Behaviorists Must Confront Psychiatry’s Pseudoscience

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Since the late 1800s, beginning with Pasteur and Koch, we have known that health care depends upon the scientific method, long used by scientists interested in the natural world. Thanks to science, our understanding of physiological and public health has grown exponentially since then. From the Spanish flu in 1918 to the Covid-19 pandemic in 2020, life expectancy had doubled. Infant mortality rates have plummeted and diseases that we had little hope of conquering at the turn of the 20th century, like malaria and tuberculosis, are now eminently treatable and curable.

Over the course of this time, medical scientists also attempted to find a physiological basis for mental disorder, but their efforts have failed. Except for only a few mental disorders (for example, Down syndrome and dementia) there have been no discoveries of a physiological basis for the great majority of mental disorders, including those most commonly diagnosed.

Nevertheless, in the absence of scientific evidence, psychiatry has medicalized mental disorder and their rhetoric has succeeded—with the public and with doctors.

Science applied to health care has rules. Scientists who abide by these rules in how they collect and analyze data are applying the scientific method. Those who violate these rules are not reporting what they are studying accurately; they are not practicing the scientific method.

Psychiatry’s malfeasance can be contrasted with the sound science that underlies behavioral psychology. From its inception, behavioral researchers have been strict empiricists and it has paid off. Behavioral research led to the creation of behavior therapy, again by careful application of the rules of science.

It is vital for this contrast to be better understood by the public and by doctors. Psychiatry must be held accountable to the rules of science. As behaviorists we must speak out about what has gone terribly wrong with mental health care (it happened before with eugenics and lobotomy) because of psychiatry’s wrongdoing with respect to the scientific method. To date, we have not done a good job of holding psychiatry accountable. Bankrolled by the deep pockets of the pharmaceutical industry, psychiatry is in complete control of the narrative.

We can date exactly when psychiatry’s medicalized pseudoscience began: 1980. That was when the American Psychiatric Association, with great fanfare, published DSM-III. The president of the association, along with other leading psychiatrists at the time, stated that DSM-III proved that psychiatry was now equal to other branches of medicine in its medical and scientific basis. Although they did not release the data for this claim, their rhetoric was persuasive, and DSM-III was soon followed by prescription of drugs becoming the prime treatment for mental disorder. Ten years later, after the system was well-entrenched, the data was finally accessed through the Freedom of Information Act. There was no new scientific data or medical data in DSM-III. DSM-III, the flagship for the medicalizing of psychiatry, was found to be without scientific or medical merit.

Psychiatry’s malfeasance has not stopped. The most commonly diagnosed mental disorders remain devoid of evidence of psychiatry’s claims of a physiological basis. Yet these claims are accepted by doctors and the public. Few know the truth, despite the facts being readily available. Too often, the media is an accomplice in disseminating psychiatry’s broken science as if it has merit. Obviously, fact checking in this arena is much more complicated, but this is a distinct problem.

The most recent example is a New York Times story (“A Balm for Psyches Scarred by War” by Rachel Newer, May 20, 2022), which cites “growing evidence that MDMA—the illegal drug known as ecstasy or molly—can significantly lessen or even eliminate symptoms of PTSD when the treatment is paired with talk therapy.”

This optimistic story in the Times is about a new drug treatment that was reported in Nature Medicine. The study is the first of two Phase 3 clinical trials of 90 people who had been diagnosed with PTSD for 14 years. In this clinical trial, each patient received three therapy sessions, spaced one month apart, as well as either MDMA (ecstasy) or placebo. Two months later, 67 percent of those given MDMA were reported to be no longer suffering from PTSD versus 32 percent who received placebo.

Let’s look at the design of this study. The Veterans Administration, the Department of Defense, and the American Psychological Association have approved detailed treatment guidelines for PTSD. These guidelines have strong research support, and they favor behavioral treatments for PTSD over drug treatments. The treatments include Prolonged Exposure (typically 10-15 sessions) which specifies two types of exposure; Cognitive Processing Therapy (typically 12 weekly sessions) which provided cognitive retraining; and Cognitive Behavioral Therapy for PTSD, which typically lasts for more sessions and focuses on specific cognitive interventions that were found to be successful in studies published between March 2009 and March 2016.

The study reported in Nature Medicine of three sessions of therapy spaced one month apart bears no resemblance to these published treatment guidelines for PTSD. The measure of effectiveness (two months post treatment) is exactly the kind of measure that has repeatedly given false readings of drug effectiveness because it is such a short-term assessment. This measure has been discredited because it is a well-known drug company ploy to report effectiveness before the adverse effects of a drug have had time to occur.

In addition, clinical trials of this sort suffer from biased samples. Because volunteers for such drug studies are told they will be treated with new drugs, anyone wary of drugs is not likely to volunteer. Thus, the patients in these studies are likely to be more favorable to drug treatment than the general population. This is a structural problem that is anathema to good science since scientific studies are designed to prevent biased samples. In addition, volunteers must be told they will get either the drug or a placebo and are informed about the side effects of the drug. The presence or absence of side effects alerts many of them as to whether they are on the drug or the placebo, likely influencing how they assess their treatment.

As for the reported effectiveness for the drug treatment, three studies of the effectiveness of behavior therapy for PTSD report higher rates than those reported for this clinical trial. And these studies were based on better data (Powers et al, 2010; Cusack et al, 2016; and Jonas et al, 2013).

Finally, we also know that MDMA can lead to psychological, perhaps even physical dependency on a drug for which there is no known reliable treatment. This potential problem should not be ignored. For example, many patients, when going off antidepressant drugs, find the withdrawal effects so painful and prolonged that there is now a psychiatric specialty offering them help rather than their getting relief by returning to taking the drug. And has our experience with the opioids taught us nothing?  In summary, this study’s design is not only defective, it’s alarming. Yet the Times advanced the study encouragingly, as if it has valuable meaning.

