outcomes are so negative. A lot of these negative outcomes have to do with people not being given any safe and chemical-free options as psychiatrists are so much under the influence of the pharmaceutical industry, with it’s own interest in maximizing profits, the subject of the Whitaker/Cosgrove book we are discussing

        • Hi BPD,

          Superficially, the results are wonderful for the 51 of 251 patients who finished the study, but the paper doesn’t really speak of what happened to the other 200. This is what is called “responder analysis” in drug development, and it is never accepted by regulatory authorities as proof of efficacy because the usual and logic assumption is that those who did not finish the study are treatment failures.

          While trying to keep an open mind, another thing that made it difficult for me to take this 2014 paper seriously was it’s citation of a paper from 1967 that concluded that hospitalization was increased by anti-psychotic drugs. 1967 is fully 48 years ago, and scores if not hundreds of clinical trials have addressed this issue in the intervening years. The vast majority of these studies reached the opposite conclusion, but are not mentioned. This sort of cherry picking of data to support a point of view undermines my confidence that the rest of the data in the paper is being objectively reported.

          So without intending to be snarky, I guess my answer to your question is that all kinds of pills can produce the results described in this paper for 20% of treated patients.

          Frank, your opinion is clearly an honest one and one you have spent a lot of time thinking about. I agree with you that the marketing of psychiatric drugs turned into a real cesspool. But the clinical data does show that they have some use, and that those treated with drug are less likely than those treated with placebo to be hospitalized or to drop out of the trial.

          • They make a lot of money for those drug companies that have weathered some of the most severe civil penalties in history. This has got to tell you something, like something smells awfully fishy indeed,. The other side of that use coin are those adverse effects that cripple people. The clinical data only shows people what they want to see. One thing, for sure, people treated with placebo are less likely to be harmed by the placebo than people treated with a chemical compound. I suggest that if they simply stayed with the placebo program a little longer, recidivism would eventually become less of a problem.

          • John,

            What happened to the other 200 people are unknown, but not necessarily “bad”. Perhaps they went to see other therapists. Perhaps they could not titrate off neuroleptics they were already on, which was a crucial factor of recovery for the 51. Perhaps they lacked the funding to stay for longer than 6 months. Perhaps their family interfered. Perhaps that therapist wasn’t a good personal fit for them.

            “Schizophrenia” usually correlates with poverty, abusive and neglectful families, overuse of strong medication, unfamiliarity with loving relationships, and other challenging psychosocial factors. So any of these elements could have interfered in varying degrees to make the majority of the group not stay in therapy – but that doesn’t mean that psychotherapy, when stayed with, is not very effective for those who have the resources to stay in it.

            So the picture is complex – there is a difference between this study’s results (of 80-90% of the 51 who stay in psychotherapy having great outcomes) for those who stay in treatment, and your idea of 20% of drug treated patients achieving such outcomes, which by the way is doubtful. When you have psychotic people only taking pills, you’ll never get 80-90% of the people who stay in a drug study getting great outcomes. You’d be lucky to get 5% becoming functional at work again, which Harrow’s longitudinal study just failed to achieve for those who stay on drugs.

            We should also note that many, many clients, often a majority, do not follow or drop out of long-term drug treatments, usually because they hate the drugs. So those studies have problems too.

            But the point of the psychotherapy study is that when people do stay in a good relationship for a lengthy period, they usually get much better. On the other hand, when people stay on neuroleptics for a long period, most of them do not have great outcomes. You didn’t address that proportional difference.

            As for your idea that 20% of people with a schizophrenia diagnosis in a drug study get these kind of results – i.e. functioning psychosocially in the normal range – I haven’t seen any drug studies where even that low number, 20% of psychotic clients went from a highly-psychotic PNSS or BPRS rating into the normal healthy range. If you can name one, I would be very interested, but I don’t believe it exists. The average improvement in these drug studies is very poor.

            The bigger point here is that people labeled “schizophrenic” are experiencing overwhelmingly difficult social, economic and psychological circumstances. These often make it hard for them to finance, understand, or stay in a long-term interpersonal relationships, and perhaps also make it hard for them to commit to drug treatment, although the latter may be a good thing.

            Unfortunately, long-term human relationships remain the primary way to ameliorate or cure psychosis, but those can be hard to get into or stay in for all the reasons I named above. But, that doesn’t mean that human relationships are not much more helpful to psychotic people than drugs when they are able to overcome their terror and lack of resources to stay in them. It’s also a lot more challenging to stay in a close relationship than take a pill.

            There are some other good studies similar to this one by Madrona – for example, Barbro Sandin’s psychotherapy trials done in the 1980s in Swedish hospitals. Open Dialogue results from the 1990s in Finland. Gaetano Benedetti’s psychotherapy trials reported in the 1990s. Need-Adapted Studies by Alanen from Sweden in the 1980s/90s.

            Also, the fact that psychotic people in poor countries do much better than people in wealthy countries (WHO studies) is likely due in part to overuse of medication in wealthy countries, along with other factors like stigmatization and lack of close family ties in wealthier nations. The WHO studies’ better outcome for poorer studies were reinforced by Jaaskelainen’s major 2013 metanalysis of 9000 outcomes for schizophrenic people in both rich and poor countries.

