In the political struggle between First-Order Psychiatry (which includes the American Psychiatric Association and Big Pharma) and the Rehumanizing Resistance (which includes many in the Mad in America community), the Resistance continues to win key scientific victories (including the First-Order’s retreat from its “chemical imbalance theory of mental illness”); however, the Resistance is losing the larger struggle against the First Order’s expansion of influence (e.g. one of four foster children in the U.S. are now on psychiatric drugs).
Winning scientific battles but losing the war will continue until the Resistance: (1) fully recognizes the political nature of this struggle; (2) accepts the reality that it has an adversary aimed at its destruction; and (3) creates and implements effective political strategies and tactics.
Recognizing the Political Nature of the Struggle
First-Order Psychiatry and the Rehumanizing Resistance are separated by a fundamental difference that results in each camp posing a political threat to the other’s survival.
This fundamental difference is with regard to the claim by First-Order Psychiatry that it is a legitimate authority to determine mental illness.
The claim by First-Order Psychiatry—the American Psychiatric Association (APA) in particular—that it is a legitimate authority with respect to determining mental illness is essential for its “treatment” and control. First-Order’s illness labeling, “treatment,” and control dominion are the sources of its financial arsenal and political power.
The Rehumanizing Resistance is a political threat to First-Order Psychiatry because it rejects the claim that First-Order Psychiatry is a legitimate authority in determining mental illness; and so the Resistance also rejects the First-Order’s “treatment” and control dominion.
First Order Psychiatry’s Political Strategies and Tactics
Grasping the political threat of the Rehumanizing Resistance to its existence, First-Order Psychiatry—the far more politically astute of the two camps—has historically tried to marginalize and destroy the Resistance. First-Order Psychiatry has multiple political strategies and tactics for dealing with threats to its authority from its critics.
When individual critics of First-Order Psychiatry are low-profile, the First Order has simply ignored and dismissed them. Blowing off low-profile critics is an effective political tactic, causing many such critics to feel helpless and give up, or become so frustrated and enraged that they are politically ineffective.
When critics are more high-profile, the First-Order has derided, slandered, and attempted to destroy them. First-Order Psychiatry has meted out retributions to critics even when their challenges are not directed at First Order’s authority to determine mental illness but only at First-Order’s treatment ineffectiveness.
I don’t know of any critic of First-Order Psychiatry who has not paid some price, such as career and licensing difficulties, legal threats, and financial costs.
In 1968, the late psychiatrist Loren Mosher became the National Institute of Mental Health’s Chief of the Center for Schizophrenia Research, and he created an alternative approach for people diagnosed with schizophrenia called the Soteria Project, an egalitarian and non-coercive psychosocial milieu. The results of the project showed that people did far better with this Soteria approach than standard psychiatric treatment, and that people could in fact recover with little or no use of antipsychotic drugs. What then happened to Mosher? He was fired from NIMH in 1980.
Mosher’s high-profile position, his successful alternative approach, and then his ultimate firing sent a chilling message to any other humanistic psychiatrist who might challenge the First-Order’s authority.
Throughout the 1980s, First-Order Psychiatry was politically threatened by competition from non-psychiatrist mental health professionals as well as criticisms from human rights advocates, including ex-patients and non-First-Order psychiatrists such as Mosher. And so, the First-Order made the political decision to partner with drug companies, which stood to heavily benefit from the First-Order’s dramatic increase in drug prescribing. This created what some have called the Psychiatric-Pharmaceutical Industrial Complex.
How corrupt is First-Order Psychiatry’s partner, Big Pharma? Even the pro-big business Forbes has rhetorically asked “Is Big Pharma Addicted to Fraud?” And Peter Gotzsche, author of Deadly Medicines and Organized Crime, has compared Big Pharma to organized crime mobsters.
In 2006, ex-patient, human rights activist and attorney Jim Gottstein provided documents to the New York Times showing that Eli Lilly had kept serious health risk information about their drug Zyprexa from being released to doctors and the general public. In retribution, Gottstein reported: “Lilly has threatened me with civil and criminal contempt sanctions and going after my license to practice law. My legal fees in defending against Lilly’s legal onslaught have so far been just under $300,000, including estimated unbilled fees, of which I still owe over $121,000. This has put me financially under water.”