Thomas Insel, director of the NIMH from 2002 to 2015, is the latest psychiatrist in a powerful position to promote the medicalizing of mental health care despite the absence of a scientific basis for doing so. His recent book, entitled, Healing: Our Path from Mental Illness to Mental Health, is the worst named book I have ever read. He acknowledges that after spending 20 billion dollars on neurological research, mental health care has not improved at all. He apologizes, acknowledging that patients are no better off than they had been. But he never backs down from justifying his expenditure.

In fact, his apology falls short in another way, as well. According to a number of measures, the record is clear: more and more patients are now on drugs and worse off than they had been before his appointment, with increasing evidence of drug treatments leading to physical damage, that sometimes is irreversible.

Robert Whitaker, author of Anatomy of an Epidemic, cites two reviewers of Dr. Insel’s book, Dr. Andrew Scull and Dr. Bruce Levine. They agree that the book is little more than another piece of propaganda for the medicalization of psychiatry, providing no scientific data for justification (appealing instead to anecdotal reports).

Perhaps most importantly, Dr. Insel writes, “It’s a pretty safe bet in most of medicine that if you treat more people, death and disability drop. But when it comes to mental illness, there are more people getting more treatment than ever, yet death and disability continue to rise. How can more treatment be associated with worse outcomes?” Indeed. Could it be, as Shakespeare wrote, that there is something rotten in Denmark?

We need to educate the public and doctors about the realities of medicalized psychiatry. For instance, consider the three basic pillars of the science of health care—diagnosis, explanation, and treatment—as they apply to research on depression, which is now (without justification) psychiatry’s #1 diagnosis. The data show that there is no good science behind psychiatry’s medicalizing of mental health care for depression.

Beginning with DSM-III, none of the DSM manuals has been found to meet basic scientific standards of reliability and validity that are required of a diagnostic manual. The chemical imbalance theory of depression not only has failed scientific testing, results are contradictory to the theory. As for the prescription of antidepressant drugs, they have been found to be no more effective than placebo, but unlike placebos, they are harmful to many.

In contrast, there is good science behind learning theory and behavior therapy, and outcomes research reveals that behavior therapy is more effective than antidepressant drugs in the treatment of depression. And this is not by measures taken two months after treatment ends, as is the case with the PTSD study, but measured by relapse prevention, a far more valid measure.

Although research funding for behavior therapy has been miniscule in comparison with drugs, treatment outcome research shows behavior therapy clearly is the better choice for PTSD, depression, and anxiety. Nevertheless, we know that behavior therapy is not a perfect treatment and needs to get better. With more research funding, that will happen, but better funding will depend upon pressure building for a more rational allocation of NIMH research dollars.

Despite the well-documented greater effectiveness of behavior therapy over drugs, the choice of treatment for mental disorder heavily favors drug treatments over therapy. This is a tragic failure of the mental health system. Stories such as the recent Times article on PTSD mislead people into believing in a biological basis for mental disorder and choosing to be treated by psychiatric drugs—when the scientific evidence is for a psychological basis and for psychological treatment.

The travesty that currently exists in mental health care must be brought to an end. Behaviorists need to become better at communicating the realities of this story, as dictated by science, to doctors, the public, and the media.

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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.

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89 COMMENTS

  1. How, exactly are we supposed to find cures for entities like “depression” and/or “schizophrenia” when those aren’t entities unto themselves, but behavioral descriptions? I should be surprised that the DSM’s are intellectualized gibberish?

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    • Right! It would be very much like curing “pain” or curing “baldness” or “high blood pressure.” Except that at least baldness and high blood pressure can be objectively measured, but still, something that can be caused by dozens or more different causes and is in some cases normal can’t be “cured” without some kind of rational analysis as to cause!

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      • Affectionatly said….I have noticed that some of us commenters have made multiple replies and then replies to their own replies and this makes their opinion amount to a long long long train with many carriages and only a few different peoples opinions can be accessed away at the very end, where no reader will ever bother looking. I am not saying this is intentional but it is becoming like a diner with only one variety of bagel on the menu in it.
        There ought to be a limit to how often one can spring up like a jack in a box in every comment reply box. if it looks like it is not a reply but just a long singular stream of consciousness lengthening the comments section with infinite replies I would suggest that the echoey not giving other perspectives a floor spot could be reviewed from time to time. All voices need to heard as….

        ALL ARE EQUAL.

        This website is for discussing alternative”s” to psychiatry. It means plural.

        In one article comment section that gardened over sixty comments a large swaithe of cpmments are in a block that are all by one enthustastic commenter. I think they made twenty seven comments in a section of sixty odd. It reads like a long scroll of only one perspeftive. I do not come to MIA for only one view. I like to have variety in my menu of philosophical debate. I am sure it is just caused by delighted impassioned arguing of fascinating topics. I myself must leave commenting. I am too certain that the Hoover Dam is going to collapse. My schizophrenia angels tell me by telepathy that when the Hoover Dam does fall it will be a SIGN that some of the loving things I say happen to be true also.

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  2. Behavioural therapy =/= Therapy (and therapy =/= help)

    The problem I have with behavioural therapy is how dehumanizing it can be.

    There is not much difference between biopsych which try to adress aberrant neurology and behavioural ministers who try to adress aberrant behavioural patterns.
    Both disintegrate the person and whisk it away, attending to segmented and autonomous mechanisms which have little to do with human beings.

    Behavioural therapy can be powerful in some situations, and at least its not neurotoxic, but it also can be a church like any other, just like psychiatry.

    Psychology will always fail putting shools and ultimately churches above the simplicity and the complexity of human beings.

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    • I agree that the hype is unfortunate but behavior therapists are driven to it because medicalized psychiatry which has no scientific basis, is so well accepted by doctors and the public. There is sound science behind behavior therapy. Done correctly it’s not mechanical, but depends for its information gathering, on a close, supportive relationship with the patient. A significant problem is that the NIMH serves psychiatry,s interests, investing tens of billions of dollars in neurological research and a minuscule amount on behavioral research. Despite this, behavior therapy is far more successful than antidepressants. But the absence of more research has allowed for the characteristics of “behavior therapy” to be too loose. I explain this in my book, “Grifting Depression: Psychiatry’s Failure as a Medical Science.”

