“There is something inherently wrong with psychiatry, with every aspect of psychiatry, in its fundamental conceptualizations, with its power and its modus operandi, something so wrong we cannot continue with it.”
– Dr. Bonnie Burstow, Psychiatry and the Business of Madness
On February 13, the Boston Globe published an atrocious opinion piece by psychiatrist Jhilam Biswas, titled “Massachusetts law meant to protect people with mental illness may make them sicker.” Though framed as an attempt to shed light on a need for better approaches to mental health law, the piece is blatantly disrespectful toward and prejudiced against those of us who have been labeled with mental health diagnoses: psychiatric survivors, mad people, and disabled people. It is rife with ableism and oppressive attitudes that would be recognized as violence were they not coming from someone in a position of power and authority, with anti-bodily autonomy undertones thrown in for good measure. The author uses all these tactics in arguing against Massachusetts’ Rogers Guardianship statute to support her ulterior motive: promoting dehumanizing legislation and the aggressive use of psychiatric drugs. These are precisely the messages that the psychiatric system feeds to the public using the corporate media.
A Manipulative Narrative
The piece leads off by describing a recent tragedy that began outside Brigham and Women’s Hospital in which police shot and killed a man they believed had a gun. Without proof, the author blames events on the fact that the man was labeled “mentally ill” and was probably “‘off his meds,’” reinforcing the popular myth that we are prone to violence.
Second, the article targets legislation that, if repealed, will make it easier to drug, detain, and incarcerate us. Biswas writes: “In …potentially dangerous moments, psychiatric treatment providers step in to procure medications through filing a request with the courts. However, this process is anything but easy in Massachusetts.” She goes on to criticize the Rogers Guardianship law, designed to protect the legal right of psychiatric “patients” to refuse psychiatric drugs, as putting too many obstacles in the way of forcing someone to take and stay on these drugs. She then warns of scary consequences of delay, including “persistent brain dysfunction and cognitive decline” and even “risk of suicide or violence.”
Third, the op-ed compares what psychiatrists call “untreated psychotic illness” (terms used throughout) to untreated heart or liver disease. This analogy is inaccurate, and the suggestion that all have potentially fatal outcomes is blatantly false. As a colleague of mine put it, “How sweet that they’d compare ‘untreated mental [illness]’ to ‘untreated heart disease’ while failing to mention that ‘treated mental [illness]’ has seen zero improvements in outcomes and a widening morbidity gap over decades while ‘treated heart disease’ (along with cancer, etc.) has seen plenty of improvement in outcomes.”
Yet another manipulative narrative in Biswas’ piece is her use of a disorder called “anosognosia” in connection with mental health problems. Her central argument is that “a patient’s refusal of medication may reflect their underlying disease state. Paradoxically and poignantly, it is a symptom of psychotic illness to believe you do not have an illness.” The medical definition of anosognosia, a word of Greek origin that roughly translates to “without knowledge of disease,” is “an inability or refusal to recognize a defect or disorder that is clinically evident.” In the mental health realm, you may also hear it called “lack of insight.”
While anosognosia is a legitimate medical diagnosis as applied to people with Alzheimer’s Disease or who have had strokes, it can’t simply be taken from that realm and shoehorned into the world of psychiatry simply because medical professionals wish for a neat way to negate a patient’s disagreements with their doctor. Within this context, the term “anosognosia” is not only insulting but also can be used as a tool to force people to comply with “treatment” even when they have evidence that such interventions have not or will not be useful to them. That seems to be Biswas’ point: Without a belief in anosognosia, the mental health system will not be able to control the people they wish to control.
Reinforcing Scientific Myths
Let’s get back to the idea that the media is being used to spread misinformation and serve corporate needs. In order to remain relevant and for the pharmaceutical industries to continue profiting off the sale of psychiatric drugs, psychiatry needs a tool for fear-mongering, and op-eds like Biswas’ serve that role. Although psychiatry thrives largely on the minimal tangible science and broader behavioral classifications it has been able to produce, neurological studies still have not been able to legitimize classifying human thoughts, feelings, and experiences as an inherent “mental illness” or “brain disease.”
