Editor’s Note: Over the next several months, Mad in America is publishing a serialized version of Peter Gøtzsche’s book, Mental Health Survival Kit and Withdrawal from Psychiatric Drugs. In this blog, he explores the research and experience of psychiatric diagnoses. Each Monday, a new section of the book is published, and all chapters are archived here.
Psychiatry was in a state of crisis in the United States in the middle of the last century because psychologists were more popular than psychiatrists.1 The psychiatric guild therefore decided to make psychiatry a medical specialty, which would make psychiatrists look like real doctors and delineate them from psychologists who were not allowed to prescribe drugs.
Ever since, massive propaganda, fraud, manipulation of research data, hiding suicides and other deaths, and lies in drug marketing have paved the way for the illusion that psychiatry is a respectable discipline that provides drugs that cure patients.1-4
As explained in the first chapter, the “customers,” the patients and their relatives, do not agree with the salespeople. When this is the case, the providers are usually quick to change their products or services, but this doesn’t happen in psychiatry, which has a monopoly on treating patients with mental health issues, with family doctors as their complacent frontline sales staff that do not ask uncomfortable questions about what they are selling.
The family doctor is most people’s port of entry into psychiatry. This is where sad, worried, stressed, or burned-out people address their symptoms. The doctor rarely allots the necessary time to inquire about the events that caused the patient to end up in this situation. The consultation often ends after a few minutes with a diagnosis, which might not be correct, and a prescription for one or more psychiatric drugs, although talk therapy might have been better. A study in the United States showed that over half the physicians wrote prescriptions after discussing depression with patients for three minutes or less.5
You might get a psychiatric drug even if there is no good reason to prescribe it for you, e.g. a depression pill for insomnia, problems at school, exam anxiety, harassment at work, marital abuse, break-up with a boyfriend, bereavement, economic problems, or divorce. This is also common if you see a psychiatrist.
In contrast to other medical specialties, psychiatry is built on a number of myths, which have been rejected so firmly by good research that it is appropriate to call them lies. I therefore warn you again. Most of what you have been told or will ever hear about psychiatry, psychiatric drugs, electroshock, and forced admission and treatment, is wrong. This has been documented in numerous research articles and books.1-11
Here is some general advice, which will lead to better outcomes than if it is ignored:
- It is rarely a good idea to see a family doctor if you have a mental health issue. As doctors are trained in using drugs, you will most likely be harmed (if not in the short-term, then in the long-term).
- If you get a prescription from your family doctor for a psychiatric drug, don’t go to the pharmacy.
- Find someone who is good at talk therapy, e.g. a psychologist. If you cannot afford it or if there is a long waiting list, then remember it is usually better to do nothing than to see your doctor.
- Consider if you need a social counsellor or a lawyer. Doctors cannot help you with a broken marriage, for example, and pills won’t help you either.
Let’s have a closer look at what is wrong with current-day psychiatry.
Psychiatrists claim that their specialty is built on the biopsychosocial model of disease that takes biology, psychology, and socio-environmental factors into account when trying to explain why people fall ill.
The reality is vastly different. Biological psychiatry has been the predominant disease model ever since the president of the US Society of Biological Psychiatry, Harold Himwich, in 1955 came up with the totally absurd idea that neuroleptics work like insulin for diabetes.9
It even seems to be getting worse. Fifteen years ago, some of psychiatry’s spokespersons were more concerned than today’s leaders about the dangers of being too close to the drug industry. Steven Sharfstein, president of the American Psychiatric Association, wrote in 2005:
“As we address these Big Pharma issues, we must examine the fact that as a profession, we have allowed the biopsychosocial model to become the bio-bio-bio model … Drug company representatives bearing gifts are frequent visitors to psychiatrists’ offices and consulting rooms. We should have the wisdom and distance to call these gifts what they are – kickbacks and bribes … If we are seen as mere pill pushers and employees of the pharmaceutical industry, our credibility as a profession is compromised.”12
Other statements were less fortunate: “Pharmaceutical companies have developed and brought to market medications that have transformed the lives of millions of psychiatric patients.” Sure, but not for the better.
“The proven effectiveness of antidepressant, mood-stabilizing, and antipsychotic medications has helped sensitize the public to the reality of mental illness and taught them that treatment works. In this way, Big Pharma has helped reduce stigma associated with psychiatric treatment and with psychiatrists.”
The treatments do not provide worthwhile effects, particularly not when their harms are considered as well, and the stigma has increased.4 But that’s how the psychiatric leaders fool people.