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  3. Thank you for speaking the truth regarding the malfeasance and scientific fraud of psychiatry, Allen. I’m glad to see at least a few American psychologists acknowledging the need of the psychologists to distance themselves from the debunked DSM based psychiatry, rather than continuing to railroad their clients to iatrogenic illness creating psychiatrists.

    Please consider sharing my psycho-pharmaceutical findings with your fellow psychologists. The antidepressants and antipsychotics are both anticholinergic drugs, and the anticholinergic drugs can create psychosis and hallucinations – the positive symptoms of schizophrenia – via anticholinergic toxidrome. Plus, the antipsychotics can also create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.

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    • Thank you Joshua for this comment! You must have read my mind.

      I’m no fan of psych drugs (to say the least), as these have proven to be not only “therapeutically ineffective”, but an indisputable menace to people’s physical health. But I don’t consider “psychotherapy” to be any less appalling and dangerous. Indeed, psychotherapy just promotes another troubling and far more crippling form of psychological dependence, as it fosters belief and faith in “the therapist/therapy” MORE THAN ONESELF –

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      • Psych drugs may be “therapeutically ineffective”, but they are also a scam because there is no need for any kind of therapy. And this forum is loaded with people writing articles, maybe not endorsing the drugs, but endorsing ideas like healing and therapeutic effect.

        Joshua

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        • I regard psych drugs as a scam in how they’re marketed and prescribed, i.e. advertised as magic bullets and prescribed indiscriminately.

          And I think words like healing and therapeutic effect are similarly misused as they mischaracterize people’s problems.

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        • Joshua says, “…this forum is loaded with people writing articles, maybe not endorsing the drugs, but endorsing ideas like healing and therapeutic effect”.

          You’re not kidding. But I like to know what people are saying and maybe learn something. And if I don’t, I just ignore it. It can’t ruin my day unless I let it. And anyways, I don’t like beating a dead horse –

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          • Is it a sin not to suffer fools gladly?
            Yes, according to St. Paul, “For ye suffer fools gladly, seeing ye yourselves are wise” –
            Is it a “disorder” not to suffer fools gladly?
            Yes, according to the DSM. It’s called Oppositional Defiant Disorder –

            Either way you’re damned.

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    • Yes, I agree that psychotherapy is suspect and many who post on this site report damages from psychotherapy, too in addition to the psychiatric drugs. Some say the damage is worse and more permanent. Psychotherapy, the way, it seems to be practiced currently does bear many resemblances to mind-altering drugs, which includes most psychiatric drugs. In my opinion, Recovery is NOT suspect and is a viable alternative to psychiatry, etc. In my opinion, many who suffered the damages of psychiatry are now in some sort of recovery from their ill-effects. Recovery, in and of itself, is a very individual thing. Psychotherapy, although most of the time, is done on a “one-on-one basis” has become a group, almost societal thing in many respects. I stand by the concept of recovery as it relates to all kinds of issues life presents. And I stand by the individual decisions each person makes in regards to the successful realization of their recovery. Thank you.

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    • Joshua says, “….when people denounce Psychiatry they are usually promoting Psychotherapy and Recovery. We need to abandon all of these.”

      Yes – one is as bad as the other. And talking can be even worse.

      A YouTube video called “To Heal Complex PTSD, Try NOT TALKING About It” offers a different approach. It’s from the ‘The Crappy Childhood Fairy’ video series.

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  5. I did not find pharmaceuticals OR psychotherapy helpful. The most damaging thing to me were “therapists” ideas that my grief and anxieties were “maladaptive”. It’s why I see “therapy” as even MORE harmful than “drugs”. Being forced to grapple with society’s unrealistic expectations in ways that didn’t ring true to me were my undoing, and what made me lose confidence in myself more than anything –

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    • And what is one of society’s most harmful “unrealistic expectations”?
      That “psychotherapy” is the BEST and ONLY way to successfully “treat” psychic distress. Just hearing this bullshit from psychologists (et al) and their numerous scores of wide-eyed sycophants is enough to make many anyone want to give up –

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      • I didn’t need a therapist. I needed parents who had a better understanding of my struggles.

        And as for therapists –
        I thought of them then as I think of them now, which is, “sleeping with the enemy”, and my instincts and experience have proven correct –

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      • Everyone needs people allied with their views to a certain extent. It called validation. But why should anyone have to pay for that? And then be pathologized for it! Do you call this “therapy”? I certainly don’t.

        I find the professionalization/monetization of private relationships insulting and therefore counterproductive, (i.e. hierarchical structure, power imbalance, money exchange, blah, blah, blah). But this is “therapy”. Good grief.

        I, for one, am not comfortable confiding in someone I can’t get to know personally, and why should I? I’ve never met a therapist who could adequately answer that. And I find it odd the only people having problems with this are therapists. They seem to think people’s boundaries apply to everyone but them –

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    • Yes Birdsong I agree! Therapy and Recovery are always based on the idea that something about you is maladaptive.

      It is of course like this with evangelical religion too.

      We set ourselves up for this when we walk into the therapists office. Now one should ever do this.

      Joshua

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      • Joshua says, “Therapy and Recovery are always based on the idea that something about you is maladaptive” –

        Exactly! Both psy-disciplines (including psychiatry) and religion play on people’s insecurities and need to be accepted –

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        • Joshua says, “Therapy” and “Recovery” are always based on the idea that something about you is maladaptive”, and “…it is like this with evangelical religion, too” –

          Religion, psychiatry, and psychotherapy all left me in a chronic state of guilt, constant striving, and cognitive dissonance. Very unpleasant.

          But since then, I’ve learned not to fetishize my insecurities and need for acceptance. And guess what happened? Life started feeling pretty darn good!

