Earlier this year, Alan Schwarz, an investigative reporter for the New York Times, published his latest book: ADHD Nation.
The blurb on the jacket states:
“More than 1 in 7 American children get diagnosed with ADHD—three times what experts have said is appropriate—meaning that millions of kids are misdiagnosed and taking medications such as Adderall or Concerta for a psychiatric condition they probably do not have. The numbers rise every year. And still, many experts and drug companies deny any cause for concern. In fact, they say that adults and the rest of the world should embrace ADHD and that its medications will transform their lives.
In ADHD Nation, Alan Schwarz examines the roots and the rise of this cultural and medical phenomenon: The father of ADHD, Dr. Keith Conners, spends fifty years advocating drugs like Ritalin before realizing his role in what he now calls ‘a national disaster of dangerous proportions’; a troubled young girl and a studious teenage boy get entangled in the growing ADHD machine and take medications that backfire horribly; and Big Pharma egregiously over-promotes the disorder and earns billions from the mishandling of children (and now adults).”
And who could argue with any of that? But the blurb continues:
“While demonstrating that ADHD is real and can be medicated when appropriate, Schwarz sounds a long-overdue alarm and urges America to address this growing national health crisis.”
And there, of course, is where we must part company.
When I first read the jacket blurb, I was curious as to what kinds of arguments Alan Schwarz would marshal to support the contention that ADHD is “real”, and that it sometimes warrants “medication”. And let us be clear as to the meaning of the word “real”. Nobody is denying that inattention, hyperactivity, and impulsivity can be real problems. The issue at stake, however, is whether it makes any sense to conceptualize this loose cluster of vaguely-defined problems as an illness. Usually when people say or write that ADHD is “real”, they mean that this cluster of problems listed in the APA’s catalog (DSM) is a genuine, bona fide illness – just like diabetes; and that people who “have” this so-called illness must take their “medication” in the same way that diabetics must take insulin. So, the promise on the jacket that Mr. Schwarz would demonstrate that ADHD is a real illness seemed significant, and as I said earlier, I was particularly interested in whether he had anything new to add to this debate.
Here’s the opening page of the introduction.
“Attention deficit hyperactivity disorder is real. Don’t let anyone tell you otherwise.
A boy who careens frenziedly around homes and busy streets can endanger himself and others. A girl who cannot, even for two minutes, sit and listen to her teachers will not learn. An adult who lacks the concentration to complete a health-insurance form accurately will fail the demands of modern life. When a person of any age has a combination of these struggles—severely enough to impair his daily functioning—with no other plausible explanation for them, then he could very well have a serious, if still somewhat mysterious, condition that medicine has decided to call ADHD.
No one quite knows what causes it. The most commonly cited theory is that the hypractivity, lack of focus, and impulsivity of classic ADHD result from some sort of dysfunction among chemicals and synapses in the brain. A person’s environment clearly plays a role as well: a chaotic home, an inflexible classroom, or a distracting workplace all can induce or exacerbate symptoms. Unfortunately, as with many psychiatric illnesses, such as depression or anxiety, there is no definitive way to diagnose ADHD, no blood test or CAT scan that lets a doctor declare, ‘Okay, there it is’—all one can do is thoughtfully assess whether the severity of the behavior warrants a diagnosis. (After all, we all are distractible or impulsive to varying degrees.) One thing is certain, though: There is no cure for ADHD. Someone with the disorder might learn to adapt to it, perhaps with the help of medication, but patients young and old are generally told that they will deal with their abnormal brains for the rest of their lives.” (p 1)
And there is it. Let’s take a closer look.
“Attention deficit hyperactivity disorder is real. Don’t let anyone tell you otherwise.”
The reality or otherwise of “ADHD” is the fundamental issue of this entire debate, and it is clear from this opening statement that Mr. Schwarz has not approached this question with anything resembling the kind of open-mindedness that one expects from an investigative journalist.
But it gets worse.
“A boy who careens frenziedly around homes and busy streets can endanger himself and others.”
