The difference between public image and first-hand inside knowledge applies to all areas of life. Nobody can have a personal experience with each and every social institution; for most of them, we rely on what we hear, read, and watch.
For example, I have never encountered police brutality, but I read about it in the media; media coverage, in turn, helps me contextualize stories that I hear from my non-white friends. Just by glancing at headlines, I immediately become aware that there is a wide range of positions on the current state of the American police.
In all major media outlets, I can see op-eds, letters, and comments written by activists of all stripes; by victims of police brutality; by victims of crime who praise police or decry its inefficiency; by police employees who defend their profession, or agree that there are systemic problems with it. At the very least, every American not living under a rock knows that many people claim that police have treated them unjustly.
The readers of this forum would surely agree that the American mental health care has systemic problems that are similar in nature to those described by anti-police-brutality activists: a lack of accountability, transparency, and external oversight; a culture of silence and cover-ups, professional training privileging coercion over dialogue and de-escalation—and all these on top of the problems specific to psychiatry, such as perverse material incentives. The closest institutional parallel is probably the private prison industry.
So, remember any headlines on psychiatric brutality? Anything in the general media written from the perspective of a psychiatric survivor or a critical-minded psychiatrist? No, all the victims and activists stay in their closed Facebook groups or on forums like this one, where they preach to the choir.
Conscientious professionals, such as David Healy or Joanna Moncrieff, publish their brilliant, scientifically impeccable critique of the prevailing psychiatric practices as papers in peer-reviewed journals or books published with academic presses and Samizdat Heath—that is, venues invisible to the general public.
I consider myself a member of the educated general public. I regularly read the news media, as well as The Chronicle of Higher Education, and I have a general awareness of the current major scientific, medical, and political controversies. And yet nothing that I ever read or heard prepared me for an encounter with the psychiatric system when my daughter had a mental breakdown and was hospitalized. I was able to liberate her before she suffered lasting damage, and she is fine and thriving now, but I am still recovering from shock.
Before this ordeal, I, like most people, never read medical journals or books about mental health—why would I? Therefore, I never came across a single critical voice and believed that One Flew Over the Cuckoo’s Nest was something from a distant past. Like other deceived citizens, I believed that modern psychiatry was a medical science that knew the nature and the causes of mental illness and had safe, efficient, and disease-specific medications.
I did not have the slightest premonition that, if anything changed since the days of the Cuckoo’s Nest, it was a change for the worse. I would never imagine that psychiatrists have unlimited legal power and the de-facto license to lie in court.
No other institution, existing in a society that has freedom of the press, is shielded from public scrutiny to the same degree as psychiatry, which, in this respect, may only be compared to the secret intelligence services. Unlike the CIA, psychiatry is considered a branch of science and a field of medicine—but its position in society is unlike that of any other scientific or medical field. For one, in no other area of science is the most funding allocated to pursuing a hypothesis after it has been repeatedly disproved.
Consider cold fusion, a hypothetical nuclear reaction that would occur at near room temperature. Evidence for such a reaction was reported in 1989, but after many failed replication attempts and many publications pointing to the methodological flaws of the cold fusion studies, the hypothesis was rejected by most scientists. The mainstream scientific conferences do hold sessions on cold fusion, since “with the world facing an energy crisis, it is worth exploring all possibilities,” but funding goes elsewhere, the National Cold Fusion Institute was closed in 1991, and the remaining supporters publish mostly in their own non-peer-reviewed journals.
Scientifically, the only difference between cold fusion and the biological explanation for non-organic mental disorders is the length of time devoted to failed attempts at proving them: a couple of years for cold fusion, many decades for research seeking a biochemical, neurological, or genetic cause of psychosis, depression, and other conditions for which no biomarkers have been identified.
If physics and chemistry were like psychiatry, billions of dollars would have still been spent on cold fusion, with all other areas of energy science marginalized, and the news media would have constantly reported the scientific breakthroughs that put us on the verge of creating boundless possibilities for safe and cheap energy. When another such “breakthrough” failed, there would have been no reports in venues other than specialized journals inaccessible to the general public. Researchers caught at falsifying their statistics and misrepresenting their findings would have been awarded and promoted.
If other areas of medicine were like psychiatry, we would have still been diagnosed with “melancholia” and “dropsy” and treated with leeches and blood-letting. How would the medical profession come to see problems with imprecise, unscientific diagnoses and with unproven treatments, if anyone questioning the notion of “melancholia” as an illness caused by the excess of “black bile” had been labeled a “menace to society”? “You see, patients may read irresponsible claims about the lack of evidence for such a thing as ‘excessive black bile.’ This will undermine their trust in science and medicine and discourage them from seeking the leech treatment, resulting in unnecessary suffering and deaths.”