            Also, check out Gottdiener’s metaanalysis of 2600 schizophrenic clients getting psychotherapy for an average of 2 years. Psychotherapy came out very well there too, while medication added to therapy made hardly any difference to the clients. Here it is –

            http://psychrights.org/research/Digest/Effective/BGSchizophreniaMeta-Analysis.htm

            So, if you look around, in my opinion there is a lot of data to recommend psychotherapy and human love as a much more helpful long-term influence than pills. But unfortunately, there are so many obstacles in society to very distressed people getting into and staying in such healing relationships.

      • BP, I have no doubt that a supportive family structure is a very important and positive thing. I think we agree on that.

        But the study you have presented indicates that 251 people entered the study. They report results for only 50, of whom 32 (13%) were reported to be stabilized in a medication-free state.

        My response is about the same as yours would be if I presented you with the results of a clinical trial of a “wonder drug” performed in 250 patients, defended it on the basis of good results in 32/50 of those patients, and refused to disclose what happened to the other 200.

        Objectivity requires that we hold all studies to the same standards of credibility, whether their results support or undercut our pre-existiing beliefs.

          • That’s another apples and oranges issue, the PNSS scores. This particular study involved people who had already been stabilized on medication for the most part. It didn’t indicate which version or arms of the PNSS it was using. Further, it included a range of different diagnoses, some less severe than typical schizophrenia, whatever that is… this reminds me of another point, that these labels are not objective, valid, or reliable.

            That would be another way that I could attack the studies you cited – that there is very little reliability and no validity behind the illness label schizophrenia, a la Mary Boyle, Richard Bentall, etc. On the other hand, to be fair I would also have to attack my own favored studies, because they use the same faulty labels. The studies I cited are in some way fundamentally wrong too, since these labels have no biomarkers and depend largely on subjective judgment. Many of the reliability ratings for the DSM IV and V conditions are horrible.

            So maybe we really know much less than we think 🙂

        • John,
          Thanks for your comment. You’re interpreting the study in a particular way based on your background, which I sense may be hard-science based, perhaps you are a psychiatrist or an academic psychologist?

          The way I interpret the Madrona paper is that it’s a study of what can often happens when psychotic people stay in a certain type of therapy for more than 6 months… in fact, an average of 2.5 years in this case. More properly, it’s what happens when these clients stay with this particular therapist. It doesn’t claim that psychotherapy works for everyone as if it were some pill you just give to people. It takes commitment and resources; it’s not like just giving someone a drug.

          Your analogy doesn’t connect for me. A better analogy, from my perspective, would be if you told me about a clinical trial of a wonder drug where there were 250 people, but only 50 people actually decided to stay on the drug, while the other 200 were known to have chosen to stop the drug early for one reason or another.

          That scenario is similar, but also different to what you said. It doesn’t mean the drug is not very effective; rather, it could mean any number of things, including that something about the environment or situation was causing the clients to stop early and not get the full dose. It’s hard to compare neuroleptic drugs and human-to-human relationships (of which psychotherapy is a form); they are so qualitatively different.

          Providing long-term psychotherapy is much more complicated than just giving someone pills for a certain period of time. It involves building a relationship and takes a lot of skill on the therapist’s part, as well as commitment and motivation on the client’s part, and these things cannot be easily quantified with the reductionist statistics that tend to predominate in the type of studies we have been discussing. In a way, every study of multiple psychotherapies is inevitably non-objective, because personal relationships are subjective and each therapist-client dyad differs. So it’s always apples and oranges, whereas giving someone Seroquel is apples only, unless they screw up the factory production! I’m sure you understand this, although perhaps differently than I do.

          The point I have been trying to make is that long-term psychotherapy for psychosis can produce very good results – but usually only when the financial resources and the “security” resources – by that I mean safe housing, supportive place to live, family on the client’s side – as well as skill and commitment on the part of the therapist, are present. It is very hard to reduce “psychotherapy” to a thing, like a pill, which is just given to people or not given, in a trial. This makes me think of the quote, “Not all that counts can be counted, and not everything that can be counted counts.” That could be seen as an evasion, but I don’t mean it that way. I mean more that there are some things we cannot know or accurately measure.

          I wonder if you ever done long-term psychotherapy (e.g. 3-5 years) with schizophrenic people? Do you have a sense what it takes to help someone work out delusions and hallucinations and learn to trust someone after going through horrible trauma? I have some experience, but only from the client/patient side.

          • Well, I guess we’ll agree to disagree.

            The concept I’m trying to argue here is that if people are getting great benefit from an intervention, they don’t usually quit the trial. As a simple example, in 1 year duration trials of weight loss drugs, the percentage of people finishing the trial is very closely correlate with the average weight loss produced.

            But in any case, good to meet your acquaintance and thank you for your thoughts.

          • Ok, good to have debated with you too John. I cautiously assume from your not answering my question that you are not a therapist who works intensively with psychotic people. If you were, I think you might have a bit different perspective.