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      • But deprogramming can take a while, and I don’t see many mental health professionals lining up to do it, now or in the future. Most of them have egos that are too caught up in their careers. But I don’t let it bother me, cause once I learned to avoid life’s blowhards, things got good –

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        • And there’s a simple reason why mental health professionals can and often do get away with so much. All they need to do is call someone disordered, which leaves clients little to no recourse. But the solution is simple: Don’t go knocking on a therapist’s door. There’s plenty of other things to do –

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          • As a psych patient, arguing your point of view with a psych professional can be to no avail and even get you into trouble, making life very difficult for you. And why is this? They say it’s for your safety, but too often it’s because a lot of psych professionals are irrational people, and they all want to avoid lawsuits. So you end up having to toe the line and bite your tongue, which is great therapy, right?

            Report comment

          • So why is it a good idea to avoid psych professionals?

            Because the odds are stacked against you if you disagree with their diagnoses and “treatments”, which could mean losing your credibility and even your freedom –

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          • And what is an irrational person?

            Some say it’s “those unable to listen to reason, logic, or common sense”. This describes a lot of therapists.

            But here’s the kicker: “They are laser focused to fulfill a need”, i.e. their obsessive need to be seen as right. This describes most psychiatrists –

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        • But deprogramming can take a while, and I don’t see many mental health professionals lining up to do it, now or in the future, as most have egos that are too caught up in their careers. But I don’t let that bother me, cause once I learned to avoid the blowhards, life got good –

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  7. I confess that I didn’t read the article, but the title is definitely compelling. Considering psychiatry as a “psuedoscience” is not new, but we must remember psychiatry as it is presently reflects who we are as a society and culture. And right now, we are at the end of the time of the Illusion. Psychiatry is just the epitome of this illusion that is sweeping society and the world before we make the next big change. Thank you.

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  11. I have never had a bad psychotherapist. I have had a number of ace brilliant psychotherapists at times in my life. I will not castigate what psychotherapy has to offer the lonely and abandoned and distressed.

    I will however agree that an ethos of armchair psychotherapy by non psychotherapists has spread throughout society and its jargon is being used by the virus of bullying to mete out pep talks to anyone who feels stressed. Bullies promote the MYTH OF THE FIXED PERSON much much much more than qualified psychotherapists ever did. So now our movies and soap operas and sitcoms are rife with the push to promote religious epiphanies and eureka moments and trauma confessions. None of those are wrong but bullying insists these are the ONLY WAY to be A FIXED PERSON. And if you are not fixed you are flawed and require educating about you. The worry is that this ethos has now swept into so many campaigns that are intending to stand for freedom of the individual, to like or refuse a choice, that it is pathologizing the free choice to stay apparently fucked up.

    If you are not free to stay broken you will never be mended.

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    • Diaphanous Weeping, I have read much of what you write and this is the first time, I have seen you use the “f… word” I agree with you. I think at one time I did not agree with you. I still personally don’t like or feel comfortable with the way psychiatry is today; with both the the theroies and the drugs employed. And, yes I have been hurt and damaged by them. However, one of the issues faced is that the more we try to speak ill of psychiatry; the stronger it (psychiatry) becomes. It is as if psychiatry, which many say is evil (I have, too said that.) is, as they say, living “rent free in our heads.” If we get rid of psychiatry, which for some people is the answer, something must be out there to fill that vacuum. There are a few things out there that might fill that vacuum, but those who abhor might not like those alternatives. As I am in the States, I now know to stay as far away from psychiatry as I can. However, I am learning alternative ways to adaptation, healing and recovery. American psychiatry does try to find the easiest way out of any problems concering their patients and it usually does involve drugs supported by psychotherapy, which in America, is really just a non-stop advertisement for the drugs. But the main thing is that everything should be more individual. And, in America, that seems to be getting more of a challenge everyday. And, thus, even if I think psychiatry is wrong and bad for someone, it is still not my place to interfere and tell them not to get involved. They probably wouldn’t believe me, anyway. It really is important for each one of us to allow other people to make their own discoveries about life. If we interfere with another person’s life, as some suggest, it reflects more on us than on the other person. I think Universal Laws suggest this, too. Thank you.

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      • https://youtu.be/G2q_VXShg4Y

        I used to listen to this record of my mother’s as a girl. More for its calming melody than lyrics, although sea shanties are in vogue. I metaphorically send it over the ocean to you.

        Rebel, I feel touched by your comment. So gracious of you to say all you have. I had a snarling morning where I barked at articles like they were deliveries to my kenel. I must pack in leaving articles in clumps and tufts and all shook up. Everytime I type a remark these days my angels say to me….

        “You are barking up the wrong tree”

        To which a soggy heap of article falls from my slack jaws onto an angel’s sandal.

        But I don’t quite know yet what is the correct tree to bark at. I am getting there. Though there are millions.

        Alternatives to psychistry or anything can happen in a month as the pandemic proved. One lockdown and billions of people had to innovate innovate innovate. The very sky turned blue. Children in polluted cities needed the blueness of the horizon explained to them. Many sorrows came of how the pandmic was managed. I am not talking about that. I am only saying that humans are extraordinary. They can galvanize in a heartbeat and begin things. But they get bogged down in arguing with those lagging behind, in petty “you did, you didn’t, you did, you didn’t” tirades. Why wait around to win an unwinnable squabble? Start something new. Start it now. That is my motto. It is no good following the dream if we all stay arguing in the nightmare.

        Ah but it is our dreams that hurt us most. We dare not hope they will ever come true. The nightmare robs us of hope. And so we stay in the nightmare shaking a fist at it and asking a nightmare to give us hope back. It is the job of a nightmare to refuse. We must accept hopelessness at that junction enough to turn away from the nightmare and discover hope in newness or ancientness.

        Alternatives threaten. That is what I love about them.

        I appreciate your savouring of every perspective and the way you are honest even when being honest sometimes delays your preferences. I feel we echo that valuing of integrity. Having integrity seldom serves the wishes of those who have integrity and so they find they have to become unafraid of loss, in order to gain a sweeter success, that of knowing they have prioritized harmony for all.
        But it is not easy.

        I stumbled on Byron Katie’s book years ago. The one about her famous four questions. They are…

        1. IS IT TRUE.
        2. CAN YOU ABSOLUTELY KNOW IT IS TRUE.
        3. WHAT HAPPENS WHEN YOU BELIEVE THAT THOUGHT.
        4. WHO WOULD YOU BE WITHOUT THAT THOUGHT.

