Editor’s Note: Over the past several months, Mad in America has published a serialized version of Peter Gøtzsche’s book, Critical Psychiatry Textbook. In this last blog in the series, he presents his concluding thoughts and suggestions for the future of psychiatry. All chapters have been archived here.
Final words about a specialty in ruins and what to do about it
Among the authors of the five textbooks count some of the most prominent professors of psychiatry in Denmark. There is no reason to believe that the systematic betrayal of public trust would be any different in other countries. We see the same lies, denial and misleading information about psychiatry everywhere,7 as illustrated so convincingly in Whitaker’s review of Insel’s book.
Those who shape psychiatry are often deeply corrupt,7,533 and they often “forget” to declare their conflicts of interest against the rules.7 These people are highly effective drug pushers. Court documents revealed that, in 1999, two such US psychiatrists, Charles Nemeroff and Alan Schatzberg, published a psychiatry textbook that was ghostwritten by GlaxoSmithKline.335
In 2000, they co-authored a report of a depression pill trial in New England Journal of Medicine where the authors had so many ties to drug companies that there wasn’t room for them in the print journal (they took up 1067 words).693 This made the journal’s editor, Marcia Angell, publish an accompanying editorial: “Is academic medicine for sale?”694 She explained that it had been difficult to find a psychiatrist to write an editorial who was not conflicted. This showed that the whole specialty has been corrupted by industry money. Nemeroff and Schatzberg declared 17 industry ties each:
Dr. Nemeroff has been a consultant to or received honoraria from Abbott, AstraZeneca, Bristol-Myers Squibb, Forest Laboratories, Janssen, Eli Lilly, Merck, Mitsubishi, Neurocrine Biosciences, Organon, Otsuka, Pfizer, Pharmacia–Upjohn, Sanofi, SmithKline Beecham, Solvay, and Wyeth–Ayerst. He has received research support from Abbott, AstraZeneca, Bristol-Myers Squibb, Forest Laboratories, Janssen, Eli Lilly, Organon, Pfizer, Pharmacia–Upjohn, SmithKline Beecham, Solvay, and Wyeth–Ayerst.
Dr. Schatzberg has served as a consultant to or received honoraria from Abbott, Bristol-Myers Squibb, Corcept Therapeutics, Forest Laboratories, Janssen, Eli Lilly, Merck, Mitsubishi Pharmaceuticals, Organon, ParkeDavis, Pfizer, Pharmacia–Upjohn, Sanofi, Scirex, SmithKline Beecham, Solvay, and Wyeth–Ayerst. He has received research support from BristolMyers Squibb, Pfizer, and SmithKline Beecham. He has equity ownership in Corcept, Merck, Pfizer, and Scirex.
I wonder if such people have time for seeing patients, or for listening to those they see.
The many erroneous and misleading statements I found cannot be explained by the advent of new, important knowledge, as the publication dates for the textbooks were recent, from 2016 to 2021. Furthermore, even though I have sometimes used recent articles to demonstrate that the authors are wrong, the knowledge I convey has existed for many years prior to 2016.
In the protocol for my study, I noted that the textbooks should mention that the causes of psychiatric disorders are mainly environmental, and not genetic or related to a visible brain abnormality. The textbooks conveyed the opposite message, and strongly so, although there is no foundation for a biological model of psychiatric disorders. The psychiatrists have not even been able to explain what exactly they mean by this.9
I also noted in my protocol that there are no reliable trials that have shown that drugs are better than placebo for overall functioning, quality of life, return to work, sick leave, and social relationships. The textbooks were remarkably silent on this important issue, even though there is clear evidence, particularly from non-industry funded randomised trials and from good observational studies, that long-term drug treatment is harmful.1,5
It was disappointing that psychologists mostly said the same as the psychiatrists, and they were sometimes even more radical and uncritical than them, e.g. in their praise of the imaging studies and the drugs. I think there are two reasons for this. In a radicalised group, newcomers tend to be even more radical than their leaders to become accepted as their equals. Therefore, fringe groups tend to become more radical with time. The other reason is related to the first one. Some psychologists want to get permission to prescribe drugs and their scientific associations often support this idea. They will not succeed if they are seen as critics of mainstream psychiatry.
One of the textbooks, Clinical Neuropsychology, which has three psychologists as editors, exemplifies this issue.20 It has three full pages describing imaging studies in depression, with many references.20:432 It conveys the impression to the students that we know a lot about the brain based on reliable studies, which is totally false. Students believe what they read in their university books of psychiatry, even though it can best be characterised as brainwashing, and they may spread their false ideas even more forcefully when confronted with irrefutable evidence to the contrary.14
Many psychologists do not realise that they have a great advantage over psychiatrists, which is that they are educated with the aim of understanding the patients where they are and helping them with psychotherapy and other forms of support. It is very sad when psychologists buy into the false narrative the psychiatrists and the drug industry have created about their drugs instead of criticising it. If we lose the leading psychologists, there is little hope for the patients who would then need to consult therapists with lesser educations. Some of them are very good, but they do not have an academic background for understanding the science.