            Your comment made sense to me this time – but my idea in response is that it can often take 6-12 months or more to benefit from a close interpersonal relationship. Working out delusions, terror, and rage is extremely difficult and needs to be supported by the family environment, by sufficient money, etc. So people may not get benefit right away.

            That is what I think was missing in a lot of those 200 cases. I don’t know that, but I’m confident it was the case for some of them, along with financial or family problems, or just lack of familiarity with how a close healing relationship works.

            Again, my point is that healing trauma is much more complex than just giving someone a pill or not. A healing relationship is not something you just administer or don’t administer to someone; people have to develop it together. And the process of working through and dealing with painful feelings can sometimes feel worse before it gets better.

  11. Great interview and a very high level of discussion.

    Bpdtranssformation, I really appreciate your stance on these questions and the depth you have added to this discussion. My only quibble would be the use of the word “medications” to describe psychiatric drugs.

    TSM, while I disagree with most of what you write here I would agree with part of the following comment:

    “Society is not to answer the question about correctness of science. The obvious historical reference is Germany in the 30’s. No, science-at its most beautiful is a political, and bound only to creative destruction (to use Schumpters economic phrase).”

    Yes, the “beauty” and correctness of science is apolitical and must always remain so. However, SOCIETY must create favorable conditions for objective science to flourish and abound with great inquisitiveness and discovery.

    At this historical moment a profit based economic and political system in today’s SOCIETY is a major impediment to the development of valuable and objective science.

    Any objective and careful analysis of the role of the pharmaceutical corporations, in collusion with the leadership of modern psychiatry, reveals a story full of conscious efforts by them to distort and manipulate science to maximize corporate profits and promote the narrow guild interests of psychiatry, as well as, the overall class interests of the most wealthy and powerful elements within our current SOCIETY. This causes enormous damage to human lives.

    I believe that Robert Whitaker and Lisa Cosgrove’s new book is a necessary and very positive attempt to challenge the legitimacy of both the science and the related narrative promoted by today’s Biological Psychiatry. It is also an attempt to understand what institutions and material conditions within our SOCIETY has interfered with, and corrupted, the legitimate pursuit of objective science.

    Bob, I share your pessimism ( although I would say I am way beyond pessimism) about psychiatry changing from within. I clearly believe that society must strip psychiatry of all authority over people’s lives and that as an INSTITUTION it does NOT deserve a seat at the table when deciding how people in serious psychological distress are to be supported and helped in today’s world. Perhaps individual psychiatrists not connected to the disease/drug based model may have something to offer, but I would want them to be separate from the institution as a whole.

    My problem with the “cognitive dissonance theory,” as it has been presented so far, is that it has been abstracted from a genuine class analysis within our current society. Bob you said:

    “…the absence of condemnation, leaders in the [psychiatry] institution may be better able to see how the economies of influence have corrupted their behavior. Second, it will focus public attention on how to neutralize the economies of influence as a solution to the corruption, as opposed to stirring public anger toward individuals within the institution.”

    I believe that the top leadership of the APA and other KOL’s for Biological Psychiatry have already sold their souls to the profit god of Big Pharma. The social role that they have created and now promote for today’s psychiatric/pharmaceutical/industrial/complex has evolved into a necessary and integral part of the American Imperialist empire.

    To create favorable conditions for systemic change, including for rank and file psychiatrists to jump ship, so to speak, we must target and CONDEMN the LEADERS of modern psychiatry. They have clearly sided with the class interests of the most powerful forces within our society and have caused enormous harm to millions of people.

    Just as I believe it would be correct to call for the prosecution of the very top leaders of Big Pharma, based on the social and criminal damage done in the world, I also believe that many of the top leaders of Biological Psychiatry fall into the same category.

    I believe that the history of social change has proven that this degree of polarization (using condemnation of high crimes against humanity, including those that perpetrate such crimes) is required as a prerequisite for major systemic transformation.

    Respectfully, Richard

    • Thanks Richard. I agree with you about “medication”; I only lapse into using this word out of habit. I will use neuroleptics or my favored term, “zombifyers”, or the process of zombification, from now on. :-/ I think of it that way because my poor father has been on multiple neuroleptics for decades and appears like a zombie.

      You had many good thoughts in your post above and I appreciate how blunt, direct, and honest you are about what could bring systemic change; although many people within the existing system would say these ideas are outrageous, I think you are mostly right.

  12. One of the interesting things about the comment thread is how it leads to unexpected issues, and one issue raised now is society and the correctness of science. First, I agree that the “correctness of science” exists apart from society, and in fact scientific discoveries often challenge everything a society holds dear (think of Galileo, Darwin, etc.) My point related to this discussion is that I think a society has a responsibility to figure out how it will care for its citizens, including its citizens who are struggling in various ways with their minds, and that as part of this responsibility, it can try to see whether its current paradigm of care is based on a “true telling” of the science that has been done, and whether the “science” itself has been conducted with the principles of good science (and a search for knowledge.) And in this arena of psychiatry, you can see that psychiatry, as an institution, has failed its “scientific” duty to the public: it has conducted trials biased by design, it has consented to a spinning of results, it has kept quiet about results that it finds threatening, and it has, in a big picture way, told the public a false story about the validity of the disorders in its diagnostic manual, and the efficacy of its drugs. What society needs, as it tries to figure out how to create a new paradigm of care, and thus fulfill its responsibility to care for its citizens in distress, is to be guided by science being honestly conducted, free of commercial and guild interests.