In other medical fields, public discussion is a routine, accepted practice, just as it is generally accepted in Western society that any area of knowledge advances through open debate. That is, any area except psychiatry, where a voice questioning the utility of a particular diagnostic classification or the efficacy of a particular treatment is immediately drowned by the loud accusations of being “irresponsible” and causing untold harm to those who are suffering. The only way not to be a “menace to society” is to accept that the current psychiatric practices represent the final, irrefutable truth and that the only small thing still left to do is to prove this truth scientifically.
A small, but delicious, sample from the Mental Illness Policy website that promises “unbiased information for policymakers + media” and trashes Mad in America: “The serotonin theory … may not have withstood the test of additional research, but the neural connective pathways that serotonin effects [sic] are still thought to be involved in depression, as are genetics. We simply don’t know enough yet.”
The logic here is exactly the same as in Hitler’s Mein Kampf: “It will be the task of a future culture and world history to make researches” and prove that all human culture is created by the “Aryans.” Just like the “unbiased scientists” from the Mental Illness Policy are sure that their unfounded “thoughts” about mental illness will be validated by some future, not-yet-existing knowledge about neural pathways and genes, so is Hitler sure that his unfounded racial theories will be validated by “future researches.”
Here lies the crux of the matter. The current biopharmacological model of psychiatry is “scientific” only in the same sense in which historians talk about the “scientific racism” of the nineteenth-early twentieth century: it’s an ideology created by powerful interest groups masquerading as science. As such, it will not go away after being scientifically refuted, nor will cruel practices and policies based on this ideology be stopped by arguing with the perpetrators, or even by bringing lawsuits against them. And yet it seems that the most brilliant and outspoken critics of the biopharmacological model devote disproportional amount of their time and energy to this hopeless task.
At this point, with all the scientific evidence available to anyone who would bother to open the PubMed database of biomedical literature and enter search terms for, say, “antidepressants suicidality” or “olanzapine risperidone side effects maintenance therapy” (as I did while trying to figure out what the hell they were doing to my daughter)—with all this evidence, all the psychiatrists acting in good faith are already convinced. Those who continue business as usual will never be convinced by any rational arguments, for the same reason as Atlantic slave-traders would not be convinced by your rational arguments about race.
To hope that another book with a university press or Samizdat Health, another paper in a peer-reviewed journal, another piece in the Psychiatric Times will make a difference is like hoping to end slavery by preaching to slave traders about its inhumanity and celebrating John Newton not as a rare, extraordinary case, but as an indication that a systemic change is about to come—see, one of them already repented, more and more will follow, and as soon as they realize that they inflict suffering on their fellow humans, they will surely stop the abomination that they are perpetrating out of sheer ignorance.
While some hope to convert metaphorical slave-traders, others entertain an even more unrealistic hope that their talking to like-minded people on an Internet platform will have any effect on society.
Mad in America is doing a great service by providing high-quality information resources and a safe space for psychiatric victims, and it also has a great potential for launching a campaign for reform.
I beg everyone reading this: please do what you can to help realize this potential.
I am afraid that what I say next may hurt some people’s feelings, but I want to be frank about predictions of the MIA commenters that “the sun will shine” and “our voices will be safely heard” while psychiatry will “slide into the morass of self-inflicted irrelevancy.” As a historian—that is, someone studying social change for a living—I know that this is wishful thinking. Never in human history did a powerful institution, no matter how harmful and corrupt, slide into self-inflicted irrelevancy. Institutions like the current psychiatric system can only be toppled by a powerful social movement.
Without such a movement, the website making an impact is not Mad in America, but rather the Mental Illness Policy. No matter that its authors do not offer any evidence to support their wild claims and rely on the charlatans’ favorite phrase “studies show that …” without citing any studies. No matter that they confuse “effect” and “affect.” What does matter is that they address the right audience—not the psychiatrists, not the patients or patients’ advocates, but “policymakers + media.” They are busy lobbying, not arguing. And the likes of them keep winning.
We’ve been there many times. Remember the lawsuits against the Prozac manufacturer, alleging that it caused violence and suicide? Remember how two kinds of publications about Prozac appeared simultaneously: the ones about its many problems in medical journals, and those extolling “a new wonder drug” in the news media? Now, three decades later, we know who won this battle between scientists who published their research in the American Journal of Psychiatry and the New England Journal of Medicine and salesmen who successfully pitched their product to the Newsweek and the New York Times.
I make a desperate plea to the scientists and mental health practitioners critical of the current psychiatric system: if you want to make a change, forget about the Psychiatric Times and concentrate on the New York Times.