Mr. Schwarz is clearly trying to create the impression that this kind of behavior is fairly typical of children who “have ADHD”, and he is also pointing out that the behaviors are serious. What he doesn’t mention, however, and perhaps isn’t even aware of, is that physically dangerous activity – including running “into street without looking” – was one of the specific criteria for ADHD in DSM-III-R, but was diluted to “runs about or climbs excessively” in DSM-IV. And in DSM-5, the word “excessively” was dropped. Here are the actual items from the three editions:
“(14) often engages in physically dangerous activities without considering possible consequences (not for the purpose of thrill-seeking), e.g., runs into street without looking” (p 53)
Under the sub-heading Hyperactivity:
“(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)” (p 84)
Under the sub-heading Hyperactivity and impulsivity:
“c. Often runs about or climbs in situations where it is inappropriate. (Note: in adolescents or adults, may be limited to feeling restless.) (p 60)
So, a boy who careens frenziedly around homes and busy streets would probably meet the standard in all three editions, but – and this is the critical point – there is no requirement in the latter editions of such extreme behavior to score a “symptom” hit. Contrary to Mr. Schwarz’s implied assertion, a child does not have to engage in such extreme or dangerous behavior to meet any of the APA’s criteria for this so-called illness. And it needs to be noted particularly that since 1994, the only requirement under this item for adults and adolescents is that they experience feelings of restlessness!
. . . . . . . . . . . . . . . .
“A girl who cannot, even for two minutes, sit and listen to her teachers will not learn.”
How can Alan Schwarz – or anyone else, for that matter – deduce that a girl who doesn’t pay attention to her teachers, can’t pay attention. This is an invalid inference, but is standard procedure in psychiatry.
. . . . . . . . . . . . . . . .
“When a person of any age has a combination of these struggles—severely enough to impair his daily functioning—with no other plausible explanation for them, then he could very well have a serious, if still somewhat mysterious, condition that medicine has decided to call ADHD.”
This again is standard psychiatric patter: the flaw is contained in the phrase “…with no other plausible explanation for them…”
Anyone who has had even the slightest experience working with children and families can attest to the fact that there are always alternative psychosocial explanations, if one is prepared to look for them. The reality, however, is that within the practice of psychiatry, these alternate explanations are almost never sought.
And the reason they are not sought is because psychiatry has effectively closed the door on these kinds of deliberations. Within the psychiatric framework, if a child (or adult) meets the arbitrary and inherently vague criteria listed in the DSM, then he has a brain illness called ADHD. So the notion of even looking for psychosocial explanations not only doesn’t happen, but would be seen within psychiatry as ridiculous.
In real medicine, if a person has pneumonia, then that is the explanation of his persistent cough, nasty phlegm, weakness, etc. The notion of a physician in such circumstances casting around for an alternative psychosocial explanation would be pointless. Similarly, psychiatrists, firmly wedded as they are to their spurious illness perspective, don’t look for ordinary human explanations of the problems they encounter. The difference, of course, between psychiatry and real medicine is that the latter’s diagnoses are indeed genuine explanations of the presenting problems. In psychiatry, the “diagnoses” are merely labels that psychiatrists assign to the loose clusters of vague problems, and have no explanatory value whatsoever.
To demonstrate this, consider the two following hypothetical conversations.
Client’s parent: Why is my son so distractible; why does he make so many mistakes in his schoolwork; why does he not listen to me when I speak to him; why is he so disorganized?
Psychiatrist: Because he has an illness called attention-deficit/hyperactivity disorder.
Parent: How do you know he has this illness?
Psychiatrist: Because he is so distractible, makes so many mistakes in his schoolwork, doesn’t listen when you speak to him, and is so disorganized.
The critical point being that in psychiatry, the only evidence for the “illness” is the very behavior it purports to explain. In other words: your son is distracted because he is distracted.
Contrast this with a similar conversation in real medicine.
Patient: Why am I so tired; why did my temperature spike; why am I spitting up such dreadful-looking phlegm?
Physician: Because you have pneumonia.
Patient: How do you know I have pneumonia?
Physician: Because I can hear characteristic sounds through the stethoscope; your chest X-ray shows large quantities of fluid in both lungs; your sputum labs are positive for pneumococcus; and because everything you have told me is consistent with this diagnosis. I can show you the X-rays if you like.
