Over the past several years, psychiatrist Awais Aftab has cultivated a public image of being an open-minded critic of his own profession, and as a result, he is now regularly the go-to source for media reports on challenges to psychiatric treatments and its diagnoses. However, this public persona obscures the fact that he is serving the interests of his profession, protecting its authority over this domain of our lives, and regularly doing so by attacking critics of psychiatry.
Normally I don’t pay any attention to his writings, even when a Substack post may send a few slings and arrows my way and at Mad in America, but his latest, titled “The Szaszian Heart of MAHA Psychiatry,” comes at a time when discussion of the merits of psychiatric medication has entered the “news cycle,” and thus I think it would be helpful to write a response. It provides me with the opportunity to make clear the nature of Mad in America’s “critique” of psychiatry, and, at the same time, to let readers see, through a deconstruction of his post, the rhetorical methods he employs when defending psychiatry from its “critics.”
Here is how the news cycle unfolded. On May 4, the MAHA Institute hosted a daylong event titled “The Mental Health and Overmedicalization Summit,” which was organized in large part by Laura Delano and her Inner Compass organization. At the end of that event, RFK Jr announced that HHS would seek to curb the overuse of psychiatric medications and provide support for patients to safely taper from their drugs, and also promote non-pharmaceutical therapies.
The New York Times then published an article by Daniel Bergner on May 15 titled “The Strange Alliance Trying to Remake Psychiatry.” He treated the May 4 event in an inquisitive manner, as opposed to a condemnatory manner, and he contacted me to ask what I thought of the event. I said I applauded Laura for her efforts to “open up a crack in the narrative” put forth by American psychiatry, but I also said that describing the problem as one of “overmedicalization” was a mistake. The “over” language implied that the problem with psychiatric care today was simply one of too much—too many people being diagnosed and treated with drugs, which could be seen as validating the disease model of care. It was not a reform of the disease model that was needed, I told Bergner, but rather a paradigm shift in psychiatric care.
This position is embodied in our Mad in America mission statement on our website.
Mad in America’s mission is to serve as a catalyst for rethinking psychiatric care in the United States (and abroad). We believe that the current drug-based paradigm of care has failed our society, and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.
Then, on May 16, Aftab published a post that was set up as a response to Bergner’s article. Here is how his piece unfolds in regard to me and Mad in America.
The Title and Opening Paragraph
The title of Aftab’s post is “The Szaszian Heart of MAHA Psychiatry” and his first paragraph states that the NY Times article “obscures what is most distinctive, and most contestable, about the Moncrieff-Whitaker-Delano brand of psychiatric critique.”
Now, I have to confess I was quite surprised to find myself named in the opening paragraph of a post so titled. What was I possibly doing here?
The implication, of course, is that I have contributed to MAHA psychiatry (whatever that means) and that I am a follower of Szasz, a psychiatrist who wrote The Myth of Mental Illness more than 60 years ago. Both of these associations are designed to immediately discredit the “critics,” as though the criticism is arising from MAHA politics and a denial that mental disorders are “real.”
Here is a fact-check that Aftab might have considered before naming me in his opening paragraph. I have not had any involvement with the MAHA initiative. While I think a societal discussion of the merits of psychiatric drugs is much needed, I personally think that doing so under the MAHA umbrella is problematic, as the critique will be conflated in the public mind with MAHA’s anti-vaccine efforts and Trump’s anti-science agenda.
As for Szasz, while I have written about his place in the history of psychiatry, I have never adopted his The Myth of Mental Illness ideas as my own. Here is my usual comment about psychiatric disorders: “The biology of psychiatric disorders remains unknown.” I am quite sure there are some biological pathways to psychiatric symptoms, and I am also sure that such difficulties may arise from what we call the “social determinants” of health—poverty, lack of housing, trauma, family difficulties, and so forth.
In sum, I do not have a Szaszian heart and I am not a contributor to MAHA psychiatry, and yet, by naming me in the opening, he is putting me into that camp. It’s a common rhetorical device: define your “opponent” in a way that will invite disdain, regardless of whether he or she belongs in that camp.
The second problem with his opening is that he links all three of us—Moncrieff, Whitaker, Delano—into one lump, as though we all share a common critique. In fact, we took different paths to arrive at our criticisms of psychiatry, and there is no reason to think we all share the same criticisms. Joanna Moncrieff is a psychiatrist who founded the Critical Psychiatry Network, which is populated by psychiatrists and other professionals, and their criticism is rooted in their clinical experience and their deconstruction of the research literature (and their own published research). Laura Delano’s critique is rooted in her personal experience as a patient and the lived experience of thousands of others. Indeed, the Mental Health and Overmedicalization Summit featured the voices of people who have been grievously harmed by psychiatric treatments.
