Psychiatry owes much of its recent popularity to the allure of its heavily advertised wonder drugs that cure life’s woes. But pills can’t be the main source of psychiatry’s sustained success, since as Irving Kirsch proved,1 they’re mostly placebos, and as Robert Whitaker showed,2 people who take them usually worsen over time. Yet most clients loyally defend and cling to their ‘illness’ (and its treaters). We only stick with things that work for us in some way. So this begs the question: Could psychiatry’s newly invented diseases themselves be the hot items that people are somehow being manipulated into buying?
Yes — I saw from within my field how it happened. Psychiatry used to help clients cope with painful feelings by venting about their causative issues (disappointment, interpersonal conflict, loss, etc.) in psychotherapy. As this role was usurped by cheaper social workers and psychologists, it adapted by pushing a new way to cope — by perceiving all unpleasant feelings/experiences as brain disease symptoms. Psychiatry makes this work for clients in many ways, without their even being aware of it:
Denial: When the NIMH says: “Bipolar disorder is a brain disorder that causes unusual shifts in mood,” it’s subtly assuring that if you adopt the bipolar label, you’ll never again need to acknowledge being upset about anything that’s wrong in your life. The DSM’s depression label covertly invites you to dismiss feelings of guilt, worthlessness, or failure as symptoms, rather than face the issues or events causing them. It implies that your life would be perfect if not for your illness. ADHD labeling, by pathologizing normal childhood immaturity, conveniently authorizes busy parents to deny that kids need to be raised.
Somatization: When the APA says: “Mental illness is nothing to be ashamed of. It is a medical condition just like heart disease or diabetes,” it’s manipulatively reframing the public’s perception of ‘mental illness’ as physical, so that viewing oneself as mentally ill becomes a legitimate, respectable, socially acceptable option. To sweeten the pot, the DSM says that ‘mental illness’ causes great suffering. The message this subconsciously conveys is: If you see yourself as mentally ill, you’ll be rewarded with attention and sympathy. To make it even more adaptive, the Mayo Clinic says: “Speaking out against stigma can help instill courage in others facing similar challenges.” In effect this implies that if you adopt a mentally ill identity, you’ll get a badge of honor for bravely and heroically battling what is now referred to as “the new cancer.”
Rationalization: When WebMD says: “If your child has ADHD, don’t blame yourself. ADHD is a brain disorder,” it’s luring you in by telling you what you want to hear — that you’re excused for any mistakes you made in raising your kid. When it says: “If you have adult ADHD, it can make it hard to succeed,” it’s letting you off the hook for any failures or bad choices. Your label authorizes you to rationalize all your troubles as due to bad genes or defective brain hardwiring, and thus pre-fated and out of your control. You’ll therefore never again feel guilty or remorseful about anything.
Intellectualization: The DSM helps you detach and distance yourself from your painful feelings/issues by meticulously categorizing them and using scientific-sounding names. Psychiatry offers endless ways to aloofly avoid your feelings via technical pseudo-explanations like “neurodevelopmental,” “brain circuitry,” “chemical imbalance,” “information processing deficit,” or “symptom recurrence.”
Regression: When WebMD says: “To get better you need expert help; a team including a health care provider, therapist and psychiatrist,” it’s subliminally enticing you to turn over responsibility for coping with life or raising your kid to parent surrogates (overtly couched as healers). Whatever goes right or wrong will now be their responsibility. It’s inviting you to return to your stress-free early childhood days, when mom/dad took care of you and made everything better. Your healers may offer to medically excuse you from all adult obligations by saying “Like any physical illness, brain illness can be chronic and disabling,” as a way to manipulate you into forever clinging to your label.
Some brain disease labels, like adult ADHD, even let you behave like a kid again. WebMD offers this by saying recklessness, outbursts, not listening, impulsivity, disorganization, not doing tasks, not focusing and lateness are symptoms you suffer from. You’re thus not held accountable for them.
Schools and employers are now mandated to make things easier for psych patients (and their parents) via special privileges (accommodations). ADHD-labeled kids are put on individualized education plans that lower demands and allow cheating. They thus get high grades despite barely working or learning. Adults with documented mood disorders are harder to fire for poor performance or absences.
Thus, medicalization confers the benefits of being physically ill without having to actually be ill. Psychiatry not only tells lies to draw clients in, it then conditions them, at the unconscious level, into adopting a ‘mentally ill’ identity. It tips the scales in favor of following this life path. And by converting unpleasant, transient emotional reactions into fixed genetic defects, it guarantees that these reinforcing benefits last lifelong. It’s no surprise that it now sells disabling illnesses; chronic illness management has always been its bread and butter. But now clients are mostly voluntary and come in droves.
Robert Spitzer, the 1980 DSM chair who saved psychiatry by switching its focus to medicalizing, trained when psychodynamic ideas still prevailed in psychiatry. He then completed psychoanalytic training. So he certainly learned how psychological defense mechanisms work for people as shown above. Allen Frances, a key player in the 1980, 1987, and 1994 DSMs, was also psychoanalytically trained. So maybe they foresaw how medicalization would be such a sellable commodity. Maybe that’s why both men repented late in life that their illness-creating had led to false epidemics.3 4
In the ‘80s, my fellow trainees and I knew Spitzer had created, out of thin air, diseases that anyone can meet criteria for. We saw how excited psychiatrists were about how the DSM improved their business. And that was pre-Prozac. I’ll never forget the first time a parent joyfully told me: “I now know why my son can’t pay attention — it’s because he has ADD.” I couldn’t believe they’d pulled it off. How clever it was to turn somatization around from a disorder into an adaptive coping tool.
So psychiatry didn’t really abandon its psychodynamic insights; it just found new, subliminal ways to profitably use them. Today’s psychiatrists may be unaware that they’re master manipulators, but I think they know. It’s one of those trade secrets that everyone knows but no one talks about. But it must be brought out in the open in order to stop their parasitic sucking of the life from our culture.
- Kirsch, I. The Emperor’s New Drugs. 2010, Basic Books, New York. ↩
- Whitaker, R. Anatomy of an Epidemic. 2010, Crown Publishers, New York. ↩
- “The Trap: What Happened to our Dream of Freedom.” 2007 Television Documentary, BBC. ↩
- Frances, A. “Psychiatric Diagnosis Gone Wild.” April 7, 2010, Psychology Today. ↩
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.