Mainstream psychiatry has a long history of overpromising and underdelivering. Insulin coma therapy, psychosurgery, deinstitutionalization, psychoanalysis, and biological psychiatry are just some of the major thrusts which provided modest benefits to some while imposing widespread costs to patients and families. It’s been a struggle for the field to acknowledge this truth to itself and to those who’ve suffered as a result.
None of that is news to the critical psychiatry movement, of which MIA is a prominent component. Critical psychiatry’s members have been documenting personal stories of harms caused by mainstream psychiatry. Some see glimmers of hope in mainstream psychiatry, such as more careful decision-making around medications, increased efforts to be collaborative rather than authoritarian, and a retreat from reducing human suffering to neurotransmitters. Still, there’s a long way to go.
Critical psychiatry should continue to point out where mainstream psychiatry falls short, but it’s primarily mainstream psychiatry’s responsibility to correct itself. It’s reasonable to wonder why this is taking so long to do. I believe one major reason is that mainstream psychiatry is beset by groupthink.
Groupthink happens when conformity is too highly valued and overrides alternative views. This can happen in any group. Mainstream psychiatry is no exception. A group tells itself it has a firm grip on truth, and denies or rationalizes any information contradicting that supposed truth. It tends to minimize or negate any opposing views both from outside and—more importantly—within the group. Those with such views are either shouted down or otherwise discouraged from speaking up, and often feel intimidated and censor themselves. The need for conformity often makes the group feel morally superior. The upshot is that discussion is narrow and stifled, leading to bad decisions.
Some examples of this in history include the Bay of Pigs fiasco and the flop that was New Coke. What about mainstream psychiatry? There is a long list of ideas that mainstream psychiatry has created or adopted that it holds to be virtually unchallengeable. Many of these are so ingrained in how mainstream psychiatry is taught and practiced that it can border on sacrilege to question them. These ideas have a rigidity to them that both inhibits dissent and is often harmful to patients. Mainstream psychiatry groupthink causes it to double-down on approaches that have yielded little, wasted time and money, and shut out better ways of understanding people.
Not all psychiatrists think this way, but there are those who have felt inhibited in speaking up within the mainstream psychiatry world out of fear. Psychiatrists, like members of any group, are not monolithic in their beliefs, and more than a few have challenged the status quo.
Mainstream psychiatry ideas include, among others, the beliefs that (a) DSM entities are reliably diagnosed and reflect some brain dysfunction (even if it can’t be identified, (b) that mental suffering equals illness, (c) the benefits of psychiatric drugs usually outweigh the downsides (d) psychiatric research will surely (eventually) reveal some brain abnormalities (e) psychiatrists are the best qualified to help those with mental distress (f) psychiatrists successfully resist pressures from pharmaceutical companies, from drug-to-consumer advertising, and from others who provide mental health treatments.
Again, this is not meant to be a complete list, but these are tightly-held beliefs of mainstream psychiatry, and mainstream psychiatry resists having them scrutinized from without and, as I’m stressing here, from within.
And, predictably, mainstream psychiatry groupthink leads it to ignore what critical psychiatry has to say as well.
Groupthink is a danger for any group, and mainstream psychiatry needs to do a lot more to counter its version. It can do so by seeking out opposing or challenging views within mainstream psychiatry in its organizations’ meetings, journals and other forums. It can speak with much greater humility about what mainstream psychiatry knows and doesn’t know. It can acknowledge that the ideas I identified earlier are unproven without saying they are useless. It can acknowledge that the biological approach has crowded out social, familial, spiritual, religious, environmental, and economic factors in considering what leads to mental distress. It can be more explicitly open to critical psychiatry in a collaborative, non-patronizing way, rather than seeing critical psychiatry only as an annoyance. Leaders of psychiatric organizations have a special duty to counter groupthink.
I believe that if mainstream psychiatry were to read what I just wrote, they would likely say that they certainly agree, that they are open, that they do invite non-mainstream views, and that, perhaps, they could do more. And then I’d ask them why they think the public’s view is different from theirs.
Similar to how mainstream psychiatry often views critical psychiatry as having little merit and can’t or doesn’t “understand the full picture,” it’s also true that some within the critical psychiatry world see mainstream psychiatry as without merit, harmful, evil, greedy, and acting with no scientific or other basis for what it does. Both mainstream psychiatry and critical psychiatry are missing possible chances to find some common ground. I think excessive group loyalty tends to make it harder to find.
I’ve outlined some features of groupthink within mainstream psychiatry. Critical psychiatry is not immune, either. Although there’s no way to measure which group’s groupthink is more problematic, fairness calls for critical psychiatry to look inward if we’re going to demand that of mainstream psychiatry. Groupthink within critical psychiatry takes various forms. How powerful these forces are is open to debate, but to say they’re nonexistent would be akin to saying they don’t occur in mainstream psychiatry.
Critical psychiatry is composed in large part of those who’ve been badly hurt by mainstream psychiatry, naturally seeking support and validation. This can make it harder to see any good in mainstream psychiatry and can lead to absolute judgments about mainstream psychiatry, such as “medication is always bad,” “no diagnosis has any validity,” or “all psychiatrists are manipulated by drug companies.” It’s not that there’s no truth to this, but critical psychiatry groupthink tends to miss shades of gray in its view of mainstream psychiatry. Nuance is minimized and can be seen as disloyalty to critical psychiatry. Within critical psychiatry, there are those who have found mainstream psychiatry helpful, but it can be hard to say so when the central narrative is that mainstream psychiatry needs to be upended.
This essay is neither about fault-finding nor whether mainstream psychiatry or critical psychiatry is more hampered by groupthink. It’s about how groupthink in both gets in the way of doing right by people. Groupthink just happens and gets worse if you don’t look for it.
When it comes to concern for people in distress, mainstream psychiatry and critical psychiatry are in the same lifeboat. Neither has the full picture. Both are partially right. Both should correct each other’s excesses without invalidating everything the other believes. Research and personal stories don’t contradict each other. Science doesn’t have all the answers, but it has some. Ethics is not the sole purview of medicine.
It may be idealistic to think that mainstream psychiatry and critical psychiatry can help each other out, but groupthink can make each side want to shoot a hole in the other’s side of that lifeboat. It may feel good to shoot the other side down, but a short-term victory is not what’s needed.
Lol! I thought for a hot min that I might not have to cancel u guys . . . like, based on the title I thought there was going to be some actual criticism of critical psychiatry ideologues, but I guess not? Mainstream psychiatry has plenty to answer for, but survivors don’t want a different brand of reductive paternalism!
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I get the sense you were looking for a deeper and more devastating beat-down on psychiatry. My focus was on how groupthink is a big problem in psychiatry, not about all the things about it that could be named. To say there was no ‘actual’ criticism seems a bit of a stretch, but I get that you wanted more. I wasn’t trying to write a comprehensive treatise in 1200 words.
In the context of this article, which is about groupthink (not about all that’s wrong with psychiatry), what do you think survivors do want?
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My issue is that you didn’t really cover the problem of groupthink in Critical Psychiatry, where a small group of professionals have moved way beyond criticism to the point of becoming quite dogmatic about their own preferred paradigm
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The groupthink we see around psychiatry may not originate there at all. It’s widespread—in committees, congresses, boards, gossip circles, and in any group whose members believe their own experience is, or should be, universal, and that they know better how others ought to be behaving. And how others should be “properly governed” from a distance—how the mechanisms of law and finance should be applied to the masses to coerce “order”.
When we educate, govern, and manage people as masses, we implicitly require mass-compatible thinking and behavior.
Groupthink is a structural element of these large, abstract systems, not just some unfortunate by-product. It’s a feature, not a bug. Trouble can be expected when a group that makes the rules is not the same group expected to live under them.
From this perspective, mental distress may arise from the strains of being asked to flatten one’s inner life to fit dysfunctional, overgrown systems that can only “see” people in simplified, standardized terms—as numbers in a collection.
Some nervous systems might tolerate that unnatural pressure to conform to a vacuous, artificial, imposed group identity better than others. Maybe that’s not a bug, but a signal?
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Yes, groupthink is a structural element that any group or system needs to limit in order to do good and be wise. To the extent that psychiatry’s system has certain built-in ideas, its of limited benefit, and groupthink is part of what keeps that system too rigid and unhelpful.
As you say, one part of it is thinking you know better and the group buys into it.
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Yes. The signal is unmistakable — for those willing to listen.
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I find this way too soft on “mainstream psychiatry.” This perhaps hard-to-define group does not only have a shared belief system to protect: It has deep secrets regarding the abuse of and disregard for human life. And while a psychopath can stand up before the press or a crowd and act like a reasonable person “willing to have a meaningful discussion,” he is secretly working out devious ways to avoid being caught.
Psychopathy is definitely a part of this picture. If either “side” does not fully appreciate that, then they lack enough understanding to move forward.
Ignorance of any workable model for the mind is also an important missing element on both “sides.” This has been developed outside of the context of psychology and psychiatry, and – worst case – will never be accepted by either group. If they don’t develop workable technologies based on workable models they will never become successful professions, nor will their detractors.
