Dr. Bruce Cohen is an Associate Professor of Sociology at the University of Auckland. His career spans over thirty years where he has time and again used empirical research to tackle the numerous shortcomings of the psy-disciplines. With his upcoming book series, The Politics of Mental Health and Illness, he continues to expose how the psychiatric discourse “doesn’t work for us” but instead greases the wheels of a neoliberal capitalist society.

In this interview he talks about how the psychiatric discourse has left the clinic and entered workplace, how the DSM has been feminized to the detriment of women, how and why the ADHD diagnosis has shifted shape, and lastly, how the global move towards “mental health” and away from “mental illness” might not be positive or benign.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.


Ayurdhi Dhar: You have explored numerous criticisms of psychiatry. What brought you to them—when and how did you end up seeing these glaring problems?

Dr. Bruce Cohen: [Laughing] I am a sociologist, so disillusionment is what pays the bills. Back in the early 1990s, I was an undergraduate at the University of Teesside. As my first research gig at the time of community care in the UK, the psychiatric institutions were closing down and I did interviews with users, and survivors of the psychiatric hospital system.

I remember distinctly seeing a psychiatrist there as part of this team, the first experience I had of meeting a psychiatrist in my life—we mentioned how we were going to look at the needs of the users in the community, beyond the asylum system. The psychiatrist said to us, point blank, “There is no point in asking them what they want, you know. They are all mad. How are you going to get anything articulate out of this population?”

This was my first but not my last experience of the arrogance and the ignorance of the psychiatric profession. When we did these interviews with users and survivors, one of the first things they told us was, “We were never listened to by the psychiatrist, by the mental health nurses in the system. They ignored our voices. They avoided us on the wards.” We learned about things that were typical of the inpatient experience that we know from Goffman and Rosenhan’s work. Such is the hubris of the professional staff there—the use of medications, ECT, solitary confinement as forms of sedation and of punishment.

The paths that led users into institution were personal problems, family issues; this included the sectioning of people against their will into these places. There was also the rarity of being able to get out of these places, and many got out only because the place was closing. That was a really interesting and formative experience for me. A few years later I ended up doing an evaluation project on a home treatment service. This service was an alternative to inpatient care for acute or severe mentally ill people like those diagnosed with psychosis or bipolar disorder or schizophrenia.

Bradford Home Treatment Team would take people who would have a crisis and usually go into the hospital, and actually keep them at home. The workers would come around and see them. This was a team set up by Pat Bracken and Phil Thomas. This team questioned the ways that psychiatry worked with these users. They were fundamentally challenging their own psychiatric knowledge base. For instance, team meetings would discuss “Should we still use psychiatric labels? Should we maintain their medications or encourage them to reduce them because of the problems many antipsychotics and antidepressants can cause? The use of ECT—should we encourage it or discourage it?”

It was interesting to see a team of psychiatrically trained nurses and doctors, psychiatrists, psychologists, be emancipated to do something different. This was fascinating for me as a sociologist, and I saw there was a potential for the mental health system to be something different.

This led to my book on mental health user narratives, which is influenced by Arthur Kleinman’s work on Illness Narratives. I did open interviews with both those who were using the home treatment service as an alternative to inpatient treatment, as well as those who only had had inpatient treatment. I found with both sets of users a psychiatric discourse that was very powerful in their identities, and in explaining their situation and their future in terms of mental illness and recovery.

Hospital-only users would really follow a biomedical discourse—I have got schizophrenia. It’s a lifelong disease of the brain. It’s in the genes. Medications can only control the worst excesses of the diseases. Relapse is bound to occur. I feel I will require several inpatient treatments in the future for the rest of my life.” With the home treatment users with social critical engagement from Pat’s team, there was a downgrading of diagnosis. You have to remember all these people were considered acute and severe. But they downgraded their own diagnosis and they were saying, “I think I had more of a depression really. Or, it was a neurosis, or it was a crisis that happened due to social and environmental reasons. It’s a one-off. I don’t think it’s going to happen again.” That’s generalizing, but that was often the narrative that we got from those users.

The team working with these users had an emancipated idea of the possibility of their living without further contact from mental health services. The psychiatric discourse, the psychiatric language, the practices, the treatments—these can all have a significant impact on our identities and our understanding of ourselves.

Dhar: You write that psychiatric discourse has become hegemonic. Could you tell us what that means, and what are some of the consequences of this happening?

Cohen: Hegemonic means that the psychiatric discourse is now everywhere. This idea comes from cultural Marxist Antonio Gramsci and it means to be ruled by consent. This is a more subtle form of power than direct control. Imagine direct control as physical force from the army or police. Hegemonic control is more subtle—the dominant norms and values of the economic elites in capitalist society are proliferated through nonpolitical institutions—public institutions such as the education system, the criminal justice system, medicine, and the mental health system.