When I announced in the Critical Psychiatry Network that I was writing a critical textbook of psychiatry that would explain what was wrong with the current textbooks, a general practitioner reported what she experienced when she went to a regional meeting about adult ADHD three years earlier to learn something. Here is what she learned:
The psychiatrist that lectured was in the pay of three drug companies. He presented no peer reviewed research and said he didn’t like rules; he just knew what worked. The audience wasn’t allowed to ask him direct questions. We were put in groups to discuss how we should implement what we had heard. Members of my group were stunned when I was chastised for asking two questions, one about how conflicts of interests might interfere with good prescribing and the other about the lack of long-term studies. I was told I was a dinosaur and too old to be flexible and innovative and go with modern medicine developments. I’ve never experienced anything like this before! I confronted the bully face to face when the group work was finished and left him with a stern reminder to keep his mind open.
Whether drugs are legal or illegal, it is unhealthy to perturb brain functions with them. Brain-active substances can lead to violence, including murder. An analysis of adverse drug events submitted to the FDA between 2004 and 2009 identified 1,937 cases of violence, 387 of which were homicide.401
The violence was particularly often reported for psychotropic drugs—depression pills, sedatives/hypnotics like benzodiazepines, ADHD drugs and a smoking cessation drug that also affects brain functions. Depression pills are being suspected of having a causal role in mass shootings, but when one of the teenage shooters in the Columbine High School massacre was found to have taken a depression pill, the American Psychiatric Association denounced the notion that there could be a causal relation and added that undiagnosed and untreated mental illness exacts a heavy toll on those who suffer from these disorders as well as those around them.695
This is sickening. It is marketing speak and standard industry tactic to blame the disease and not the drug, but this is what psychiatrists do all the time. The other murderer had taken both sertraline and paroxetine.
Drugs and guns are a dangerous cocktail, but America abounds in both, including easy access to opioids on prescription, which makes this country the most backward in the Western world.
There are many other high-profile cases where the mass murderers were on depression pills,696 but in many cases, information about the shooters’ prescription drug use and other medical history has been kept from public records. Drugs causing homicide is taboo.
The hypocrisy is all over the place. As an example, universities are happy to accept enormous gifts from industry at the same time as they implement stringent conflict of interest policies for their faculty and their relationship with commercial sponsors.697
One of the chapters in my book about organised crime in the drug industry was “Psychiatry, the Drug Industry’s Paradise”.6 Psychiatry is second to none in exploiting people with harmful drugs and in killing, incapacitating or maiming hundreds of millions of people. In 1990-92, 12% of the US population aged 18–54 years received treatment for emotional problems, which went up to 20% in 2001–2003.698 Although there are hundreds of diagnoses in DSM-IV, and even more in DSM-5, only half of people who were in treatment met diagnostic criteria for a disorder. In 2012, the US Centers for Disease Control reported that 25% of Americans have a mental illness.699
We must put an end to this insanity in a profession that is supposed to take care of the insane. We have a chance of influencing those who study psychiatry before it is too late and they have accepted the false narrative. This was my motivation for writing this book.
As child and adolescent psychiatrist Sami Timimi explains, psychiatry ignores much of the genuine science there is and instead goes on supporting and perpetuating concepts and treatments that have little scientific support.10:20 He calls this “scientism”. It means that psychiatry likes to talk in the language of science and treats this as more important than the actual science.
In Timimi’s debates with fellow psychiatrists about the evidence, three defences are common. The first is the use of anecdote—such and such a patient got better with such and such a treatment, therefore, this treatment works. The second is an appeal about taking a “balanced” perspective. But each person’s idea of what a balanced position is depends on where they are sitting. We get our ideas on what is balanced from what is culturally dominant, not from what the science tells us. The third is that when molecular genetics has consistently failed to produce anything about diagnoses being related to specific genes, we are told that the area is “complex.”10:63 This is bullshit.
When I published my 10 myths about psychiatry, which are harmful for people, in a major newspaper in January 2014, I ended my article this way:189
Psychotropic drugs can be useful sometimes for some patients, particularly in short-term use, in acute situations. But after my studies in this area, I have arrived at a very uncomfortable conclusion: Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability causes more harm than good. The doctors cannot handle the paradox that drugs that can be useful in short-term treatment are very harmful when used for years and create those diseases they were meant to alleviate and even worse diseases. In the coming years, psychiatry should therefore do every-thing it can to treat as little as possible, in as short time as possible, or not at all, with psychotropic drugs.