    I also agree with Richard: society has a responsibility to create the favorable conditions that allow good science to flourish, and our society, when it comes to the testing of drugs, has clearly failed in that regard.

    As for MIA being critical of non-drug therapies, I think MIA should bring a critical — meaning thoughtful, questioning perspective–to all psychiatric therapies. I recently wrote a paper for a European journal which I opened with a quote from the title of a book, which is something like: We have had one hundred years of therapy and the world keeps getting worse. That goes along with what I wrote in an earlier comment; I don’t want MIA to “favor” any therapy.

    Finally, in terms of who writes for MIA, I think we do have at least a few people who prescribe medications and see a use for them. We also just published a very thorough review of neuroleptics by Volkmar Aderhold and Peter Stastny, and they presented an evidence-based case for “minimal use” of these drugs. The discussion about the use of these drugs however should take place within a context of informed consent: what is known about how the drugs act on the brain and change the brain; what are their short-term and long-term effects (both on target symptoms and what might be described on the person as a whole, in all domains of his or her being), and what is known about their full range of side effects. And I am quite sure that the prescribing of psychiatric drugs has not occurred within a context of informed consent, and the violation of that informed consent starts with the idea of how they fixed chemical imbalances in the brain.

    And in a personal note to TSMONK, I’d be delighted to share a beverage at some point when I am in New York.

    • I think – maybe the lexicon of *critical psychiatry* ; the terms and phrasing used to describe the practices of the institution of psychiatry are as misleading as the terminology and phrasing ; the lexicon introduced to market biomedical psychiatry by the *institution of psychiatry* –or rather, none of this is making sense–

      In a comment above, Robert Whitaker writes:

      “The first thing is this: what is clear is that we have a paradigm of care in the United States (and increasingly this is true globally) that is organized around a false narrative of science. ”

      I think, maybe a more accurate description is that we have substantial evidence of the mass marketing of dangerous drugs achieved via endorsement by prominent academic psychiatrists, ALL of whom have engaged in corrupt, unethical practices- beginning with lies regarding scientific evidence for psychiatric diagnosis and drug treatments. The motive has also been clearly substantiated as financial gain, while the harm done to vulnerable people is as evident as the potential for further harm can be predicted IF this *paradigm of care* continues.

      Language is key at this juncture. Psychiatrists we know by name were caught pitching their schemes to Pharma companies, also named. Since when did our society condone, much less even suspect that anyone in the medical profession would be motivated by* commercial and guild interests* disregarding their professional duty of *caring for our citizens in distress*?? The public trust has a firm foundation in reasonable expectations around matters pertaining to the conduct of medical doctors. What society needs to do in the wake of stark evidence of the breach of our trust carried to this extreme , is condemn, and criminally prosecute the psychiatrists and Pharma KNOWN to have pulled off this heinous assault on our most vulnerable citizens, children. Condemning the institution that spawned and perpetrates this is a good place to start.

      I can report from recent experience as an imbedded double agent, or rather,as a staff nurse on adolescent, young adult and geriatric psychiatric inpatient units, there is zero interest in changing this *paradigm of care*- and less tolerance for any nurse who suggests *we* (psychiatric clinicians) might want to rethink our *paradigm of care*.

      Wishy washy rhetoric coming from investigative journalists who have uncovered the greatest threat to our children IS watering down the take home message. Looks no different than the magic bullets for brain disorders campaigns that provided the puzzle, whose solution just happened to be a scandal that is now a scourge unlike any we have known. Hello? Note the innocent children being sacrificed? They are “the new market”. I am just personifying the * commercial guild interest* to bring the message closer to home. When you see the harm, as I have, — and still do, in terms of Harvard Child Psychiatry victims who have not made it out of the woods yet– the rhetoric of justifying crimes against humanity is a HUGE trigger! Especially from this site, this particular source.

      Well, hopefully, I will get a bit of empathy for being so politically incorrect– at the very least?

  13. I agree with much of Mr. Whitacker’s statements here, though I would broaden their scope considerably. The “institutional corruption” and COI he describes extend to the entire field of medicine, with practioners being paid piecemeal for performing procedures they themselves recommend. The same considerations apply to Mr. Whitacker’s profession: What journalist or book author has ever undertaken any investigation only to conclude that “There is nothing unusual or troublesome going on here”. Books, magazines and newspapers are sold by provocative headlines and claims of having uncovered scandals that are exceptionally widespread and severe.

    What is needed to ignore the assessments of both those with a financial/career interests in both the overstatement and understatement of the risk-benefit ratio of pharmaceuticals. NICE and the Cochrane group might be reasonable examples of such organizations. Systematic reviews by the former organization have supported a favorable risk/benefit ration for antidepressants in moderate to severe depression and dysthymia, but not in mild, short term depression. The latter group has concluded that certain antipsychotics are useful in the acute treatment of schizophrenia exacerbations, but finds very limited evidence for maintenance treatment with most drugs.