My path to becoming a “critic” of psychiatry was borne from my career as a journalist. After the American Psychiatric Association published DSM III in 1980, it told the public a narrative of great progress, that researchers had discovered that chemical imbalances were the cause of major psychiatric disorders, and that it now had medications to fix those chemical imbalances, like insulin for diabetes. However, as I discovered while researching both Mad in America (2002) and Anatomy of an Epidemic (2010), psychiatry’s own record of research findings, which could be found in studies funded by the NIMH over the course of six decades, told a very different story.
The research literature told of how the chemical imbalance theory of mental disorders had been investigated in the 1980s and 1990s and had not panned out. Indeed, the literature told of how psychiatric drugs, rather than fix a chemical imbalance, perturbed the normal transmission of chemical messages in the brain, and that in response to that perturbation, the neurons went through a series of compensatory adaptions in an effort to maintain a “homeostatic equilibrium.” As NIMH director Steven Hyman wrote in 1996, at the end of this compensatory process, the brain is operating in a manner that is both “quantitatively and qualitatively different than normal.”
As for the efficacy of psychiatric drugs, the research literature tells of how SSRIs and atypical antipsychotics, which were heralded as “breakthrough medications” when they first arrived on the market, provide a very small benefit over the short term, so small that the drug-placebo difference doesn’t rise to the level of a “minimum clinically important difference.” As for their long-term impact, there is abundant evidence that psychiatric drugs increase the risk that a person will become chronically ill and functionally impaired. In fact, the handful of researchers that have dared to acknowledge this worsening of outcomes have pointed to the brain’s compensatory adaption to the drugs, which is known as “oppositional tolerance,” as a likely cause.
Thus, in short, my two books led to this conclusion: American psychiatry has told the public a story that is out of sync with its own research. Instead of serving as an honest communicator of its own research, American psychiatry—as an institution—told a story that served its guild interests and the interests of the pharmaceutical companies. As Lisa Cosgrove and I detailed in Psychiatry Under the Influence, this was a classic case of “institutional corruption.”
After Anatomy of an Epidemic was published, I turned my personal Mad in America website into a webzine, and I did so with the purpose of continuing this journalistic effort, of making known research findings that belie the narrative that American psychiatry has told to us ever since it published DSM III.
As can be seen, my “critique” of psychiatry is the product of a journalistic effort, and as such, I don’t even think of myself as a “critic” of psychiatry. You can even find that in MIA’s mission statement: it is “scientific research, together with the voices of those with lived experience, that calls for profound change.”
I should also note that Mad in America, while sounding that call for profound change, publishes blogs that espouse a variety of opinions on the shortcomings of psychiatry today and of possible solutions. We want to be a forum for a societal discussion for “rethinking psychiatry.” As evidence of this, please see our MIA Radio podcast this past week, which featured an interview with G. Eric Jarvis, a prominent psychosis expert and Editor-in-Chief of Transcultural Psychiatry. Even among MIA editors, there is no set dogma that we all agree on, and we often publish blogs that one or more editors—and that includes me—heartily disagree with.
Aftab’s Argument: The Critics Are Simpletons
Having set up his MAHA-Szaszian foil for defining the critics of psychiatry, Aftab then asserts that while the critics are caught up in a simplistic binary way of thinking, he and his peers have a nuanced and philosophically rich understanding of mental disorders, as well as a keen appreciation of the science. The disease model may have been promoted in the 1980s, but even when DSM III was published in 1980, much of psychiatry, he writes, was already moving on to a rich bio-psychological-social model.
You know what else was published in 1980, by the way? George Engel’s “The clinical application of the biopsychosocial model” in the American Journal of Psychiatry. The “medical model” that Bergner places as having taken over psychiatry in 1980 was already, in 1980, being articulated in a form quite different from the one [Bergner] describes.
As I have written before, there is a long-standing public confusion in which the medical model is identified with the idea that all psychiatric conditions are discrete biological disease entities of the brain. This caricature isn’t true even of much of general medicine, which routinely deals with multifactorial syndromes, problems shaped by environment and trauma, conditions defined by symptom clusters without identifiable biomarkers, and it certainly isn’t true of psychiatry. What we call the “medical model,” properly understood IMO, is an aspiration to extend the conceptual and practical tools of general medicine to mental health problems: classification and diagnosis, attention to natural history, multi-level causal explanation, and the use of a wide treatment armamentarium that includes, but is by no means exhausted by, pharmacotherapy. It is also a model that, in theory, comfortably exists in a broader pluralism of clinical and non-clinical approaches.
The binary of disease-based reductive psychiatry on one side and “critical psychiatry” on the other nudges us to assume there is nothing in between. In fact, the space between is large and well populated. Various strands of explanatory and methodological pluralism and theoretical developments like embodied cognition, enactivism, complex dynamic systems, phenomenological psychopathology, psychodynamic psychiatry, social determinants of health, etc . . . these are not minor footnotes. They are scientifically grounded, neuroscientifically and psychologically informed, philosophically aware, humanistically oriented, and deeply skeptical of reductionism.