In this conversation, there is no circularity to the reasoning. The pneumonia is the cause of the symptoms and constitutes a genuine and useful explanation.
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“No one quite knows what causes it.”
Well actually, lots of people know what prompts children to “careen frenziedly around homes and busy streets”. It is very simply that the discipline and self-control to refrain from this kind of activity has not been instilled at an appropriate age. And it’s not “somewhat mysterious”. It’s something that parents and grandparents have been dealing with probably since prehistoric times. And the same goes for the other ADHD behaviors, misleadingly called “symptoms” in the DSM.
. . . . . . . . . . . . . . . .
“The most commonly cited theory is that the hyperactivity, lack of focus, and impulsivity of classic ADHD result from some sort of dysfunction among chemicals and synapses in the brain.”
And just when we thought that the long-discredited chemical imbalance hoax was about to die! Mr. Schwarz seems unaware that most leading psychiatrists are at the present time busy distancing themselves from this particular inanity, which was a mainstay of the psychiatric hoax for decades. The very eminent and highly prestigious Tufts psychiatrist Ronald Pies, MD has even gone so far as to claim that psychiatry never promoted this hoax – an assertion that adds an entire new dimension to academia’s allegorical ivory tower.
Then Mr. Schwarz gets to the point:
“Unfortunately, as with many psychiatric illnesses, such as depression or anxiety, there is no definitive way to diagnose ADHD, no blood test or CAT scan that lets a doctor declare, ‘Okay, there it is’—all one can do is thoughtfully assess whether the severity of the behavior warrants a diagnosis. (After all, we all are distractible or impulsive to varying degrees.)”
So despite the earlier vagueness, and despite Mr. Schwarz’s condemnation of what he describes as the over-diagnosis of ADHD, he is clearly a firm supporter of psychiatry’s contention that inattention, impulsivity, and general gadding about constitute an illness, if the behaviors cross some ill-defined threshold of severity.
This is another of psychiatry’s core fallacies, routinely promoted, not only in the successive editions of the DSM, but also in the defensive writings of psychiatry’s most prestigious promoters: if a problem of thinking, feeling, or behaving crosses some arbitrary and vaguely defined thresholds, of severity, duration, or frequency, it becomes, through some alchemy known only to psychiatry, an illness. The fact that no organic pathology has ever been identified is of no consequence. If the problem is severe enough, then it’s an illness.
And the reason for this travesty is that within the looking-glass realm of psychiatric diagnosis, the cause of the problem is irrelevant. This is the essential point of Robert Spitzer’s phenomenological approach as embodied in his DSM-III and in subsequent editions. Why a person exhibits a problem is of no consequence. If, in the case, say of “ADHD”, a child is inattentive, overly active and impulsive to the degree specified, albeit loosely, in the text, then he has the illness. Whether he emits these behaviors because of lax parenting, inconsistent parenting, indulgent parenting, sibling rivalry, emotional abuse, or some other cause, makes no difference to the “diagnosis”. In marked contrast to real medicine, where diagnosis and cause are virtually synonymous, in psychiatric diagnosis, the cause of the problem is immaterial. If the child emits the behaviors in question, for any reason or cause, then he “has the illness”. The “illness” in fact is nothing more than the presence of the vaguely-defined problem behaviors. There is no requirement of neurological pathology, nor any evidence that the behaviors in question entail a neurological pathology. DSM-III describes this approach as “…atheoretical with regard to etiology or pathophysiologic process except with regard to disorders for which this is well established and therefore included in the definition of the disorder.” (p xxiii), which is not the case with ADHD.
Far from acknowledging the obvious dishonesty of this “atheoretical” approach, DSM-III-R actually makes of it a virtue:
“The major justification for the generally atheoretical approach taken in DSM-III and DSM-III-R with regard to etiology is that the inclusion of etiologic theories would be an obstacle to use of the manual by clinicians of varying theoretical orientation since it would not be possible to present all reasonable etiologic theories for each disorder.” (p xxiii)
In reality, however, by ignoring etiological questions, the APA created the context in which “mental disorders” could be created at will on the basis of any human problem, and these “disorders” could be, and indeed are, morphed readily into “mental illnesses”, and, of course, as we see in Mr. Schwarz’s text, neuro-chemical imbalances. Psychiatry has conveniently abandoned the notion that new diagnoses must be grounded on proven organic pathology. Real doctors discover new illnesses through painstaking research and study – often taking years or even decades. Psychiatry just makes them up and confirms their ontological validity by a committee vote.