These ideas are communicated to us as being commonsense and become taken for granted ideas of how society should function. For instance, gender roles and the policing of the binary within the genders. So psychiatric discourse has proliferated. It has left the confines of the psychiatric hospital and the therapist office, and is present in our everyday lives, in schools, workplaces, unemployment centers, homes. It’s constantly in the media and social media. It’s a regular feature of our day-to-day conversations.

Previously, discussion of mental illness amongst the general public was rare. Now it’s commonplace. We can all name a few mental disorders. Most of us can name symptoms and even suggest causation, for example, it’s a brain disease, or chemical imbalances, or it’s due to trauma. Some of us can probably also name typical medications and other treatments. My research has really been primarily concerned with answering this question as to why psychiatric discourse has become hegemonic across Western society.

One of the obvious reasons is maybe more of us are mentally ill than ever before. But that’s incorrect. Robert Whitaker has noted that, using the marker of people in the US who are disabled by mental illness. The number of mental illnesses present in the DSM have gone up. We had 106 in 1952, we now have 374 today. For many of these classifications, the symptoms required to reach a disorder have been reduced. For instance, the DSM removing the exclusion criteria for major depression for bereavement following the death of a loved one. So that’s kind of problematic in measuring has mental illness really gone up?

An interesting bit of research is Amy Johnson’s article from last year. It’s an analysis of US National Health Interview Survey data between 1997 to 2017. She uses psychological distress and asked people how much are you worried, etc., about these issues. She concluded that there is little evidence that psychological distress has actually worsened over time.

Lots of people, including Whitaker and Cosgrove and myself, have talked about the ongoing validity problems with the psychiatric science in accurately defining, measuring, and explaining mental illness. Just one example recently is that Allsopp and colleagues looked at the major diagnostic categories which included depression and anxiety disorders in the current DSM, and they concluded that all the categories were scientifically worthless as tools to identify discrete mental disorders.

There is Irving Kirsch’s work among others, that point to the problematic conclusions of most antidepressants and antipsychotics being no more effective than placebo. The wonderful historian sociologist Andrew Scull concludes that the causation of most mental illness remains obscure, and its treatments are largely symptomatic and generally of dubious efficacy.

My answer for why the psychiatric discourse has become hegemonic is because Psychiatry has learned to speak the public language since the 1980s. Back in 1965, Mike Gorman addressed the American Psychiatric Association, and said, “Psychiatry must develop as public language. It must be decontaminated of jargon, and it must be suited to discussion of universal problems of our society. This is the difficult task that we face in psychiatry, but it must be done if psychiatry is to be heard in the civic halls of our nation.”

Our emotions, feelings, and behaviors, in the recent DSMs, are now considered common mental disorders, and they reflect our concerns, our anxieties living in late capitalist society. Throughout these diagnostic classifications are things that speak to our anxieties about not multitasking effectively enough. We are not working or studying hard enough. We are not happy with our work-life balance. We feel we are ineffective parents or carers. Our sex lives are a mess. We are gaming or drinking or smoking too much, etc. These are all within common mental illness categories. My argument is—psychiatric hegemony has actually successfully medicalized more and more aspects of our everyday lives, and the discourse has become totalizing.

Some people might say this is a great thing, that this can really help us because “I just thought I was feeling lazy or I was self-obsessed and then I got diagnosed as ADHD or whatever.” Many are relieved. But these are not mental disorders. My argument obviously follows Gramsci in that psychiatric discourse is, and always has been, a form of social control, which actually works to the better of capitalism; it doesn’t work for us. So, with the advent of a neoliberal ideology in the 1980s—a discourse that focuses more on the individual for reform or change of character, for improvement of ourselves—this discourse has become increasingly important. It’s not neutral or value-free, it actually reflects a dominant ideological rhetoric that speaks to a specific epoch, and has done ever since psychiatry has been around in industrial society.

Dhar: According to you, which diagnosis more than any other, betrays psychology’s ties to neoliberal capitalism?

Cohen: The most obvious one for me is ADHD. It was previously Attention Deficit Disorder. Before that, it was hyperkinesis, and before that it was various terms like minimal brain dysfunction. We see the expansion of categories in the DSM. In the 1970s, significant shifts take place in Western society. There is deindustrialization, the rise of service industries, a collapse of welfarism. There is a rise of neoliberal politics and desire to deregulate the market, take it out of state hands, sell off public industries, make cuts in welfare services and provision, and force the general population to rely more on themselves rather than the state to have to upscale, to have to work on themselves.

How does ADHD fit into this? The education system and the work environment had to change towards more seatwork, more intensive study, more analytical sets of skills, more flexible skills for the service economy, more IT skills and so on. And we can see this in the way ADHD actually changes. First, it focused on young people and later on adults as well. So, young people at school and then adults more in the workplace. Whereas hyperkinesis in the 1950s to 1970s was really seen as a rare condition amongst primary school children, ADHD is based on the changing demands of schooling at that time.