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Yes, I could have spent more ink on beating on mainstream psychiatry. I get you wanted more of that, but it just wasn’t the focus, which is groupthink, not the bad parts of psychiatry.
I agree about the need for workable models. Psychiatry has some, which I find have some use, though I am well aware of their limitations. We need other models, and they won’t come if there’s too much energy spent on criticizing current limited models, no matter how valid those criticisms are.
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Can you describe what “workable model(s)” is employed by psychiatry? Just a couple of examples would help. To clarify, I don’t mean “therapy that sometimes seems to help.” I mean a way of THINKING about “mental illness” that yields reliable results when repeatedly applied. A scientific model, if you like, that both explains and predicts “mental health” phenomena.
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Richard, we don’t know each other, so there’s no reason for me to expect you to know where I’m coming from, but I didn’t write my comment because I wanted you to “beat on psychiatry.” I get that groupthink is kind of a cool concept, a way to explain why a group won’t let any other ideas in. I wrote it because I don’t think that’s what’s happening with Psychiatry. Then I stated what I think is going on with Psychiatry.
1) The group has perpetrated crimes against humanity and they of course don’t want to admit to this.
2) They lack a workable technology. And due to 1) and perhaps for other reasons, they refuse to even consider the possibility of trying other technologies that seem more workable.
Groupthink is a defense mechanism for groups that are under pressure for reasons that are quite possibly irrational or unjust. Psychiatry, on the other hand, is only under pressure from a few sources, and that criticism is entirely rational and just. The criminal has different defense mechanisms. They may look like groupthink, but they have different motivations. Groupthink was applied most appropriately to managers in business, not criminals in medicine. (Sorry for the exaggerated invective, but I feel strongly about this.)
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I”d admit I was struck by the first sentence of your original comment.
I understand how you see psychiatry, though it’s a challenge to get through the ‘exaggerated invective.’ It’d be interesting to have you edit out the exaggerations, so they don’t become a distraction. Not to get into politics here, but calling Trump a fascist or having him refer to those who disagree with him as deranged lunatics are, to me, distractions from the issues themselves.
Groupthink as originally described was not seen as a defense mechanism, but something that typically develops in a group, whether they’re being attacked from outside or not.
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I have to take your word about groupthink. I haven’t really studied it.
But it’s hard for me to believe that it would develop without any pressure on the group, at least some sort of propaganda, training, or performance anxiety.
I am looking at psychiatry from the point of view of its institutional history. I have never worked around psychiatrists and have met very few of them. But I really don’t see them, as a group, working towards any useful product (except maybe nice cars and houses for themselves). I see them as essentially a criminal group offering “help” but delivering suffering, pain, and death. I believe that’s what their history tells us. I include in that history their involvement in the Holocaust as well as more recent genocides. As materialists, they more or less believe in eugenics, even though that is officially now a pseudoscience.
I know there have been some among them who have been critics. Well, that’s fine. But how does the group treat those critics? It denounces them or abandons them. A group of managers in business would just have a maverick transferred, or perhaps fired.
And of course outside critics have been totally dismissed, labeled unqualified, not expert, or worse. The venom doesn’t match the criticism, particularly when the criticism includes suggestions for improvement.
As a psychiatrist, you are a member of that group on some level. What I would like to know is what they talk about when they meet at their conferences or whatever.
For a short time, I worked around a group of database engineers. (They worked for Boeing.) They liked to talk about their families, their house upgrade projects, their vacations; seldom about their work. There was no sense of intense interest or purpose in their work. They just did it to make money.
Before that, I worked in a group that was quite poor as individuals, because it spent most of its income on expanding and improving its service network. We talked mostly about work, and the discussions could be quite intense. So most of my adult experience involves working around people who are very involved in what they are doing, and very committed.
We might expect less of many professions. But here we are talking about psychiatry. Their work is not making society better; it may even be contributing to making society worse. So they are in no position to rest on their laurels or practice business as usual. If they don’t fix themselves, someone else will eventually come in and do it for them.
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I might be out of sequence here; there was no option to reply to your last comment on the site, but I will, and very briefly.
It’s great that we live in a place where we can believe and say what we want. Sometimes that leads to a wonderful exchange.
Your more recent post included, prominently:
“I have never worked around psychiatrists and have met very few of them. But I really don’t see them, as a group, working towards any useful product (except maybe nice cars and houses for themselves). I see them as essentially a criminal group offering “help” but delivering suffering, pain, and death. I believe that’s what their history tells us. I include in that history their involvement in the Holocaust as well as more recent genocides. As materialists, they more or less believe in eugenics, even though that is officially now a pseudoscience,” I couldn’t think of a way to respond that I thought would move things along in a good direction. You have every right to your views, and I wish you well
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I agree that my view seems almost irrationally condemnatory. It is difficult, though, to be rational when confronted with a history so tainted.
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In the NT when Jesus said “blessed are the peacemakers”, I don’t think he quite meant what seems to be proposed here.
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Knowing what Jesus meant is beyond my understanding, but I am curious as to what you think Jesus would post here.
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Take Olanzapine 10mg every day for a month, and then write a follow-up article. That could be one thing he might suggest. Are you game?
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If I did that, and came back to Jesus in a month and said I’m tired, have gained weight, and don’t want to do it any more, what might Jesus say, and how would that tie in to being peacemakers?
If he suggested that to “teach me a lesson,” I wouldn’t think that was very Jesus-like, but I’ll defer to you on that.
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Strange, I thought you had no idea what Jesus may have meant in any context (beyond your understanding). I imagine it may boil down to something like living in the service of others. In the case of psychiatry, it would (or should) be in the service of the client. The understanding that it’s more than just weight gain and being tired all the time, would be the beginnings of understanding the true effects of the drugs. The lowest dose, and even a fraction of it (2.5mg or less) already cause the metabolic and sedatory effects you mention.
The connection should be obvious now, I hope. The client or patient is the enemy in your narrative, so there is the need to strengthen the “army” of psychiatry. Make it somehow more resilient to critique.
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couldn’t respond directly to your last post.
I have no idea where you got the idea that I think the client/patient is the enemy, but I’m glad that we got to the “beginning of understanding”
It’s a start
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Ah, I see the problem in your query where I got the idea from. You use terminology in the article which at times sounds quite benign. Overpromise, underdeliver, modest improvements. It gives the impression that they just need a nudge in the right direction, think a little less in the box (groupthink). In my view, it is far more fundementally flawed. Stricter laws and mor e transparency limiting their power over some in our society is what is needed most, in my opinion.
There is also the fundemental basis on which I assume all psychiatrists to some degree work on. It’s more about conformity than groupthink. They serve the societal power structure. That’s their job in essence. In most cases, even if there is a law or two limiting their actions, they tend to not be all too concerned if they overstep.
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Great points, Jeroen.
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My prescription: stop overwriting reality.
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not sure if I follow you here; can you help me out?
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Your argument depends on the framework defining the person. That interpretive control is the mechanism that makes “groupthink” possible.
Every form of psychiatry is built on that move.
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I’ve always appreciated your ability to capture the heart of the matter without a hint of pretense or apology. Bravo Birdsong.
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🙂
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A careful reading of the first paragraph would suggest that insulin coma therapy and psychosurgery both “provided modest benefits to some…” Is that really what the author intends to say here? Can we not at least agree that both insulin coma therapy and psychosurgery were practices that had NO practical benefit and were ultimately destructive to pretty much all of those receiving them? How can there be a reasonable discussion about mainstream psychiatry if we are still trying to pretend that psychosurgery was anything but barbaric and intentional brain damage? That’s not “groupthink,” that’s just an observable reality! No one benefits from having their frontal lobe destroyed!
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That’s for sure.
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OK, Steve, 2 ways to go that I can see without losing the forest for the trees.
(1) I find 1 report of someone who benefited from insulin coma and 1 from psychosurgery, which would invalidate your point that they had NO practical benefit
(2) You are correct that not a single person benefited from those procedures.
Are you mostly trying to just find a criticism to make? Even if it’s valid, this article is about groupthink. It’s not intended to be another opportunity to show the evils of psychiatry, which I’m not going to defend or explain here ( aside from groupthink as ONE factor). If I’d left out ‘insulin coma and psychosurgery,” would be it possible to move on together about groupthink?
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No, I want to be sure we’re not “both siding” here. There’s a big difference between saying “some” or even “a lot of people report benefits from taking antidepressants” vs. “psychosurgery had limited benefits.” Even if you could find a person or two who claimed they benefitted, it is not necessary to prove no one ever benefitted in order to establish a procedure to be barbaric and destructive in actual fact. For instance, some people who get hit by a truck and survive suddenly change their lives and stop soul-killing stockbroker executive jobs and find peace as sheep farmers in Montana. This doesn’t make pushing people in front of trucks valid “therapy.” Most people are killed or severely injured. That’s a fact, not a bias.
I absolutely agree that groupthink is the enemy of rational problem solving. But part of groupthink is the assumption that nothing in psychiatry is fully destructive when there is evidence to the contrary. This is as “groupthinky” as saying that psychiatry is universally evil and that no one ever benefits.
