Psychotherapy: Less Expensive and Better Than Pills, It’s What the Patients Want but Don’t Get

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Psychiatry must be the weirdest business on earth. If it had not been a monopoly, but an enterprise with true competitors, it would have gone bankrupt decades ago.

Psychiatry does not deliver what the customers want. And what it delivers kills so many customers that it might be the third leading cause of death. I found this out based on the most reliable placebo-controlled randomised trials and comparative cohort studies of psychiatric drugs I could identify. Even if psychiatric drugs are “only” the fourth or fifth leading cause of death, it is indisputable that the death toll is colossal.

Psychiatric drugs are so widely used that they incapacitate hundreds of millions of people around the globe. This iatrogenic psychological and physical disability is caused by the drugs. In all countries where this relationship has been examined, the increase in disability pensions for mental health issues follows rather closely the increase in psychiatric drug consumption.

These findings resonate closely with what the general public have concluded based on their own experiences. A survey of 2,031 Australians showed that people thought that drugs for depression and psychosis, electroshocks and admission to a psychiatric ward were more often harmful than beneficial. The social psychiatrists who had done the survey were dissatisfied with the answers and argued that people should be trained to arrive at the “right opinion.”

They should not. Their opinion agrees with the scientific evidence. It is the psychiatrists that should be trained to arrive at the right opinions, but they are trained to arrive at wrong opinions.

A Black woman sits with a therapistIn 2022, I published Critical Psychiatry Textbook, which will be serialised soon on Mad in America. This book describes what is wrong with the psychiatry textbooks used by students of medicine, psychology, and psychiatry. I read the five most-used textbooks in Denmark and uncovered a litany of misleading and erroneous statements about the causes of mental health disorders, if they are genetic, if they can be detected in a brain scan, if they are caused by a chemical imbalance, if psychiatric diagnoses are reliable, and what the benefits and harms are of psychiatric drugs and electroshocks. Much of what is claimed amounts to scientific dishonesty. I also describe fraud and serious manipulations with the data in often-cited research. I conclude that biological psychiatry has not led to anything of use, and that psychiatry as a medical specialty is so harmful that it should be disbanded.

What the customers want is psychotherapy but this is not what they get. A 1996 paper showed that 91% of 2,003 lay people in the UK thought that people with depression should be offered counselling and only 16% thought they should be offered depression pills—a six-fold difference—and 78% regarded the pills as addictive, a fact which is still being firmly denied by leading psychiatrists.

A 2002 survey of US child and adolescent psychiatrists showed that 10 times as many of their patients (91%) were treated with psychiatric drugs as those that received psychotherapy only (9%).

In Sweden, the National Board of Health recommends that all adults with mild to moderately severe depression are offered psychotherapy, but only 1% get it.

This documents that psychiatry is a perverse trade. It doesn’t help the patients as they want to be helped but helps itself while it kills millions of people and incapacitates many more so that they cannot live a normal life.

I cannot see any difference to the tobacco industry, apart from the fact that most psychiatrists genuinely want to help their patients. It is therefore clear that the drug industry and leading psychiatrists, which are very often corrupt, have led the whole profession astray.

Psychotherapy is better than pills

Studies with long-term follow-up show that psychotherapy has an enduring effect that outperforms pharmacotherapy (see references below). This effect is not only seen for soft outcomes that can be influenced by observer bias, but also for hard outcomes. My daughter and I did a meta-analysis that showed that psychotherapy halves the risk of a new suicide attempt in people at high risk of suicide, those acutely admitted after a suicide attempt. Depression pills double the suicide risk, both in children and adults.

It wasn’t until 2014 that the first trial of psychotherapy in people with schizophrenia who were not on drugs was published. All the patients had declined to be treated with drugs. The effect size was 0.46 compared to treatment as usual, about the same as that seen in trials comparing psychosis pills with placebo, which is a median of 0.44. However, the drug trials are seriously flawed for several reasons, one of which is that the patients were already in treatment with a psychosis pill before they were switched to placebo. Many patients in the placebo group are therefore harmed by withdrawal symptoms, some of which fulfil the criteria for a psychosis.

This means that the effect of psychotherapy is likely better than the effect of pills in acute psychosis. Experiences from the Open Dialogue approach in Lapland confirm this. Follow-up data after 19 years showed that, compared to the standard approach in Finland, 19% vs 94% had more than 30 hospital days, and disability allowances at some point occurred for 42% vs 79%. Psychosis drugs at onset were used by 20% vs 70%, and at some point by 55% vs 97%. These differences were highly significant (P < 0.00001) and so large that they cannot be dismissed with the excuse that it was not a randomised comparison.

Psychotherapy is also far better than pills for other psychiatric disorders, e.g. anxiety disorders and obsessive-compulsive disorder.

Psychotherapy is cheaper than pills

A common argument against psychotherapy is that “we cannot afford it.” This is wrong. A health technology assessment report showed that psychotherapy is more cost-effective than other forms of therapy.

For schizophrenia, a NICE guideline mentioned a systematic review of the economic evidence that had shown that cognitive behavioural therapy improved clinical outcomes at no additional cost, and also that economic modelling suggested it might result in cost savings because of fewer hospital admissions, which is exactly what was found for the Open Dialogue approach.

Also for depression, psychotherapy is cheaper than pills. In the Treatment of Adolescents with Depression Study (TADS), 327 adolescents aged 12 to 18 years were randomised to fluoxetine, cognitive behavioural therapy, or their combination. After 36 weeks, the direct costs—including time and travel—had been $1301 per patient for the fluoxetine group and $2538 for psychotherapy. But there were also costs outside the study related to service and travel, and when these were added, psychotherapy was cheapest, $5640 vs $6684. It was also cheaper than combination therapy, which is what the authors recommended. But one should of course not use a drug that does not work in adolescents and doubles their risk of suicide.