DSM is a fascinating document; DSM-III had things like “inattention caused by failing to finish things he or she starts, often not listening, easily distracted, having difficulty concentrating on school work, has difficulty staying seated, difficulty sticking to a play activity.” These are all things directly related to the classroom.

But then it moves into the adult world of work—the person will make careless mistakes at work or during other activities as well, they miss or they overlook details, their work is inaccurate. We have seen that one of the problems for capitalism has been the active worker disengagement—absenteeism or sickness. In the latest version of ADHD, and quite blatantly, they have just added lots of stuff to make it about your occupation as well. Now they have added poor time management, fails to meet deadlines at work. These are all symptoms of mental disorder. So, if you are not paying your bills on time, you are not keeping appointments, you could have ADHD.

Peter Conrad has talked about the modern form of ADHD as the medicalization of underproductivity. For example, at the university, one regularly gets requests for student extensions and the related mental health issue is often ADHD. In academia we have a mountain of work and I had a colleague who has a reflective critical attitude towards mental health system, but was actually relieved to get the diagnosis of ADHD. They could now access Adderall or Ritalin and perform more, which is of course the major component of Adderall or Ritalin. These are not mental illnesses per se, but they are actually issues of performance in neoliberal environment.

Dhar: This reminds me that for Emil Kraepelin, one of the primary indicators of dementia praecox was the fact that this person does not want to work. We can’t have that.

Cohen: Yeah, absolutely. This is the conservative nature of psychiatry going back to its birth.

Dhar: You write that psy-disciplines have provided a lot of pseudoscientific evidence to support neoliberal capitalism, thus turning social problems into individual problems, and social issues into individual deficits. I wanted to know more about this pseudoscientific evidence.

Cohen: The really conservative nature of psychiatry throughout its history reflects wider society. That’s a struggle between the workers and the owners and the means of production. It reflects the dominant norms or values of that society, particularly being a profession that is dominated by white middle class men. They are a profession that are the lackeys of capitalism.

Looking at gender inequalities, patriarchal power, and the roles of women and men—these are sociopolitical issues of sexism, discrimination, partner violence, poverty, compulsory heteronormativity. Why would psychiatric discourse promote these ideas? As lots of critical feminist scholars have signposted, and I with Rearna Hartmann have argued, this is to enforce patriarchal capitalism, that is, to keep women as second-class citizens to service the economy as unpaid or low-paid labor, to take the majority of the housework, as well as reproduce the future labor force here.

We have referred to this increased focus over time on women’s roles by psychiatry as feminization of the DSM. There has been an increase in the number of mental illnesses that are really gender biased against women, like the whole history of personality disorder. We see borderline personality disorder, body dysmorphic disorder, female sexual arousal disorder, gender identity disorder, female orgasmic disorder, binge eating etc.

Dhar: PMDD?

Cohen: Yes, exactly! Feminist scholars have said these are feminist categories that are connected to prevailing moralities and norms regarding gender, sexual expression, the gender order, and heteronormativity. For example, premenstrual dysphoric disorder symptoms include a lack of energy, specific food cravings, physical symptoms such as breast tenderness, joint or muscle pain, bloating, weight gain and so on. This is the medicalization of menses.

DSM states there is a decreased productivity and efficiency at work, school, and the home. PMDD is a pathologization of women as being victims of their own biology. And hey, this is not the first time it’s happened; it’s 200 years of history and a lot of that by psychiatry—“the women are subject to raging hormones.” It functions to legitimatize traditional constructions of femininity, and to restrict women’s access to equal opportunities. That includes taking up senior professional and public positions.

We argue that PMDD cautions women not to place their work responsibilities above the family responsibilities. That’s captured in contemporary advertisements for Sarafem, the preferred recommendation for PMDD. You see these adverts in which women are of course homemakers, they are carers, they are represented as mothers and wives.

Dhar: About your upcoming book, Selling Mental Health, you have written that the “mental health” discourse appears more benign than the “mental illness” discourse but it’s just as dangerous. Could you tell us more?

Cohen: As with the work of missionaries and anthropologists towards the colonial project, the mental health project can be understood as the advance troops of psychiatric hegemony. This is a way of proliferating the hegemony to capture more and more people. It captures all of us. There is still a chance that hopefully some of us can escape the mental illness label, but the clever and simple phrase “mental health” actually captures us all in it. Mental illness is becoming a bit passé in public health discourse as opposed to the phrase mental health, which obviously has a more positive conversation.

Even though we actually have no idea what the hell it is we are talking about, we are just like, “Well it’s got to be a good thing, it’s about mental health.” But when you break that down what the hell is that? One thing it is—it’s really big business.