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I agree with Steve. I don’t think groupthink adequately explains the behaviors we are seeing here. It’s not really a matter of whether or not anyone thinks they have benefited. Some people have benefited from NDEs. That doesn’t mean we should all go out and get an NDE in order to benefit. There must be a saner, calmer and safer way to get similar benefits. (And there are.)
And so with psychiatry. Some (not all) patients want to get through whatever they are going through and get on with life. So some will say they have “benefited” from a “mental health” intervention just because they wanted to get better and they did; possibly in spite of the intervention. But I am not prepared to go out and recommend that intervention to people if, overall, it does not have a record of being calm (nonviolent), safe, and effective.
Others who wanted to help have found such ways (I think they should be highlighted more on this website). Psychiatry wants us to think theirs is the only way, which I take to be arrogant and predatory. It’s much worse than groupthink. Groupthink, in theory, can be cured. I am not so optimistic about the subject of psychiatry, or at least the group that presently pretends to practice that subject.
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Just to be clear, I’m not putting all of the problems you cite on groupthink – not by a long shot.
I’m also not trying in my essay to resolve the problems of psychiatry, just pointing out that groupthink is one factor. One.
We can talk at length about how to make psychiatry and ways people can improve without psychiatry at all. Vital topic, but I’m trying to limit my input here to the groupthink theme. Otherwise, the conversations go in more directions than I can mange here.
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Alright then.
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“This can make it harder to see any good in mainstream psychiatry and can lead to absolute judgments about mainstream psychiatry, such as ‘medication is always bad,’ ‘no diagnosis has any validity,’ or ‘all psychiatrists are manipulated by drug companies.'”
Well, I don’t believe most of us here on MiA say these things, but maybe I have said similar things, in my anger and disgust phase. But I know people who claim to be helped by the antidepressants, despite the fact the common withdrawal symptoms of such, were misdiagnosed in me (according to the DSM at the time), which was blatant malpractice.
But the claim, ‘no diagnosis has any validity,’ is true – when the psych industries are falsely claiming their DSM disorders are biologically caused, as the psych industries currently are.
Especially when one understands that the antidepressants and ADHD drugs can cause the bipolar symptoms. And the anticholinergic drugs (including both the antidepressants and antipsychotics), can create anticholinergic toxidrome – a known medical way to poison a person – via anticholinergic toxidrome – and create the positive symptoms of schizophrenia. Not to mention the antipsychotics (aka neuroleptics) can create the negative symptoms of schizophrenia, via neuroleptic induced deficit syndrome.
Then the DSM diagnoses turn into iatrogenic illnesses, not “genetic,” nor “biological” illnesses.
As to, ‘all psychiatrists are manipulated by drug companies.’ Well, it does seem too many are. But that doesn’t mean all are.
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Part of why I wrote this is to indirectly point out that groupthink, wherever it occurs, leads to more absolute black-and-white statements which are simply not based in what we know to be true. Too much about humans shows shades of gray, and we don’t really move anything forward by digging in about those absolutes. I sense that you get that, and I’m appreciative that you do.
I don’t agree with everything you said, but I’m not looking for that. I value the clarity of one’s views ( including my own) as a better starting point.
Thanks.
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Out of curiosity, what don’t you agree with, Richard?
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I think psychiatry is a valid specialty. However, I believe that using drugs that have the potential of causing harm is not a good solution. It’s all “trial and error” and like playing a game of Russian Roulette. Yeah, there’s a small chance a drug could help, but there’s an even greater chance that it could cause harm. No thanks! I’m trying to find my way out of psychiatry after 30 years with nothing to show for it.
I hope that the field of metabolic psychiatry overtakes mainstream psychiatry one day as the gold standard of care. So far, mainstream psychiatry hasn’t done a very good job.
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one of the mainstream groupthink’s is to minimize or deny the trial-and-error factor in selecting a drug, and you’re right to point it out
I’m sorry that treatment was of no value for you
Metabolic psychiatry does sound promising, but I gotta say that there’ve been a lot of promising ideas in psychiatry that turned out to be not so great. I’m hopeful that it will be better than what we have now
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Future Psychiatric Survivor, can you explain why you think psychiatry should be regarded as a valid specialty?
To me, a field that claims to be a legitimate branch of medicine, or a genuine science, must employ rigorous testing and experimentation and be guided in its practices by verifiable, universally valid findings.
Do you believe that ANY of the numerous, often conflicting schools of psychotherapy satisfies these essential criteria? Or are all of them–as I contend–mere pastiches of more or less plausible hypotheses that either evolve or are discarded in accordance with shifting cultural trends and public attitudes?
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Starting with your premise that a legitimate branch of medicine must employ rigorous testing and experimentation and be guided in its practices by verifiable, universally valid findings, it follows that ANY medical practice not based on those is illegitimate. Just following your logical flow.
All branches of medicine, including psychiatry, aspire to that. There is not a single one – not one – that doesn’t to some degree fall short of that. Some fall more short than others, and there’s room for debate as to which ones fall more short. Think about those who treat fibromyalgia, migraine, irritable bowel, even cancer, and you’ll find practices not based on “universally valid’ findings. Based on that, I wouldn’t disqualify psychiatry as a medical specialty.
Schools of psychotherapy are about treatments within psychiatry ( and psychology and others). I believe that some of the standards you set here are met – not fully and not perfectly – by cognitive therapy, psychodynamic therapy, dialectical behavior therapy, and a few others. If you were to say that the diagnostic categories are not well validated, I’d agree, but that doesn’t change the replicated findings that some of those therapies help people who are diagnosed with those not-fully-validated conditions. In other words, some people are (not always) but predictably helped. Ditto for the ‘medical’ conditions I mentioned earlier treated by some methods.
I agree that cultural trends and attitudes do indeed affect how diagnoses are made, and that is a problem. I just don’t think it means we throw the whole specialty out the window.
Thanks.
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I would disagree that psychiatry in any way aspires to be guided by verifiable, universally valid findings. If it were, it would not deny obvious data that ECT, for instance, does serious brain damage. It would not deny, as it did for decades, that tardive dyskinesia is caused by antipsychotics, that antidepressants DO in fact have severe withdrawal effects, or that “ADHD” children who are “medicated” don’t do better in terms of outcomes than those who aren’t, to name just a few. You yourself said that psychiatry is not willing to admit that their drug selection and prescription was “trial and error.” How does this reflect a desire to operate on verifiable, universally valid findings?
I reiterate my question below that you have so far not answered: What scientific model is psychiatry guided by, that both explains “mental health” phenomena and accurately predicts them? So far I have not seen any such model in action.
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I think that part of why we are sparring is that we differ on 3 (at least) core issues. (1) I see most of psychiatry’s errors ( please allow me that broad term) as driven by mostly ignorance and hubris in the context of a conscious wish to be helpful. I think your view is more of psychiatry fueled by bad faith, greed, and a self-serving attitude with negligible good intent. You doubt its aspirations are to be better. (2) Though I won’t be able to come up with a model that fully meets your criteria, I don’t see that as inherently disqualifying psychiatry and psychiatrists from being able to do good. (3) I cannot so easily lump the many psychiatrists I have known and seen at work with the broad-brush criticisms that do somewhat apply to ‘mainstream psychiatry.” You can tell me I have some blind spots, and I’m sure that’s true, but I cannot accept a broad dismissal of the field based on the lack of a unitary powerful scientific model; humans are not fully understandable using science. If I did come up with one, how would you assess how well it explained mental health phenomena or predicted them? How good would it have to be to get your approval? Not a rhetorical question.
I won’t get into the data regarding ECT and “serious brain damage” because I don’t think we’ll agree on what that term means or how it’s measured.
I knew almost 50 years ago that TD was caused by antipsychotics. I guess some minimized it or thought the benefits to the patients were worth it. If you want to call that denial, OK, but I wouldn’t.
We haven’t known all that long about antidepressant withdrawal; I think psychiatry did miss that one big time.
The ADHD data is not so simple as you put it. It’s true that the diagnosis is fuzzy, but there’s also some truth to the idea that people diagnosed with it generally do better with stimulants. I can see how that might look like a house of cards. Here’s a recent complicated study that sheds some light on this complicated issue:
Kay BP, et al. Stimulant medications affect arousal and reward, not attention networks. Cell. 2025 Dec 24;188(26):7529-7546.e20. doi: 10.1016/j.cell.2025.11.039. PMID: 41448140; PMCID: PMC12834599.
And I’m glad we agree that groupthink is something to be mindful of, regardless of what group we’re in.
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As to ADHD, I’m talking about long-term outcomes. There really isn’t any good evidence suggesting that learning, high school completion, college enrollment, delinquency, teen pregnancy, or even self-esteem are improved in the long term by stimulant treatment. Sure, there are short-term effects that could be termed “positive,” though it depends on who is deciding what that means and who is “measuring” it. But any such advantages are temporary. No advantage is conveyed in the long term.