For decades, psychiatry, confident in the knowledge that few people read the DSM, simply lied with regards to the absence of organic pathology. They told their clients, the public, and the media the blatant lie that the “chemical imbalances” existed and were the cause of the problems. And – the biggest whopper of all – that the drugs corrected these non-existent imbalances. They also routinely asserted that their “patients” would in many (or perhaps most) cases have to take the drugs for life. And here again, Mr. Schwarz follows his psychiatric mentors, lock step.
“One thing is certain, though: There is no cure for ADHD.”
Again note the dogmatic arrogance. Children who are inattentive, unruly, disobedient, and disruptive to the inherently vague degree specified in the DSM are incapable of acquiring an age-appropriate level of discipline! How in the world could Mr. Schwarz know this? As early as 1973, Huessy, Marshall and Gendron (Five hundred children followed from grade 2 to grade 5 for the prevalence of behavior disorder, Acta Paedopsychiatrica, 39(11), 301-309), showed that hyperactivity is not a stable pattern across time. There is also an abundance of research going back to the 60’s that demonstrates clearly that children who are habitually inattentive, impulsive, and hyperactive even to an extreme degree, can be trained readily to behave in a more productive and less disruptive fashion. In fact, prior to the mid-60’s, no such research was needed, because parents and teachers routinely and successfully trained children to control their movements, and to pay attention to their studies and to their chores. Indeed, parents and teachers accepted that this was an intrinsic part of their responsibilities. But in 1968, with the publication of DSM-II, psychiatry’s “top experts” decreed that these problem behaviors constituted an illness that required specialist attention. This “illness” was labeled hyperkinetic reaction of childhood. The description ran to four lines:
“308.0 Hyperkinetic reaction of childhood (or adolescence)*
This disorder is characterized by overactivity, restlessness, distractibility,
and short attention span, especially in young children; the
behavior usually diminishes in adolescence.” (p 50)
. . . . . . . . . . . . . . . .
“…patients young and old are generally told that they will deal with their abnormal brains for the rest of their lives.”
Despite decades of lavishly funded and highly motivated research, and despite the numerous enthusiastic, and subsequently discredited, claims to the contrary, there is not one shred of evidence that people who have been given the ADHD label have any brain pathology whatsoever. In fact, no edition of DSM, including the present DSM-5, has ever included any kind of brain pathology as a criterion item for this so-called illness. DSM-5 does include ADHD in the Neurodevelopmental Disorders section, but all that this entails is that the onset of the problem was in the developmental period. There is no requirement of neurological pathology. “The neurodevelopmental disorders are a group of conditions with onset in the developmental period. The disorders typically manifest early in development, often before the child enters grade school, and are characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning.” (p 31) Describing “ADHD” as a neurodevelopmental disorder strikes me as extraordinarily deceptive, in that most people would interpret the term “neurodevelopmental disorder” to entail some kind of neurological pathology. What the APA has done here is convey the impression that there is a neurological pathology involved in “ADHD”, without having to produce evidence that this is the case.
The “Over-Diagnosis” of ADHD
Then Mr. Schwarz gets to the main theme of his book: that ADHD is being grossly over-diagnosed, a theme incidentally that many psychiatrists have adopted in recent years in an attempt to rescue their crumbling profession from the criticisms of anti-psychiatry. Watch how Mr. Schwarz does this:
“The American Psychiatric Association’s official description of ADHD, codified by the field’s top experts and used to guide doctors nationwide, says that the condition affects about 5 percent of children, primarily boys. Most experts consider this a sensible benchmark.
But what’s happening in real-life America?