There are these taglines of “no health without mental health” and “mental health is everybody’s business.” These have become commonplace. It’s not unusual to see workplaces holding mental health awareness sessions or school instituting mindfulness classes. Every disaster crisis leads commentators and campaigners to say we need more targeted mental health services. And we have consumer products which are now sold to us on the basis that they are actually good for our mental health and wellbeing.

So, the Selling Mental Health book actually continues this analysis about psychiatric hegemony, but through this concerted focus on promotion and the selling of the psychiatric discourse. The profession is legitimating the services, products, and the treatments, and doing it under this beautiful umbrella of “mental health.” And it’s under the guise of “it’s all for our public health, it’s all for our benefit.”

Dhar: These cracks that have been appearing for the last decades in the biomedical model—the dopamine hypothesis is under fire, prominent psychiatrists are saying, “Oh, we never said it was a chemical imbalance,” and we are taking psychiatric drug withdrawal more seriously. I wonder if switching from “mental illness” to “mental health” effectively neuters any kind of progress that we could make—“Oh, we don’t have to call it an illness, it’s a more health thing.”

Cohen: Absolutely. That normalization has happened very successfully. There is this saying “your wellbeing comes first.” Many universities have taken up this mantle for staff, faculty, and students. During COVID, with the staff losses we had, it was still “your wellbeing comes first.” We have a social wellness committee. It’s established to help foster, it says “a positive workplace culture and environment that promotes staff wellness that’s both physical and mental, and that is welcoming, inclusive and safe for all staff”—all very well.

We have had loads of activities—Auckland Bike Challenge, Auckland Walk Challenge, posters about of course mental health awareness week, etc. However, and this is where it gets political and serious for me: myself and my colleagues are basically expected to do more and more over time with less. This is especially true over the last couple of years, but I would say this goes back five to eight years. We lost administrative staff, two to three in sociology, there’s been a virtual freeze on new academic employments. Even our tea room was taken away from us.

The morale is not good—how can chair massages take away the fundamental problems of institutional under-resourcing? These mental health initiatives in the workplaces have spread out in a relentless way on the back of slogans like “mental health is everybody’s business” which is the idea that mental health is costing businesses a lot of money, so basically, the more you can aid the mental health of your workers, the more productivity will go up.

But, the finding of a number of surveys suggests this is more of a surveillance and social control process. This is despite evidence that if you made your workplace more favorable for the employees, that would have a positive effect on mental health. So, you had this focus on basically individuals rather than organizations. There is a report for the Australian government that suggests more explicitly involvement of employees themselves in surveillance measures.

Writings from North America suggests three things. First of all, all of this is about coercive practices which force workers to self-label as being mental disordered. There are expectations for the employees to be mentally well at all times.

Secondly, it’s the reframing of workplace conflicts as personal issues. Structural issues within the organization such as downsizing our university, these are individualized through mental health initiatives—there is a concentration on the employee and their emotional reactions and need for personal adjustment. They have one of these sessions when they are about to sack employees.

The third issue is an increased use of diagnostic labels and discriminatory behavior against those who are labelled as mentally ill within the workplace. It actually avoids the focus on power imbalances and structural issues of the work environment. Instead, we can medicalize workers as at-risk of biological or psychological issues.

They have found in these cases that these are issues related to conflicts with manager or their supervisor. Despite arguments for mental health workplace programs having positives like leading to accommodation for workers, actually the employees are usually severanced out. Write a check, severance them out.

What this program seems to be about is it’s really a case of surveying, pinpointing who’s got mental health issues, getting rid of them, and making sure that their employees know that they have to be mentally well and productive at all times.



MIA Reports are supported, in part, by a grant from the Open Society Foundations.


  1. I respect this doctor because definitely he is on the right course of discourse about mental health, illness, sickness etc.
    But I will say something that may rub some people off.
    Either you have biological (and everything is biological including thoughts) or you have social condition. If you are complaining about something, the solution or the acceptance will either be biological equilibrium or social change. Example can be you recover from trauma, or you divorce your spouse who has been “staining” your social sphere.
    Recovering from childhood trauma, at minimum, in my experience (and I am not special or unique or hugely different), is that it was something cleared up in my brain. All of sudden, I started to see things differently and I felt the rush in my brain and can pinpoint where the rush happened but since then, I saw my childhood trauma differently. This convinced me my “blocked” was biological, but it needed my own understanding and patience to unlock.
    I never had depression, anxiety, or psychosis at the clinical level (whatever that even means). I am highly functional and highly open to experiences and did well considering my beginning of life was hell (that may be even understatement). But when reached out for therapy, I was diagnosed with ptsd. I laughed cause it was a place holder for invoicing IMHO. I have had experiences that are listed but no flashback, no nightmare, no phobia, no anxiety, no fear, nothing…just the words were thrown at me and I put it on the side and went to work what I needed.
    I think this argument biological versus non-biological argument is distraction.
    I was very highly normal socially. I worked hard. I made money and took full advantage of the capital society (I am a great immigrant) and I am physically healthy or so I thought…but childhood trauma is physical…it is not just in the brain. It is in the body – mainly I will say in the muscles. So we cannot throw the baby with the bath. – whatever that expression is.
    If you are “hurting” something must be “healed”. And that is biological pain being removed. My two tiny cents but not need for medication if this is ultimately what the argument is. Never took one and do not know tomorrow.