        I wrote them in bold to interest anyone. It wasnt shouty. Im not woofing tonight. I am cheerfully sharing this because I have benefitted from knowing of these questions. I like deriving humbleness by using them, in pausing just before getting full of certainty.

        The questions seem timely in our fraught world these days where the delineation between “insecurity” and “certainty” is becoming painful in all of human kind. As individuals are beckonned to become one camp’s puppets on strings or another camp’s, all who then become challenged by a thousand variations on what it means to be good or true or right or proper. It feels exhilarating to be honest in all of this global heckling. Not honest as is in my friends say this about that, or my friends say that about this, but honest from the thumping loud hectic ventricles of the passionate heart.
        The animal heart.
        The free wild heart.

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    • Diaphanous Weeping,

      I’m so glad you’ve had good experiences with psychotherapists. I think that’s as much a tribute to you as it is to them.

      And thank you for saying, “….bullying insists these are the ONLY WAY to be a FIXED PERSON. And if you are not fixed you are flawed and require educating about you”.

      You’re absolutely right –

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      • Darn it….I don’t want to be right. My renegade misfit slippers must be slipping. I am freed by being everyone’s idea of wrong.
        How can I rescue wrong?
        I shall practice a new comment…

        “The DSM makes a good pillow for a back spasm. The APA carpark has the shiniest cars. Pock marks from injectable antipsychotics can be made a fashion feature of”.

        Thank you, Birdsong, jesting aside I value your very nice reply. For I have had a brutal day today. The weeping has been torrents.

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        • Dear Diaphanous Weeping,

          You’re most welcome, DW. Reading your comments is always a pleasure, as I find your writings beautifully written and remarkably insightful. You must be a lovely person to know.

          Do take care,
          Birdsong ~

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  12. Dr. Leventhal,

    Thank you for your article, service to the profession, integrity, and passionate advocacy for this topic.

    I was in a position once to try and fight the good fight. I had a natural soapbox as editor of the Behavior Therapist and commissioned a scholarly work I remain fiercely proud of to this day: https://www.google.com/url?sa=t&source=web&rct=j&url=https://services.abct.org/i4a/doclibrary/getfile.cfm%3Fdoc_id%3D51&ved=2ahUKEwjj0eGmh6r4AhUmxDgGHSSLBekQFnoECAkQAQ&usg=AOvVaw16x3zkE2I11eLgqjk7AESd. I had high hopes that science, critical thinking, and humanism would prevail, encouraging our colleagues to do something to right this obvious wrong.

    The next year, ABCT passed a new by-law expanding the organization’s mission to promoting the cognitive, behavioral, and “biological” aspects of human behaviour. They added the “biological” part so as not to discourage the groundswell of biomedical researchers from the organization. The higher-ups who drove this through had pricey grants for doing biomedical research and were committed to steering modern-day behaviorism in a biomedical direction.

    Behaviorism, as you and I know it, has changed. It is now, at the highest level, “biogenetic behaviorism.” And the leaders of this new field are not receptive to your or my arguments. They don’t care. They have abandoned principles for incentives. All the incentives surrounding their work and jobs align them to adhere to the DSM-based biomedical model. Their livelihoods, reputations, publications, grants, etc. are reliant on following incentives. And the incentive business is thriving.

    Just ask ABCT president Michelle Craske, the driving force behind adding “biological” to ABCT’s mission, who is one of a few experts in charge of UCLA’s grand challenge of ending depression in the world via biogenetic research. I’m not making that up. They think they can rid the world of “depression” via biomedical research. And this from what counts today as a superstar behaviorist.

    My experience is that the only people in our profession who ever publicly say or do anything about this are at retirement age. Like yourself. I tried fighting this fight in the middle of my career. I learned a powerful lesson from it: almost nobody gives a shit, even the ones who should. Sure, many agree in secret, backchannel, say keep fighting the good fight. But nobody cares enough to do anything. All incentives are aligned against this. Which flies in the face of the ultimate incentive for us to have entered this profession in the first place. To this day, I am still reeling from the implications of this reality for how I see my profession. In any case, my best to you. -Brett

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    • Powerful comment, Brett.

      I’m an eclectic, humanistic therapist who tried to enter the field in the mid ’70s, and ran away screaming after getting a 43 in my undergrad midterm for the ‘Behaviorist’ semester of Intro Psych. (I did pass the course with a 61, mostly to flip the bird at Otello Desiderato, who I considered and entitled fuckwit of the lowest order.)

      When I returned to the field in my 50s, I started with a strong bias against both biological psychiatry and behaviorism. The first bias changed very little when I was in clinical training, but my feelings about behaviorism have mellowed considerably over the years. I still strongly favor psychodynamic, collaborative and postmodern modalities, but I no longer consider behavioral interventions parlor tricks or gimcracks for short-term or crisis work. Sometimes, these interventions can be the very scaffolding that allows other modes of treatment to work– or maybe it’s the other way around. If my clients are happy, if they keep stepping down to lower frequency of therapy, maintenance, and discharge, and if I keep getting calls and emails from them 5 or 10 years later telling me they’re thriving, honestly, who cares?

      Part of what changed my opinion was work in Anger Management and IPV groups, where I witnessed clients experiencing enduring gains from behavioral interventions I once would have laughed at– and which were the catalyst for my own journey in 12-step recovery, which combines behaviorist, psychodynamic, and spiritual interventions and principles.

      What I really connected with in your letter: The idea of working in backchannels. My colleagues and I take a very dim view of therapists and researchers who try to ‘make a name for themselves’ in the traditional sense, or who seek to become ‘superstars.’ It’s not 1972, our culture has devolved to the point where being a ‘superstar’ in just about anything seems to require a devotion to institutionalized servility and mediocrity. The folks in my cohort don’t seek grant money, are not involved in research, and set reasonable fees. Most of us reserve pro-bono slots for folks from marginalized communities.