As to TD, no, it was complete denial by the “thought leaders” for decades, they blamed it on “the disease” or minimized its significance:
“Crane’s colleagues did not respond kindly to his efforts. He was, they suggested, making a mountain out of a molehill. Tardive dyskinesia, wrote Nathan Kline in 1968, was a “rare side effect” that is “not of great clinical significance.” Jonathan Cole, who previously had directed NIMH’s Psychopharmacology Service Center, described Crane as “a Cassandra within psychiatry” who was needlessly “foreseeing doom in many aspects of our current scientific and clinical operations.”
“Yet another physician, John Curran, chastised Crane’s alarms as “not only premature but misleading,” and reasoned that even if the drugs did cause brain damage, that wasn’t reason to stop using these drugs. “While it is true that any psychosis can remit spontaneously, I honestly do not see how one can withhold a treatment of proved efficacy for fear of inflicting or aggravating putative brain damage.” Others chalked up TD to brain damage from earlier therapies, particularly lobotomy and electroshock, or attributed it to the disease.”
https://www.madinamerica.com/2020/11/tardive-dyskinesia-brain-damage/
Now it’s certainly obvious that we “disagree” on the points that you mention at the beginning. But science is not built on AGREEMENT, it is built on OBSERVATION OF FACTS. I would certainly not accuse most psychiatrists as individuals of a CONSCIOUS WISH TO BE DESTRUCTIVE, and I certainly never said anything of the sort. But psychiatry AS A PROFESSION has been well aware of hard facts that undermine its claims and assertions, and has engaged in intentional propaganda to promote those claims, and has engaged in intentional attacks on those who challenged the “accepted wisdom,” as highlighted in the quote above. To add another example, depression was proven NOT to be the result of a “chemical imbalance” of serotonin as far back as 1985, before Prozac even came to market. Withdrawal symptoms from antidepressants were also well understood to exist by the publication of Toxic Psychiatry in 1992. But again, those who gave credence to such scientific FACTS were attacked as being “antipsychiatry” or called “Scientologists” or were simply ignored because the PROFESSION of psychiatry benefitted from the known FICTION that depression was caused by a serotonin deficiency. It took over 20 years for those facts to become accepted within the profession. This is not misguided hubris – this is an intentional marketing effort attempting to silence dissent due to the benefits of this particular fiction to the profession. The fact that most of this fiction was created by drug companies is of no significance – psychiatry as a profession was in the position to contradict such claims and yet chose not to do so, rather to promote them despite knowing them to be false. That’s beyond misguided. That is ill intent, and is observably and provably so, beyond you and I disagreeing in our personal views. Until and unless a critic is willing to recognize that ill intent and greed DOES in fact affect what the PROFESSION of psychiatry (as a profession, not as individuals) states and presents as “truth,” their critique will fall well short of describing the realities we are up against.
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Oh, and based on not answering my earlier question, now asked twice – are you willing to acknowledge that psychiatry does not have a scientifically valid and reliable scientific model on which to describe “disorders” or provide “treatment” for these putative “disease states?”
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Steve has researched this stuff heavily; he knows what he’s talking about.
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Thank you, Larry!
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Last things first: Yes, I am willing to acknowledge that psychiatry does not have a scientifically valid and reliable model for describing all disorders and providing treatments. Full stop. You put some terms in quotes, which suggests you don’t think they really exist. I can live – and have lived – with using existing flawed models with enough success to say that they do have usefulness to most patients I’ve seen. I doubt we’ll ever see a fully comprehensive, all-explaining and all-predicting model, so my job is to do the best in the meantime and acknowledge limitations.
About ADHD, I suppose we’d need to nail down what we mean by short- and long-term. I see you sort of agree that short term meds can be “positive,” but there are those pesky quotes again, so not sure if you really believe meds do even that.
There are some data in support of sustained benefits of longer term treatment. that is not the same as saying it’s therefore the thing to do, but to say there is no data would be not the full story. I appreciate that this forum is not the best place to parse this study or that.
Psychiatry was slow to recognize TD, and yes, it didn’t want to. Might not matter to you, but this was in the early years of psychopharmacology and some drugs seemed to really make a difference ( and we didn’t want to keep on with ECT as a mainstay). Set aside psychiatry for one minute – think of someone finding a new thing that seems to work better than anything you have till now – who is going to be eager to see the negatives? It’s a little like falling in love, and someone tells you your new love is not so great. Who’s going to say “OH THANKS FOR TELLING ME!” I don’t mean to make light, but these are human beings we’re talking about, even though you are trying to separate the evils of the psychiatry profession from individuals.
I know you see more ill intent in all of this than I do, based on what you observe. You could be right, but I’m also betting that if I inferred evil based on what I observed in you or anybody else, you’d tell me to be cautious. I might tell you I’ve seen enough to be sure it’s evil intent.
Again, for the nth time, I’m not saying greed or evil has played no role, but we just disagree on how big a part they play. The road to hell is often paved with good intentions as well as bad ones.
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The quotes around “positive” do not mean I don’t think there are things that could be called positive results. It indicates “positive” as a term that is used which is not clearly defined, and so something is “positive” in the view of the person making the evaluation. People can differ widely on what a positive outcome might be, and some of that does depend on their intent. For instance, if you’re a teacher, a kid sitting in his desk for longer periods could be termed a “positive” result. However, from the child’s viewpoint, they may have lost their sense of humor or feel lethargic or “zombielike” (all descriptors I’ve had kids give of their experience) and they would NOT consider the results “positive” in the least. So “positive” is only meaningful from a given viewpoint.
Saying that psychiatry “didn’t want to” accept TD as caused by antipsychotics is a good point of agreement, and goes directly to my point. If psychiatry is engaged in the scientific pursuit of truth, whether they WANT TO accept the causes of TD should not matter in the least. The facts pointed to the cause without question, and some scientists recognized it immediately, but it appears they were shouted down by the profession. It doesn’t matter to me why, it simply indicates that the intent of the group is not to promote science but to promote their product. TD was bad marketing, so they pretended it didn’t exist. This could have been considered a one off, a mistake or a matter of missing the boat this time around, except that there is one example after another after another throughout the history of psychiatry. This indicates psychiatry having an agenda that is NOT scientific. There are many things written about the creation of the DSM III that show this was not a big secret at the time of its writing. Psychiatry was trying to position itself to grab a larger market share, that was being undermined by therapists with Masters degrees. So they needed to push medical explanations, they INTENDED to push medical explanations, and the result is a system that insists on medical explanations despite lack of evidence, and yet denies negative outcomes despite strong evidence supporting them. This is NOT saying that psychiatric drugs have no value to anyone, nor that some people don’t like having a DSM diagnosis. This is saying that scientific inquiry is NOT the core of the DSM or any of the entire psychiatric endeavor. Whether or not that amounts to malfeasance I leave to the readers’ discretion.
Thanks for answering my question, BTW. It is reassuring to know we are on the same page about a number of things, even if our conclusions differ pretty widely sometimes.
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Well, Richard, we are circling back once more to our previous fundamental disagreement on the proper use of terminology.
I strongly object to such words as “diagnosis,” “symptom,” “treatment,” “therapy,” “psychopathology,” and “patient” when referring to individuals experiencing various, often indefinable states of emotional distress. These medicalized metaphors are not innocuous figures of speech, but are fraught with potentially harmful physical and emotional consequences for those unfortunates who are labeled arbitrarily with them by would-be professionals who lack a sound, credible scientific model informing their practice (as Steve aptly noted).
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Richard, you assert that “some” schools of psychotherapy are supposedly more effective than others. May I ask you what objective, verifiable criteria you employ in making this judgment? How can you determine the exact degree of efficacy?
Also, can you specify the percentage of clients who benefit from each of these supposedly effective therapies and those who derive no benefit at all?
It’s my assumption that a field that aspires to the status of a legitimate medical discipline should be able to justify its claims with data obtained through replicable findings. Otherwise, there is no valid reason for recognizing its credibility and authority.
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It’s a fair question, and I want to say a bit about how it’s complicated.
Psychotherapy – whatever kind – is not equally helpful for every condition, so to be exact, you have to see if Psychotherapy Type A is better than no therapy for Condition X. You have to have measurement sticks that are reasonable and valid and meaningful to the person being treated. You have to decide what is a meaningful different between treatment and no treatment. For example, f we find that Type A helps 70% and no treatment results in 45% getting the same benefit, we have to decide if that’s an important difference or not. And then a person with condition X should be informed off that data and then decide if they want it or not. You can plug other numbers in there and still have the same question. And we can ask if A works for X, might it work for condition Y, which seems similar to X. And so on.
What I just said applies equally to how you assess treatments for any condition – depression, diabetes, cancer, stroke, etc
There’s a whole lot more to how you get good data, like how long does the benefit last, what are the downsides…this is not at all a problem just in psychiatry.
I’ll paste here 3 studies that you might look at if you want to see more about how researchers and clinicians try to get at this.
Resick, P. A., LoSavio, S. T., Monson, C. M., Kaysen, D. L., Wachen, J. S., Galovski, T. E., Wiltsey Stirman, S., Nixon, R. D. V., & Chard, K. M. (2024). State of the Science of Cognitive Processing Therapy. Behavior therapy, 55(6), 1205–1221. https://doi.org/10.1016/j.beth.2024.04.003.