    • @John Smith,

      The points you raise make a good case for taking Cognitive Dissonance off the table as an explanation for the exceptionally widespread, severe scandal that has been reported by Whitaker and Cosgrove. There is a big difference between not coming to grips with causing harm and willful denial of evidence that ALL prudent, logical, rational means for preventing harm were NOT employed. In other words, given the M.O. of our most prominent academic psychiatrist’s , the only possible outcome of their rogue negligence and abject arrogance would be harm. The rest of the discussion is about how much harm and what can be done about it.

      Embellishing the report of an investigation to sell books? Probably not going to turn out as well for an author as the same deception for financial gain scheme panned out for–Dr. Joseph Biederman , for example. Considering how many drones have been deployed to discover some means of discrediting Bob Whitaker–; considering how deep the pockets of Pharma are known to be and how successfully they have disposed of their traitors, we would have known long before now, if Whitaker and his new co-author Cosgrove had pumped up the volume on this book. That’s the thing, isn’t it? The report is accurate– but I think it falls short of revealing the full magnitude and implications of these factual accounts of the making of an empire out of the institution of Psychiatry.

      No matter how many times these ingredients are mixed together, or how many different ways they are combined, the product of this recipe is a very nasty smelling, ugly mess that no one wants to eat.

      Neutrality is not an appropriate stance at this juncture, and I daresay your proposal that we simply rearrange the furniture on the Titanic — again, is not going to be heard over the roar of shouts to : “Man the life boats”!

      The survivors will need to test the waters of our criminal justice system before we set sail toward a new horizon.

      • Just to elaborate my position a bit Katie: I think we all agree that most companies in most fields over-hype the value of their products. In medicine we try to protect patients from this by having a learned intermediary – a doctor – act as a gatekeeper between the drug manufacturer and the patient/client.

        In the case of psychiatry in particular, the role of the physician as a gatekeeper who puts the client’s interests first has been undermined by pharma payments that sometimes run into the hundreds of thousands of dollars. I share your concern about this. $100,000 is clearly enough money to affect anyone’s objectivity.

        For purposes of transparency and comparison, it would be interesting if Mr. Whitaker would share with us his total earnings from book royalties, speaking engagements, etc. related to criticism of the practice of psychiatry to date. I don’t think this is an entirely unreasonable request given the strong focus of much discussion on this site on the affect of pharma payments on the objectivity of psychiatrist viewpoints.

        • That is an interesting thinly veiled accusation. It would turn this from a discussion of psychiatry into a discussion about one person. It also ignores what seems to be one of the main points of Whitaker’s and Cosgrove’s book, which is that the problems of psychiatry are NOT caused ONLY by big pharma money corrupting individual psychiatrists, but also by psychiatry’s own guild interests. And it would be ridiculous to suggest that it would require money for anyone to be critical of psychiatry, which, in the the words of Philip Hickey, is an institution that is “fundamentally flawed and rotten.”

          • Its not an accusation at all.Its a request for transperancy. COI is not synonymous with corruption or even bias, but empirical studies have shown it is a significant influence. If it weren’t, why would companies spend so much money on docs, and why would it be such a topic of discussion on this website?

            From my POV, writers of popular books about healthcare have their own common financial and career interests that parallel those of psychiatrists. It is a guild as well.Controversy generates notoriety, career opportunities, and financial rewards. The more severe and pervasive a problem undercovered by an investigative journalist, the more controversy and headlines generated. No reporter ever won a Pulitzer Prize, became a household name, or became wealthy by wtiting a book stating “mostly fine, but I found a few things that could be tweaked”.

            In 3 clicks you can go to Dollars for Docs and see how much pharma money was recieved last year by any member of the psychiatric profession. I don’t understand why it would be percieved as an accusation or in anyway threatening to ask for a similar disclosure from others who earn their livelihood as commentators on the field.

          • I never said your question was threatening; I said it was changing the subject. If you think that Whitaker’s reporting about psychiatry is off base, then you can cite examples from his work and make your case.

        • JohnSmith says: “In medicine we try to protect patients from this by having a learned intermediary – a doctor – act as a gatekeeper between the drug manufacturer and the patient/client.”

          That’s worked out just great for everyone except for the patients.

          “I share your concern about this. $100,000 is clearly enough money to affect anyone’s objectivity.”

          I agree with uprising.

          Name one example of Robert distorting something, hyping something, hiding information or being dishonest in any way in any of his books or talks.

          • I am sure Mr. Whitaker honestly believes every word he says. I also believe that like every other person on the planet, his beliefs are subtley influenced by his financial and career interests. That is why transparency is important

            In terms of Mr. Whitaker’s ethics, I am confident they are very high. I would offer only the very minor criticism that this website, which is supported by donations, apparently provides free advertising for books on which Mr. Whitaker earns royalties.

          • Actually uprising, it wasnt me who changed the subject, it was you who responded to my
            request for COI disclosure with a demand that I present evidence of wrongdoing. The two issues are related but different. I merely redirected the discussion back to the original topic.

        • John,

          No one on this earth lives a bias free life and that includes you and Bob Whitaker. The difference is that neither one of you is treating me for a medical condition nor is Bob pushing his book on me to treat anything.