My article caused an outcry that lasted for a couple of months, spearheaded by the drug industry and their paid allies among doctors and journalist friends. I got the whole Danish establishment on my back, and the Minister of Health threatened that I could get fired.7:278 The only thing I had done was to tell people the truth. But this cannot be tolerated when the subject is psychiatry.
Outside the power circles, my paper was much appreciated.700 Numerous articles followed, some written by psychiatrists who agreed with me. For more than a month, there wasn’t a single day without discussion of these issues on radio, TV or in newspapers, and there were also debates at psychiatric departments. People in Norway and Sweden thanked me for having started a discussion that was impossible to have in their country, and I received hundreds of emails from patients who confirmed with their own stories that what I had written was true.
Nothing changed, however. Perhaps a little here and there, but nothing material. On the other hand, it matters for some people that we protest. Many patients and relatives have told me that my books have saved lives, as they gave the patients the courage to withdraw from their drugs against their doctor’s advice.8:167 These emails documented a high level of ignorance and arrogance among psychiatrists and here is a typical example:
Her psychiatrist told her she had an incurable genetic disease and needed psychosis pills for the rest of her life. When she complained that she could no longer concentrate, slept a lot and believed the drugs affected her memory, making it hard to study, the reply was that the problem wasn’t the drugs but that she lost neurons due to the psychosis and that her brain wasn’t the same anymore. So, she needed to take psychosis pills indefinitely to protect her brain from losing more neurons; otherwise she would become demented. When she had withdrawn the drugs despite this advice, she was told she would have a new psychotic episode. When she said she didn’t want to take the drugs for the rest of her life, her psychiatrist replied that she would then not see her anymore because she only worked with patients who wanted to be treated.
What should be do about this? I have these suggestions:8:172
- Leave mental health issues to psychologists and other caring professions. They are not medical diseases. Consider involving recovery mentors who have lived experience.
- Psychiatry as a medical specialty should be disbanded. In evidence-based healthcare, we do not use interventions that do more harm than good, which psychiatry does. Let psychologists who are against using psychiatric drugs be heads of psychiatric departments and give them the responsibility for the patients.
- Psychiatrists should be re-educated so that they can function as psychologists. Those who are not willing to do this should find themselves another job.
- The focus should be on getting patients off psychiatric drugs, and to avoid starting them. Never start a drug without having a tapering plan.
- Establish a 24-hour national helpline and associated website to provide advice and support for those adversely affected by prescribed drug dependence and withdrawal.
- Provide tapering strips and other aids at no cost to help patients withdraw from their drugs. This would lead to huge savings for society.
- Apologize. It means a lot for victims of abuse to get an apology.
- Change psychiatry’s misleading narrative, which starts with the semantics. Speak about depression pills, psychosis pills, speed on prescription, etc. Stop using words such as psychiatry, psychiatrist, psychiatric disorder, psychiatric treatments, and psychiatric drugs, as they are stigmatising and as patients and the general public associate them with bad outcomes. Talk about mental health instead.
- Discard the psychiatric diagnosis systems entirely and focus on the patients’ problems.
- Drop the rating scales, both in research and practice, and focus on recovery, i.e. a return to a normal productive life.
- Make forced treatment unlawful.
- Make psychiatric drugs available only for use under strictly controlled circumstances:
- a) while patients are tapering off them; or
b) in rare cases where it is impossible to taper off them because they have caused permanent brain damage; or
c) in patients with alcoholic delirium, as sedatives under operations and other invasive procedures, e.g. colonoscopy, and in other circumstances to be defined.
- Make it unlawful to use drugs that are registered for nonpsychiatric uses, e.g. anti-epileptics, for mental health issues.
- Avoid financial conflicts of interest with manufacturers of psychoactive drugs or other treatments, e.g. equipment for electroshock.
- Forbid all rules about demanding a psychiatric diagnosis to get social benefits, or extra economic support to schools.
- Make it illegal for general practitioners to prescribe psychiatric drugs, which they cannot handle. In relation to depression, the chairman for the Danish Association for General Practitioners said in 2014 that they didn’t have “oceans of time” and couldn’t set aside a whole hour for one patient, as they also needed to think of their economy.701 They therefore hand out depression pills liberally. A US study showed that over half of the physicians wrote prescriptions after discussing depression with patients for three minutes or less.172
- Tell the patients that it is rarely a good idea to see a family doctor or a psychiatrist if they have a mental health issue. There is a huge risk that they will be harmed.
To see the list of all references cited, click here.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.