A large number of observational studies compiled by Robert Whitaker tell a similar story: The long-term outcome for patients is worse if they are treated with depression pills than if they are not. Thus, if we don’t do anything, it is better than pills, and it is also vastly cheaper than pills because few of these patients would receive psychotherapy. The common excuse for using drugs, which is that there is a waiting list for psychotherapy, is therefore invalid.

In my view, these pills should not be used for anyone but should be taken off the market, so that no one will be tempted to use them. Other psychiatric drugs should not be used long-term either. On Mad in America, there are similar compilations for other drugs, e.g. psychosis drugs and stimulants, that show that long-term use is harmful.

References

1. Bighelli I, Rodolico A, García-Mieres et al. Psychosocial and psychological interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis. Lancet Psychiatry 2021;8:969-80.

2. McPherson S, Hengartner MP. Long-term outcomes of trials in the National Institute for Health and Care Excellence depression guideline. BJPsych Open 2019;5:e81.

3. Spielmans GI, Berman MI, Usitalo AN. Psychotherapy versus second-generation antidepressants in the treatmentof depression: a meta-analysis. J Nerv Ment Dis 2011;199:142–9.

4. Cuijpers P, Hollon SD, van Straten A, et al. Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmaco-therapy? A meta-analysis. BMJ Open 2013;26;3(4).

5. Shedler J. The efficacy of psychodynamic psychotherapy. Am Psychol 2010;65:98-109.

6. Furukawa TA, Shinohara K, Sahker E, et al. Initial treatment choices to achieve sustained response in major depression: a systematic review and network meta-analysis. World Psychiatry 2021;20:387-96

7. Amick HR, Gartlehner G, Gaynes BN, et al. Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and metaanalysis. BMJ 2015;351:h6019.

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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.

66 COMMENTS

  1. The discussion of psychotherapy vs. drug infusion is clearly a dilemma solved on a1 by1 basis. The therapeutic benefit of analysis could very likely negate any need for drugs. However the skills required by the Dr. would be enormous. How many have the qualifications to meet this demand? Hence the psycho-med. prescription. The band aid approach is clearly the less expensive therapy. The psychologist can prescribe to patients but is no more qualified than a PA. or Rpn. Or on and on. A psychiatric trained specialist is what’s needed. One willing to embrace the challenges of the patient. Very likely not to happen.
    Also, the lumping together the variety of depressional disorders is wrong.
    The garden variety of the 70s and80s depression is miles from a manic depressive. Not to discount any depression, there’s some and then others.
    It became easier to classify and prescribe.
    AND A WHOLE LOT LESS EXPENSIVE.

  2. Psychotherapy can certainly help but more PTSD and Dissociation-like trauma may respond much better to body centered treatment like Chiropractor and Somatic Experiencing. Another layer of psychiatric lies that needs to be peeled away; that “its all in the mind”. Don’t forget the rest of your body !

    • In 22 years my BH management firm (Preferred Mental Health Management, Inc.) for private self-insured employer health plans, 65,000,000 callers to our staff psychologists complained of either depression or an anxiety disorders. Anecdotally just about 100 % of the callers were aware of the source or sources of their current life difficulties and unlike the BH industry at the time our psychologists never authorized psychiatric drugs to address these patient’s life difficulties. After our psychologists’ assessment we referred these callers to Ph.D. licensed psychologists or licensed clinical social workers for solution focused psychotherapy which averaged just under six sessions. After discussing their problems with a PMNM psychologist about 15% of the callers refused a referral saying they felt they could now handle the presenting problems. If a caller asked about their need for medication our policy was to start therapy and if medication were found to be needed the patient should call back and a referral to a psychiatrist for medication would be implemented. As far as I know not one patient called back for drug treatment. A satisfaction survey was sent to each caller referred for psychotherapy (there was a 28% return) and over 90% of those returning the surveys were very satisfied with their therapy. Psychotherapy for BH problems is very cost effective when provided by well trained psychotherapists.

      • This makes such obvious sense – so it is great to see you have some real numbers to support common sense. It seems to me that psychotherapy (or even a life coach) should be the first line of treatment… with referrals from that of problem cases to some other treatment. Prescriptions should be a last resort… since they also ‘do harm’ in many cases.

    • How does psychotherapy help? What is the “mechanism of action” or what occurs specifically within the patient who participates in psychotherapy that is healing? Insights? Uncovering hidden trauma? Exposing the subconscious to the light of the conscious minds of patient and therapist? Is it the new perspectives we achieve on past hurts? Is it learning to be honest about our motives, our secret ambitions or ways in which we hide from our own failings?

  3. I wish people commenting on psychotherapy would read and understand the work of William M Epstein and especially his three books the illusion of psychotherapy, psychotherapy as religion and psychotherapy and the social clinic, soothing fictions.

    In these and other books he takes apart the research literature including the so called foundational texts smith and glass etc, in addition to the psychometric measures (tick boxes) and assesses the industry in relation to the culture. What he demonstrates is that the industry and its research is as bad if not worse than the drugs industry and the research and has no real evidence supporting it and just like the drug industry it can harm.

    The problems and the solutions are mostly located in myriad cultural disorders, not personal ones.

  4. Hello Dr. Gotzsche,
    I am also interested in changing Mental Health Delivery. I trained in a County Psychiatric Hospital and worked as a therapist for 40 years. My ability to effect change was quadrupled when I trained in EMDR. But this system of therapy is rigid and extremely expensive. I learned that it can be done as self-help. REM brain has a potential for healing that is just being discovered. There are dozens of programs that are available. But they all are limited to just providing Bi-lateral stimulation and do not incorporate other therapies. Se-REM (Self effective – Rapid Eye Movement) uses hypnosis, EMDR, Mindfulness, Music Therapy, Gestalt Child Within Therapy, and Awe Therapy (connecting profoundly with Nature), to make it much more effective than other programs. I am looking to give the whole project away to some institution that will use it as a template to develop similar programs that will target
    specific traumas. Se-REM has shown extreme effectiveness in treating childhood abuse, sexual trauma, military trauma, crime trauma, medical trauma, domestic violence, and even phobias. Please Google search Se-REM. It has a 95% trustworthy rating. I will respond to an email from you with the link to a Free download. Please write to me at: [email protected]. Respectfully, David Busch, LCSW (retired trauma therapist).