The critics of psychiatry depend on this binary being invisible. If the only choices on offer are 1980s neuro-reductionism on one side and a self-righteously critical, anti-medical posture on the other, then anyone disenchanted with the first is shepherded toward the second. Once you see the binary, you see that the rhetorical machinery of critical psychiatry runs on it.
Two comments in response.
First, this presentation of psychiatry’s history, dating back to the 1980s, is a form of historical gaslighting. American psychiatry, of course, promoted a disease model to the American public following the publication of DSM III, with this model presented to the public by Nancy Andreasen, a long-time editor-in-chief of the American Journal of Psychiatry, in her bestselling 1984 book The Broken Brain. The chemical imbalance story stood at the heart of that disease model: the pathology was known, and the profession now had drugs that fixed that pathology. Indeed, many psychiatrists began calling themselves psychopharmacologists, and ever since then, the profession’s primary activity has been prescribing psychiatric drugs.
What American psychiatry has not been doing since 1980 is promoting non-drug therapies to the public or embracing environmental alternatives like Soteria House. As a profession, it has not been operating in the “space between” that Aftab ascribes to himself and his peers.
Second, notice his comparison of the intellectual merits of the critics versus those who live in the “space between.” The critics are depicted as simpletons, stuck in a binary form of thinking, and who are, in terms of their character, “self-righteous and antimedical,” while he describes himself and his peers in psychiatry as “scientifically grounded, neuroscientifically and psychologically informed, philosophically aware, humanistically oriented, and deeply skeptical of reductionism.”
All I can say, after reading that litany of self-praise, is wow. I’m tempted to write something snarky in response, about thumbing through my DSM and looking for diagnoses associated with delusions of grandeur, but best I just let his self-description speak for itself.
The Conclusion: He Has Already Vanquished the Whitaker-Moncrieff Critique
After telling of the intellectual failings of the critics, Aftab writes this: “As I’ve written previously, the Whitaker-Moncrieff version of critical psychiatry, at its core, is a philosophically and scientifically exhausted movement.”
I had no idea what he might be referring to, and so I looked up the post he had linked to.
I am not mentioned by name in the post, and neither is Moncrieff. Nor is there any description of my particular critique of psychiatry, that American psychiatry has not been a reliable narrator of its own research. Instead, it is just a lengthy diatribe against critics of psychiatry, describing them as zealots who are feeding into societal conspiracy theories, while describing his own (mild) criticisms of psychiatric thought and practices as the true path of the rigorously skeptical mind.
I guess Aftab assumed that nobody would bother to click on the link.
However, it is the type of commentary that the American Psychiatric Association apparently appreciates, as its Board of Trustees recently gave Aftab its “Distinguished Service Award” for “exceptional meritorious service to psychiatry and the APA.”
Man Bites Dog
As I wrote in the opening to this post, there were two reasons that I was moved to respond to Aftab’s post, and the surrounding news events.
The first was to make known the nature of the “Whitaker/MIA” critique. It arises from a very straightforward journalistic effort, which provides a documented account of how our society has organized its thinking around a narrative told by American psychiatry that is out of sync with its own research.
The second was to provide a deconstruction of Aftab’s post. As the media now regularly turns to him for a comment on psychiatric matters, he has become a prominent figure within American psychiatry, and thus, to a large extent, his post can be seen as an example of how psychiatry, as an institution, responds to its critics.
I should add that I am sure that Moncrieff and Delano, if they were so inclined, could provide their own deconstruction of Aftab’s post.
I titled this post “Psychiatry’s Attack Dog Is at It Again.” The “at it again” in the title expressed my weariness at having to respond to criticisms of this sort, which have been ever present since I published Mad in America and E. Fuller Torrey, in a review of the book, described me as apparently having fallen under the influence of Scientologists. The title also implied that Aftab’s post was not to be taken seriously, that this was just more of the same. Indeed, to be honest, when I came to the part where he described himself and his peers with an ode to their collective brilliance, I laughed out loud. So this is how, when they look in the mirror, they see themselves!
But with that Attack Dog title in mind, I am thinking of summing up my response with a quip, keeping a note of humor present in this reply, and with one that brings his post and my response full circle.
So call it, Man Bites Dog.
Well done! Aftab’s criticism of “anti-psychiatry” – as binary-thinking and “self-righteously critical, anti-medical” – is actually self-description. And he and biological psychiatry are, or pretend to be, blissfully unaware of it.
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Dear Robert, Like so many other survivors of psychiatric abuse, ignorance and torture, I am profoundly grateful to you for all that you have done.
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Szasz never denied that there may be *some* biological pathways to psychiatric symptoms.