A systematic review of 33 studies found that biogenetic causal attributions weren’t associated with more tolerant attitudes; they were related to stronger rejection in most studies examining schizophrenia.13 Biological pseudo-explanations increase perceived dangerousness, fear, and desire for distance from patients with schizophrenia because they make people believe that the patients are unpredictable,13-16 and they also lead to reductions in clinicians’ empathy and to social exclusion.17
The biological model generates undue pessimism about the chances of recovery and reduces efforts to change, compared to a psychosocial explanation. Many patients describe discrimination as more long-lasting and disabling than the psychosis itself, and a major barrier to recovery.14,15 Patients and their families experience more stigma and discrimination from mental health professionals than from any other sector of society, and over 80% of people with the schizophrenia label think that the diagnosis itself is damaging and dangerous. Therefore, some psychiatrists now avoid using the term schizophrenia.15
Sharfstein admitted that, “there is less psychotherapy provided by psychiatrists than 10 years ago. This is true despite the strong evidence base that many psychotherapies are effective used alone or in combination with medications.” What a tragedy this is. This is not the progress we hear so much about.
Sharfstein couldn’t resist the temptation of playing the “antipsychiatry” card: “responding to the antipsychiatry remarks … one of the charges against psychiatry … is that many patients are being prescribed the wrong drugs or drugs they don’t need. These charges are true, but it is not psychiatry’s fault – it is the fault of the broken health care system that the United States appears to be willing to endure.”
Of course. All the harms psychiatrists cause by overdosing entire populations are NEVER their fault, but someone else’s.
Psychiatrist Niall McLaren has written a very instructive book with many patient stories telling us that anxiety is a key symptom in psychiatry.11 If a psychiatrist or family doctor doesn’t take a very careful history, they might miss that the current episode of distress, which they diagnose as depression, started as anxiety many years earlier when the patient was a teenager. They should therefore have dealt with the anxiety with talk therapy instead of handing out pills.
Niall has developed a standard way with which he approaches all new patients in order not to overlook anything important. It takes time, but the time invested initially pays back many times over and leads to better outcomes for his patients than the standard approach in psychiatry.
Niall has an interest in philosophy but has been met with extreme hostility when he challenged his colleagues by asking them what the foundation was for their biological model of psychiatric disorders. There is none. In his own words:11
“So we can forget biological psychiatry. Trouble is, an awful lot of people have an awful lot of money invested in giving biological treatments for mental disorder, and they won’t give it up without a fight. Worse still, there’s an awful lot of high-flying academic psychiatrists around the world who have invested their entire careers, and their egos (which is much worse), in claiming that mental disorder is biological in nature. They will fight tenaciously to save their jobs and their reputations. So we’re stuck with biological psychiatry for a while. Just because it has been proven wrong doesn’t mean it will fade away overnight. The value of biological psychiatry is that it isn’t necessary to talk to a patient beyond asking a few standard questions to work out which disease he has, and that can easily be done by a nurse armed with a questionnaire. This will give a diagnosis which then dictates the drugs he should have.”
Biological psychiatry assumes that specific diagnoses exist that result from specific changes in the brain, and that there are specific drugs that correct these changes, which are therefore beneficial. We shall look at these assumptions one by one.
Are psychiatric diagnoses specific and reliable?
Psychiatric diagnoses are neither specific nor reliable.4,6,18,19 They are highly unspecific, and psychiatrists disagree wildly when asked to diagnose the same patients independently of each other. There are few such studies, and their results were so embarrassing for the American Psychiatric Association that they buried them so deeply that it required extensive detective work to find them.19 The funeral took place in a smoke of positive rhetoric in surprisingly short articles, given the importance of the subject. Even the largest study, of 592 people, was disappointing, although the investigators took great care in training the assessors.20
Psychiatric diagnoses are not built on science but are consensus-type exercises where it is decided by a show of hands which symptoms should be included in a diagnostic test.18 This checklist approach is like the familiar parlour game, Find Five Errors. A person who has at least five symptoms out of nine is declared depressed.
If we look hard enough, we will find “errors” in all people. There is nothing objective and verifiable about this way of making diagnoses, which are derived from an arbitrary constellation of symptoms. How many criteria and which ones do we vote for need to be present to make a given diagnosis?
I lecture a lot for various audiences, both professionals and lay people, and I often expose people to the recommended test for adult ADHD (attention deficit hyperactivity disorder).4,21 It never fails. Between one-third and one-half of the audience test positive.
When I tested my wife, she scored a full house, which is six out of six criteria. Only four positive replies to the questionnaire are needed for the diagnosis. Once, when one of my daughters and her boyfriend visited us for dinner, we discussed the silliness of psychiatric diagnoses and to illustrate it, I subjected them to the test. My daughter scored five, like I did, and her very laid-back boyfriend whom I would never suspect would be positive, scored four. So, we were four people enjoying our dinner and company, all with a bogus psychiatric diagnosis.