    • How can a therapist know when the traumatic memories combine with healthy memories in order to relieve suffering? Memories consist of bio, chemical, electric bits of molecules? and literally join molecules untainted with negative information? Or, just how does it work? How do you identify bad memories and good memories and how do you blend them? Do bad memories ever taint the good memories and produce the opposite result?

      Fascinating stuff.

      • Hi Fiachra,
        Thank you for commenting on my post. It is discouraging that all the other commenters merely ignore what I have written. Se-REM.com is a not-for-profit program that intends to disrupt all of psychotherapy delivery. Many people have written to say it works better than their years of therapy. It has worked when nothing else has. It needs to be widely adopted and mainstreamed. Even though its main objective is not treatment of depression, the root cause of many depressions is untreated trauma.

  5. Peter Gotzsche writes;

    “A survey of 2,031 Australians showed that people thought that drugs for depression and psychosis, electroshocks and admission to a psychiatric ward were more often harmful than beneficial. The social psychiatrists who had done the survey were dissatisfied with the answers and argued that people should be trained to arrive at the “right opinion.””

    And to have them arrive at the “right opinion” they will subject them to drugs, electric shocks and forced admissions to psychiatric facilities and call it ‘treatment’. A lot like trying to report misconduct to police will result in you being referred to a ‘friendly’ for ‘treatment of your “hallucinations” that police will do anything about their corruption.

    P.G. writes;

    “What the customers want is psychotherapy but this is not what they get.”

    Their anosognosia at work perhaps? Who are the ‘experts’ here? We can’t give the people what they want, they lack a “sophisticated” understanding of the issues. (a comment made by the head of the AMA when a Doctor walked into a Police station and provided them with the murder weapon, the place she had disposed of the body and a full and unconditional confession. The Head of the AMA suggesting that the Doctor lacked a “sophisticated knowledge of the law”. The fact is she managed to have Euthanasia Laws passed as a direct result (forced the hands of politicians on the ‘joint enterprise’ issue. Whose ‘sophisticated’ now?), something they are now looking to have ‘amended’ to widen the parameters a little. Perhaps we can include the anosognosics? And those pesky elutheromaniacs? And with a little State sanctioned document “editing” anything is possible.)

    P.G. writes;

    “This documents that psychiatry is a perverse trade. It doesn’t help the patients as they want to be helped but helps itself while it kills millions of people and incapacitates many more so that they cannot live a normal life.”

    Your assumption that the aim is to “help patients” may be incorrect Doc. Stated and Unstated Aims, Intended and Unintended consequences. It’s very easy to conceal your ‘intended consequences’ as being ‘unintended’ whilst making the stated aim that your intent was to “first, do no harm”. “They will take their oaths as a cover” and “conceal truth with falsehoods”.

    P.G. writes;

    “I cannot see any difference to the tobacco industry, apart from the fact that most psychiatrists genuinely want to help their patients.”

    I’m surprised by this statement. Really Doc? I smoked cigarettes for many years, though not once did I have the State allow me to be ‘spiked’ with date rape drugs and have police point weapons at me for saying I was going to stop smoking. Snatched form my bed and given an ‘assessment’ because I fell below the 30 ciggies a day benchmark?

    Sure there was some slick marketing involved in getting us kids to smoke by age 12, but not once did I have anyone with a gun ensuring that I became addicted to the ‘product’ under their supervision, and whilst locked in a cage.

    I also think you have minimized the ‘links’ between psychiatry and psychotherapy. I can give you an good example of how a ‘tag team’ (psychologist identifies the wealth, the psychiatrist ‘treats’ with electricity and drugs until it runs out) works to extract the wallet from individuals, but I doubt you’ll even read my comment anyway. It can be seen in some of my previous comments in this place, or…… you could ask to see the documents .

    Good luck in exposing the myths for the ‘students’ Doc. But I think most of them are smart enough to ‘read between the lines’ and figure out what’s really going on. If not, they can always be trained as ‘spotters’ for those who are.

  6. A few thoughts and a summary
    The Serotonin Fixation: Much Ado About Nothing New Psychiatric Times
    1. Despite claims to the contrary,6 there has never been a full-blown theory of depression proposed by a monolithic entity called “psychiatry,” asserting that depression is directly caused by abnormal levels of 1 or more neurotransmitters.7,8 In fact, there are numerous quotations from psychiatrists and researchers dating back to the 1960s about why that is not likely. For example, as pioneering psychiatrist Joseph Schildkraut and neuroscientist Seymour Kety put it in 19679:

    “It should be emphasized…that the demonstration of…[a catecholamine] abnormality would not necessarily imply a genetic or constitutional, rather than an environmental or psychological, etiology of depression…it is equally conceivable that early experiences of the infant or child may cause enduring biochemical changes and that these may predispose some individuals to depressions in adulthood…[and] any comprehensive formulation of the physiology of affective state will have to include many other concomitant biochemical, physiological, and psychological factors.”
    Indeed, a detailed review by one of us (GD) found no references to a “chemical imbalance theory” of mental illness in any standard psychopharmacology textbook or peer-reviewed psychopharmacology literature over the past 30 years. The conflation of monoaminergic, catecholaminergic, or indoleaminergic hypotheses of depression with a so-called chemical imbalance theory of mood disorders is inaccurate.