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At least he didn’t call you a scientologist or diagnose you with a personality disorder.
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I found the NYT article to be incredible. The Times mostly sides with mainstream psychiatry and mainstream medicine in general. This article was not something it typically publishes and it was mostly attacked by those posting comments.
As for RFK, I agree that criticizing psychiatry under the MAHA umbrella is problematic given the many unscientific positions taken by him and the Trump administration.
But I don’t believe that’s the major issue hindering meaningful reform.
The psychiatric profession and the pharmaceutical industry have a tremendous influence in our government and our society because of the money they spend to protect their profits. They influence the media, physicians, psychologists and organizations that are supposed to benefit the public. I fear that overcoming this power may not be possible.
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Bob Whitaker has done an excellent job of pointing out how psychiatry tends to smear its critics by lumping them all together with groups that have negative approval ratings with the public. He points out how his own investigations as a journalist led him to conclude that psychiatry’s push for chemical cures was contradicted by its own research. He concludes that psychiatry and the mental health field need a new and different paradigm.
What is psychiatry’s paradigm? It has often been labeled “the medical model” because it subsumes “mental health” under the domain of medical theory and treatment and reduces human behaviors to medical illnesses caused by disorders in the body, most recently, the brain.
But psychiatry’s paradigm is more aptly called “the pseudomedical model” since psychiatrists routinely engage in the kind of behavior regular doctors disdain. I am referring to the fact that psychiatrists commit people involuntarily and “treat” them against their will and also seek to exonerate criminal behavior via the insanity defense.
Long ago psychiatrists and other members of the mental health tribe labeled Thomas Szasz and other critics as “antipsychiatrists.” While it is true that Szasz thought that psychiatry’s main claim was false, he practiced and supported “voluntary psychiatry,” especially psychotherapy. However, in later years he came to believe that the distinction between voluntary and involuntary had been largely obliterated.
Calling people antipsychiatrists because they object to unethical and illegal conduct by psychiatrists would be akin to calling people anti-Catholics because they objected to sexual child abuse (and cover-up) by the Catholic church. It deflects from the objectionable behavior and seeks to discredit the people calling attention to it.
While Szasz is best known for his 1961 book, “The Myth of Mental Illness,” in 1960 he published a short essay of the same name in “The American Psychologist.” (He later reprinted the essay in his 1970 anthology, “Ideology and Insanity”).
Szasz describes the pseudomedical model: “The assumption is made that some neurological defect, perhaps a very subtle one, will ultimately be found to explain all the disorders of thinking and behavior…These difficulties — which I think we may simply call “problems in living” — are thus attributed to physiochemical processes that will in due time be discovered (and no doubt corrected) by medical research.”
Szasz then explains “the two fundamental errors” of this paradigm: “In the first place, a disease of the brain, analogous to a disease of the skin or bone, is a neurological defect, not a problem in living…The second error is epistemological. It consists of interpreting communications about ourselves and the world around us as symptoms of neurological functioning.”
In other words, problems in living belong to the fields of philosophy, sociology, anthropology, political science, economics, religion. But psychiatry treats them as if they were physical diseases belonging to the field of medicine. This is psychiatry’s paradigm, or category, mistake.
Szasz makes clear that if some behavior were to be discovered to have a physical cause, it would then be moved from psychiatry to classical medicine. Syphilis is perhaps the primary historical paradigm.
Psychiatrists used to treat ulcers which were considered to be caused by stress. But since Australian physicians Dr. Barry Marshall and Dr. Robin Warren discovered that the bacteria H. pylori was the primary cause of stomach ulcers, psychiatrists no longer treat the disease. Regular doctors use antibiotics now.
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Dr. Hoeller — thank you for naming Drs. Barry Marshall and Robin Warren and the ulcer story. I am addressing this to you specifically. The disease I have also in all likelihood stems from long-standing H. pylori — the same bacterium Marshall and Warren proved caused ulcers. Here is what psychiatry learned from Marshall and Warren: how to make sure that a “psychosomatic” disease never escapes back to an organic cause. Here are the archaeological artifacts of my case study.
1972, age 16: my first barium x-ray. They could not find my veins to draw blood — possibly because I was anemic — and gave up.
1997, Sutter: hypersegmented neutrophils, TPO antibodies, brain lesion within two weeks.
As part of my HIPAA amendment dated March 4, 2026, Dr. Patrick C. J. Ward, MB, BCh, BAO, FFPathRCPI, MASCP — master pathologist — wrote to six institutions, on March 2, 2026, stating that this was enough to diagnose me.
April 16, 2012: blood drawn for intrinsic factor blocking antibody. LabCorp billed correct diagnosis to Anthem on May 3, 2012 (ICD-9 281.0, pernicious anemia). Quest billed the same on May 31, 2012. Sutter portal interpretation by their clinician was appended six days late — a delay that gave me the opportunity to get diagnosed by someone else.
