Sociologist Questions Effectiveness and Ethics of Mental Health Services

Medical sociologist David Pilgrim argues that mental health care often relies on flawed research and ineffective treatments.


In a new article in the Journal of Mental Health, David Pilgrim questions the effectiveness and ethics of mental health treatment. He suggests that mental health care is neither effective, nor “kindly,” as it often relies on flawed research, ineffective treatments, and ultimately engages a system of involuntary detention that he argues is a human rights violation.

David Pilgrim is Honorary Professor of Health and Social Policy, University of Liverpool, UK and Visiting Professor of Clinical Psychology, University of Southampton. His publications include A Sociology of Mental Health and Illness (Open University Press, 2005- winner of the 2006 BMA Medical Book of the Year Award), Mental Health Policy in Britain (Palgrave, 2002) and Mental Health and Inequality (Palgrave, 2003) (all with Anne Rogers).

Pilgrim notes that the interests of professionals, the pharmaceutical industry, and lay people are all influencing the nature and provision of mental health services. He further notes that users of mental health services are not a monolithic group, but have varying opinions about psychiatry, diagnosis, and treatment (up to and including anti-psychiatry). This aggregation of interests, often at odds with one another, may have led to a system that is not effective or humane.

Pilgrim suggests that the ubiquitous focus making mental health care synonymous with medication runs contrary to the evidence that socioeconomic factors and trauma are implicated in the creation and exacerbation of mental health concerns. Even when mental health care is not equated with medication, it is still outside the purview of a therapist to improve poverty or to intervene to prevent childhood adversity.

“Given that many of the social conditions that inflect mental health, especially poverty, urbanicity and variants of childhood adversity, are outside of the control of health services then the prospect of a medical cure for their adverse psychological impact may be a nonstarter.”

Pilgrim notes that many mental health service users believe in a biochemical cause, and thus a medical cure, for mental health concerns. However, he writes that “Honest academic psychiatrists, not swayed by drug company funding, show us unequivocally that this positive image of psychotropic drugs is thoroughly unsustainable.”

Pilgrim finds the notion that a drug can “fix” years of childhood adversity, trauma, and poverty is absurd. He suggests that it is disingenuous of the psychiatric establishment to promote their treatments as “effective” while carefully selecting outcome measures that are unrelated to these core socioeconomic problems.

However, more concerning to Pilgrim is the system of involuntary detention and forcible treatment that some users undergo. Pilgrim argues that involuntary detention in order to forcibly “treat” mental health concerns is a violation of human rights which does not meet its own standards of equity.

He suggests that patients have very different experiences of hospitalization and that in some cases they are not provided with even adequate care “in exchange for […] Their loss of liberty, without trial and with no ensured advocacy for their freedom.” After all, he writes, there have been and continue to be lawsuits brought by the US Department of Justice stating that states have failed to provide adequate mental health care.

Pilgrim writes that the need to involuntarily detain someone is generally based on the perception of danger—is that person a danger to themselves or others? Perhaps in an ideal world, this would be acceptable; however, we live in a world where biases based on race, gender, and other traits color all such decision-making. Pilgrim provides the following example: “If a societal norm is to perceive young, black men as being abnormally dangerous, then that will be mirrored in admissions to psychiatric units and risk-averse staff decision making, thereafter, about discharge and security levels.” He cites research that has found just these biases in mental health practice:

 “‘Mental health legislation’ exists to manage, at times very robustly, some people but not others. It is about the lawful control of one group of problematic patients and not the promotion of mental health,” Pilgrim writes.

After all, undiagnosable people engage in all sorts of risky behaviors, making themselves a danger to self and others. However, they are afforded the privilege to do so, while people with mental health diagnoses are monitored for any indication of risk, and involuntarily detained without trial, and without necessarily breaking any laws.

 “Mental health professionals are still ultimately rule enforcers,” Pilgrim argues, who are part of a system with a double standard: ensuring that cultural values around normalcy are followed, with dire consequences for those who are not deemed normal.