Forbes, D., Creamer, M., Bisson, J. I., Cohen, J. A., Crow, B. E., Foa, E. B., Friedman, M. J., Keane, T. M., Kudler, H. S., & Ursano, R. J. (2010). A guide to guidelines for the treatment of PTSD and related conditions. Journal of traumatic stress, 23(5), 537–552. https://doi.org/10.1002/jts.20565.
McLean, C. P., & Foa, E. B. (2011). Prolonged exposure therapy for post-traumatic stress disorder: a review of evidence and dissemination. Expert review of neurotherapeutics, 11(8), 1151–1163. https://doi.org/10.1586/ern.11.94.
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I have to say, as a practicing counselor, I never approached any situation from a statistical probability viewpoint. It is important to remember that if 70% of people benefit from a particular approach, that means 30% do not, and I would consider it my job to discover what works FOR THAT CLIENT, not to use Approach A that works for 70% and hope I luck out that my client is one of them. I much preferred Milton Erickson’s famous quote: “Therapy must be reinvented for each client.” It’s my job as a therapist to figure out what works for the person in front of me, not to play the odds and hope.
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BTW, I do want to acknowledge my appreciation that you are willing to engage in extended discussions on these issues.
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@Richard, I second what Steve says, and also wanted to add onto it. You’re approaching each “condition” as though it is the same problem & would therefore require the same solution, correct? Well, there are no “conditions” in psychiatry, only “syndromes.” By definition, every mental “disorder” in the DSM is a cluster of “symptoms,” not an explanation of their underlying “pathology.” That’s part of what makes “mental health” so fundamentally different from physical health. Surely, as a psychiatrist, you know this, right?
Okay, so Person A and Person B may both have the same “Condition X” — let’s say it’s depression. But they very well may have nothing in common beyond that. If the reason underlying Person A’s depression is a toxic workplace, and the reason underlying Person B’s depression is childhood trauma, do you really believe they both need the same treatment? Well, according to what you said above, they do, simply because they share a diagnosis! Let me go even more specific: Let’s say a new study comes out that says 70% of depression patients experienced improvement after quitting their current job, compared to 45% of those in the control group. (I’m keeping the numbers consistent for simplicity’s sake.) Well, that might make it the hottest new “evidence-based” treatment for depression! So as a psychiatrist with two patients presenting with depression, you would recommend both patients that treatment, since they share the same “condition,” right? But regardless of what the “evidence” shows, common sense tells us that that treatment is only going to work for one of those patients — Person A — because it directly addresses the cause of their depression, whereas it has nothing to do with the reasons for Person B’s depression! On the other hand, what if the “evidence-based treatment” in question is some form of trauma therapy or psychodynamic therapy? Well, in that case, it’s probably going to help Person B more than Person A, because it does nothing to help Person A’s ongoing workplace situation, which is the source of their distress.
I guess the only way one could honestly look at mental health & physical health in a comparative way is by recognizing that “mental health disorders” are SYMPTOMS, not diseases themselves. So one physical health ailment that might be comparable is a fever. A fever is not a “condition” in & of itself, it is a symptom that can have many underlying causes. It may actually inform very little about treatment. If you have two patients who both present with a fever, would you give them both antibiotics? What if one of them has a fever due to the flu, and the other has strep? Well, since strep is a bacterial infection, and the flu is a virus, antibiotics would only be effective in one of them, even though they may both have a fever & other overlapping symptoms.
Another physical symptom that could have many potential causes: abdominal pain. But what if we treated abdominal pain as a disorder itself? And what if we found that “Abdominal Pain Disorder” improves in X% of patients after removing their appendix? Are we gonna just go around giving everybody who has abdominal pain an appendectomy now? Well, it’s the “evidence-based treatment” after all! But obviously it’s only helping X% of patients because those were the percentage of patients whose abdominal pain was caused by appendicitis in the first place! What about the others? What about someone whose abdominal pain is caused by pregnancy? Menstrual cramps? Celiac disease? Or maybe they just had really bad gas? Well what if we found the most effective treatment for “Abdominal Pain Disorder” to be Gas-X? Should we just give all patients a prescription of Gas-X and send them on their way? I’m probably beating a dead horse at this point… you get the idea…
In summary, anything “mental health”-related is a SYMPTOM, not a “condition,” and symptoms, whether mental or physical, are signals that something is “off” in a person’s life or body. Treat people as individuals, not “disorders.”
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Very nicely stated, Jasmine!
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Fantastic rebuttal, Jasmine. The best I’ve ever come across.
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Yes, Richard, I do indeed maintain that any field that wishes to be recognized as a full-fledged branch of medicine or science should be able to justify its claim to such a status.
History is replete with examples of crackpot notions and speculations that aspired to wear the mantle of scientific respectability, e.g. Benjamin Rush’s concept of excess blood flow as a cause of insanity, drapetomania, eugenics, Wilhelm Reich’s orgone box, Freud’s death instinct, the serotonin deficiency hypothesis, and last but not least, the fictitious categories of the DSM.
Bruce E. Levine, among others, has written about the overweening ambition of psychiatry to win acceptance in the medical community despite its sorry decades-long record of abuse, corruption, denial, and cover-ups.
In view of these well-documented facts, it’s not at all unreasonable to conclude that whatever “good” many be achieved by individual practitioners, the mental health field in general serves no socially beneficial purpose and deserves the same fate that rightly befell the other discredited pseudo-scientific fantasies mentioned above.
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Joel – you asked some good questions in your previous post which I attempted to address as directly as I could. Your latest response seems to have blown past them, and you reverted to deploring psychiatry’s past and current failures. Just saying that it’s not the kind of post that suggests you want to have an exchange other than to restate your views. I’m not here to debate the truth of your views, just to point out it’s not a conversation you seem to be after. Respectfully, if you want to continue this with me, that would have to change if I’m going to respond again.
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Well Joel, maybe a little encouragement is what’s needed here? I don’t know what is meant by “Future Psychiatric Survivor”, because one cannot presume to survive an unspecified future. But to presume one’s self to survive psychiatry for one’s unforeseeable future, is pretty much the fate of a crash test dummy. In this respect, I at least hope “Future Psychiatric Survivor” has procured grants and all manner of well-deserved funding for the undertaking of surviving his/her “psychiatric future” … In the interest of all “future psychiatric survivors”, I’m confident the APA would be all too happy to provide generous funding for our trailblazing interlocutor!
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I hate to put you on the spot, but this looks like one bad idea replacing another bad idea.
Metabolic “psychiatry” might be a much improved handling for the BODY. But psychiatry is supposed to heal the PSYCHE, not the body.
Regular Medicine requires reforms, too. And the metabolic approach would probably be a good reform. But that’s Medicine; body health. Some of us here argue – and I think for very good reason – that Psychiatry per se should not be a part of Medicine. Unless Medicine moves into the field of the mind, which it could do in some form, the mind stands as its own subject, and currently outside the scope of Medicine. Mind and body are of course tightly connected, which causes them to be confused. But they shouldn’t be. It has been demonstrated that the mind is not a bodily organ or some part or aspect of any bodily organ. It’s its own thing. And the first step a proper Psychiatry would have to take would be to recognize that.
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Truly, I’m not sure what metabolic psychiatry is; it’s not yet considered a branch of the field, and it might mean different things to different people.
Actually, psychiatry derives from psyche as in soul.
Efforts to meaningfully draw a line between mind and body have not been useful in medicine. Just ask a PCP, or someone treating addiction, pain, postpartum issues, cancer, hormonal problems…it’s a long long list.
Also, if by psyche you mean “mind,” it seems to me true that there is no mind without a brain, which is intimately connected with the rest of the body. If you don’t agree, then where is that mind? If it’s, as you say, its own thing, where is it? If you mean the soul, that takes us in a different direction and presents us with the challenge of defining soul in a way that there’s consensus on. So, again, trying to draw a line is way easier said than done.
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“Metabolic psychiatry” basically posits that many symptoms thought to be mental disorders are actually caused by metabolic problems and can be cured by changes in diet and reduction or elimination of drug use. Early work showed that a strong ketogenic diet cured some people (often children) of epilepsy. Similar results have been seen among autistic children. The first return in my search engine is from Stanford Medicine, highlighting the work of Dr. Shebani Sethi. They have a Facebook group (Stanford Metabolic Psychiatry) with about 1,000 followers.
Now, here is an example of groupthink in Psychiatry and in Medicine: “Efforts to meaningfully draw a line between mind and body have not been useful in medicine.” This is rubbish; yes, it has been useful! But it does break the biological model of mental illness.
It has been discovered by a variety of researchers – some even psychiatrists (Ian Stevenson) – that the mind and body are in fact separate. Past life recall has been verified as real, and this could not take place if the mind and brain were totally co-dependent. Other work, which could be considered more esoteric and may not actually be that helpful, sees the mind as an energy field more or less surrounding the body that it controls and of course intimately connected to (but not the same as) the body’s nervous system.