August 13, 2013: I submitted in advance sixty pages of my Sutter blood-work history and tissue pathology. Stanford told me to bring my recorder. Dr. Stanley Schrier — founder of Stanford Hematology, past president of the American Society of Hematology, section head for this disease on UpToDate — read the materials himself before the visit. He told me, on tape, that I had and have pernicious anemia, that I did not have paraneoplastic, did not have celiac, did not have psychosomatic. He billed Anthem with three correct codes: iron deficiency anemia, pernicious anemia, atrophic gastritis. Three weeks later, I broke my hip — a known complication of untreated pernicious anemia. On October 6, 2013, Stanford used the “Problem List Replacement Utility” to remove the pernicious anemia and the atrophic gastritis from my record. The iron deficiency stayed.
2015: Dr. Ward and I arranged a Mayo retest on my 2008 stored serum. On Mayo letterhead: positive intrinsic factor blocking antibody, with elevated numbers. A positive IFBA is diagnostic. The antibody was in my blood in 2008.
Dr. Rahul Verma, Sutter, 2018: one page documenting chronic H. pylori with false-negative assays for years, intestinal infections (from no stomach acid), antibodies pointing to Eaton-Lambert.
2022: a neuroendocrine tumor was excised from my stomach using a snare during endoscopy. Stanford’s pathology report correctly identified it as a neuroendocrine tumor, Grade 1 (WHO) — but the same report includes a false history of colon cancer, and misspells “atrophic gastritis” so the diagnosis is not locatable by computer search. My Stanford gastroenterologist denied to my face that what was excised was a neuroendocrine tumor, contradicting the pathology report. The University of Minnesota separately reviewed the tissue in 2023 and confirmed the neuroendocrine tumor, Grade 1 (WHO). Annual surveillance is now uncertain due to the disease disappearance from my electronic record.
2022, intrinsic factor blocking antibody: Mayo’s test, returned through my Stanford portal. “Indeterminate”. No numbers. No range. The clinical warning has flipped: Mayo now warns of false POSITIVE near a B12 injection — opposite of Dr. Ward’s 2002 published warning of false NEGATIVE. A new SNOMED code has now been introduced for the intrinsic factor blocking antibody TEST itself — adding another layer between the definitive test and the diagnosis it once decisively named. Dr. Schrier stated on tape in 2013 that this single test alone is diagnostic.
After Marshall and Warren, medicine decided there would never be another Barry Marshall. My case is the record.
Marshall and Warren discovered H. pylori in 1982 (published in The Lancet) and won the Nobel in 2005. One year after the discovery, in 1983, Stanford’s Dr. Keith B. Taylor — discoverer of the intrinsic factor blocking antibody — inserted into a clinical nutrition textbook he co-authored the requirement that anemia be present for a pernicious anemia diagnosis. He knew that was incorrect. That qualification became the working textbook definition. Any patient without overt anemia could now be excluded from the diagnosis. However, in 2013, Dr. Schrier named the autoimmune disease on tape.
Master pathologist Dr. Ward has sent multiple corrective letters over a decade 2016-2026. The institutions have not corrected the record.
Dr. Hoeller, thank you for bringing up this important illustration. Another H. pylori-driven disease: pernicious anemia/atrophic gastritis/autoimmune gastritis, deserves recognition for the fact it is not a psychiatric disease.
Originals available.
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Aftab seems to think that the word “Szaszian” is a pejorative — to me, it’s a compliment.
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“self-righteous and antimedical?” self-righteous, maybe, but only because we are in the right. But do tell me what is “antimedical” about all Robert’s research and findings that both the antidepressants and ADHD drugs can create the bipolar symptoms, since they can/do.
Plus, I did my homework, and learned that both the antidepressants and antipsychotics are also known as anticholinergic drugs. Especially when combined, the anticholinergic drugs can create the positive symptoms of schizophrenia, via anticholinergic toxidrome. Plus, the antipsychotics/neuroleptics can create the negative symptoms of schizophrenia, via neuroleptic induced deficit syndrome. What is “antimedical” about my research findings?
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Thank you!
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The best way to think about Aftab is that he is psychiatry’s lawyer, which is to say a mob lawyer. He uses the same rhetorical methods as do many mob lawyers, and like mob lawyers, paints a completely fictional image of his client and their history.
In the New York City I grew up in, mob lawyers were routinely in the press defending their clients, and they got to be pretty well known. Bruce Cutler defended John Gotti, and Cutler got paid plenty for it. Even more famous was Roy Cohn, who was used by several leading Mafia figures and got paid plenty, and Cohn later became the mob lawyer for the Trump Family mob, but when Cohn got AIDS, Trump threw him under the bus.