Pilgrim calls for trauma-informed care, which at least would be more “kindly” and humane. And, of mental health treatments, he writes:

“If expecting them to be ‘efficacious’ is asking too much, we might at least expect that they should at all times be acceptable to patients.”



Pilgrim, D. (2018) Are kindly and efficacious mental health services possible? Journal of Mental Health.  doi: 10.1080/09638237.2018.1487544 (Link)


  1. Psychiatry should protect the meaning of psyche, the rights of people who are psychologically beyond simple apollonian ego level. They should give a meaning to the psychosis and depression, be on the one side with psychological minorities. Meanwhile, they betrayed psyche and form a sort of the ego cult (apollonian archetype), which has nothing in common with the rest of the psyche, it is completely unpsychological by definition.
    Psychiatry is the greatest enemy of the psyche, of the psychological man, the should be loyal to the human psyche, they are not. The behave as if psyche was the greatest enemy of the state. Biological psychiatry fallacy is a continuation of NSDAP programm of dehumanisation killing people and destroying psyche in the name of mental health which is already,a a betrayal. Mental health theories eliminates every aspect of the human psyche by definition. Mental health = racial purity.

    James Hillman Re-visioning psychology

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  2. I want to thank Mr. Pilgrim for pointing out these obvious flaws and injustices of today’s “mental health” system.

    I agree, “‘Mental health legislation’ exists to manage, at times very robustly, some people but not others. It is about the lawful control of one group of problematic patients and not the promotion of mental health.” Except I question why such is “lawful,” since the “mental health professionals” are pretending to be medical professionals there to help the person, not “control” or silence them, most often for unlawful reasons.

    I say this because you are correct, “the notion that a drug can ‘fix’ years of childhood adversity, trauma, and poverty is absurd.” And child abuse survivors are the number one group of people that the “mental health professionals” are trying to “manage, at times very robustly.” Today, over 80% of all those labeled with the “psychotic and affective disorders” are misdiagnosed child abuse survivors. Over 90% of all those labeled as “borderline” are misdiagnosed child abuse survivors.

    Why all this misdiagnosis of child abuse survivors? Because child abuse is listed as a “V Code” in the DSM, and the “V Codes” are NOT insurance billable disorders. Thus, in order to get paid for helping any child abuse victim, all of today’s “mental health professionals” must first misdiagnose all child abuse survivors with the other billable disorders.

    I do agree, “trauma-informed care” is needed. But I do not see a desire on the part of today’s “mental health professionals,” and the universities that are still teaching the “invalid” DSM, to change the system.

    Truly today’s “mental health professionals” are the “omnipotent moral busybodies,” about whom C. S. Lewis forewarned us:

    “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”

    The “robber barons” or “elite” have, based upon fraudulent science, empowered the “mental health professionals” to function as “omnipotent moral busybodies,” primarily to cover up their child abuse, child and human trafficking, SRA, and other evil crimes – appalling crimes of the “elite” that are now filling the internet.

    And we must ask ourselves, should we trust “mental health professionals,” who have been profiteering off of silencing, drugging, torturing, and killing millions of child abuse victims with the psychiatric drugs for decades, to all of a sudden change their ways?

    When the “omnipotent moral busybodies” can’t even see the error of their ways.

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    • Omnipotent moral busybodies will go to great lengths to defend the ruined lives in their wake.

      My parents have moved around a lot till my dad recently retired. My community mental illness centers kept asking why I moved with them despite my controlling, smothering mother.

      Answer: I was afraid to be left to the tender mercies of the mental illness makers with no family to go to bat for me. Seriously.

      Better to live with Fay Dunaway from Mommy Dearest than with the MI System. Ugh!