I am getting desperate, because I see a unique historic opportunity being missed.
A movement for psychiatric reform will never succeed on its own. There will never be a truly mass movement for the rights of mental patients, because it will never attract a sufficient number of the right kind of supporters. We need to find allies and to become part of a larger movement. The circumstances have never been more favorable than right now, when the race to the Covid vaccine created an unprecedented public interest in clinical trials, regulatory processes, and the workings of the pharmaceutical industry. The media have been never more willing to give voice to medical professionals.
Just think of the Great Barrington Declaration signed by epidemiologists critical of the lockdown policies. The declaration is, actually, rather shallow. The authors propose “to allow those who are at minimal risk of death to live their lives normally … while better protecting those who are at highest risk,” but do not explain how do achieve this in practice. They just say that a “list of measures, including approaches to multi-generational households, can be implemented,” without describing either these measures, or the ways to implement them. Nonetheless, the declaration was widely discussed in all the major media outlets.
These same media outlets are currently writing something about the “mental health crisis” on every other page. A declaration of mental health professionals is guaranteed to attract widespread attention. For that matter, there are a lot of declarations by highly credentialed scientists critical of the current psychiatric system, but they are buried in the places, such as the Open Excellence Foundation or ISPS websites, where they will be seen only by those who already agree with them.
Right now, the problems with biopharmacological psychiatry can be presented in the context of the pandemic, the mental health crisis associated with it, and the failure of the major pharmaceutical companies—which is now already being forgotten, with all the talk about the “Pfizer” vaccine that in reality was, of course, invented by a small family-owned German company.
This is what I mean by missing a unique opportunity: seeing how public anger at the Big Pharma is already subsiding, as descriptions have switched from “BioNTech vaccine” to “BioNTech—Pfizer vaccine” to “Pfizer—BioNTech vaccine” to the now most widely used “Pfizer vaccine.” One window of opportunity to capitalize on the public backlash against the Big Pharma is already closing.
Another context for publicizing psychiatric drug woes is provided by the opioid epidemic, with clear parallels between the marketing strategies for Oxycontin and psychotropics. What if the leading journalists and policy-makers are approached by concerned scientists, who will remind them of all the “pain awareness” campaigns and promises of a safe and non-addictive “wonder drug”? What if they make an argument that a similar epidemic is currently in the making, with reports of street “abuse of antipsychotics, particularly second-generation antipsychotics” being largely ignored?
Yet another opportunity is provided by the Black Lives Matter movement. Anti-police-brutality protests exposed the cases when people in mental crisis were killed or abused by police. What if non-white psychiatric victims reach out to BLM and share their perspective on why giving more rights and resources to mental health services, without reforming them first, would not be a good solution?
The ample evidence that poor, uninsured, non-white—and Black in particular—patients are disproportionately targeted by all forms of psychiatric violence is available on this website, in the Psychrights materials and, again, in specialized publications, but nowhere else.
And what about student activism? What if we contact human-rights organizations at the home universities of psychiatrists who conducted unethical human experiments on their patients? What if we join forces with students protesting the undue influence of the wealthy donors on their schools?
For now, activists concentrate mostly on the likes of the Koch brothers who use their “philanthropic” donations to meddle with economics and climate science disciplines, but they seem to be natural allies in a fight against the pharma companies reigning over the medical and psychiatric departments.
A whole different field of opportunities is provided by movements such as Open Science and concerns about the replication crisis. This, and other trends within the academic community with great potential to advance the fight against the “pharmacological-psychiatric complex,” should be discussed separately, probably in a different blog post. What most concerns me now is that I see another great biopharmacological wave coming with the growth of the medicinal marijuana business, and possibly other herbal remedies.
For now, they are just cutting their teeth, but there is already one “psychedelic-medicine center,” “which develops hallucinogens to treat mental illness.” Imagine the market opportunities! In a couple of years, another “discovery” of the brain chemical imbalance causing mental illness and corrected by marijuana, or by whatever other drug turns out to be most profitable, will be on all the front pages, and it will be next to impossible to raise a voice of reason. It is still possible now. But to do this, it is imperative to move out of the cozy and obscure corners of the Internet into the wide world.
Therefore, I would like to conclude this post by addressing the readers who think that it may be worthwhile to give a try to the ideas for outreach sketched above, or who have their own ideas for campaigning and raising awareness of problems with psychiatry in society at large. Let’s get connected and start brainstorming and planning concrete actions. If you are interested, please feel free to email me at [email protected], or if you have a better idea for how to get connected, please post it in the comment section. I can’t wait to hear from you!
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.