Aftab is clueless to his actual role as a mob lawyer, and so unlike Bruce Cutler and Roy Cohn, Aftab appears to be doing his lawyering pro bono, happy to get a “Distinguished Service Award” from the APA. Aftab has every right in the world to spend his life doing pro bono lawyering for mobsters, and I have every right to laugh at him for doing so.
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Thank you Robert Whitaker for your continual critiquing of the psychiatric research literature often using the psychiatric literature itself to elucidate the problems and opposite of what the psychiatric profession often professes and tends to cause so much harm. Your research and analyses and reanalyses and critiques have been soooooo very helpful to me personally, and I have repeatedly tried to refer so many others to your research. And, am glad that you have focused your analyses and critiques on a variety of different psychiatric drugs.
In response to your below paragraph:
“As for the efficacy of psychiatric drugs, the research literature tells of how SSRIs and atypical antipsychotics, which were heralded as “breakthrough medications” when they first arrived on the market, provide a very small benefit over the short term, so small that the drug-placebo difference doesn’t rise to the level of a “minimum clinically important difference.” As for their long-term impact, there is abundance evidence that psychiatric drugs increase the risk that a person will become chronically ill and functionally impaired. In fact, the handful of researchers that have dared to acknowledge this worsening of outcomes have pointed to the brain’s compensatory adaption to the drugs, which is known as “oppositional tolerance,” as a likely cause.”
Am so very glad that you have taken the time to focus on some of the problems of short-term psychiatric medication too because as i mentioned to you years ago, I have been soooo very frustrated at numerous well-versed critics of psychiatry, including yourself in the past, seeming to provide, at least publicly, a pass for short-term medication. And, my experience has been that many emergency room/departments tend to create excuses and/or create conditions to administer “short-term” psychiatric medication to “patients” which i think they may do so for convenience, justification of hospitalization, and/or intentionally so that the patient becomes unable to attend to what subsequently occurs, etc.
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The emergency room hospital doctors regularly use the psych meds to cover up easily recognized iatrogenesis for the mainstream medical doctors, not to mention also child abuse for the unethical pastors and priests.
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Thank you, Patricia! I agree, have had a similar experience myself at the start of my psychiatric journey. Now, twenty years on, after many an attempt to taper with harm reduction approach and others, so far unsuccessfully, I am functionally impaired and have iatrogenic injury…people do end up on dialysis and die by year twenty five oftentimes on my medication…all this seems to be a mere statistics to the doctors in the white coats. Primum non nocere, first do no harm, they had sworn to it! But that sounds like a far away cry for justice and empathy in this day and age of big pharma money driven medicine.
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Aftab; famous for Evidence Free Arguments.
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I have a fraught relationship with psychiatry — one that has spanned twenty-five years and altered the course of my life in ways I am still reckoning with. I came to these professionals seeking healing, but what I often encountered was not compassion. It was a kind of confident ignorance, a transaction dressed up as care.
Reading Robert Whitaker’s writing, as I do from time to time, reconnects me with something I think of as my original self — a purity that the field of psychiatry gradually displaced. I can imagine what it might feel like to move through the world without it: to take a step, to draw a breath, untethered from a diagnosis and the medication that has been part of my biology for thirty years. That image is not available to me in practice. The hook is still in. The drug is a serious biological fact now, not a choice I can simply revisit. I know that. I accept it, more or less.
I could find a kind psychiatrist — one capable of something like a real therapeutic relationship — but that costs money, and I have long suspected that what I actually needed was never psychiatry at all. It was a compassionate human being. Someone genuinely present. Not a charlatan operating from within an institution that, as Whitaker documents, has never fully grappled with the limits of what it knows.
What I find valuable in Whitaker’s work is the language it gives me. The language to explain how drugs that cross the blood-brain barrier interact with the brain in ways that are imprecise — that they are treating hypotheses, not confirmed pathologies, and that the uncertainty built into that process carries real risk for the individual. And that is before accounting for stigma, for the way a diagnosis becomes part of your identity, for the shame of shielding it from the world while simultaneously ingesting something that alters the most fundamental substrate of your being — all because a psychiatrist assessed you in a limited way, in a limited hour, and made a consequential decision.
My central question, the one I return to, is this: if I had never been given an antidepressant in my early years, would I have ever experienced mania? My parents, who had never seen that behavior in me before, believed the drug caused it. The psychiatrist responded like a stone wall. The behavior, they implied, came from within me — not from the medication. That was the moment I understood I had entered into a relationship with a field that could not be wrong, and that I would have to defer to it or risk having no framework at all for understanding myself. I was frightened enough by the manic episode — the antipsychotics, the disorientation, the loss of coherent self-narrative — that I handed over the keys. I did not know what else to do.