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  2. Uvalde was especially disturbing because like Sandy Hook, it was at an elementary school. TX Governor Greg Abbott wants to say that this is all because of Mental Health. Trump tried to say the same thing about the spree shootings.

    They are wrong. Citing Mental Health just amounts to saying that morality is declining, personal failure. This is wrong. You won’t be able to make sense of it by looking into the head of the shooter.

    It is some kind of a society wide problem.



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  3. “acute and severe”. Identity can’t be acute. Acute is monistic hatred to psyche. Hatred in medical disguise is an abuse. Mentally health people are imbeciles on rhetorics level. Stupidity and arrogance won’t look good just because of pseudo scientific disguise. Psychological man is pychological man, it is not frill or “something wrong withe the head”, normal people with scientific thinking about imagination emotions, are third grade imbeciles without soul. They put personal blame on sth which is beyond ego will – this is disaster. Your happiness is not yours, his politheistic nature of psyche is not his. Dummy people want to look serious. Silly ego cult with the nature of the worst sect ever. Psychiatry should take their satanic jargon and go back to hell. Grow up to sth more than power over people, paid by papers without worth.Unfair judgment – is all they have.

    The problem with psychiatry which care about materialism, not the psyche, is that they should take care of the psychological man ang give back his stolen identity. In many cases – this people work is psychological work. Psychological work is not material one. Autistics and schizophrenics won’t be your slaves, because their roots are not marxistic. Cheap labor is the identity of normal poeple without the right to psychological, the real one. They agree with this, they also agree with destruction of psychological man. So psychological man must die, because the real identity was stolen. Normal people just don’t have identity, they have work and material function. So everyone who means more than monistics cheap “ora et labora” must be destroyed. Church main blame is a collaboration with materialism’psychiatry without the psyche. Spiritual and materialism is monism without psyche, without the right to live for people with more complex and overriding identity stolen by monism. Church also lies about the situation of psychological man, they see them as a cheap labor. Or on theological level- lazy people or poor stupid lambs. Laziness is the catchword of psychiatry too. And that psychiatry is based not on the psyche real nature, but on monotheistic materialism. THEY ARE LYING. Spirituals and materialists are lying and using the psyche/psychological man for their own purpose. Spirituals and materialists agreed to destroy psychological definition of life. To destroy psychological man in places of destruction. They call it “mental health care”. So they didn’ have to care about the fact that they are the killers. Psychiatry is ego cult without the psyche.

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  4. I am not a political expert. My choice has been a spiritual life. In my observation the political have hope that “the world” can be improved by humans. In my observation humans are much like cattle who cannot get their act together because they prefer to think they are Gods. I believe that the spiritual regard the world as largely beyond our control, much like storms and tempests and meteor strikes are. The beyond control nature of existence gets worse, it seems to me, when humans endeavour to en mass control it. That is where “consensus opinion” arises and can at times become a colossal bully to individuals who are eccentrics or drop outs or outsiders. Those who get bullied then band together to form a new “consensus opinion” or “us” to the “them” and the wheel of atrocity keeps on endlessly turning.

    If any “consensus opinion” is not making ALL of “us” US then it is an opinion I prefer not to hold.

    I know many schizophrenics who have very extreme opinions on how to make the world improved but all of those gentle philosophers do not impose their grand schemes on everyone else. That is not to suggest do not share a vision or a dream…

    but if your dream is more important than a human being
    break your dream and become one.

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    • To add here on a different day I just want to say EVERY schizophrenic that I know has found Intensive Home Treatment Teams to be utterly useless. More of a patronizing insult really. This is not because the concept cannot yeild fruit, it just is not fit for purpose as it is.