I accept the above facts without question, though I realized this is a big stretch for anyone trained in traditional science and medicine. Further, various past life regression techniques perfected by various differed practitioners have yielded very good results both in the field of mental health and in the field of body health. That’s why I say “metabolic psychiatry” cannot possibly be the entire answer. It’s about body health. Of course a being feels better when its body is healthy. That goes without saying. But there are very healthy beings who are very mentally ill. And the fact that the mind is separate from the body is the basic finding that leads into answers for mental problems that have no obvious body health correlate.
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There are some mental disorders linked to nutrition and diet. Most – so far – have not been linked as causal. Better nutrition is always a good thing, but it’s usually not specific to some disorder.
Metabolic psychiatry is a new and somewhat imprecise term, but if it leads to good things, I’ll be a cheerleader.
That somebody has a lot of followers means nothing about its validity; many whom you probably think are full of crap have more followers, so that proves nothing.
People have tried for centuries to solve the mind-body problem. You may well think it’s settled. You could be right, but I don’t think so.
Accepting “facts without question” not only is a big stretch for almost anybody, and it’s a little surprising that you are doing so.
There are many who believe that being ‘very healthy’ includes both mental and physical health, not just physical as you seem to say.
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One reason nutrition will never be found to be causal to a particular “disorder” is the assumption that all people suffering from that “disorder” have the same problem and need the same remedy. The DSM itself disavows any such assumption it its introduction, but apparently that is either not read or ignored by most practitioners. If nutrition solves, say, 20% of ADHD cases, it will be regarded as “ineffective against ADHD.” But that’s 20% of ADHD cases that could be eliminated with diet! I’m sure you are aware of the multiple studies showing that a 30% reduction in ADHD diagnosis is effected simply by putting a child in school a year later. Iron deficiency and sleep apnea have also been implicated in a significant minority of cases. Clearly, there are multiple causes and multiple possible solutions to this particular problem, but calling ALL of these cases “ADHD” means that solutions that peel off a significant percentage of the cases are dismissed as “less effective” because they don’t affect a large enough PERCENTAGE of these “cases,” which are clearly so heterogeneous in origin as to never be able to yield consistently to one approach.
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OK. Well, we are closing in on the end of these conversations. But I write for whoever may come later to read this over, not just for those directly involved now.
Steve has done the best he can to explain his point of view on this. But to be a little more obvious and crass, many of us believe that the whole business of classifying human behaviors into “mental disorders” is wrong minded, if not even that true to the medical tradition.
A patient presents with a pain in his arm. Do you assign that symptom to a physical disorder? No. You have to find what’s really going on, then treat that. Maybe it’s easier with physical disorders. But if it’s a broken arm, it needs to be set, and the exact way it is set depends partly on the exact way it was broken. And if the pain is caused by something else, putting the arm in a cast is unlikely to help.
Now, a patient presents with the origination that they “feel depressed.” So, they get the label “Depressive Disorder.” And many practitioners, for various reasons, will take it no further and write a prescription and send them on their way. That’s not only bad psychiatry; that’s bad Medicine.
To be fair, many mental phenomena are more obvious than this, like the phobias. While others are quite nebulous.
By the way, how does psychiatry treat phobias? I rarely hear that subject discussed. I know that Steve Burgess would normally attempt to regress the person to an incident (of the patient’s own choosing, by the way) that bears on that phobia in some way. Other workable practices use a similar technique. Certainly, there is no drug that treats a fear of spiders!
But that’s the point. The whole approach is off. And I believe it’s off because, basically, psychiatry has no clue. You don’t even know if the mind and body are separate things.
When I stated, by the way, that I accept this “without question,” I would say the same thing about assertions regarding the shape of the Earth. So many researchers have demonstrated its globe shape, that there is really no point to question that finding further. It’s been known for years and it’s a workable finding.
And the same is true of body/mind duality (or whatever you want to call it). It’s been known about for years, and it’s a workable model. Most psychiatrists don’t know this, but is that because of their “groupthink?” I just call it ignorance, arrogance and lack of real curiosity or in fact lack of any real aspiration to do better. That is in many ways overly condemnatory. But what else am I to think?
If someone in engineering or science refused to extend their work starting with a working model, they would be condemned as fools. My training is in engineering. What am I to think? They won’t even seek out other models that work for others and try them themselves. What other conclusion can I come to?
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The first things this piece brought to mind for me were these three logical fallacies:
1. The middle ground fallacy
2. Attacking a straw man fallacy
3. False equivalency
Also this sociology paper titled “Fuck Nuance” (Healy, K., 2017)– yes that’s literally its name– and a video essay that references it: https://youtu.be/f9CMRMg0zjY?si=Piw3fx48TTvwP5Kg
I highly recommend reading and/or watching those if you’re bored and have 45+ minutes to spare.
Anyways, I have a lot more thoughts on this piece… not sure if it’s worth my time to share them all here though. I might have more to say later, might not, we’ll see.
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Hard not to be intrigued by a paper with that name. I will read it.
And if you opt to say more, I’ll read that too
I don’t want to read anything into the 3 fallacies you cite. I’ll just say, for myself, that I’m not seeking some ideal middle ground, or that everyone has equal responsibility for the problems in mental health care. My essay is about groupthink, which every group is at risk for; some groups have a lot, some less, and maybe a few have none. Groupthink is not the central reason why we have the problems we have, but it’s a force that is counterproductive.
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Thanks for your reply. I hope you enjoy reading the paper. I thought it was relevant because you mentioned the need for “nuance” and “shades of gray” (especially in your analysis of critical psychiatry).
If your essay were only about groupthink, and how it can become a problem in any or all groups if left unchecked, then I would totally be on the same page as you. However, you appear to be saying & implying a lot more than just that.
I’ll elaborate a bit on those 3 fallacies and where I found them in your essay.
1. Middle ground fallacy — “Both mainstream psychiatry and critical psychiatry are missing possible chances to find some common ground.” … “Both are partially right. Both should correct each other’s excesses without invalidating everything the other believes.”
Though you don’t use the word “middle ground” specifically, you are alluding to it with words like “common ground” and “correct each other’s excesses.” The underlying premise of the middle ground fallacy is the notion that the truth/ best possible solution must always lie in the middle of two extremes or opposing positions, ignoring the possibility that one or both sides may be entirely correct or entirely incorrect.
2. Straw man fallacy — “[Groupthink in critical psychiatry] can lead to absolute judgments about mainstream psychiatry, such as ‘medication is always bad,’ ‘no diagnosis has any validity,’ or ‘all psychiatrists are manipulated by drug companies.'”
It’s easy to dismiss an argument if you put it in such black-and-white terms: “always,” “never,” “all,” etc. I rarely, if ever, hear critics of psychiatry making such statements seriously. Most of us acknowledge that SOME people may feel helped by medication, not ALL psychiatrists are evil, etc. However, I would have to disagree with your portrayal of “no diagnosis has any validity” as a false statement. If we’re talking about scientific validity, that is simply true. If we’re talking about some other type of validity, then I don’t even know what you mean by that.
3. False equivalence — “Similar to how mainstream psychiatry often views critical psychiatry as having little merit and can’t or doesn’t ‘understand the full picture,’ it’s also true that some within the critical psychiatry world see mainstream psychiatry as without merit, harmful, evil, greedy, and acting with no scientific or other basis for what it does.” … “Although there’s no way to measure which group’s groupthink is more problematic, fairness calls for critical psychiatry to look inward if we’re going to demand that of mainstream psychiatry.” … “How powerful these forces are is open to debate, but to say they’re nonexistent would be akin to saying they don’t occur in mainstream psychiatry.”
Comparing mainstream psychiatry’s pitfalls to critical psychiatry’s pitfalls is like comparing apples to oranges. First of all, without acknowledging the institutional power that mainstream psychiatry holds over critical psychiatry, you’re inherently tipping the scales in mainstream psychiatry’s favor, portraying both sides as “equal” when that is not the case at all. It’s a bit absurd to claim that “there’s no way to measure which group’s groupthink is more problematic,” and that “how powerful these forces are is open to debate” when one side CLEARLY has more social & economic leverage than the other, and thus, more widespread harms.
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If you’ll allow me, there are some fallacies intermixed with some truth in your post. What I wrote was not intended to be, as some have read it, some kind of defense of mainstream psychiatry. Some have read that into it, but that’s not on me. And I was limited to 1200 words, so covering everything was not an option.
My essay is about groupthink as a FACTOR in how both mainstream and critical psychiatry conduct themselves. It’s incorrect to say I’m saying it’s the most important one, and it’s also incorrect to say that my essay is stating that both sides are equally dug in or equally at fault for what goes on in mental health care. I tried to carve that out in what I wrote.
I didn’t say – and I don’t believe – that some solution means meeting in some idealized middle, halfway for each. No question that the power differential means mainstream has to go further. I am saying that both need to look at their own groupthink – that is the only equivalence here.
It’s a little like a marriage in which one spouse is an abusive drinker and the other is an enabler. yes it takes two to tango, but no, the former has more responsibility to change than the latter.