Many of the doctors in the years that followed listened in stale silence. I have recently found someone who acknowledges that the issues predating the drugs and the diagnosis are the true underlying ones for me. I believe him. And yet I am also aware that he earns a significant income consulting with people like me — people lost somewhere between their original problem and the system that was supposed to address it. I do not say that to entirely discredit them. Maybe there is some jealousy in it. I wish I had been more materially successful at my age. There is no question that the derailment of my psychiatric experience contributed to that.
Psychiatry is among the highest-earning professions in this society. There is something dystopian in that fact — that the field laying claim to mood, to perception, to the central organ of human experience, profits so substantially from that claim. I am angry about this. And psychiatry, of course, would classify that anger as a symptom, which is perhaps the most efficient power move available to any institution.
What I take from this article is a small, quiet win. A piece of language. A documented account that says: the story you were told was not the whole story, and the confusion you experienced was not simply a product of your own deficiency. That matters to me. I will write about it. I will sit with it. And I will carry it alongside the loss — because it does feel like loss, this large empty tract of my life — as something that, at least for a moment, tips the balance slightly in my favor.
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Another excellent article,thanks.
And the contributions from subscribers are so well informed.
Even if we can’t slay the monster, the growing awareness of its extent and toxicity gives me the comfort of knowing that there is a community of thoughtful, intelligent and insightful naysayers to the corrupt and blinkered regime of psychiatric “medicine”.
Cheers,from Scotland to all at M.I.A..
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The critique steeped in the psych industries’ ignoring science and wrongfully promoting scientific theories proven not true is among the strongest critiques of the psych industries, and I commend Whitaker for calling out the corrupt industry. I also commend him for noting the accusation that the “critics are simpletons.” Medicalization is a worthy criticism as well, and those bravely saying so should not be depicted as simpletons. The “biology remains unknown” point speaks to prescribing without understanding, but the medicalization critique of the psych industries remains crucial. That is, the Whitaker critique (which I applaud) opens the door to a counterargument that if there were a proven biological cause, then medicine would (could/should?) be the correct answer. Medicalization arguments are important – they question the type of society we want to have, the role of DSM in defining deviation from normal and teeing up pharma to step in, and the role of medicine even for conditions in which biology plays a known or undisputed role. It would be best for those critiquing the psych industries to align or point to their overlapping consensus. Political polarization, ad hominem attacks, and discrediting undermine both the scientific and sociological criticisms. The lack of evidence is often shocking to the unwitting public, but if evidence arrives, the people must be prepared and engaged in deep thinking about who gets to define emotional wellness and mental disorders and look at who benefits from sweeping definitions that declare so many in society disordered.
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thank you for tirelessly fighting the good fight for all of us.
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Awakening the public to the dangers and inadequacy of medication for emotional problems is a slow process, but it is succeeding. MadinAmerica could push the evolution by more actively promoting the self-help program it allowed me to introduce to its readers, Se-REM.com. It is helping people in 36 countries, and has the potential to change mental health delivery worldwide. It’s rate of success is far greater than medication. It is easier, far less expensive and has no side effects.
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Thank you, Robert!
On top of my own iatrogenic injury, I have recently discovered my father has been medicated with antidepressants for twenty years resulting in early dementia and kidneys collapse. This is all criminal. Sorry to say. These kind of attacks and misleading the public do not help the informed consent approach at all…let alone allow for alternatives.
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The “common rhetorical device: define your “opponent” in a way that will invite disdain, regardless of whether he or she belongs in that camp” appears so common that Robert resorts to it as well in self-defense of its deployment against him, distancing himself from amorphous anti-vaccine and anti-science associations, in turn associated with MAHA/Trump agenda.
Echoed here is a common distinction variously made at MIA between false claims of psychology and evidence-based physiology. Specialized focus obscures how all of medicine, of which psychiatry is part, has been corrupted by pseudoscience, subservient to ruling class agenda of profit and power. This monopolization of knowledge applies to all of science as well, for the most part an extension of the MIC or deep state, which serves purposes of (fascist) corporate state control of the many by the few via technologies of social engineering (aka political science). The current totalitarian takeover of ‘our’ social relations in the digital (c)age, which Trump 2.0 oversees with techbroligarchs, is the latest demonstration of this pattern of rule in the name of progress.
Modern medicine commodifies health care as individualized consumer-based business under ownership of such interests as Rockefeller big oil to sell us snake oil poisons for designated diseases, comparable to the DSM, that misdirect us from social causes of psychosomatic problems in the system of exploitation and oppression we live like prisoners. The germ theory of disease championed by the pharmafia’s chemical warfare on invisible pathogens draws attention away from sources of so much morbidity in our environment, hiding in plain sight the natural environmental science (terrain theory) which industrial capitalism’s ‘creative destruction’ must violate by necessity if it is to grow (like cancer) to the benefit of owners, who make a (literal) killing on the market all the more by burying the truth under lies of allopathic cures and palliatives for permanent treatment of guaranteed mass illness, and madness. That modern medicine still shares a hidden history of (de)population control with eugenics, assuming planetary proportions with convid, should not go unmentioned, either.