Don’t believe it? Consider this quote from a peer-reviewed journal article, housed in the National Institute of Mental Health’s U.S. National Library of Medicine:
To date, there are no biomarkers of any kind available to any of the psychiatric disorders, and perhaps establishing those will be one of the most difficult tasks that medical scientists will ever face, This is due to several reasons: (1) the multifactorial characteristic of psychiatric disorders, (2) these are multigenic disorders in which each gene has a small effect; (3) the environment exerts a heavy influence in the establishment of the disease. These reasons lead us to conclude that “the biomarker” for a psychiatric condition will never exist .
But this “illness” narrative has allowed the mental health system to become a conduit for social conformity. The problem is that once we are labeled with a mental health diagnosis, that becomes the only narrative the public believes about us.
Since there are no pre-existing biomarkers that indicate any form of psychiatric “illness” or “disease,” we must recognize that labeling people as such is a reflection of systemic social factors, including class and a culture of ableism and unsustainable expectations. In light of these societal conditions, we should be granted the autonomy and the right to identify with our experiences however we see fit, and not merely to comply with these labels.
Psychiatry has not only created an illness-based narrative it “markets” through the news media, but also has granted its practitioners an almost king-like power. As the late Bonnie Burstow wrote in her book Psychiatry and the Business of Madness, psychiatrists are the only people in the state who can have anyone locked up without their having committed a crime and can do so with impunity. Psychiatrists are more focused on billing and reimbursement using a list of socially observed “symptoms” than being helpful, and historically, psychiatry has been used as a way to make the oppression of marginalized people publicly acceptable.
A Pattern of Bias
The recent Boston Globe piece isn’t the first to reinforce this form of prejudice. A series of pro-forced-treatment articles released in 2016, titled “Spotlight on Mental Health: The Desperate and the Dead” was so bigoted against those labeled mentally ill—again playing the “violent” card— it drew a large number of critical responses and even public demonstrations.
The Boston Globe has been building an abhorrent reputation these past few years. In this op-ed, they targeted people labeled with schizoaffective disorder. In doing so, the Boston Globe didn’t just depict us as violent; they painted us as incapable of knowing what is best for ourselves. They also made a conscious decision to publish an article by Biswas, who not only serves as the director of the Psychiatry, Law and Society Program at Brigham and Women’s Hospital but also, more importantly, is a forensic psychiatrist at Bridgewater State Hospital. They made a conscious decision to include her charge that “untreated” people with psychiatric diagnoses would suffer “persistent brain dysfunction and cognitive decline.” And they published this piece knowingly leaving out the fact that plenty of studies show that psychiatric drugs are killing more and more people. That psychotropic medications are often the cause of the brain dysfunction and cognitive decline Biswas mentioned. But it doesn’t stop there: These drugs also cause liver damage, kidney failure, heart disease, seizures, and much more serious ailments. Psychiatry manufactures the “illness,” sells the “treatment,” and offers barely any information on how to get off these drugs.
And yet here is the largest newspaper in the state joining the medical, criminal justice, and pharmaceutical industries in influencing the public on psychiatry’s behalf, conveniently ignoring the fact that Biswas represents one of the most oppressive institutions in the state. Bridgewater State Hospital is, after all, notorious for its abuses and unattended deaths, going back as far as the 1980s.
With this essay, the Boston Globe continues to promote the psychiatric narratives we are all expected to believe without question. Psychiatry has power and influence over every system and institution with which we interact—education, criminal justice, employment, housing, healthcare, and more. Let’s stay critical of what the mental health system and the media want us to believe.
Special thanks to Sera Davidow, Shayn Mcdonald, and Khalil Power for editing assistance.