About the straw man, groupthink leads to more absolute statements, all the more reason to keep it in check. My experience with MIA here is that I see more such statements than I see in my reading of psychiatry. There are more than a few who believe the field is inherently illegitimate; I see that as extreme, and it pretty much shuts off debate.
Meanwhile, looking forward to the nuance paper this weekend.
thanks
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Thank you for your reply. You’re right in that i was probably jumping to some conclusions in my critiques made above. I recognize that this is a relatively short piece focusing on one particular issue, and is therefore limited in scope, nor is it representative of your overall views. However, where are you getting the idea that you are limited to only 1200 words? I’ve seen you mention this at least twice now. As someone who’s written for MIA before, I can assure you that there is no submission type (that I’m aware of) that has an upper limit of 1200 words. In fact, even under the new guidelines, the submission type with the lowest MINIMUM requirement still has a lower limit of 1250 words. (If my memory is correct, the old guidelines were 1500-3500 words for all blogs/essays.) For blogs, you can write up to 2500 words, and for essays, up to 5000. Hopefully that helps so that in your next piece you won’t feel so rushed.
Here’s the up-to-date submission guidelines if you want to read the rest: https://www.madinamerica.com/submitting-a-blog/
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FYI – I was told by Bob Whitaker a month or so ago that MIA was making changes in their submission categories and process. that meant submitting a proposal to Peter Simons first. I did so and he informed me that mine fit in a category that limited me to 1000 words, which he generously extended to 1200.
I was a little surprised when my current essay showed up under ‘blogs’ category, but I was just glad that it was accepted.
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@Richard: Huh, that’s interesting. Maybe they weren’t sure what they were going to change it to yet. Well, now ya know what the new guidelines are, at least.
Anyways, I hope you enjoy reading the “Fuck Nuance” paper!
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Nicely said! “Economic leverage” feels like a good example of a broader kind of groupthink that isn’t science-based, yet is widespread enough to shape daily life—and to generate real widespread mental distress.
We often insist on scientific evidence and proof when discussing mental suffering, while overlooking that many of its causes are rooted in social agreements rather than empirical truths.
The value of money, for example, cannot be established by (natural) science—it exists because people collectively believe in it and organize life around it.
Once the value of a dollar is accepted, economists can make a science out of it. Economics (exclusively) describes behavior of those who “understand” the value of money—albeit a very large group.
When survival depends on that belief, financial insecurity becomes psychological insecurity. And all kinds of grief is introduced by “financial necessity.”
The resulting distress is individualized and maybe medicalized, while the broader belief system producing it remains largely invisible.
Is understanding the value of money groupthink (in this case imparted via effective indoctrination)? Recognizing our (co-)dependence on it, could it be considered an “addiction”?
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good points
so much of what we’re talking about is not capable of being nailed down by science, and that’s more a matter of the cards we’ve been dealt than a failure of science ( and psychiatry. Part of this is trying to sort out what science can tell us – and what it can’t, in which case we should be proportional is both what science – medicine- psychiatry promises and what the rest of us criticize them for.
Being dependent on something is not, in my view, the same as being addicted. I don’t find it helpful to equate the two. I guess we’re all addicted to air in that sense, which doesn’t really convey much meaning.
We need ‘enough” air and, more squirrelly, “enough” money. Folds back on how much is enough; to say none makes little sense, and to say there is no such thing as enough can lead to a lot of evil.
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I take your point about addiction vs dependency, and I agree they aren’t the same thing. What I was trying to point toward is the difference between necessities imposed by nature and necessities imposed by human systems.
Air is required because of biology. Nature requires this dependence. Money is required because we’ve collectively organized life that way. We depend on air because nature says so; money is a manufactured dependency of our own creation.
When a human abstraction like money is treated as a fact of nature, dependence on it can feel inescapable in a different way—and that’s where I see much psychological harm entering.
Just by the way, something that seems to align with what Jasmine was saying:
Look at a stand of aspens—thousands of trees rising together. But it isn’t thousands of organisms. It’s one single living system, sharing the same DNA, connected underground by one root network.
And yet, no two trees look exactly alike. This one has a branch where the one beside it doesn’t. The trees along the edge of the hill are shorter than those in the middle. Some lean. Some twist. Some bear scars.
It can appear as though these are separate individuals, and that some are simply more resilient, stronger, or better than others.
But the differences aren’t the result of individual character or disorder. They’re the result of conditions, of lived experience.
Some trees receive more light. Some endure more wind. One was chewed by a deer when it was young. Another was stepped on by a bear. Some grew sheltered; others were exposed. Each tree carries the history of what it encountered.
We don’t—and can’t—know all the factors that shaped each one. But one thing is clear: assigning cause or responsibility for these differences to the individual trees would be absurd.
They share the same nature. What differs is what they were exposed to and what life asked of them.
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My intended previous post, surrounding the middle ground fallacy and false equivalence, was RIGHTLY and thankfully flagged by Steve McCrea, so I just canned it altogether. But given Jasmines well elucidated points here, I want to point out a particular feature surrounding false equivalence that largely go unaddressed, of which I think of as the “negative differential” (e.g., Saussure, etc.). In the metaphorical sense, the negative differential isn’t the difference between apples and oranges, per-say, but more so the difference between apples and hand grenades (per-to make my point clear, only). In this respect, the negative repercussions generated by mainstream psychiatry and the “negative consequences/repercussions generated by critical psychiatry, are where the real differences in false equivalencies are “suppressed” (and unconsciously denied and defended as a matter of discourse). The “negative consequences” rendered by critical psychiatry primarily revolve around the dissemination of troubling and uncomforting information, bruised egos, challenging vested interests, and so forth. But the negative effects from mainstream psychiatry are rife with adverse life consequences to not insignificant human populations, unnecessarily compromised care (usurping far more effective known care/therapies), the systematic overuse of drugs to treat non-medical conditions rooted in interpersonal and social systems of dysfunction and abuses. I could continue on in this vein for quite some time, but I believe I’ve made the important point here, however otherwise better unpacked and detailed in Steve McCrea’s above responses to the author of this blog.
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LOVE THIS COMMENT!!!
Hugely relieving to read something that actually grasps the true meaning & nature of nuance.
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Psychiatry treats its own framework as reality rather than interpretation.
Inside that worldview, its authority feels objective rather than constructed.
Epistemic capture is invisible from within the system that’s captured.
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Well said (as usual and thank you). It makes me think about what I’ve been calling “systemism”—when a system begins to define what counts as real, reasonable, or true. We see this in scientism , where a useful lens hardens into a worldview. I like science, don’t get me wrong.(Economism is another example.)
But statements like “it isn’t true unless/until science proves it” point to scientism, where science shifts from a method of inquiry into a kind of final authority. (Where science becomes a religion?)
Psychiatry offers a “captured” lens: a paradigm for understanding human distress that, once institutionalized, starts to feel (to practitioners) like objective reality. If an explanation or understanding doesn’t fit the paradigm, it must be uninformed and suspect.
One way I think this happens is through abstraction. Systems extract whatever their lens can recognize and process, while externalizing everything else. What gets seen, categorized, diagnosed, or managed comes to stand in for the whole person (or a collection), while history, context, relationship, and interior life fall out of view. A person becomes just another number (or pick your label according to whichever system’s lens is being focused).
Over time, the abstraction can (to practitioners) seem more real than the living humans it represents.
People are treated as instantiations of an abstraction rather than as a whole person. That’s how systems (and practitioners) can sincerely believe they’re addressing “the problem,” while missing the person(s) almost entirely.
Trying to manage a “case” of abstraction isn’t useful to a person (or a people) needing first to be understood. To manage people as abstractions is mismanagement, a system error created by the systems themselves.
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Nothing humans do can capture the entire picture, especially when it comes to other humans.
One of my favorite quotes says that “everything that counts can’t be measured and not everything that can be measured counts.”
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Remember, though, that this is an example of groupthink that is prevalent throughout the social sciences. There is ample evidence that the traditional “limits of human knowledge” are a fabrication, and that a much deeper level of knowledge is possible. That doesn’t mean it is easy to achieve.
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Thanks Dan. You truly get it 🙂
Mainstream psychiatry doesn’t know the difference between objectivity and interpretation.
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The argument presumes psychiatry’s framework is reality.
It operates from inside the worldview it critiques.
Epistemic capture conceals itself from those shaped by it.
An unexamined premise underlies the entire frame, making its own groupthink unreadable from within.
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Right.
The task is get outside one’s insular view and defy the groupthink that keeps it going
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Mainstream psychiatry isn’t very good at that. It habitually resists doing that for reasons it habitually denies.
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Coined by Irving Janis (see first link to his 1971 Psychology Today article), groupthink recalls the 1951 Solomon Asch conformity experiments (Asch conformity experiments), and Stanley Milgram’s 1961-62 work (Milgram experiment). Groupthink describes a phenomenon more than explaining it. As the word ‘conformism’ more clearly communicates, groupthink doesn’t simply arise spontaneously and naturally but in response or conformity to social pressures of which it is derivative, downstream from its source. And as Milgram’s work strongly suggests, the source is the force of authoritarian relations among people.