Rather than dismissal, the kind of investigative research Robert conducts in Mad in America is warranted for virology and vaccinology as well. One site to sample such critique is Dr. Sam Bailey’s Substack. Here’s a pop doc on the subject: https://odysee.com/@cv19:b/The-End-Of-Germ-Theory:cf. But merely associating any criticism of the scientific-technological complex in this case with propaganda theatrics like MAHA and Trump simply perpetuates the divide-and-rule polarization of political positions which are manufactured from left to right to mislead us (e.g., it was in fact under Trump 1.0 that ‘Operation Warp Speed’ began the campaign for universal ‘vaccination’ (genetic modification), while Trump has claimed it the greatest achievement of his first term!).
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Brilliant response, well done Robert!
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‘Here is my usual comment about psychiatric disorders: “The biology of psychiatric disorders remains unknown.”’
Unless by “psychiatric disorder” Robert means a metabolic or other physical/medical disorder and/or disease caused by psychiatric drugs and/or interventions or by psychiatrists, why believe that such things as “mental illnesses,” “mental disorders,” “personality illnesses” or “personality disorders” exist – other than in the minds of delusional would-be diagnosticians (their victims included)…let alone have any underlying or explanatory “biology” other than the tendency of folks to label people seeming different enough from themselves “abnormal,” I wonder, please?
“La folie, c’est de n’avoir pas d’autres normes que soi-même.”
La folie, c’est de n’avoir pas d’autres normes qu… – Santé mentale au Québec – Érudit https://share.google/Z5btK9UAcUv7kuenH
With the most enormous respect,
Tom.
“…for we are all as God made us, and many of us much worse.” – Sancho Panza.
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Having read Delano’s memoir, I’d like to offer a few observations otherwise not warranting being addressed in Robert Whitakers’ response to Dr. Aftab’s post.
First off, in my reading of Delano’s memoir, one of its great strengths was that it took a journalistic narrative-approach to her life’s conditions and personal experiences, with her corresponding inner states, to that of ‘objectivity’ representing her psychiatric care. In my reading, Delano’s critique of psychiatry wasn’t any interpretation or value judgement assertions of her psychiatric care, it was the actual ‘track record’ of her psychiatric care (number and range of diagnoses, drug protocols, ineffective symptom focused treatments, etc.). That Delano didn’t experience substantive improvement from her presenting ‘psychiatric condition’, until, “years later’, she began moving away from and disidentifying with her psychiatric diagnoses and treatment, is, in my reading, the most psychiatrically damming feature of Delano’s memoir.
But what begs mentioning here, is that Delano was the ideal psychiatric patient! Delano was as faithful and responsive to her psychiatric care as could be expected of any patient. Delano came from a good family with a wealth of resources, and was educated at, and excelled from America’s finest educational institutions, and therefor able to ‘optimize’ her psychiatric care as instructed. In this respect, there weren’t the myriad dialectical sand traps that arise and tend to be (psychiatrically) exploited when the patient comes from variously difficult and challenging backgrounds. Simply stated, Delano’s wealth of resources went a long way in her being able to hold up a mirror to her psychiatric care, whereby people in a similar scenario from an abusive and collectively challenged backgrounds, would have risked being swallowed up from that ‘level and duration’ of psychiatric care-and never heard from, or otherwise been one the many tragic accounts that populate MIA personal story’s.
Equally damming, was that the faithful patient, Delano, received her psychiatric care at one of our nations most revered psychiatric institutions (McClean’s if memory serves). In this respect, I suspect that what is so antagonizing about Delano to Dr. Aftab, isn’t his disingenuous claims of Delano’s Szazian-bent motivations, but rather that Delano had the temerity of so many good fortunes, to so intimately peel back the curtain of psychiatric Oz, and dare to give it a most credible voice in the public square.
Moreover, given that Delano received her psychiatric care at McClean’s, would it not be likely that Delano’s diagnoses and care would be infused with the “embodied cognition”, “enactivism”, “complex dynamic systems”, “phenomenological psychopathology”, “psychodynamic psychiatry”-my personal favorite, and the “social determinants” of health, that Dr. Aftab proudly touted? And though I can’t speak to whether or not these theoretical frameworks were a deliberative feature in Delano’s care, there wasn’t a single allusion to them in Delano’s memoir; and I remain dubious that they saw the light of clinical day in Delano’s care. And, quite frankly, I don’t believe Dr. Aftab or anyone could present any evidence that these theoretical frameworks are a substantive intrinsic feature of psychiatric doctrine, education, training, praxis, APA doctrine and discourses, et al. I personally find Dr. Aftab’s assertion that these theoretical frameworks are a deliberative feature in psychiatric care, to be virtue hoarding/signaling CYA bullshit.
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