      Please do not lose hope– and don’t underestimate the power of working quietly, in the background. At the institution where I work, ‘psych referrals’ are more rare than they were even five years ago, prescribing is way down. I have to believe this is, at least in part, because so many independent clinicians are contracted with the institution, and have been quietly and relentlessly chipping away at the crumbling edifice of biological psychiatry.

      It is really refreshing to hear the sentiments you expressed from someone who is well trained in a theoretical orientation I once found reductive and dehumanizing. I know that harder work lies ahead– little has changed for my clients who are hospitalized, or who get trapped in one of the many deadfalls and oubliettes of ‘mental health’ care at HMOs or in hospital.

      I hope that you, and Allan, do not lose hope. You are not alone. Your postmodern colleagues… well, we’re not just sitting around quoting Foucault and smoking Gaulouises. We’re just quietly and patiently trying to dismantle a different part of the system… whenever no one is watching us.

      –Catalyzt

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    • I see the only way through this to be to find non-biological remedies that are very effective and promote them loudly and persistently. Then, like with organic foods and other better alternatives, we might at least build a user base (or market) for therapies that are actually beneficial.

      Some people, factually, don’t really want to get better, but only want to demonstrate to others that they are “doing something about it.” They don’t care if the remedy doesn’t work; they are more comfortable being “sick.” We are up against this problem in all of the healing professions, as well as more broadly (such as in politics). It is something to keep in mind.

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  13. There’s probably little point in trying to educate the public and doctors about the realities of medicalized psychiatry. That’s because psychiatry has become a religion to people looking to alleviate their distress. You can no more convince people suffering from psychosis or depression that psychiatric drugs are unlikely to help than you are to convince a Christian to abandon their faith.

    The problem is compounded by the fact that some of these drugs do work for some people (not the majority), something Robert Whitaker has acknowledged.

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    • Marie says, “There’s probably little point in trying to educate the public and doctors about the realities of medicalized psychiatry”.

      I agree. There’s little to no point. But as the saying goes, “you can’t fix stupid”, especially when doctors are the ones writing the books and making the Kool-Aid –

      When I say stupid, I’m referring to (most) doctors, not as much as the public, as doctors are the ones who lead the public –

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  14. Allan – what do you make of the dodo bird finding with regards to outcome research?

    And Allen do you acknowledge that 4e or enactive approaches to cognitive science are (in the words of one of the leading exponents) ‘no longer the barbarians at the gates of cognitive science but now occupy the cafes and wine bars’. If so what forms of psychotherapy do they support – do you know?
    (Science at the cutting edge)

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    • Oh…let me dwell on it…well one had been in Bedlam lunatic asylum where he bought a couple of cars from his hospital bedside. They were in a catalogue on his hospital locker. He went on to be a chaplain in another asylum. Another therapist had renounced being a psychiatrist. She could not bear it anymore. She was gifted. Very witty. We laughed a lot. It was like paying a ticket to spend an evening with a comedian. A lot of sessions she took no money at all.

      But I feel your question comes from the same pain as occurs in my schizophrenia when I want to yell about how tormenting it is. All suffering ones need their sad sorrows to be believed.

      My mother is old and likes a song called “Hard Times”. I did not like it at all. She kept wistfully trilling it at me, by trailing her fingertips as if musical notes in midair, to intermittently remind me of it. I grew irritable hearing it. Until one afternoon I hated it.

      But I love my mother. Over months I seldom saw her. I found myself missing her and so I invited her to my birthday party for one. She sipped coffee and absent mindedly devoured most of my sponge cake. I brought her books and ornaments and offerings as if she was a weather deity.

      Sometimes feeling moved is not caused by something.

      It is a stand alone feeling of deep ancestral connection tinged with a sense of mortality. I can see she is getting frail.

      I found myself bringing her loved song to her, a recording.

      I brought “that person I love” her favourite song that I hate. Oddly this transformed the sound of the song to me into a wistful lullaby.

      This gesture, of bringing the different what they really adore, even when you hate it, is redemption.

      Like feeding different creatures in a wilderness what their exact nutritional choices are. Their choices.

      Joshua, I fetch you your loathing of psychiatry and play it as a loved song for you.

      And I love that you love through loving your song.

      For I have no wish to see you not feel wonderfully different.

      It may not be my song. But your liking it is its own song for both of us.

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      • Daiphanous, these therapists sound like colorful people. But as therapists they would be asking you to disclose your most personal affairs to them. What role then would they play in seeing to it that you are publicly vindicated and that your social status would be restored?

        This being a civilized society, the first place one usually looks for help in obtaining such public vindication is an attorney.

        If this is not to be, then it becomes a political project.

        When you are not seeking pubic vindication, that is when it becomes a recovery, healing, and self-improvement project.

        Classic book now:
        https://www.amazon.com/Anti-Social-Family-Michele-Barrett/dp/086091545X/ref=sr_1_1?crid=1TO4SKU38B7EJ&keywords=anti-social+family&qid=1655405651&sprefix=anti-social+family%2Caps%2C331&sr=8-1

        The authors explain that Psychiatry, Psychotherapy, and Recovery merely turn your perception of injustice into a medical problem and a self-improvement project.

        Joshua

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        • With all due respect, I checked that book out at Amazon. but it is not something I would buy. First, one thing I have learned in life is “radical thinking” although attractive solves nothing. Yes, there are many problems with psychiatry, etc. One is that they no longer care about self-improvement. Since Prozac, their main “purpose” seems to be maintenance on drugs augmented by therapy. Self-improvement is a good goal in life, but it is up to the individual, of course; as we are born with “free will.” One of my favorite sayings is that one about “change.” But the main thing to learn is what we need to change about ourselves and what we don’t need to change. Much of the time, what we really need to change is actually in improving our gifts and being true to ourself. The latter is not really an improvement, but an acknowledgement and acceptance which is the key to growth and fulfillment of our ideals and purpose on Earth. In my opinion, “Radical” seems attractive, but it can emphasize an angry relationship with the world. In self-growth terms this can set someone back. This is why I do not choose that path. I believe it is the path of love, forgiveness and healing that brings the most positive results. Thank you.