More recently, the First-Order has faced another kind of high-profile challenge. Robert Whitaker is an investigative journalist who won the George Polk award for medical reporting and was a finalist for the Pulitzer Prize for Public Service for his 1998 Boston Globe series “Doing Harm: Research on the Mentally Ill” (co-authored with Dolores Kong). Whitaker has since authored Mad in America (2001), Anatomy of an Epidemic (2011) and Psychiatry Under the Influence (2015, co-authored with Lisa Cosgrove). First-Order Psychiatry’s reaction to Whitaker? In 2015, former president of the APA, Jeffrey Lieberman, publicly declared Whitaker to be a “menace to society.”
First-Order Psychiatry’s political arsenal is fueled by Big Pharma financial backing, enabling the First-Order to monopolize the media and exploit people’s fears of the unfamiliar. This results in First-Order treatment domination, and it is the lack of informed choice to which the Rehumanizing Resistance battles against.
In addition to retributions for critics, First-Order Psychiatry has employed many other strategies that authoritarian institutions have utilized to stay in power. One example is co-opting (taking control of something that could potentially cost them power and use it for their own purposes). The First-Order has attempted to co-opt some of the language of the Rehumanizing Resistance; and it has attempted to co-opt the peer support movement by, at times, hiring ex-patients not as genuine peer supporters but to assist the First-Order to maintain control.
First-Order Psychiatry has also evidenced political agility when faced with the occasional societal challenges to its mental illness labeling authority. In the early 1970s, gay activists challenged the APA’s pathologizing of homosexuality, and the First-Order, recognizing that it was on the wrong side of societal change, pivoted and discontinued labeling homosexuality as a mental illness.
Within First-Order Psychiatry itself, “pathologizing preeminence” gives individual psychiatrists prestige and power, and so members of the First-Order quibble among themselves about what is and what is not a mental illness (for example, DSM-4 task force director tells us with respect to the current DSM-5 to “ignore its ten worst changes”).
However, while First-Order Psychiatry can revise their DSM, and while First-Order big shots infight for pathologizing preeminence, First-Order Psychiatry knows that its very existence depends on the societal acceptance that it is a legitimate authority in determining mental illness.
For the Rehumanizing Resistance, the First-Order’s entire rationale for all of its psychopathologizing is unscientific and illegitimate. The Resistance believes that just because behaviors, cognitions, and emotional states may cause tension or even frighten some of us, or may appear bizarre to many of us, or may even render us incapable of occupationally and interpersonally functioning, this is not scientific evidence of illness.
This fundamental difference with respect to the acceptance or rejection of psychiatry as legitimate authority to determine mental illness is why the First-Order and the Resistance pose a political threat to each other.
The Rehumanizing Resistance’s Political Naivety
Unlike First-Order Psychiatry, the Rehumanizing Resistance has historically been politically naïve. So, the Resistance has often squandered its time, energy, and resources attempting to dialogue with the First-Order trying to reform it. It is politically naïve for the Resistance to attempt to reform the First-Order when the First-Order considers the Resistance to be an existential threat to the First-Order’s survival and wants to destroy it. This naivety is part of why the Resistance repeatedly wins scientific battles but is losing the greater political struggle.
The Resistance has relied on articulating scientific truths and moral principles such as the right to informed choice. Scientific truths and moral principles can be politically powerful but only so if utilized with political strategies and tactics.
It is naïve to think that truth and morality wins regardless of political savvy.
In future Real Politics 101 pieces, I will focus on: Resistance strategies and tactics that have been effective; when direct action and confrontation can succeed and when it cannot succeed; taking advantage of the general cultural climate; alliances and coalitions; organizing; film, media, and other powerful tools; as well as Resistance dissension, team-building, morale, and creating and maintaining the energy necessary to politically do battle.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.