    2. Psychiatrists have known for decades that the etiology of depression and other mood disorders cannot be explained solely in terms of 1 neurotransmitter—whether serotonin, norepinephrine, or some other biogenic amine. For more than 40 years, the operative paradigm in academic psychiatry has been the biopsychosocial model10—which, ironically, was articulated in rudimentary form by Schildkraut and Kety themselves, in the very passage quoted previously. Furthermore, in the period of 1990-2010, psychiatrists and neuroscientists proposed at least 17 other hypotheses regarding depression, with 8 additional ideas since then.11

    3. The complexity of serotonergic systems and signaling in the brain is not captured in the Moncrieff et al review. Detailed recent reviews suggest that the early serotonin studies did not capture the complexity of the 5-HT system and should be viewed as merely preliminary sampling of a very small part of the universe of serotonin-related hypotheses. Recent work in this area reveals that although serotonin systems are now much better characterized, additional work needs to be done.12 Moncrieff et al’s claim that psychiatric research on serotonin has yielded no useful information—and that this whole area of research should be brought to a close—does not accurately reflect the current scientific research program.

    On the contrary, more recent integrated theories incorporating 5-HT systems with other depression hypotheses are under active development. Several research groups are using multi-omics approaches, in which the data sets are multiple omes, such as the genome, the proteome, and the transcriptome. Approaches that examine serotonin and its metabolites have been used by some research groups to predict antidepressant response and have been internally replicated.13 A recent review of 50 studies of the metabolomics of major depression concluded that several metabolites are altered in major depression, including kynurenine—a tryptophan metabolite thought to be a key mediator of psychiatric illness that interfaces with the immune and mood systems

    Depression is a complex, heterogeneous disorder with biological, psychological, and sociocultural determinants and risk factors. Very few—if any—US psychopharmacologists and academic psychiatrists have ever endorsed a sweeping chemical imbalance theory of mood disorders. Historically, psychiatrists have never explained clinical depression solely in terms of reduced serotonin or any specific neurotransmitter. As with SSRIs, many drugs in clinical medicine work through unknown or multiple mechanisms, and this does not affect their safety, efficacy, or approval for medical use. There is ample evidence from placebo-controlled studies that serotonergic antidepressants are safe and effective in the treatment of acute major depressive episodes. If serotonergic agents are not helpful, antidepressants from other classes (eg, noradrenergic/dopaminergic agents) may be considered.

    Finally, we hope that patients and clinicians are not deterred from the use of antidepressants by the UK review, or the mere fact that SSRIs’ mechanism of action is complex and not completely understood.

    • “The findings suggest that the serotonin theory was endorsed by the professional and academic community,” the authors write. “The analysis suggests that, despite protestations to the contrary, the profession bears some responsibility for the propagation of a theory that is not empirically supported and the mass antidepressant prescribing it has inspired.”

      https://www.madinamerica.com/2022/04/psychiatry-ever-endorse-chemical-imbalance-theory-depression/

      https://www.sciencedirect.com/science/article/pii/S266656032200038X

    • “Depression is a complex, heterogeneous disorder with biological, psychological, and sociocultural determinants and risk factors.”

      Do you know what happens if one puts million people to study and write always new minor details about something and then makes them repeat what they have read from other similar minor detail producers?

      Does there appear to be visible red line connecting all the dots or does the subject start looking more fuzzy and more complex than it really is? Physics can make accurate predictions and check them to falsify claims and keeping researchers on line with reality, but psychiatry does not have as solid self correcting mechanism.

      Thomas Schnell, I’d suggest you start by reading drug info. You’ll find that in main menu. There is an extremely good collection of studies with sources that answer to most of those exact claims you are doing, because they are not as unheard here as you may feel. Not every article here has every detail.

      “””
      “Psychiatric drugs are so widely used that they incapacitate hundreds of millions of people around the globe.”

      Dr., would you cite the source and the page #? Thanks
      “””

      If you are interested in those sources and you get not answer here you might want to read his books. They have sources. This Mad In America is based mostly on work of Robert Whitaker so those main menu pages likely do not contain that. Robert Whitaker is usually nicer with his words than Peter C. Gøtzsche, MD and does not as directly talk about deaths.

      It is healthy habit to be careful and doubtful when facing something unfamiliar, and I hope that you’ll be interested enough to dive deeper to check all the facts until you are satisfied.

        • I agree with you. Accusations that psychiatric drugs kill would really need good public article with sources and ability to debate. It is not okay to have to buy the book just to be able to verify something.

          That amount of number of deaths is not directly from any research but an estimation that Gøtzsche made based on research. This is from a book “Deadly psychiatry and organised denial” chapter 14. He went trough individual studies about added mortality on older people ordered by medicine group and used Denmark 2013 data to check amount of drug users on that age group. Then he multiplied those and compared numbers to another causes of death.

          For example for older antidepressants users he used two studies:

          Antidepressant use and risk of adverse outcomes in older people: population based cohort study BMJ 2011;343:d4551 https://www.bmj.com/content/343/bmj.d4551

          “Absolute risks over 1 year for all cause mortality were 7.04% for patients while not taking antidepressants, 8.12% for those taking tricyclic antidepressants, 10.61% for selective serotonin reuptake inhibitors, and 11.43% for other antidepressants.”

          (3.6% of treated patients dead in a year when compared to untreated)

          And:

          Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women’s Health Initiative study Jordan W Smoller et al. Arch Intern Med. 2009.
          https://pubmed.ncbi.nlm.nih.gov/20008698/

          “Tricyclic antidepressant (TCA) use was associated with increased risk of all-cause mortality (HR,1.67 [95% CI, 1.33-2.09]; annualized rate, 14.14 deaths per 1000 person-years). There were no significant differences between SSRI and TCA use in risk of any outcomes.”