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  16. To me this analysis, though valid, is a bit superficial.

    As Dr. Levelthal notes: “As behaviorists we must speak out about what has gone terribly wrong with mental health care (it happened before with eugenics and lobotomy) because of psychiatry’s wrongdoing with respect to the scientific method.”

    So this does not date from 1980; it started much earlier. Eugenics and psychosurgery are also based on the false premise that mental characteristics are essentially structural. The “modern” work on this began with behavioral experiments (!) in the late 1800s. So behaviorism is stuck in this rut along with medical psychiatry, it is just that behaviorists were more willing to use scientific processes which led them in the direction of more workability. Their most common explanation for why behavioral interventions work is that they cause “neural pathways” to “rewire” which is almost as ridiculous as the chemical imbalance theory.

    Psychiatry (of course) but also psychology has been neglecting other work done in this field in some sort of mistaken sense of territoriality (at best) or fixed ideas about how life works (itself a rather unscientific approach to knowledge). There are even pockets within psychiatry and psychology that are exploring these areas, but tediously (probably without proper funding) and extremely conservatively (so as not to ruffle too many feathers?). After all these years, you would think human nature might have made some progress, at least among our academics, but it appears it hasn’t.

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    • As usual, your commenting brings up interesting points and assertions. What caught my eyes this time was in regards to “neural pathways” “rewiring” due to “behavioral interventions.” I know that recently there has been an increasing interest in the possiblity of “brain plasticity.” I had been taught in school that if you lose a brain cell, say through excessive alcohol use, you have lost that cell for life. I don’t quite understand “brain plasticity” and I am not sure it really works. However, there is now also a notion that “our brains are wired to do specific things and not others.” I am beginning to believe that there might be some some truth to that. As far as “rewiring the brain” either through “behavioral interventions,” “psychiatric drugs” or “psychiatric therapy” I am beginning to believe that any “rewiring” is only temporary. Perhaps, if the “behavioral interventions” “psychiatric drugs and therapies” continue, then this illusion of rewiring can continue. If stopped, this alleged rewiring will end. But, here is also what might be the kicker. The brain will eventually say, “no more.” At that time, it will somehow stop of itself this “illusion” of being “rewired.” Now, all of this is basically tailored to the individual. And, I also believe there is a point where after the most significant point in withdrawal, it would seem there might have been some “rewiring” or the individual may have felt they have been “rewired” but in the end, even that is an illusion. And, that is probably the biggest issue with present day psychiatry in that people can change. People can learn to adapt and many they do without psychiatry. And many times, people do need explanations or “labels” to describe their life history, because there are significant patterns in each person’s life and some do lead to what has recently being termed “neurodivergent conditions.” Psychiatry usually does not want to see the patterns unless they can describe one of their alleged DSM illnesses. However, many times, they are basically “putting words in their patients’s mouths” so their records can fit one of those illnesses, when it may be another condition or issue or it may be nothing at all, except a pattern of one’s life that the person needs to acknowledge and basically put to good use for both him or her and society. Thank you.

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      • Thank you, and feel free to contemplate the whole notion that behaviors are “wired” in the brain. I, however, thoroughly reject it, though it might work as a kind of analogy, as the mind IS very mechanical and operates similar to some sort of electrical machine.

        You might be familiar with learning how to drive, or how to play an instrument, or some other skill like that. With time and practice, those trained behaviors can become so well learned that a person doesn’t have to “think” any more in order to do them. That’s the sort of “rewiring” that a “behavioral intervention” can accomplish. I don’t know why they can’t just call it “training.” That’s what my teacher calls it.

        I have been taught that the mind is an energetic construct that is invisible to most people, though a few people have the ability to “see” or “read” another’s mind, and most of us have the ability to recall past events, even to revivify them. So while the brain serves as a analogy for the mind, it is NOT the mind, nor is it the location of the mind.

        There are even a few people who exist (or have existed) that have little or no brain mass but lead somewhat normal lives.

        https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61127-1/fulltext

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        • What you say is again interesting. Unfortunately, when dealing with both the brain and the mind, we are still hopelessly stuck with analogies and metaphors. Neither really explains the brain and mind, but perhaps it is best that we not get too familiar with the brain and mind. Perhaps, like God, it is better left somewhat of a mystery. Those thing you mention, such as driving a car or playing an instrument have been forgotten by some and that is in abscence of even brain damage or disease. Thank you.

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          • Of course forgetting is possible and is part of exerting good control over the mind.

            But I disagree with you that it is better to leave these subjects unexplored. Thousands of people are using the model of the mind I have described successfully every day. It is a little beyond the analogy stage at this point.

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  17. l.e. cox I may have mis-represented myself. I think it may be a paradox, in that we do need to both explore the brain and the mind and yet also consider it a mystery. There are probably areas of both that we may never be able to explore. Sometimes, we do have to acknowledge our limitations, but on the other hand we need to reach as far as we can, especially, if we can improve the quality of life. There is no one size fits all or most. I, just, have always had this notion of don’t go where angels fear to tread; especially one’s guardian angels. But, that is just me and my bias. Although we share things as human beings, in the end much depends on the individual and even the individual cells within the individual. So, I think no matter what we choose to do, we must respect the individual and their right to say yes or no. Thank you.