      The schizophrenic may be going bonkers and so they call that team, a phone number on a scrap of paper. A succession of harassed fatigued and cynical psychiatric boffins are maybe allocated to pop in for a cuppa once a day for twenty minutes. Long enough to hear the details of the complicated mess going on in your mind but that’s it. That is all they do. You see a different stranger every day. A man or woman you have never spoken to before. They listen to your grubby hot episode whilst manicuring their appointment diary and intrusively commenting on your choice of rug. Then they go. Their exit causes a vaccum that was not there before they arrived. As if the fabric of your mystical cocoon has been snagged on their bag or coat zip or file. The sense of isolation left behind has more of a personal and empathetic solidity of form than when the qualified charlatain was present. What a cushy job! A joke job. The teams do zilch, in my opinion. You can phone them up once an evening to derive succour from an exchange of smooth voices but as for constructive impute it is a stock joke in schizo circles that these people only ever tell us to have…

      “A hot bath and a milky cocoa”.

      If you wanted to jump from a tall building for the past forty hours would that patronizing phrase do it for ya?

      What is going to happen is people with schizophrenia are going to be scolded if they need more than that. They will be regarded as willfully malingering and resistant to trauma therapy conversion.

      Few schizophrenics can make it to their own birthday party let alone a smart sleek therapy office accross town.

      Psychiatry has not found the exact cause of schizophrenia yet and it has been berated into crestfallen defeat about that delay. It has taken to blaming the victim of schizophrenia for not healing that embarrassment to the proffession straight away by being instantly healed. Gone are the pyjamas and shackles and electrodes and out comes the avuncular priest in a confession box waiting to hear of your tragic abuse so they can recommend new stuff and say this was the cause all along. And they will say silly you if you do not agree, even though you have a university degree and are not so dim or crazy as you cannot dial their number and get told to…

      “Have a hot bath and a milky eggnog”.

      In this manner schizophrenics are being told they are LIARS for explaining the hallucinatory hell they go through hourly.

      They are being told they have mock depression or big fright or sad sad.

      When they just want to die they are being told there is nothing wrong with them so quit complaining. How is this an improvement from being told they are all wrong inside and need persecuted and locked up? Schizophenics have always been societies LEPERS and PARIAHS and so here we go again. Grab your partner here we go round and round the ballroom of indifference heel to toe. Schizophrenia is NOT caused by faulty thinking. Analytical thought won’t put a smile on a person’s face who is being beaten by relentless hallucinations.

      Youth are confusing the concept of mild enjoyable drug induced trips to the ill feeling of uncontrollable unending unstoppable misery of hallucinations and this makes them flippant and narrow minded about the ability to shrug it all off.

      You can shrug off a dripping tap for a week.

      A prison guard can reduce a grown man to a heap of howling by using the same unending nightmare repetative drip.

      Torture is found not in the act but in its ghastly anticipatory anxiety. There is no let up from that startle. Stay startled for a month, six months, a year, and see what being told to have a milky drink does to you. I am not arguing for pills. That is hopeless. The pills help hardly anyone I know. I am not even arguing for the buffoon home treatment teams to spruce up. I am no longer wanting ANY help.

      I just do not want to be told that my illness of schizophrenia is a laughable error of my own independant judgement. To say that the schizophrenic is too thick to know they may have nothing wrong with them is the ultimate slap in the face to the dying.

      People sneer that they have not found the molecule that causes schizophrenia so therefore the schizophrenic must get nannied to drop their diagnosis lest they imbibe a desperate pill that is not good for them. A man desperate for a bottle of whiskey does not get pestered on his way to the pub and nannyingly told he has nothing wrong with him. And he does not get told to drop the glass and toddle off for conversion therapy. People are always getting up to no good and doing risky things to their own health without a barrage of complaints that what they are doing is bad form. So what makes the schizophrenic uniquely different in needing schooled to take a sober good look at themselves “properly”?

      I am telling you that if you want a world of greater wellbeing NOBODY should be schooled out of how ill they feel. If we live in a world that does not recognize that some people are sick then this is a sick world making sick people sicker. Just as much as when it tells millions they are schizophrenic when they are maybe not that.

      Nobody has found the “dysphoria mollecule” and yet people with that hellish distress, which is comparable to my uncontrollable bodily hallucinations even though it is not the same thing, are people who are not quite so readily told their torment does not exist. They are not quite so often told they have been reading the wrong books or letting themselves be beholden to the medical model. They are not nearly as swiftly told that they cannot do risky and drastic things to cope with it, like down a pill or get a massive surgical intervention. These people are thankfully more respected to report exactly who they say they are and what treatment or acceptance they want. It is a blessing that increasingly these fine people are educating others and are now more or less treated like adults who can clearly describe their inner hell and not be so instantly publically shunned and cross examined. Though they have a long way to go to get justice and freedom.

      I understand that some people feel healed by getting rid of the idea that they have anything the matter with them. Some prefer the abuse narrative as an explanation. Fifty percent of schizophrenics say they have NOT been abused. But nowadays with even being looked at oddly on a bus can be traumatizing for some nobody believes that anyone was not abused. It is like no one used to believe their medieval neighbour was not lazy and sinning.