Fifteen percent of youngsters in the United States—three times the consensus estimate—are getting diagnosed with ADHD. That’s millions of extra kids being told they have something wrong with their brains, with most of them then placed on serious medications. The rate among boys nationwide is a stunning 20 percent. In southern states such as Mississippi, South Carolina, and Arkansas, it’s 30 percent of all boys, almost one in three. (Boys tend to be more hyperactive and impulsive than girls, whose ADHD can manifest itself more as an inability to concentrate.) Some Louisiana counties are approaching half—half—of boys in third through fifth grades taking ADHD medications.
ADHD has become, by far, the most misdiagnosed condition in American medicine.
Yet, distressingly, few people in the thriving ADHD industrial complex acknowledge this reality. Many are well-meaning—they see foundering children, either in their living rooms, classrooms, or waiting rooms, and believe the diagnosis and medication can improve their lives. Others have motives more mixed: Sometimes teachers prefer fewer troublesome students, parents want less clamorous homes, and doctors like the steady stream of easy business. In the most nefarious corner stand the high-profile doctors and researchers bought off by pharmaceutical companies that have reaped billions of dollars from the unchecked and heedless march of ADHD.” (p 2-3)
But what Mr. Schwarz doesn’t mention, and perhaps isn’t even aware of, is that 69% of those “top experts” in psychiatry who “codified” the criteria for ADHD for DSM-5, and whose prevalence estimates Mr. Schwarz accepts implicitly, were also in the pay of pharma.
Nor does Mr. Schwarz seem to be aware that these same “top experts” who codified the criteria for ADHD have progressively liberalized the criteria for this so-called illness. I have listed the DSM-IV (1994) relaxations in an earlier post. The relaxations for DSM-5 (2013) were:
– the number of inattention “symptoms” required for adolescents and adults reduced from six to five (p 59)
– the number of hyperactivity/impulsivity “symptoms” for adolescents and adults also reduced from six to five (p 60)
– DSM-IV specified that some symptoms of ADHD had to have been present prior to age 7 (p 84). DSM-5 relaxed this age-of-onset criterion to 12 (p 60).
It needs to be stressed that none of these relaxations were, or indeed could have been, based on empirical evidence or science. There is no definition of ADHD other than that set down in successive revisions of the DSM. The notion that the pharma-paid “top experts” compared ADHD-as-it-really-is with the description in the DSM, and found discrepancies, is simply not possible. There is no ADHD-as-it-really-is. There is no definition other than the one that the APA made up, and they can, and do, change it at will. And, so far, the vast majority of the changes have been in the relaxation direction.
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And this is the central point. To bemoan the over-diagnosis of ADHD is an empty, futile exercise. Given the facts that:
– the criteria are impossibly vague and subjective, and
– pharma makes more money the wider the net is cast, and
– psychiatry shares in these profits through a variety of avenues, and
– the drugs are addictive, and
– schools receive additional funding for every ADHD child on their rolls,
“diagnosis” creep is inevitable. “Diagnosis” creep is not some accident or some pharma-produced sabotage that has befallen psychiatry despite its best efforts to remain pure and undefiled. “Diagnosis” creep is an integral component of the monster that psychiatry has consciously and deliberately created. “Diagnosis” creep is an integral part of psychiatry’s expansionist agenda, and was facilitated enormously by Robert Spitzer’s atheoretical, phenomenological approach in DSM-III (1980). Though, incidentally, in the case of “ADHD” it was occurring prior to 1980. Here’s a quote from Ullmann and Krasner’s A psychological Approach to Abnormal Behavior, Second Edition, (1975):
“The treatment of children who have received the label of ‘hyperactive’ has been a source of further controversy in both psychology and pediatrics…Drug therapy, particularly stimulants such as amphetamines, have become the popular form of treatment including up to 10% of all students in some school districts…” (p 496)
And even then, forty-one years ago, there were clear dissenting voices:
“The label plus the drug treatment brings the child into the mentally ill or sick category and the social and self-labeling that follow…The use of drugs enhances the belief in the efficacy of outside agents rather than attribution of change to one’s own efforts (an important element in the development of self control in children and responsibility in teachers).” (Op. Cit. p 497)
If should also be noted that the relaxation of criteria is not confined to “ADHD”. DSM-5 also relaxed the APA’s definition of a mental disorder, effectively expanding the net for all their so-called diagnoses.