          (0.5% treated patients dead in a year when compared to untreated)

          Latter study had a lot smaller drug induced death rate, but according to Gøtsche that was most likely explained by more vague classification and younger patients and patients that lacked many typical risk factors. So he used value 2% of antidepressant users dead in a year of people older than 65 years old when calculating his estimation. For antipsychotics and benzodiazepimes he used 1% dead in year in similar age group based on other studies.

          Calculating causes of mortality is not always easy. For example there are Finnish register based studies with results that usage of antidepressants and antipsychotics lowers mortality of schizophrenia patients.

          Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study Jari Tiihonen et al. Am J Psychiatry. 2016.
          https://pubmed.ncbi.nlm.nih.gov/26651392/

          “Moderate and high-dose antipsychotic and antidepressant use were associated with 15%-40% lower overall mortality, whereas chronic high-dose use of benzodiazepines was associated with up to a 70% higher risk of death compared with no exposure.”

          So there are two highly different story lines and the both sides try to explain what is wrong with the reasoning of the other group and causes of it.

          “Mad In America” and similar groups accuse that majority of psychiatry research is poorly made pointing the exact mistakes in research methods and studies like not having proper placebo group because everyone is medicated and “unmedicated” patients not really being unmedicated, but sometimes using more medication than the “medicated” group or being abruptly withdrawn and that withdrawal caused deaths and hospitalizations should be calculated as drug caused deaths and hospitalizations.

          “Mainline psychiatry” what seems to be your information source accuses groups like “Mad in America” for twisting the results and cherry picking data. Among that storyline drugs are safe and save lives and only problem with succesful treatment is that patients do not follow their treatment plan and do not understant that they need for medication.

          That is the world the majority. Permission to talk publicly on newspapers and on television and on science magazines is mostly given to latter group and any professional speaking publicly against treatment standards is usually forced to lose his job quickly and removed from his positions for making wrong and dangerous claims.

          In that storyline those who oppose psychiatry and call it nonscientific and corrupted do not understand science and are antipsychiatric sensationalists and conspiracy theorists thinking with their emotions and not with their reason.

          Sometimes I wonder if there is any way for typical people to confirm which side is right. Part of the problem is that reading scientific text is complex and evaluating it needs lifelong commitment to subject or personal experiences. Another part of the problem is that those texts are source of income for their authors. And for that I do not mean the typical “money combined with wrong motivations corrupts”, but simply the problem that we saw here:

          Someone says something and to confirm that one has to buy access to article or book. Then that source says something and to confirm that yet another access to another data has to be bought.

          • “Conclusions: Moderate and high-dose antipsychotic and antidepressant use were associated with 15%-40% lower overall mortality”

            He should have his stats analyzed by peers and published which makes his research less expensive to access. No doubt some meds have side-effects. There is always a trade off. Do the benefits outweigh the risks?

          • Yes, that is how science should be working: Someone finds something that contradicts the current research and publishes the results and after a peer reviewing process the mistakes are pointed out or in rare cases the new scientific consensus is formed.

            That process is proven to work in many single cases, but there seems to be some kind of hindrance in some sciences: Strong motivations to believe something like for example income and job and reputation and possibility of being judged by law depending on some well accepted truth causes the peer reviewing group being subjective instead of being objective.

            Those specializing in psychiatry work the most likely as psychiatrists in health care. They constantly give statements that are legally binding and if a citizen opens a legal case against some decision then reviewing if the decision made by the psychiatrist was correct is given to another psychiatrist and reviewing his work is handled in a similar way.

            So the job and the freedom and the reputation of a whole group depends on the consistency of the group and that consistency comes from the consistency of the science behind their decisions. Any major change in the scientific evidence base that would question any part of it would make the whole group vulnerable.

            Which is of course the case with any area of science: But the collapsing of the bridge and the crashing of the spaceship and verifying the cause is much more exact process and not related to moral values like the idea behind psychiatry that some way of feeling or some deed is “good” and some way of feeling or some deed is “bad”.

            Things related to that “bad” are called symptoms and things lessening that “bad” are called “lowering the symptoms” and the substance lowering that “bad” is called “the medicine” and “the help”.

            If that thing considered as “the help” is proven to happen then psychiatry is called “evidence based” and the moral base and subjective words as “good” and “bad” are hiding under a discussion that uses the same words as discussion of hard natural sciences and forgets turning moral values into exact facts.

            That leaves a strong possibility that the thing that sounds “bad” or “good” or in your language “outweights the risks” and is stated as self-evident fact is not objective at all and can cause things considered as “harmful” by everyone in the long term or immediately. Instead of describing and explaining how the system works the focus on medical sciences is on how the system should work and how to cause that change.

            That goes against “there is no ought from is” what is one the most famous deduction errors listed. So at the very same time much of the psychiatric deduction is based on feelings instead of a natural phenomenon and at the very same time there has to be exactness of the natural science and no mistakes done. So there cannot even be discussion about that uncertainty of the basic concepts.

            Let’s take an example. I had read your conversation here about what happens when someone stops using medicine. You claimed that a worsening state of the patient was caused by the relapse and need for medication: Underlying sickness comes back. Others here claimed that it was usually because of dependency on those drugs.

            That is not a question that is a matter of opinions, but the fact that can be studied and fact proofed, because reason of something happening is unrelated to whether thing happening is “good” or “bad” while it can completely change that opinion:

            If the unwell things happening after stopping antidepressants are usually caused by earlier long term exposure to medicine that would change both the opinion about medicines and the opinion about the people promoting them as extremely negative.

            If the things happening after stopping antidepressants are usually caused by underlying sickness and earlier long term exposure to medicine is unrelated then opinion about medicines and people promoting them stays good, but opinion about those resisting the medication and therefore resisting the psychiatrists look really bad.

            Do those extremely unfavorable and extremely favorable consequences of something being true or untrue have an effect on the self correcting nature of the scientific process? Or do they affect only untrained patients that have limited reasoning abilities?