      What is at stake is our faith in each other to be full of HONESTY.

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  5. Donald Trump spoke at the NRA convention in TX and he says that the solution to these spree shootings is in Mental Health.

    He is completely wrong!

    Now I do know that we need gun control, but I also don’t think gun control alone is going to do it.

    We need gun control and we need something else, but we must not go to a Mental Health Police State, must not have Psychiatric Policing.

    I read some of this:
    The Wiley handbook on violence in education : forms, factors, and preventions / edited by Harvey Shapiro (2013)

    Because it has a chapter about Elliot Rodger, the 2014 Isla Vista Shooter.

    That chapter was written by Ralph W. Larkin, and he has been one of the major writers on the Columbine Shooting. He sees Rodger in a similar way, the product of a culture and doctrine put out by the NRA, of violent retribution, and that message being the folk message of The Republican Party.


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  6. Thank you Ayurdhi Dhar and Bruce Cohen for this interview, I found myself nodding along pretty much the whole time. I agree completely regarding how dominant the psychiatric hegemony has become and how dangerous ‘leading with consent’ – but not informed consent – truly is. Excellent discussion.

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  7. As information is coming out about Uvalde, it is starting to sound more and more like Columbine, Sandy Hook, and Elliot Rodger of Isla Vista.

    Uvalde Texas School Shooting my reaction from a Retired NYPD Detective DutyRon

    Dangers of Cowardice | Uvalde, Texas Shooting Case Analysis

    Details emerge about suspected gunman after Texas shooting l GMA

    Sheriff Grady Judd addresses school safety following Texas shooting


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  8. I first learned of TX Governor Greg Abbott with the El Paso shooting. I think it was in a Walmarts, and its seemed to be prompted by the racism which was coming from the Trump White House.

    Abbott showed up and he kept on saying, “Capital Murder”.

    Well yes, that is the law, and in Texas they hand out and follow through with lots of death penalties. But I don’t think it good to tell people that they should look to the death penalty is the answer to common crimes. I think it just make the situation worse, make the society more fatalistic.


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  9. by the way Doug Harvey ( for those that may not know) was a hockey player. He was a hall of famer defenseman that skated in the NHL for many years… i read a biography of Doug, once which discussed his emotional, cognitive challenges…. i admired his play so much, as i also played defense… but really i know little about him or HOF goaltender Terry Shawchuck. But certainly severe head trauma played a major factor in both their lives on and off the ice. we do know this, now. Harvey died only a week after his 65th birthday, and was interred in the Notre-Dame-des-Neiges Cemetery in Montreal. i agree with the author, we’ve normalized all this psychological language. but what does any of it mean? and what is the shadow side of this “ mental health” rhetoric and systems ? good questions, very good questions, imo. i also fear sometimes this publication overlooks some of the helpful advances in drugs and psychotherapy. but this is more of a question? another GD question. oh well, i think it was Sam Keen who said something about living in the question. Or maybe it was Rilke? in any case i’ve been re-reading Donald Kalsched’s great book on Trauma. And what struck me this time was the essential nature of the therapeutic dyad. How important, over and over it is to “ tame the fox” ( using Antoine de Saint-Exupéry, little prince)… it takes a tremendous effort to gain someone’s trust when they’ve been severely abused. and this “ trust “ runs both ways. what we now partially refer to as transference and counter transference. which kalsched and others have experienced ( which is also my experience) as having a psychosocial/ spiritual dimension. which clearly, is beyond the scope of “mad in American” and most mainstream psychology. but it is partly through stories, myths and biographies that we live into the answers. these again are some of my discursive thoughts after listening to this interview, which i thought overall was quite good. i thought the young Professor interviewing was engaging, as well.

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  10. Excellent article. I am finding the phrase ‘mental health’ increasingly annoying. Here is an extract from my recently updated book ‘A straight talking introduction to psychiatric diagnosis’:

    ‘We all have mental health’
    Until comparatively recently, it was assumed that only a minority of the population was ‘mentally ill’ and the rest of us were more or less ‘normal’, whatever that is. However, a popular current slogan ‘We all have mental health’ is being widely promoted by schools, charities and celebrities. Hailed as a way of reducing stigma, it encourages an ever-increasing number of us to admit to having ‘mental health issues’ and to talk about them openly.
    This attempt to break down ‘us and them’ barriers and be open about our struggles is generally accepted to be a good thing, and it is certainly well-intentioned. However, I think the trend is worth examining more closely. Firstly, the phrase is very confusing. ‘Mental health’ was once used as a contrast to ‘mental illness’, but in this case, it is actually being used to indicate something closer to ‘illness’ than ‘wellness’ – in other words, it refers to a lack of ease and wellbeing. As such, the phrase retains the medical associations of the word ‘illness’.
    Secondly, the term ‘mental health’ is rapidly becoming a replacement for what we used to call, quite simply, our feelings. Once upon a time we all went through periods of what we described as feeling miserable, or frustrated, or anxious, or afraid; we all sometimes felt lonely, or inadequate, or unsure of ourselves. Nowadays there is strong pressure to translate this whole complex range of emotional reactions into ‘I have mental health’ or ‘My mental health.’ In doing so, we may be able to voice a need for support, which is good. But at the same time, there is a risk of re-framing ordinary human responses, which arise for good reasons in our lives, into ‘mental health’ language which invites ‘mental health’ solutions. The causes of our distress may become hidden as we take on the identity of someone with ‘mental health issues.’
    This shift has happened extraordinarily rapidly. Whatever the relief it brings to some people, it also represents a massive expansion of medicalisation – lightly concealed behind an apparently benign slogan – into our lives. As we have seen, we no longer need to await an official diagnosis by a professional. Spend two minutes on social media or Google and you will soon find that there is, in the words of a group which campaigns against psychiatric labelling, ‘A disorder for everyone’ (www.adisorder4everyone.com).
    As we have already noted, we are often told that one in four of us has a ‘mental illness.’ In fact, recent research from New Zealand shows that by the age of 45, nearly 9 out of 10 of us will meet the criteria for a psychiatric diagnosis, and probably for several (Caspi et al., 2020). By the time we reach our sixties and seventies, it seems likely that this will be true of nearly all of us. And there are yet more diagnoses waiting in the wings. The newly identified phenomenon of ‘climate trauma’ (Woodbury, 2019) -sometimes called climate distress, eco fear or eco trauma – has yet to appear in DSM or ICD, but there is a real risk that our justifiable and necessary responses to the most profound threat we have ever faced will be reduced to a personal deficit.

    At that point a curious paradox kicks in. When everyone is ‘mentally ill’, then no one is ‘mentally ill’, because a diagnosis of ‘mental illness’ is based on a judgement that you are different from the norm, and it will soon be statistically normal to fit the criteria for at least one ‘mental illness.’ ….Perhaps we need a better, and less contradictory, way of acknowledging and accepting our human struggles and skills, similarities and differences? And perhaps we need to think more deeply about why it is so hard to do this?

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    • As usual, I agree with you almost completely. The one exception is your comment that you are sure the “mental health” meme was entered into with “good intentions.” Nothing expands that quickly without funding behind it, and that funding comes from our friends in the Pharmaceutical Industry. I am certain this phrase was chosen specifically because it had the effect that was wanted, and it was spread as propaganda through the usual “advocacy” groups and social media sites with the intention of making it ‘popular,’ as a means of marketing their wares. The more “mental health” is normalized, the less people look for other explanations, and the more drugs and “services” are sold. The intentions are NOT good!

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    • I like the term “well being”. It’s sounds fairly innocuous.

      But as for “PMDD”-
      A doctor told a friend of mine that her daughter (who was all of eight years old) had Pre-PMS, and now it’s morphed into PMDD. Fluctuating hormones is a natural process, NOT a “disorder”, but anything that interferes with “optimal performance” is seen as a “disorder” –

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  11. I think mass drugging with Prozac egg took off in the 80’s as neoliberalism took hold and ADHD, nuerodiversity etc took off in the wake of the 2008 crash. This analysis goes along with the idea that psychiatry’s main function is to distract from the causes of distress.

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  12. I agree with Daiaphanous weeping.

    Schizophrenia is a real illness, or more accurately, group of illnesses/neurodevelopmental conditions with different biological causes. There is a lot of research which backs this up, and more is becoming known about autoimmune psychosis.

    Why should I have to downplay my symptoms, or invalidate the cause of my suffering? Getting someone with schizophrenia to dismiss their illness as a neurosis is akin to getting someone with cancer to dismiss their illness as a headache. And getting people to deny the existence of ongoing or reoccurring psychosis, naively holding on to the idea that each time is just a “once-off” isn’t helpful either.

    Having someone visit you in your house can be helpful during the less severe periods of illness, but in worse episodes of psychosis, hospital is a necessity in order to prevent accidental death or suicide. I know hospitals can be abusive places, but without their help I almost certainly would be dead. The goal should be to prevent abuse and mistreatment in hospitals, not to abolish them altogether. Neoliberalism promotes avoiding hospital care in favour of drug treatments, as hospital care is a cost to the government, while drug treatment results in profits to the pharmaceutical industry. This leaves people with schizophrenia who wish to avoid harmful antipsychotics, with no help at all. And if you complain or seek support, you will be accused of having a personality disorder or of staying in the “sick role”. And if you dare call your illness by its name, you are “self-stigmatising”, and making a big deal over nothing, since hallucinations are now considered normal and your problem is just that you have poor coping skills.

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