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  18. Joshua, You commented that self-improvement is an adaptation of Protestantism. However, Protestantism is a very big religious category within Christianity with many different beliefs and interpretations of the Bible, theology, etc. Is it from the strain that gave us Lutheranism or the Calvinist strain that influenced much of Presbytarianism? Or is it from the Charismatics or what some have called Fundamantalists? With all due respect, saying something comes from Protestantism is like saying BBQ comes from the United States. There are many strains with many different variations. Lutheranism is closer to Catholicism. Charismatics farther away. Calvinists maybe a little morein the middle. And actually, that doesn’t even scratch the surface. Books and books and books have been written and they don’t even scratch the surface. In my personal opinion, the desire for self-improvement has probably been there since humans realized they were a separate creature from the other creatures on the Earth. However, with the growth of the industrial age and now as we are in the technological, we have the availabilty if more leisure time to conside the ideals of self-improvement. The concept of improving one’s self has a been complex history. People’s desire to improve themselves will, I believe, be always apart from any religion, other belief system, govenrment or education, etc. however yes, there will be influence from these sources. By the way as a daughter of an Army Chaplain who served honorably in Vietnam, I do not necessarily consider Prostestanism, the family or any of those bad. But each person has the right and the responsibility to find where they belong and most imprtantly who they are and why they are and what contributions to society they are to make. But, even that all boils down to the individual. The individual and the family are the building blocks to a happy, healthy and strong society. When there is even a smal breakdown, it does lay open for alternatives like psychiatry that can do more harm than good. However, like most things in life, the individual must discover that through trial and error. No one can make decisions for another person. And I realize there is slightly a circular argument here as psychiatry has a history of making decisions for other people that can be quite damaging to that person. But I know from my experience, a person will not realize that unless he or she discovers and confirms that for himself or herself. No one can or should live the life of another person. Thank you.

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    • As I saunter away….I hear a soft voice….and I look back….
      and say to you, dear Rebel, that I could not agree more with your fine comments here.

      In the future women’s ways will fall on deaf ears though. This is because all over the country an alliance of powers are gearing up to be Titans and nothing will impede their hunger for conflict. Women will be pushed aside as if children who know nothing. It may seem counter intuitive but we must let this occur. In much the same way Jesus let himself be ridiculed and arrested. Half the population of the planet have been absorbing nightmarish psychological poison and it won’t heal until they find it coming to the surface, like the breaking of a fever. Any try at being tender and offering to mop a frowning irrate brow here or there is not going to slow the decent into endless bickering. It is going to be like trying to sweep back the violent tide with nothing but a seagull’s feather.

      We must be patient. We must be standing back now as if stepping away from a brewing storm. We must retreat into our own caring ways and leave the masses to their menacing of menace.

      Some women are candles in this coming era of darkness but for a while these women ought to keep their light only for other women who know. There is a level of pitch blackness that just swallows any flickering glow of compassion. Far better to build a women’s hut and have those intimate walls turn golden with our female bond of truth telling.

      Rebel, no one is listening to us.

      It is coming to pass exactly as it has to. Allow it to pass through town. Allow people in this world to be as sheep. After the hostile darkness of night comes a beautiful dawn. It may take years. Batten down the hatches. Go within.

      In future, very soon, all women must seek refuge within the calm cloisters of our own balance and our own emotional dignity.

      Follow me through the leafy verdure, away from worldly stress and arguing, to find your own way back to your caring Garden of Eden.

      That is all I can say now.

      From my guttering candle.

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      • I appreciate a lot of what you say. Some of your observations about women sound sad. I hope they do not come to pass. However, I do think the answer to any crisis, personal, or in the world is to turn inward. I think earlier you mentioned your skeptism with the words, like activism and activist. I agree, because words that end in “isms” and “ists” are outward looking words, so they are usually doomed to fail. Only when we look inward and connect with that inner sense that each one of has, some more than others, will we solve any problems our world has. Someday, the activists and others will learn that. I hope and pray each evening that it is not too late. But as long as there living, breathing humans on Earth, I don’t think it is. Thank you.

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        • We may be forced to chant some dictator’s “ism” before long. The trick is to have enough of a well stocked interior soul so that it does not matter what our voices are coerced to externally champion and shout support of.

          I am so glad you have your own interior to be safe in.

          Love from Diaphanous Weeping.

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          • Though it may be inappropriate for me to interject into this conversation, my concept of “soul” is not so much “interior” as “superior.” Though a proper sense of self does require some “soul searching” producing a healthy level of self-awareness, there is no reason to see this as an “internal” thing particularly. Though one may not wish to show one’s real self in all situations, it does tend to shine through, using both the body’s energy and its own energy. I love it when a being feels free to show their true self to me (very common in children). It can be a truly awesome experience compared to interacting with someone who is putting on a show or so worried about what others will think that they suppress their own “light.”

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          • Last comment. Rebel, my quip regards Dawkins is not a smirk at your disdain of him. I am not his fan. My angels let me be me. I do not have to like anything they like. I am happy when you believe ONLY what you believe. I feel the comments section is a recipe for disaster because it is like a therapist trying to have a one to one with one commenter in a crowded hall where other commenters feel tetchy if the one to one is not identical to the one to one you had with them.

            In a family no two children are identical so why should the feedback or comments you want to make ever be? The lack of one to one privacy is a bit like when people in a community have to share everything with everyone. It starts with your choice of ribbon or headscarf and soon comes round to having to share your kids.

            As I go I want to say that I have never been abused by any of the twenty psychiatrists I saw. Nor was that the case with any psychotherapist I saw. Nor psychologist. For a number of years I was very persuasive towards psychiatrists because my illness was making me uninhibited. I have to be truthful and say that NO psychiatrist EVER took advantage of my flirtatious delusions. I am pleasant looking so it was not that I could not raise a pulse. But NONE of MY PSYCHIATRISTS EVER So much as glanced at my silly dresses. I believe millions of women have this experience of feeling SAFE with their PSYCHIATRIST. The drugs are not safe but neither is neat vodka downed hourly for years. No one heckles bar staff for pouring out that drug. I am able to say that men who were NOT psychiatrists DID NOT treat me with my PSYCHIATRISTS compassion or dignity.

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  20. Happy Bastille Day!

    https://youtu.be/TXlVh5g7VmE?t=793

    https://www.youtube.com/watch?v=ptTef5Jykck

    Just imagine if all the revolutionaries had been shunted into psychotherapy. They’d be confessing their anger and punching pillows and screaming at them, and learning that it is morally superior to vent histrionically than to engage in violence.

    No storming the Bastille. No freeing the prisoners or seizing the gun power, no killing of the guards and parading their heads on pikes, and no tearing down the fortress brick by brick.

    Joshua

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