          Contrast that with a former sleep doctor who pushed a medication on me that was contraindicated according to the drug insert because this physician was probably visited by a drug rep before my visit. Or what about the physician who is pushing drugs on patients that he/she consults with drug companies on. Now that doesn’t mean the drug choice might not be inappropriate but as a relative said regarding ethics, it isn’t even good to give the appearance of being unethical even if you aren’t.

          By the way, I feel the same way about alternative healthcare professionals who sell products in their office just so you know.

        • John,

          Doctors as intermediaries and gate keepers for patients developed in concert with THEIR *guild* interests that absolutely were inspired by pharmaceutical companies bank roll– The evolution of the medical professional from patron or partner with her patients to gatekeeper and intermediary is a topic Dr. Healy writes extensively about in his books and on his blog. I have 40 years in the field– so I have seen and been part of something that newcomers cannot imagine– even from studying the history– IF any of you do study the history of your profession. In any case, you gloss over the most revealing aspect of the scandal that has been laid out pretty clearly– and like it or not, it was psychiatrists who led the way for it.

          Smooth talking Pharma reps did NOT design the TMAP guidelines, nor did they coerce Dr.Joseph Biederman into designing his disease invention clinical trials–. Allen Frances, AKA * the most powerful psychiatrist in the world*, ushering in no less than 70 new disorders and laying out a plan (documented in emails to J&J) , deserves credit for widely disseminating the perfect formula for creating life time users of Pharmas wares. THEIRS (the aforementioned psychiatrists) )was not the behavior of a doctor in the strict sense of the word. By the mid nineties these two psychiatrists had helped to transform what was once the work of a doctor.. getting to know a patient (boy does that date ME ), into third party diagnosing, made easy with the use of check lists–Even lay people could tick off boxes– showing before and after improvement in the *behaviors* the third parties had cited as most disturbing to THEM. This, by the way, is how childhood bipolar disorder was invented– and why Zyprexa and Risperdal were first line treatments . The sedation effect proved Biederman’s theory– that he had misdiagnosed a whole bunch of kids as ADHD– when, damn if they weren’t actually Bipolar– the very disorder Pharma was targeting for another batch of *mood stabilizers* as well–. Coincidence? Not likely.

          I never bought the *Pharma made us do it* crap, because I was witnessing doctors acting like businessmen — maybe before you stepped foot on a medical or psych unit?– The thing is, psychiatrists were the first to tap this gold mine, and they did it by deleting every aspect of medical practice that was predicated on * the best interest of the patient*.– Focused on ticking boxes, rating sales, third party observations– and profit sharing in the sales of drugs.

          In psychiatry, it is the the satisfaction of the third parties that keeps the business running. Even psych staff on the front lines, prefer controlling behavior and describing it with labels. A tough audience , kept blissfully ignorant in a vacuum where the light of anything real and concerning about this scandal never gets in.

          You are no less at risk for protecting guild interests that ALL newcomers must confront when hearing about the scandal that begs the question: Psychiatry? Why has it been allowed to exist as a medical speciality? Your strategy is to keep creating doubt and confusion, buying time for something that will vindicate psychiatry to be discovered.

          Intellectually speaking, you appear up to the task– but I would caution you to consider the reason doctors have the clout and power given to them by our society– a trust they no longer deserve. Once upon a time, a good doctor was one who had a healthy respect for what she DID NOT know– . Questioning everything based on the results shown by the patient– the ONE patient getting the treatment was key. No way, would this good doctor be the slightest bit influenced by either RCTs or a Pharma rep bearing gifts.

          Good doctors don’t let patients become a market in the first place. No reason for a good doctor to ever view herself as intermediary or gatekeeper– When you said , “In medicine, WE….” you got my attention. What followed, IMO was another valiant attempt to save the profession you have already paid for– in tuition and personal sacrifice.

          Us old timers like have been trying to impart words of wisdom to our young colleagues for several years now. David Healy actually goes so far as to issue warnings to newcomers and current practicing psychiatrists who don’t question their *paradigm of care* and fail to take some action to sort out the risks and flat out dangers it poses for their patients,
          . Healy warns that via their complacency, they are committing career suicide–.

          Come a time, when the plaintiff’s psychiatrist will be the focus , the main focus in malpractice and wrongful death litigation– the court cases that Pharma has been taking the bullets for — over a decade. WHY? Because a tipping point is arriving regarding the information reported by those whom you suspect are serving their own guild interests – as authors.

          If you plan to stay whre you are, Kimosabe, you had better put on a mask.