My little exercise makes people realise how foolish and unscientific psychiatric diagnoses are. I always tell people that I am in the same boat as them and that they shouldn’t worry but be happy, as the song by Bobby McFerrin goes, because some of the most interesting people I have ever met qualify for the ADHD diagnosis. They are dynamic and creative and have difficulty sitting still on their chairs pretending they are listening if the lecturer is dull.
Yet, the psychiatrists have had the barefaced impudence to tell the whole world that people with an ADHD diagnosis suffer from a “neurodevelopmental disorder.” The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) used in the USA and the International Classification of Disorders (ICD-11) used in Europe both say this.
One of the times I lectured for “Better psychiatry,” a woman in the audience said: “I have ADHD.” I replied: “No, you haven’t. You can have a dog, a car or a boyfriend, but you cannot have ADHD. It is a social construct.” I explained it is just a label, not something that exists in nature, like an elephant everyone can see. People tend to think they get an explanation for their troubles when psychiatrists give them a name, but this is circular reasoning. Paul behaves in a certain way, and we will give this behaviour a name, ADHD. Paul behaves this way because he has ADHD. Logically, it is impossible to argue this way.
I often joked during my lectures that we also need a diagnosis for those children who are too good at sitting still and not make themselves seen or heard in class. This became true, with the invention of the diagnosis ADD, attention deficit disorder, without the hyperactivity. From that day on, I have joked about how long we shall wait before we will also see a diagnosis for those in the middle, because then there will be a drug for everyone and the drug industry will have reached their ultimate goal, that no one will escape being treated.
The depression diagnosis isn’t much better. It is very easy to get this diagnosis even though you are not really depressed but just feel a little beside your usual self.4
Even the more serious diagnoses are highly uncertain. Many people—in some studies, by far most of them—have been considered on revision to have been wrongly diagnosed with schizophrenia.4
Given this immense uncertainty, disagreement, and arbitrariness, it should be very easy to get rid of a wrong diagnosis. However, it’s impossible, and there is no court of appeal like in criminal cases. It is like in medieval times where people were condemned for no reason and with no possibility of appeal. As you will see in the section about forced treatment in Chapter 4, the law is routinely being violated, which we would not tolerate in any other sector of society.
It doesn’t seem to matter whether a diagnosis is correct or wrong. It follows you for the rest of your life and can make it difficult to get the education you dream about, a job, certain pensions, to become approved for adoption, or even just to keep your driver’s licence.22,23
Furthermore, psychiatric diagnoses are frequently being abused in child custody cases when the parents get divorced.22 Even when the diagnosis is obviously wrong and the psychiatrist herself seriously doubted it when she made it, you cannot have it removed.23 It sticks to you forever, as if you were a branded cow.
Danish filmmaker Anahi Testa Pedersen made the film Diagnosing Psychiatry24 about my attempts at creating a better psychiatry and about her own struggles with the system. She got the diagnosis schizotypy, which is a very vague and highly dubious concept (see Chapter 5), when she was admitted to a psychiatric ward due to severe distress over a divorce.
It was obvious that she suffered from acute distress and should never have had a psychiatric diagnosis or been treated with drugs, but at the ward they gave her quetiapine, a neuroleptic, and escitalopram, a depression pill. Anahi was deeply shocked to learn that even though she had voluntarily contacted the psychiatric ward, the doors were locked behind her. When she questioned her diagnosis at discharge, she was told: “Here, we make diagnoses!”22 The drugs doped her and made her apathic, and she withdrew from them.
Another shock came eight years later when she received a letter from Psychiatry in the Capital Region. They wanted to examine her daughter. They believed that psychiatric disorders are inherited and that it is therefore likely that children of the mentally ill will also become ill.
Anahi became angry. Her daughter is well functioning, happy, healthy, and has many friends. The summons came without her being asked about her course after discharge, or her daughter’s situation and well-being, and the letter stigmatised both her and her daughter. She phoned a psychiatrist at the department where she had stayed eight years previously, but even though her family doctor assured her that she was well and that it was remarkable that she got the diagnosis in the first place, she was also told, by the psychiatrist, when she asked for a re-examination: “The system doesn’t do that!” She was left with a lifetime, yet erroneous, sentence. This wouldn’t have happened if she had been wrongly sentenced for a crime, but in psychiatry, this is perfectly “normal.”
To read the footnotes for this chapter and others, click here.
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.