The definition of a mental disorder in DSM-IV (1994) was:
“… a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as descried above.” (p xxi-xxii)
This definition can, I think, be accurately paraphrased as: any significant problem of thinking, feeling, and/or behaving. And indeed, it is extremely difficult to think of a significant problem of thinking, feeling, and/or behaving that is not listed within DSM.
The definition of a mental disorder in DSM-5 (2013) is similar to that quoted above, but contains additional verbiage, and one enormous relaxation of the definition. To enable readers to judge this for themselves, here’s the DSM-5 definition:
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflicts results from a dysfunction in the individual, as described above.” (p 20) [Emphasis added]
The word usually on the fourth line expands the potential range of psychiatric “diagnosis” enormously. One might even say that it becomes so wide as to embrace the entire population. The point being that in DSM-IV, the problems had to reach a certain level of significance or severity. But in DSM-5, that requirement was effectively dropped. Admittedly, both phrases are vague, but DSM-IV’s requirement that distress or disability be present, is obviously a more stringent standard than DSM-5’s assertion that distress or disability is usually present. In effect, the severity threshold has been abandoned, and there is a clear invitation to practitioners to assign “diagnoses” to individuals with increasingly milder presentations. And it needs to be stressed that this change was not based on any kind of scientific information or discovery. This change was simply a decision by the APA to expand the prevalence of their so-called illnesses to virtually everyone on the planet. It also needs to be stressed that this is not an empty issue, but has already been implemented in the case of “ADHD”. Compare the severity criterion for ADHD in DSM-IV with that in DSM-5:
“D. There must be clear evidence of clinically significant impairment in social, academic or occupational functioning.” (p 84) [Emphasis added]
“D. There is clear evidence that the symptoms interfere with , or reduce the quality of, social, academic, or occupational functioning.” (p 60)
Here again, both statements are vague, but significant impairment in… is obviously a tighter standard than interfering with, or reducing the quality of….
Given all of these considerations, it’s extremely difficult to avoid the conclusion that the APA not only supports the wide expansion of this so-called diagnosis, but has actively pursued and facilitated this expansion for decades.
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Mr. Schwarz has done a good job of exposing pharma’s tactics and strategies. Although much of this story is well-known and has been told before, he does present the scam in a detailed and readable form. He also addresses the problem of parents pushing to get their children “diagnosed” and on drugs, and the undeniable fact that people do become addicted to these products. He also exposes the link between CHADD and pharma.
Perhaps now he can take a look at the even bigger scam: psychiatry’s spurious and destructive medicalization of literally every problem of thinking, feeling, and/or behaving, including childhood inattention, impulsivity, and general lack of discipline.
Pharma does indeed push their products using very questionable methods. But they couldn’t sell a single prescription for methylphenidate or for any other psychiatric drug without psychiatry’s bogus and self-serving “diagnoses”. And they couldn’t have increased their sales to the extent that they did, without the commensurate relaxation of the “diagnostic” criteria, that psychiatry knowingly and willingly provided. Bemoaning the use of hurriedly-completed facile checklists is empty talk, unless one is also willing to turn one’s criticism against the DSM’s equally facile “symptom lists”, of which the checklists are simply mirrors.
Psychiatry is nothing more than legalized drug-pushing. There is not one shred of intellectual or scientific validity to their so-called taxonomy. They invent these so-called illnesses to expand their turf, and then liberalize the criteria to expand it further.
Under the guise of medical care, they routinely rob people of their sense of competence, their dignity, and in many cases, their lives. They have radically undermined the concept of success-through-disciplined-effort, and have ensnared millions of people worldwide in their ever-expanding web of drug-induced dependency and self-doubt. They are not the thoughtful and expert codifiers of genuine illnesses, as Mr. Schwarz contends. Rather, they are drug-pushing charlatans and hoaxsters who have systematically and deliberately deceived their clients and the general public to enhance their own prestige and their incomes.
If there was ever a subject that called for thorough investigative journalism, psychiatry is it.