          Best,
          Katie

  14. One thing I clearly see as a survivor of unscientific medical “care” , unscientific dental “care” and most especially unscientific psychiatric “care”. It’s a miracle the resiliency of the human being ,their determination to survive revived enough times to finally understand what happened to them , millions or billions of human beings fallen by the wayside in the face of all the corrupted guilds out there guided by a relentless applied reptilian profit motive mated with the moral code of a serial killer all feeling so-oo respectable , credentialed , educated, all wanting to become a rockefeller or carnigie or morgan willing to take away everything from their fellow man for their own aggrandizement.
    Thank G-D for the investigative journalists , reporters , and real seekers of truth like Robert Whitaker , Edwin Black, Greg Palast, and so many here at MIA both bloggers and commenters.
    Crimes against humanity have been committed . Let the trial’s begin.” Science oh science what crimes are committed in thy name. ” Joseph Liss ND

    • I forgot , Reparations are also necessary and bring home the troops to surround big pharma .
      The answers are in the real fields of liberty and health freedom . The first do no harm real modalities include Traditional Naturopathy, Homeopathy, http://www.YuenMethod.com (an energy healing system) , and much that is offered at Monica’s site BeyondMeds.com
      Of course there are charlatans involved in all efforts and fields. There are also well meaning people. But some fields themselves are inherently fraudulent at the root of themselves within their foundational ideas and actions and have a track record of overwhelmingly causing to much damage to too many human beings. And yet that is certainly among the goals of many people of great wealth and power in the world. Read Edwin Black’s book “War Against The Weak”. History must be understood to get a grasp of what is happening in the present, and first do harm pharma ,health professionals, psychiatry and eugenics as a team have a track record and its not getting any better just more profitable.

    • Likewise, Fred. To me, it feels like pure light when we recognize and embrace each others’ heart and spirit this way. I embrace humbly my identity as a psych survivor, as it has taught me more about myself than anything else possibly could.

      “I feel that knowing I was loved and an internal abhorrence for injustice helped carry me in a positive direction.”

      The magic ingredients, knowing love and awareness of where there is lack of love. Where there is corruption and injustice, there is a blatant lack of love. And where there is lack of love, there is lack of safety. I wish more people could feel they are loved, because that makes us strong and confident, faithful. That’s the best healing the universe can offer.

  15. ” Where oh where is this going?”

    Precisely the question ALL well informed psychiatry survivors- patients and clinicians alike, are asking.

    The exposed scandal of psychiatry’s scourge should be going to court? Heard by a jury? Certain psychiatrists and Pharma execs should be going to jail??

    We’ve got evidence- written, documented from: investigative journalists, psychiatrists, ethicists , psychologists, therapists, nurses– ALL confirming the testimony of psych abuse survivors–.

    Why oh why hasn’t a charging document been written? Where are the federal prosecuting attorneys? the State’s attorneys? The Attorney General?

    We are a civilized, developed nation based on laws– some of which STILL offer protection for *we the people* from being exploited and harmed by fraud – THIS fraud has and does threaten the most vulnerable people in our society; this fraud created the wealthiest industry in the world. The buck should stop right here. where it ALL started.

    Otherwise, what is the freaking pint??

  16. Regarding John Smith’s request for transparency, I can first assure him that writing critically of psychiatry and the pharmaceutical industry is a very lousy way to try to earn a living. In fact, both MIA and speaking related to Anatomy of an Epidemic have presented something of a financial hardship, as they have taken me away from the schedule of publishing of trade books that I had been on before Anatomy was published, which is how I had been making a living.

    I started this website, madinamerica.com, as a personal website after publishing Mad in America, my first book on psychiatry, in 2002. I then turned it into a webzine in the first months of 2012, after publishing Anatomy of an Epidemic in April of 2010.

    Although Mad in America, the book, is not much publicized on this site, I do get a small amount of royalties each year from that book — a couple of thousand dollars a year.

    As for Mad in America, the website, I invested $20k in it to start the website (and got some other investment as well). I have never taken a penny from the website in pay, and most of our initial investment is gone. The money we get from donations does not cover our operating costs, and we are going to have to figure out other sources of revenue if we are going to continue the website over the long-term. We are investigating those possibilities now. But for me personally, it has represented a serious financial drain.

    As for Anatomy of an Epidemic, which is sometimes featured in a box on the front page (partially because some people come to this site looking for more information about that book and my speaking engagements), I have yet to earn any royalties on that book. The way the trade industry works is you get an advance against royalties, and then you don’t get any more royalties until you sell enough books to pay back that advance. Talk to any writer today, and unless you are a famous celebrity writing a book, or a best-selling fiction author, and they will tell you that writing books is a very lousy way to earn a living.

    As for speaking, yes, I speak a lot, and in the past few years, I suppose my honorariums have totalled around $12k per year, even though I am on the road for more than 100 days a year. The reason of course is I am speaking to groups without money, or to professional groups that pay smaller honorariums even to their keynote speakers.

    So there is your transparency. In our society, I think financial conflicts of interest develop when you are singing the praises the powerful and corporate interests, not when you are challenging them, and doing so in such a contentious space as psychiatry. Your “pay” for challenging such powerful interests comes in the form of thinking that you are doing something meaningful with your life. There is an old adage in journalism that your job is to afflict the comfortable and comfort the afflicted, and I like to remember that as I think whether what I am doing with mad in america is a worthwhile endeavor.

