In contemporary U.S. society, financial conflicts of interest, flip-flopping, belittling, and arrogance are no drawbacks to becoming a powerful authority—this is true today not only for national leaders but for influential psychiatry authorities (discussed later).
Illegitimate authorities are often embraced when fear subverts critical thinking. Americans appear to be increasingly terrified by the possibility of ostracism, including ostracism for failing to conform to psychiatry dogma. This fear subverts critical thinking and freethinking, and results in boring discourse, which includes boring discourse in psychiatry.
Prior to the current era, in a less fear-based society, it was possible for a handful of freethinking, thought-provoking psychiatrists to become well-known and influential.
Thomas Szasz: Anti-Psychiatrist or Anti-Coercion?
The freethinking psychiatrist Thomas Szasz (1920-2012), well-known and highly influential in the 1960s and 1970s, became increasingly unknown and marginalized as psychiatry began partnering with Big Pharma and capable of effectively ostracizing its critics. Szasz was thought-provoking precisely because he cared only about his philosophical integrity. He was unafraid of offending any camp—be that camp “pro-psychiatry” or “anti-psychiatry.”
Throughout his career and following his death, Szasz has often been labeled as an anti-psychiatrist despite the fact that he was always adamant about rejecting that label. In 2009, three years prior to his death at age ninety-two, journalist Natasha Mitchell asked Szasz, “Would you describe yourself as an anti-psychiatrist?”
Szasz responded: “Of course not. Anti-psychiatrist sounds like anti-Semite, or anti-Christian or even anti-religion. I’m not anti-religion, I just don’t believe in it. Anybody who wants to have their religion is fine. Anybody who wants to go to a psychiatrist is fine. Anyone who wants to take psychiatric drugs is fine with me. That’s why ‘anti-psychiatrist’ is completely inaccurate. I’m no more anti-psychiatry than pro-psychiatry. I am for freedom and responsibility.”
Szasz was a libertarian, and his Faith in Freedom: Libertarian Principles and Psychiatric Practices (2004) states: “The libertarian philosophy of freedom is characterized by two fundamental beliefs: the right to be left alone and the duty to leave others alone.” Szasz opposed the use of psychiatry to forcibly treat and detain, as this undermined the human right to freedom; but he also opposed the use of psychiatry to provide excuses for behaviors as, he believed, this undermined moral responsibility.
Szasz remained consistent in his beliefs throughout his career. He rejected the “anti-psychiatry” label because he believed that people had a right to believe in whatever they wanted to believe—be it facts, delusions, science, or psychiatry.
Genuine freethinkers such as Szasz, in contrast to dogmatists, invite challenges, which Szasz did throughout his life—in print and in discussions. Szasz was routinely challenged about his idea that mental illness is a myth or a metaphor. Not only did he respectfully respond to these challenges, but appears to have enjoyed the opportunity for dialogue.
Szasz provokes several questions for me:
If, as David Cohen observed (“It’s the Coercion, Stupid!”), the institution of psychiatry’s “coercive function is what society and most people actually appreciate most about psychiatry,” then given Szasz’s unequivocal opposition to coercion, would he make a distinction between anti-the belief system of psychiatry vs. anti-the institution of psychiatry?
While I have not read everything Szasz has written, it appears that his brand of libertarianism is the standard American variety, one that does not challenge the coercive nature of corporate capitalism, and this provokes other questions for me: The “libertarian-socialist” (anarchist) Mikhail Bakunin said, “Freedom without socialism is privilege and injustice; socialism without freedom is slavery and brutality”—what would Szasz’s reaction be to that? And the democratic-socialist Erich Fromm’s position was that corporate capitalism could be as coercive as totalitarian communism, concluding that in both such societies, “Everybody is a cog in the machine, and has to function smoothly”—what would Szasz say about that?
Szasz provokes another question for me. He made clear, “I don’t believe in Scientology. . . . I no more believe in their religion or their beliefs than I believe in the beliefs of any other religion.” However, because Scientology’s Commission on Human Rights (CCHR) opposed involuntary psychiatric treatments, Szasz served on CCHR’s Board of Advisors as Founding Commissioner. Regarding this, my question for Szasz is one about political wisdom: Would he now see how that even though he publicly rejected the belief system of Scientology, his association with CCHR would be used to discredit his criticism of psychiatry?
Perhaps, somewhere Szasz did respond to these questions; but if not, given his history, I’m sure that such questions would have resulted in a respectful and enjoyable dialogue.
E. Fuller Torrey: Flip-Flopper and Ridiculer
Because Szasz was authentic in his quest for philosophical integrity and truth, he provoked questions and dialogue. In contrast is E. Fuller Torrey, the founder of the Treatment Advocacy Center and one of the most influential psychiatrists in the United States. Because of Torrey’s flip-flopping and his ridiculing of others who retain positions that he has since abandoned, he provokes neither questions nor dialogue—at least from me—but rather fight or flight.
Today, Torrey is considered as perhaps the most prominent advocate of forced psychiatric treatment, including so-called “assisted outpatient treatment” (AOT) court-ordered treatment to ensure treatment compliance. However, this current advocacy is a monumental flip-flop.
In 1974, in a more anti-authoritarian era in which it was mainstream to confront the authoritarianism of psychiatry (One Flew Over the Cuckoo’s Nest won the Oscar for Best Picture of 1975), Torrey published The Death of Psychiatry, which was highly critical of psychiatric coercion.