      Mom became concerned when I came home and sobbed and wailed in the shower from the abusive, cult-like practices I endured in “day treatment.” Afterward I found out cults use this method called “The Breaking Point” where the Leader of a group will sick all the other members on the newbie or dissident to tear them down and “rebuild” them as the Leadership sees fit. 🙁

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  3. It’s good to see a professor, an academic, making such points. I think rights, particularly one’s rights to liberty, should be front and center. It’s one thing to harm someone who consents to the practices that harm him or her. It’s quite another thing when a person is harmed over objections to the practices that harmed him or her.

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  4. I’m with Carlin on the human rights stuff, ya don’t have any. Think you do google japanese americans 1940. Its only when you need them most you find you don’t have them. Something any person subjected to involuntary treatment is all too aware of.
    Lets just not make it too public lest there be rumblings from the peasants.
    Good to see some old faces and new 🙂

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      • Thanks Julie. Good to see you and Puzzle.
        Note dru mentioned carrots and I turn up :). Seems that modern psychiatry ran out of carrots a long time back, its all stick these days in Oz. The basic idea behind terrorism is kill one to scare a thousand and a lot of people seem to be very compliant given that these human rights abuses are being sanctioned by the State (and thus it doesnt meet the definition of terrorism). It does however look a lot like a police state and not a constitutional democracy. I want my carrots back lol

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  5. I am pleasantly surprised that a sociologist is finally applying “the sociological imagination” (and common sense) to the wild world of Mental Health, Inc. The sociology instructors and professor I remember from years past never questioned the concept of mental illness or psychiatry or…anything, really. All I learned back then was that the “severely mentally ill” had a rough run of things, and it’d be nice if we could reduce stigma and spend more $$$ on disability benefits. Actually, now that I think of it, I do remember 1 younger Sociology professor encouraging a female student to seek out “professional help,” telling her that “there are prescription medications that might help you.”

    I’m going to go out on a limb here and guess that serious sociological inquiry into psychiatry and friends has only recently become “cool.” From what little I know about these things, once it becomes “cool,” a select group will jump on it, then when the “cool” factor goes down a couple notches, one might see a trickle down to lower tier schools. Wait a couple decades…and the process will probably repeat…

    meanwhile, those of us who are in, have been in, or are trying to exit Mental Health, Inc. will only find “help” from the MDs, PhDs, etc. when our suffering furthers careers and/or advances a cause.

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  6. I dislike “day treatment” and “clubhouse” as much as the drugs. They have helped to segregate me from society and humiliate me in the eyes of the community. Often they would force us to volunteer and go on field trips while notifying everyone around that we were “special.”

    The case workers told us we should only date within our groups because “normal” people couldn’t understand us. All SMI folks are exactly alike after all. Ha ha.

    Never again!

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    • I can’t even imagine. sounds like they went out of their way to -create- “Schizophrenia” or…whatever…in your case. I’ve never had all that, Praise God.

      I had a cousin, on the other hand…she got uppity, and her shrink (private practice) sent her off to the state hospital. Her parents went thru hell trying to get her out. Thankfully, where I live, they’re not big on the state hospital…usually, its the very far gone people who have been thru way too much “treatment” already and women from “good families,” especially in criminal cases. Most of it has been shut down. Even the criminal cases are often in and out in under 6 months, then “treated in the community.” ahhh, the asylum without walls. what progress.

      sorry about what you were subjected to. Just goes to show how ridiculous psychiatry is…one shrink will call it “personality disorder,” another “Schizoffective.” A shrink in one state has the authority to commit to the state hospital, so the person needs “long term treatment.” A shrink in, say, my state doesn’t want to use tax payer $$$ without justification, so the person needs “treatment in the community.”

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      • “Bipolar 2” is the legend. I no longer have mood swings or ACT “bipolar” but it doesn’t matter.

        “Once a thief always a thief,” says Jalvert in Les Miserables.

        “Once a Bipolar always a Bipolar,” says the unmerciful shrink.

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        • And I started out depressed and anxious. The shrink put me on Anafranil and I didn’t sleep while I was on it. For 3 weeks.

          Denied the drug was to blame. All my fault of course.