    • It is laughable to compare the few farthings you pull in from speaking engagements and book sales to the hundreds of billions of dollars involved in the pharmaceutical industry corruption of psychiatry and our society as a whole. I for one appreciate the sacrifices you have made to get this message out, and I seriously believe the publicity surrounding your book has had a dramatic impact on the conversations going on nationwide regarding the “mental health” system. I hear SO much more critical thinking and so much less acceptance of medication as the panacea for “mental illness” than I did even 5 years ago, it’s quite remarkable. So thanks for putting your passions before your pocketbook. If the majority of those in the psychiatric field did the same, we’d be having a very different conversation today.

      — Steve

      —- Steve

    • Robert, MIA is a valuable forum. If it is struggling financially, I’m sure you are considering all options, but at some point, making members publicly aware of what level of donations would be needed to bring it closer to breaking even might be useful. Maybe this is on the site somewhere and I haven’t seen it.

      Further, you could do a one-time kickstarter.com funddraiser, or a once-a-year kickstarter donation drive.

      Or you could let Big Pharma sponsor the site.

      Just kidding about that last one 🙂

    • Just because I’ve had a ringside seat from the beginning of MIA as a webzine, I’d like to verify that the site has not benefitted anyone financially – and in Bob’s case it has been a large, unrecouped loss. In addition to that, every time we have been faced with a choice that could have benefitted Bob, whether financially or just by making his life a little easier or more pleasant, he has always chosen resolutely on the side of MIA’s greater mission, rather than for his own interest. In fact it has sometimes seemed to me that he had begun to choose against his own interest out of habit, or some sense of obligation. That is why I have hung in there, through some difficult times. The only way any of us has benefitted has been in the knowledge that we are doing something good at an important time in history, and for that we consider ourselves lucky.

      • Hi Kermit,

        I just contributed to the site and I hope others do too. I wonder how we could get MUCH more funding for this site? It seems to me that the resources here are unique and absolutely crucial. Particularly Bob’s videos from the Copenhagen 2014 conference. I don’t know of anyone else who has successfully distilled and evaluated the whole known literature on psych drug risks and benefits and yet can present the results in a way that almost anybody can understand.

        – Saul

  17. Thank you for an honest disclosure. As a clinical social worker struggling now with writing about the issues that matter to us and that clearly disturb the establishment I can confirm all that you say about money not being a motive or incentive for doing any of our work. What we lose financially, we gain morally and emotionally.
    We really don’t have to defend ourselves….do we?

  18. Thank you all for this thought provoking discussion. I was in high school when Dr Sidney Wolfe began his work on deinstitutionalization. I don’t know how many of you were aware of how bad things were at that time. One summer I worked copying old court records for civil commitments. Everyone involved in this discussion and for all psych professionals it should be required reading. So very , very sad. So many folks were committed and died shortly after. I had the opportunity to see some of the state asylums for both the DD and the Mental Health folk. At times, there were inappropriate patients stuck in bureaucratic hell. By then most of the worst buildings had been cleaned up but it was still not a place one would ever really want to put a loved one in.
    There was so much hope for community support and that was dashed especially for the Mental Health folks. I don’t know the backstory and narrative of the whys and wherefores but it should be looked into. Mental Health seemed to get the raw end of the deal.
    Then there was the focus on abuse and again my hopes were raised. Nothing came from that as well.
    I get that some folks have been helped by medication and that in fact did allow the beginning movement of the end of asylum care. With my own experience, medication was helpful short term but devastating long term. Therapeutic interventions were definitely not ever in the excellent range and most somewhat helpful. Most of my recovery came fro my research and making my own treatment plan with various very expensive options. Luckily it worked. Peer support was essential.
    At this time there is no program or treatment that I find workable for all. There are black holes and gaps in all sectors!. I find Robert’s work to have been life saving. The writing here even when I disagree always helpful in some, shape or form.
    I would love to use the legal system. I experienced clear medical malpractice. The trouble is no attorney is willing to pursue a case even if it involved plain old medicine much less psychiatry.
    I think this issue is just the tip of the iceberg in our current age. There is so much corruption,
    so much greed, so much falling apart of the old system of responsibility and human caring for one another that money rules everything over and above all the traditional ethics.

    • Yes research and the courage to move ahead and design a plan that works for you. That, along with journalists who do a great deal of the probing and investigating, is the way to begin to take some control over a dehumanizing and destructive medical process. You are so right!

  19. Robert Whitaker,
    I am not particularly religious, but so many times when I read what you write, the phrase “God bless you!” jumps into my mind. Thank you for giving what I consider to be a hefty financial contribution for creating Mad in America. And thank you for devoting so much of your time for very little financial return.

    John Smith,
    if you are still on this thread, I just wanted to let you know that I did notice your efforts in trying to stay respectful when asking your question. I think it is ideal when different ideas and opinions can be hashed out in a respectful way and I hope you continue to comment and questions things in the future, I think people who comment respectfully with different opinions can only make our site stronger, Indeed it has been through great back and forth threads arguing over ‘issues’ that has made me realize how sound Robert Whitaker’s arguments are.

    I just wanted to add, though, that many people who comment here have suffered so greatly and have risen above great odds. I know for myself, I have often found myself hoping, ( on other sites where I comment), that people can see the ‘pain behind the anger’ in some of the things I say. Many people like me also feel that we owe so much to Mr. Whitaker so I am not surprised to see people jump to his defense!