In The Death of Psychiatry, Torrey, then a big fan of Szasz, stated, “As Szasz points out, a drunken driver is infinitely more dangerous to others than is a ‘paranoid schizophrenic,’ yet we allow most of the former to remain free while we incarcerate most of the latter.” Torrey informs us that studies of psychiatric patients following their discharge “have almost unanimously shown a lower arrest rate than that of the general population,” and he details two such studies.
Included on the back cover of The Death of Psychiatry is a blurb from Szasz praising it: “Dr. Torrey presents a reasoned review of the mythology of mental illness and the persecutory practices of psychiatry. . . . His work should help to make psychiatric barbarities couched in the idiom and imagery of medical care morally more distasteful and hence politically less useful.”
After The Death of Psychiatry was published, Szasz reports, “Torrey presented me with an inscribed copy. The inscription reads, ‘To Tom, with many thanks for saying nice things about the book. If it has 1/10th the effect which your books have had, I shall be happy. Fuller.’”
However, by 1986 in a more authoritarian American society, Torrey completely changed his tune about Szasz, as he flip-flopped from adulation to ridicule, stating: “Thomas Szasz is an anachronism, the Studebaker of American psychiatry.”
In a fear-based society, flip-flopping and belittling are no impediments to becoming an influential American psychiatrist, just as flip-flopping and belittling are not impediments to becoming influential in other spokes of the societal wheel, including becoming a U.S. president, one example being Donald Trump (Trump has had demeaning nicknames for all of his opponents, both Republican and Democrat ones; and he has flip-flopped for political expedience on major issues, for example, abortion, declaring in 1999, “I am Very Pro-Choice,” but then, in 2015, in order to win the Republican nomination, flip-flopped to, “I’m Pro-Life”).
Joseph Biederman: Financial Conflicts of Interest and Arrogance
Another symptom of a fear-based society absent of critical-thinking is its incapacity to distinguish between confidence and arrogance, and so people are attracted to arrogance, even if it is of the cartoonish variety. Returning to Trump, as a candidate in 2016, he famously bragged, “I could stand in the middle of Fifth Avenue and shoot somebody . . . and I wouldn’t lose any voters.” Such arrogance, at least for many Americans, appears to be confidence.
A parallel to Trump with respect to arrogance is psychiatrist Joseph Biederman, one of the most influential psychiatrists in the world, especially with respect to the popularizing of the pediatric bipolar diagnosis for children and adolescents.
In 2008, Biederman was exposed by Congressional investigators for taking $1.6 million from drug makers from 2000 to 2007; and the New York Times also reported that Biederman had told Johnson & Johnson that his proposed research studies on its antipsychotic drug Risperdal would turn out favorably for Johnson & Johnson—and such studies did in fact turn out favorably.
In a February 26, 2009 deposition given by Biederman to several states attorneys (who were claiming that makers of antipsychotic drugs defrauded state Medicaid programs by improperly marketing their medicines), the New York Times reported Biederman’s response when he was asked what rank he held at Harvard:
“Full professor,” Biederman answered.
“What’s after that?” asked one state attorney, Fletch Trammell.
“God,” Biederman responded.
“Did you say God?” Trammell asked.
“Yeah,” Biederman said.
Despite the New York Times and the rest of the mainstream media reporting on Biederman’s conflicts of interest and arrogance, his career as a psychiatrist appears not to have suffered. The Massachusetts General Hospital continues to list him as: “Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital, Director of the Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorders at the Massachusetts General Hospital, and Professor of Psychiatry at the Harvard Medical School.”
Why Society Accepts Psychiatry’s Unethical Ethics
Financial conflicts of interest are not viewed as unethical in the institution of psychiatry. In 2021, utilizing the Open Payments database, Robert Whitaker reported in Mad in America (“Anatomy of an Industry: Commerce, Payments to Psychiatrists and Betrayal of the Public Good”): “From 2014 to 2020, pharmaceutical companies paid $340 million to U.S. psychiatrists to serve as their consultants, advisers, and speakers, or to provide free food, beverages and lodging to those attending promotional events.” Roughly 75 percent of the psychiatrists in the United States, notes Whitaker, “received something of value from the drug companies from 2014 through 2020,” with 62 psychiatrists receiving one million dollars or more.
Psychiatry’s conflicts-of-interest “ethics” does not stand out in current U.S. society because such “morality” is increasingly the norm for other major institutions in U.S. society, including U.S. government leaders; among the countless examples, one reported in a 2021 Esquire article, “Speaker of the House Announces Support for Conflicts of Interest,” about the Democrat Speaker of the House, Nancy Pelosi.
In a critically-thinking society, psychiatry’s blatant disregard for financial conflicts of interest would result in its complete loss of credibility as an institution, but psychiatry’s institutional corruption is merely one spoke on a societal wheel replete with institutional corruption.
In a fear-based society that is absent of critical thinking, there is no cost to authorities who are guilty of financial conflicts of interest, flip-flopping, belittling, and arrogance, and so such authorities—including psychiatry authorities—pervade mainstream discourse. This is a major reason why those who continue to embrace freethinking and critical thinking are so bored by mainstream discourse—including mainstream discourse in psychiatry.
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.