          My sister had an allergic reaction to penicillin but no one punished her for it or labeled her a dangerous menace to society.

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          • Anafranil? I never heard of its use as an antidepressant, even though it’s one of the tricyclics. Sounds like irresponsible prescribing to me if you weren’t filling your time with obsessive activities and rituals- stuff the Germans called “zwang”.

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          • 8Anafranil used to be used both as an AD and an anti-anxiety drug. It was more used for anxiety, but I saw it used for both, even in kids. Also used as a sleep aid at times, though the side effect profile was so bad it was abandoned. Oh, and they used to use it in the early 90s to “treat ADHD.” I had to advocate to get a kid off of it because he was having extrapyramidal symptoms, which they were calling “making funny faces” at his school. They had him on a behavioral reward system to discourage the “funny faces” which he had zero control over. I guess they used it for whatever they could pitch it for.

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        • Rachel777, I was at my “natural” doctor this week, sorting out my biome.

          She said she wanted a Sam-e/Methionone metabolism profile, and started to say, “All of my bipolar patients….”

          and I said, “Doctor, I am not bipolar, that was medication errors.” (she is a new doctor, and is making assumptions)

          And she said, “But you’re anxious aren’t you?”

          I said, “No, I am on coffee!”

          If I’d been super clever (you know the things you say in hindsight) I would’ve said, “I refuse to medicalise normal human emotions.”

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          • JanCarol I have never heard of a “natural” doc who used psych labels. Any of the ones I have consulted steer clear of such medicalizing of normal behavior. Isn’t anyone a little nervous when they get poked and prodded? I have stopped going to docs who do that, “natural” or not. I refuse to give them my business. BTW, life coaches shouldn’t label people but the majority of them do.

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          • Shrinks are agin’ life coaches–and other non-psychiatrists–labeling folks as well. They’re scared it will show how easy “diagnosing” someone else is.

            It’s like “diagnosing” someone with ailments such as Stupid, Ugly, Slowpoke, and Weirdo. Just a bunch of fancy pants name calling. The DSM is a thesaurus of insults. “Scientific” of course. Lol.

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          • Julie – many “orthomolecular” or “functional” medicine folks find these labels useful to decide what of their natural protocols they want to apply.

            My last one also used the term “bipolar,” and I heard other labels from her to (though not applied to me) of ADHD, Depression. Her focus was on B vitamins, methylation, and minerals. She got me in pretty good shape, and my thyroid situation much better. Then she closed her practice!

            This one is focusing on gut biome, which can be responsible for a lot of mood (but I’m not complaining of mood, I just want to manage my thyroid in the absence of this other one (without thyroid I will wind down like a clock). Our first visit was quite scary, I could see her latching onto my bizarre delayed cycle sleep and IBS.

            But it’s reasonable to look at gut biome, and I”m getting something that I’ve wanted for years, which is a profile of my gut bugs, and an attempt to square them around.

            I probably could do it myself with weeks of bone broth, but I like to live, too. (that means eat food, and share it with my husband)

            So – I agree – scary – to go among medical professionals. Much of my health problems were caused by drugs and surgeries. Were the surgeries necessary? Don’t know. I was in a lithium fog at the time. But came out 10 years later with no thyroid, no ovaries, and a wrecked bowel. I will do anything to avoid anyone with “surgeon” in their title!

            I will not share my mood as a medical event. Ever.

            And Rachel777 – I reckon many of them DO diagnose us with Stupid, Ugly, Lazy, Slowpoke, Weirdo, Freak – they just don’t write those in our charts….it tends to go along with the other labels they dish out!

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          • I would not go to one that decided I had any mental disorder, no matter what kind of doc it was. My current naturopath says “depression” but stresses that it’s not a disease but a way people sometimes feel, certainly not a condition one has in one’s character makeup, but a transient and very understandable human way of feeling. Since I am rarely depressed the topic doesn’t come up at all with him. If any doc decides I have mental issues I run away very fast. Any kind of mental disease or label.

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