            What has to be kept in mind is that if motives like unfavorable outcomes of something being true prevents autocorrecting of science and is causing incorrectness building inside the evidence base you cannot ask proof for that opinion from anyone working in the area of psychiatry.

            Which is more of the problem than you might think, because the whole fact verifying process of our society lies on the “trusted source” that is the area of experts trained for some specific work field and their consensus.

            Let’s use your fact proofing process as an example.

            What you seem to be seeking is some “trusted source” that gives you the exact fact that you can then repeat. That seems to be your method of fact checking and it depends completely on the source you trust being trustworthy. That means that you can believe that things said there are true even if you do not check them yourself.

            As we have seen here your behavior pattern is that you will find those that say that something you have read is not true and cite them the source you find you can trust. And because your way of fact proofing is that source you trust and you already know what it says there is true there really is no way of changing your opinion.

            That is extremely likely the very same process that many doing peer reviewing repeat when reviewing an article. The claim is compared with the words of some source they think that is trustworthy and then those words are repeated.

            There lies the problem. Those questions still are not matter of words and can be verified, but still a method of fact proofing happens by comparing the words with some pre-existing text source and then repeating them.

            Therefore there really is no way of anyone here making an argument you would find convincing.

            Your verification method is exactly the same as Wikipedia and dictionaries and newspapers and textbooks use. Concept of “trusted source” is the main method for fighting against nonsense and misleading information.

            It would be interesting to hear a story of what happened when Gøtzsche tried to publish his findings about mortality. Many of his other writings are accepted, but reputation is everything for any organization and for every magazine. Losing reputation means losing the customers and being left out from important discussions. Was his article cut down in the scientific peer review process or before that and left unpublished?

            For those publishing medical science opinions of those working in the field mean a lot. Losing their support and respect could mean the end of the magazine. That problem with motivations with psychiatrists being the trusted source and still having strong unscientific motives exists therefore also with the medical magazines and scientific organizations.

            If you read his Wikipedia page it tells a story how Gøtsche was expelled from the board of the scientific charity organization and from the organization. Many resigned with him as a protest. That losing a job seems to be a common story for anyone speaking against scientific methods of psychiatry and their treatment results. That kind of fact proofing by an invisible hand that hurts makes psychiatry very authoritative and exclusive.

            That requirement of trusted sources and not angering them as a proof of acceptable behavior and scientific validity is not that much different from Russian requiring newspapers to use a source that the government accepts. Endangering his job is not something many are willing to do. Guarding against wrong and dangerous opinions turns easily from preventing misinformation to promoting it.

  7. I am surprised at the finding that psychotherapy is less expensive – I assume for the patient. I thought that was one reason that more people weren’t getting it. I don’t know how really true this assertion is. You have to take time off work to get therapy (if you work). The average person doesn’t look at the overall cost of an action, but at its monthly cost in money and time. They can go on taking a drug or paying off a credit card or an insurance policy forever, even though that choice is much more expensive in the long run.

    Of course it is not less expensive for psychiatrists to deliver therapy, but much more. Most psychiatrists, we have found, want to be paid more than they want their patients to get well.

    Though therapy works better than drugs, I know full well there are other healing modalities that work better than psychotherapy. The major problem here is getting insurance to cover the expense. Without insurance coverage, only the rich can afford many of the more effective treatments. Only total sanity among the ruling classes could change that situation.

  8. Thank You Dr Peter,
    This is your best one yet. As someone who nearly lost their life in the Psychiatric System and regained it through leaving the Psychiatric System I’m very grateful.

    Robert Whitaker “Anatomy of an Epidemic” Quotes:-

    “…Rather than fix chemical imbalances in the brain, the drugs create them. (207)..”

    “…Prior to being medicated, a depressed person has no known chemical imbalance. (81)…”

    “..If you expand the boundaries of mental illness, which is clealry what has happened in this country during the past twenty-five years, and you treat the people so diagnosed with psychiatric medications, do you run the risk of turning an anger-ridden teenager into a lifelong mental patient? (p. 30)..”

    “Recovery on the med model requires you to be obedient, like a child,” she explains. “You are obedient to your doctors, you are compliant with your therapist, and you take your meds. There’s no striving toward greater intellectual concerns. (123)”

    “The “cure,” it seemed, had once again been proven to be “worse than the disease.”

    • “Our results suggest that the association between Val66Met polymorphism of BDNF and short-term treatment response varied with antidepressants. The underlying mechanisms linked to the differences merit further investigation.” ScienceDirect

      WE are scratching the surface. Antidepressants impact brain chemicals indirectly that demonstrate efficacy in relieving depression.

        • it’s still important to make sure that severe depression is diagnosed and treated properly. Antidepressants can be helpful here, and for some people may be the only way that they can get back into a daily routine or start going to psychotherapy.
          Studies show that the benefit generally depends on the severity of the depression: The more severe the depression, the greater the benefits will be. In other words, antidepressants are effective against chronic, moderate and severe depression. They don’t help in mild depression.
          10% of Americans 12 and older take antidepressants. That’s 30,000,000 people. They have been taking them for generations.

          For someone to say that they’ve been killing millions and incapacitating hundreds of millions without a source besides the writer himself and without being challenged by Mr Whitaker, the commenters or the volunteers is alarming.

          • There are a lot of different medications for treating depression. But it’s difficult to predict how well a particular medication will help an individual. So doctors often first suggest taking a drug that they consider to be effective and relatively well tolerated. If it doesn’t help as much as expected, it’s possible to switch to a different medication. Sometimes a number of different drugs have to be tried before you find one that works.

            Studies show that the benefit generally depends on the severity of the depression: The more severe the depression, the greater the benefits will be. In other words, antidepressants are effective against chronic, moderate and severe depression. They don’t help in mild depression.