This leads back to Janis’ work, as it’s situated in state power relations, addressing policy ‘failure’ like the Kennedy administration’s Bay of Pigs fiasco, mentioned above. This and other cases supposedly show poor planning as the result of cognitive constraints from groupthink upon its ‘victims’ (repeatedly impressed upon readers), and Janis’ aim, or service to power, is to correct that for the purpose of improved planning (see his concluding recommendations). Curiously, his work roughly coincides with David Halberstam’s The Best and the Brightest (1972), echoing essentially the same theme of intelligent policy planners stumbling into errors of judgment if not stupidity, also making use of groupthink. Both echo the theme heavily propagandized to explain, or rather excuse, the war in Vietnam and SE Asia as mistaken but best of intentions to come to the rescue of people as the defender of the free world, or whatever variation on such humanitarianism and noblesse oblige could cover for crime against humanity. ‘Oops, sorry! All that death and destruction was the fault of epistemology (but not evil!). Our bad!’
This isn’t to imply the same spin is applied here to psychiatry – ‘Oops, we didn’t really mean to fry your brain with electroshock, or chemically lobotomize you with MK-Ultra mind control!’ – but to explore a bit more background to groupthink. So back to the Bay of Pigs, for starters. Its actual operation was the result of conspiracy, hatched at the time of the 1959 Cuban revolution when then VP Richard Nixon plotted with the CIA and Mob to overthrow Castro and ‘communism’, largely behind Eisenhower’s back in expectation that Nixon would succeed him. When Kennedy became president instead, he was happy enough with the plan, as long as it involved pro-Batista Cuban exiles, not US troops. The invasion occurred to maneuver him into direct military intervention, not just by proxy, and failed when he refused (contributing to conspiracy to eliminate him with extreme prejudice).
One might say this additional information still confirms relevance of groupthink, as if conflicting agenda of state bureaucracies end up at such odds as to bury the other by reason of unreasoning entrenchment. But that would continue to mask the nature of state power at war with internal as well as external enemies. And it seems such naked power is what the powers that be don’t want the many of us to see. That’s why WW2, for instance, did not simply begin with the attack on Pearl Harbor, as Janis also brings up, being no more than ‘failure to be prepared’ for a surprise attack, but a carefully crafted set-up by the Roosevelt administration to draw the Japanese to war by moving the Pacific Fleet from California to Hawaii, among other provocations behind the backs of the propagandized public. That’s why most major events affecting ‘our’ society are planned in the first place to disguise what’s really going on, why the very nature of rule by the few necessitates constant conspiracy, planning behind closed doors from the get-go with the coup to create the U$ constitution’s centralized state power on behalf of capitalist class rule, hiding in plain sight how ‘our’ social relations are governed by bizzness as usual of organized crime working behind the pomp and circumstance of rule of law.
Recall WW2’s Manhattan Project, a vast conspiracy across the nation to build the Bomb. It worked by means of ‘compartmentalization’ overseen and enforced by Lt. General Leslie Groves, key aspects of which were:
Need-to-Know Basis: Information was restricted; scientists often did not know what colleagues in other departments—or even in adjacent labs—were doing.
Physical and Logical Isolation: Major, geographically dispersed sites were used (Oak Ridge, TN; Hanford, WA; Los Alamos, NM) to prevent information leaks.
Security Measures: Employees were issued color-coded badges indicating clearance levels. Workers were warned that unauthorized disclosure was punishable under the Espionage Act.
Information Silos: Workers constructing facilities often did not know what the buildings were for. For instance, individuals at Oak Ridge worked on uranium separation without understanding the end purpose.
Control over Scientists: While scientific director J. Robert Oppenheimer required some information sharing for scientific progress, Groves fought to keep teams separated to prevent unauthorized, broad understanding of the bomb’s design.
These features weren’t invented then. They had long been researched and developed in industry where owners waged class war upon the divisions of labor with such ‘scientific management’ as Frederick Taylor pioneered. In other words, this kind of industrial and military engineering may be extended in front of our faces from behind our backs throughout the entirety of society. That includes the professional classes who for the most part, despite diverse composition and exceptions to consensus, serve as middle managers of population control by monopolized and monetized knowledge gatekeeping access to resources; like that of ‘health care’, both a commodity for profit and means of social engineering by never-abandoned eugenicist agenda under humanitarian cover, experimenting on us with drugs tested and approved by partners in crime at state regulatory agencies, dispensed by dutiful doctors drug-pushing everyday patients, legal apparatus favoring the former in case of accident and injury to the latter (Oops!), promoted as product in mass media to the exclsuion of alternatives…and so on and so forth on down the assembly line of everyone just doing their jobs.
It’s compartmentalized thinking, prior to groupthink, which keeps the machinery in motion, and explains how so much ‘progress’ in the control of human resources does not proceed randomly and separately among free people liable to make mistakes, but is by design a centralized system of power over us, as much as it says it serves us. And just doing our jobs, thoughtlessly, is how Hannnah Arendt described the ‘banality of evil’ by which monumental crime against humanity is made possible for more malicious masters at the center of power.
We live in the matrix, and it’s the real madhouse. It’s unlikely ruling institutions and their professional ranks will substantively change from within without common people who form the mass base of society rising in revolt for a better life among us all. Just think of the psychiatric survivor movement showing up the pseudoscience or gays exposing the fraudulence of homosexuality as a ‘disorder’ likened to disease, if not the whole insupportability of the DSM having anything to do with diagnostic criteria rather than politics, and deals behind closed doors. These are examples of how true progress has only ever been realized for any of the many under the rule of the few, breaking ranks with bizzness as usual to become co-creators in more compassionate and caring and just relations of society. That’s why it’s up to us to be the change, why we’re the ones we’ve been waiting for.
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John – thanks for this, which is thoughtful and, somewhat amusingly to me (no disrespect intended), longer than my essay.
It’s not really feasible for me to respond in detail, but I do appreciate the time and thought you put into it
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Ha!, I was thinking the same thing by the time I finally finished, both in regard to being longer, and in being so probably (but not intentionally…) making it more unfeasible for response.
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Thanks for telling it like it is, John. A real eye-opener, that’s for sure.
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Links to Asch and Milgram experiments (Wikipedia):
https://en.wikipedia.org/wiki/Asch_conformity_experiments
https://en.wikipedia.org/wiki/Milgram_experiment
And the section above on compartmentalization’s key aspects came from an AI entry on the Manhattan Project.
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Well, I mean… I liked the article? Thought it was nice. I can appreciate it without having to agree with every word, and I’m glad it was shared.
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thanks – I’m glad you liked it. Agreement not expected or required or even requested.
you’re a good egg
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In response to Steve’s several comments, which are a little scattered throughout the others and somehow don’t provide a “Reply” as they usually do…
(1) thanks for your gracious comment about my encouraging longer discussions here with you and others. I so appreciate that
(2) I am also a huge Erickson fan and have been since the 70’s. Although it’s somewhat true that therapy has to be reinvented for each patient, it’s equally true that a good therapist has learned from what other patients have said and experienced, and what worked or didn’t with them. So it’s not quite starting anew with each new person. We bring that prior experience to bear and are mindful not to make too many assumptions. To bring ADHD into the mix, as you did separately, a person who tells me they have ADHD, as I’ve heard many times before, earns a deep dive into what that means to that person. That dive is informed by previous people who either – in my view – didn’t ‘have ADHD, do have ADHD, have ADHD and some other issue. I’m not running to offer adderall.
(3) I don’t find the DSM ADHD category particularly helpful, but I don’t entirely discard it.
Ultimately, the patient is the final judge of what constitutes a (here come your quotes) “positive” outcome. 2 people with ADHD (I know you don’t see that as valid) can have 2 positive outcomes that might not overlap. It’s not exactly science, but I am still glad they had those positive outcomes.
(4) Whoever was the first to refer to DSM as the ‘psychiatric bible” should be drawn and quartered. I’m pretty sure it’s the media to blame, not the APA. I have written more than a few times or called into talk shows to try to point out how detrimental and misleading that is.
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I appreciate your reply and in focusing on the areas we agree. I think a client seeing a psychiatrist would be fortunate to have run into you. I agree, of course, we bring our prior knowledge and experience into play as therapists, so we aren’t starting from scratch, but vis-a-vis THIS client, I always start with the assumption I know absolutely nothing about them despite what their “diagnosis” might be. They get to tell me what is “wrong” if anything, and they get to decide what a “positive outcome” means to them. It sounds like you do use a somewhat similar way of thinking about outcomes.
No, it’s not exactly science, is it? And we’d do better to admit that fact. I actually think it is fascinating that the term “Bible” emerged spontaneously to describe the DSM. I am afraid I find the designation ironically quite apt, as it requires a certain level of faith to believe in these utterly subjective “diagnoses,” which as Jasmine rightly points out, are at best syndromes and not “diseases” or “disorders” in the medical sense. I don’t find it misleading in the slightest.
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Psychiatry has never been good at examining its own groupthink. If it could, this entire conversation would be unnecessary.
The profession habitually resists meaningful self-reflection — and just as habitually denies that resistance.
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