            The various antidepressants have been compared in many studies. Overall, the commonly used tricyclic antidepressants ,
            and SSRIs and SNRIs, were found to be equally effective. Studies involving adults with moderate or severe depression have shown the following:

            Without antidepressants: About 20 to 40 out of 100 people who took a placebo noticed an improvement in their symptoms within six to eight weeks.
            With antidepressants: About 40 to 60 out of 100 people who took an antidepressant noticed an improvement in their symptoms within six to eight weeks.

            In other words, antidepressants improved symptoms in about an extra 20 out of 100 people.

            That’s 20%. 20% of 30,000,000 is 6 million people who have been helped by antidepressants.

          • And another 24 million who may have been told that “this is the answer” and remain in despair, and are prevented from seeking other solutions by the faith they put in their doctor’s promises.

            I would love to see what percentage of doctors tell their clients there is about a one in five chance you will get a significant benefit, let alone how many inform their clients of the wide range of other options available. I talked to a woman on the crisis line I worked one time, and she’d been seeing a psychiatrist for well over a year and seen no benefits. She was frantic, telling me she thought nothing would ever work and she’d feel that way for the rest of her life! I asked her if anyone had told her there were other things she could do for depression besides drugs? She was silent for a moment, suddenly calm. “No,” she said. “Well, there are,” I told her. “Oh!” she said. “Well, THAT’S good!” Her despair was gone in a moment as soon as she learned there were other options, but NO ONE had discussed these options with her!

            There is a very great harm in telling people that you know the cause of their suffering when you don’t, and even greater harm when you tell the person you have a solution when that solution has a 4/5 chance of failure.

          • OK. So you – and these studies – are defining “help” as a relief of symptoms. And for how long? I have heard many of those studies only lasted for a few weeks.

            But what about finding and handling the underlying cause of the depression? I have engineering training. I know I can’t fix a piece of equipment where a warning light is blinking by putting a piece of tape over the warning light. I need to find out the underlying cause of the alarm.

            By telling “millions” that these drugs are “helping” them we are also telling them to expect nothing more than a temporary alleviation of symptoms. And that’s not what they really need or want, nor is it what society really needs or wants. In short, it’s a scam pushed on us by doctors who care more about their pocketbooks than their patients and the overall health of their communities and the planet.

            I have no patience (pun intended?) for people who claim they are “helping” millions by masking their symptoms for a few weeks, and I don’t think you should either. They are ignoring their actual responsibility to their patients and to society. They are being notoriously arrogant, pretending “we don’t know all the answers yet” to hide their unwillingness to deliver real help.

            I see anyone claiming that these drugs “help millions” as hiding from reality.

          • “Let’s face it. We are interested in evidence which we believe denies the allegations that cigarette smoking causes disease” (Philip Morris, 1970)

      • I wrote, “Antidepressants help and have helped millions and millions.”
        You wrote, “Show us the studies, please.”
        I thought I did.
        You said, “I see anyone claiming that these drugs “help millions” as hiding from reality.”
        They relieve suffering. You said for a few weeks. Explain, please.
        You said they aren’t looking for the causes. How do you know that? You added, “They are being notoriously arrogant, pretending “we don’t know all the answers yet” to hide their unwillingness to deliver real help.”
        Do you mean to say that because they are too proud they either have, or could find, the real answers but they refuse to reveal what they are?
        How long should antidepressants work before crediting them with being helpful and how do you know these scientists aren’t delivering the best products/answers based on what the research reveals?
        You say that you’ve read that many of these antidepressants only work for a few weeks. Can you cite those studies, please?

        The words in this box are so big, I can’t find where to make edits

    • “Recovery on the med model requires you to be obedient, like a child,” she explains. “You are obedient to your doctors, you are compliant with your therapist, and you take your meds. There’s no striving toward greater intellectual concerns. (123)”

      If it works. One can always stop taking the drugs if they don’t work or are too unpleasant.

          • THE IMPACT OF FLUPHENAZINE DECANOATE DISCONTINUATION –A RETROSPECTIVE COHORT STUDY (Copy and Google) (Circa 2020)

            Anyone incapable of successfully withdrawing from the above drug was classified as “Relapsing”.

          • A person with diabetes has a measurable deficiency in insulin, and giving insulin directly repairs that deficiency and leads to physiologically measurable results.

            No child or adult has ever been shown to have a measurable deficiency of Ritalin or Adderall, and giving Ritalin or Adderall is not repairing any such deficiency.

            The situations are not in the least comparable, as anyone who looks beyond the surface arguments should easily be able to comprehend.

          • THE IMPACT OF FLUPHENAZINE DECANOATE DISCONTINUATION –A RETROSPECTIVE COHORT STUDY (Copy and Google) (Circa 2020)

            Anyone incapable of successfully withdrawing from the above drug was classified as “Relapsing”.

            Apples and oranges

      • thomas Schnell December 30, 2022 at 9:54 pm

        “I said that to point out that addiction is a mental illness, imo.”

        thomas Schnell December 29, 2022 at 7:20 pm

        “If it works. One can always stop taking the drugs if they don’t work or are too unpleasant.”

        Too late, your human rights have now been removed for following doctors orders (any symptoms of addiction means you now have a mental illness by your reasoning), and you can be snatched from your bed and force ‘treated’ against your will. (note the policy in my State of ensuring there are NO EMPTY BEDS in mental institutions…. ergo the carte blanche to enable “outpatients” to be snatched form their homes based on forged documents completed by ‘mental health professionals’)

        Most long term drug pushers know the score on this one. My local heroin dealer would love to be able to have police deliver and restrain people for ‘treatment’ until they no longer needed to be forced to buy his product, and now needed it to function (despite the damage it is doing)

  9. I am waiting that Critical Psychiatry Textbook series. You are writing important books as is Robert Whitaker. It is not easy for uneducated people like me to try to go trough complex studies in foreign language just to be able to argue with those that make decisions.

    When educated calm and nice professional says “that is studied a lot and it is safe and proven to help” the other side is quite helpless. “Don’t you want to get better? It is normal to be scared of medicines at first and it takes time to find the right medication, but they help you.”

    Those studies about medicines are particularly tricky. If there are two RCTs and the both say that “this lowers symptoms” then without extra knowledge not found in those studies one cannot separate that one way of lowering symptoms leads to early death and rest of life depending on others and the other way of lowering symptoms leads to being able to work and behave as reasonable citizen.

    For almost any reader or listener lowering symptoms is always a good thing and means that patient is improving. Idea that lowering symptoms can destroy someone’s health is really foreign. And even more foreign idea is that worsening sickness (relapse) can improve health in long term.

  10. One of best Blogs of 2022
    “Antidepressants No Better Than Placebo for About 85% of People”:-

    This was definitely my experience. I was prescribed ADs between 1984 and 1990, and they made NO difference whatsoever, but coming off them was NOT too difficult.

  11. 3RD LEADING CAUSE OF DEATH
    “..Psychiatry does not deliver what the customers want. And what it delivers kills so many customers that it might be the third leading cause of death…”

    SEROQUEL has a Black Box Warning and is banned in the American Military. At low doses Seroquel is very effective for sleeping – but it is discouraged by doctors as Seroquel can Kill. This might be a Problem for Normal People, but not for a middle aged Psychiatric Patient who can be classed as dying from Natural Causes.

  12. thomas Schnell December 31, 2022 at 9:46 am
    Topher December 24, 2022 at 3:12 am

    I used psychotherapy not meds.

    I read many anti-psychiatry folks and using their knowledge especially David Cooper and Thomas Szasz and not to mention many other western philosophers after I started therapy cause I was confused and curious. This is how I ended up at MadinAmerica as well.

    As someone who grew up in an extremely collective society, a mental condition has very high bar so to diagnose by a doctor (not a psychiatry), one does something so outrageous that everybody including the doer may agree there is an issue here. Some other mental conditions may be diagnosed mostly somatically. Anything else is managed by the family or relative. I am not saying this system is good…it has its many flaws and exploitations to be sure, but my point is at least behaviourally, I had no outward issues. As for symptoms, I was not even aware of them enough to call them symptoms. I went to therapy as part of my education, and I had childhood trauma (some worked through and some lingering in my psyche).

    English is not my mother tongue, but I am affluent enough. So first for me at least, English language assumes high boundary, so people speak on surface level. in therapy, a second layer of communication is utilized, not what one said but one intended at least in the context is the focus. This may be called transference, or it is interpreted by the therapist etc.

    In my culture, this is normal way of talking. People call out what we call defense mechanism here all the time (in some collective society the social policing is higher, and the boundaries are lower). This interpretation process may diminish the client’s cognitive function and may “shrink” the client to respond primary level processing of emotions and instincts to get to the source of pain. This may give the therapist a great overview observation without actually asking a real consent to access the client’s mind and of course one implication is they can diagnose you this level. There is a reason we have boundaries. This unspoken mind intrusion consent is not spoken about directly though probably legally everybody signs informed consent. The next one is the power to influence, again this consent to be influenced is not spoken about directly. I have to emphasize these are my personal experience and my trauma was this level. Other people may have other areas as their focal points and may differ how they may react or experience in therapy.

    If one has trauma which basically means an intrusion to one’s mind, this type of relationship may be very triggering if the parameters of the game are not explicit. The elephant in the room is both client and therapist can be triggered but only the client is to benefit from the experience (therapy benefits is side affect). All these information is not discussed about. To me this created sort of double-bind thing that created my own childhood trauma, so I was impacted negatively for years in therapy.

    I am not a good writer so to bring this home, I will share an excerpt from David Cooper that may touch what I am failing to convey.

    According to D. Cooper’s the language of madness, the experience has some inherent issues of objectification that must be talked about, so they do not sullen the inter-subjectivity. One of the reasons not to have this level of transparency is power in the hands of psychiatry and psychotherapy tries to copy that. So Cooper continues to say, “the doctor forms an impression of the patient or ‘sums him up’ but at the same time the patient is forming an impression of the doctor, summing up the doctor who is summing him up; but then the doctor has to sum up the person who is summing him up to include….” (p.158). This can continue for a long time as you may sense already. I do not see this type of pattern working to better another without both knowing and acknowledging this is happening. And by being curious to notice, may land you a label or a diagnose. It is the double bind nature and the objectification of the client or patients that I found to be disturbing. To shut off this observation or suspend one’s cognition may require one to twist their logic into pretzel!

    Therapy worked for me only because in all fairness, I had a solid and really safe relationship outside so my reality did not diminish but only until I educated myself did I see the benefits. Now the experience of therapy made me to learn all about therapy and I could utilize that knowledge to soothe some of the technical confusion but those who may not have same drive or same resources, then if their intelligence is crippled in the dynamic of therapy relationship, I would say psychotherapy may be harmful.

    • I just wanted to add to clarify few things: though I had familial trauma what stuck in my psyche was the cultural and religiosity indoctrination and when I sat in a room with a stranger (perhaps in my mind sitting as representation of society), my trigger was being brainwashed again; hence, my reaction and my recovery reflects that I do not like groupthink and I do not like people going into my mind to fiddle with without consensual and reciprocal relationship – non power imbalance….normal relationship.

      But because my therapy was based in our individualism society which influenced me to balance my past, my experience and my reactions were invalidated because it felt as if I was avoiding responsibility when in fact (knowing what I know now), my culture, society, and the failure of my parents was the problem since I was a child during my trauma…My accountability and responsibility was I stood up to a very tight cultural and religion knit which showed me I may have been broken but I was not erased completely!