Unshrunk and Beyond—Important Lessons/Bigger Questions

Why are psychiatry and its medical model now stronger than ever, with zero signs of weakening or collapse? In fact, arguments could be made that the medical model is not only getting stronger, but also becoming more deeply entrenched and necessary as a means of social control for the survival of this current class-based capitalist/imperialist system. More importantly, all of these developments are taking place within the backdrop of an increasingly dystopian political landscape that seems to be accelerating daily towards end-stage markers within the American empire, including extreme forms of political polarization leading to a possible civil war, and/or the outbreak of a catastrophic world war.

I am not trying to fear-monger or promote political hyperbole here. This troubling assessment about the current state of the American empire and its relationship to psychiatric oppression is just as real as all the recent moves toward fascist authoritarian rule in every major institution in this country. As a simple reality check, do I need to mention Jan. 6, Christian Nationalism, Project 2025, ICE “gestapo” raids, Renee Good, Alex Pretti, banned books, university purges, “whitewashed” Black history, attacks on science, loss of abortion rights, the Epstein cover up, climate catastrophe, Venezuela, Greenland, Iran—just to name a few? Ironically, just by saying these words I could be “diagnosed” as a left-wing “lunatic” with Trump Derangement Syndrome (TDS).

What we see happening with our very own eyes on a daily basis, we are being told is not real – that we must be “delusional” or something worse. This is gaslighting on a massive scale, with extreme and dangerous consequences for this country and the world. We cannot ultimately end psychiatric oppression and the harm done by the medical model without understanding the direct connection between all these dire political developments and the unrelenting power dynamic of psychiatry in today’s world.

A Decisive Case Has Been Made—Why the Hell Has It Been Denied!?

It is now past the one-year anniversary of the publication of Unshrunk: A Story of Psychiatric Resistance, authored by Laura Delano. This important book arrived 15 years following the publication of Anatomy of an Epidemic—Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Robert Whitaker’s tour de force of investigative journalism and Delano’s powerful first-person account of psychiatric oppression are inseparably linked in many ways. The latter may not have ultimately arrived without the former, and both provide a significant one-two punch exposing the scientific fraud and enormous harm (affecting tens of millions of people) committed by the colluding relationship of Big Pharma and the institution of modern psychiatry.

Between the publication of these two journalistic masterpieces, there have been dozens, if not hundreds, of other excellent books and journal articles written by highly credentialed scientists, researchers, mental health clinicians, and other anti-psychiatry activists throughout various parts of the world, including dissident psychiatrists breaking sharply with their professional interests. These publications are often combined with powerful firsthand patient accounts, all written in a highly articulate manner with emotionally painful details of abuse (and an untold number of deaths) over the past five decades of the medical model’s pervasive growth and cultural dominance in our society.

Taken together, these writings, combined with other forms of public testimony and exposure (including survivor support sites on the internet), have shattered the myth of the “chemical imbalance” theory and have completely deconstructed every psychiatric diagnosis, such as ADHD, major depression, bipolar disorder, and all forms of so-called psychotic disorders, to name just a few. Not to mention the critical analysis of the continued existence of electroshock therapy (ECT), one of the most egregious examples of psychiatric harm that brazenly continues to this day. Over these 15 years, the entire mental health system, and their “disease”-based (and drug-centered) medical model of treatment, has been thoroughly debunked and decisively exposed for doing far more harm in the world than help for people suffering various forms of extreme psychological distress.

To many historians, scientists, and critical thinkers, this entire portfolio of scientific analysis and political exposure detailing psychiatric harm (including the resulting traumatic survivor stories), would seem to have been more than enough to seriously damage and weaken the hold of the medical model, and also deeply discredit psychiatry’s reputation in the world. So why has this not even remotely come close to happening, and why is it total fool’s gold (and possibly far worse) to believe that it could somehow happen in America under Robert F. Kennedy Jr’s MAHA/MAGA Bizarro World buffet of pseudo-science, sprinkled with just a few tantalizing kernels of truth about psych drug dangers and unhealthy food additives, etc?

Those That Wield State Power Always Control the Narrative

There is a simple answer for why a plethora of high quality anti-medical model critiques have not succeeded in their goals. In the “marketplace of ideas” in a pluralistic capitalist society, threatening truths (to the status quo) are allowed to be published because they are so easily swallowed up by a powerful corporate media, and relegated to the “back pages.” In the case of the medical model, it was literally hundreds of billions of dollars worth of false advertising blasting the American public over multiple decades—all money that Big Pharma and psychiatry was able to make back in spades with the exponential growth of psych drug sales and increased volume of outpatient psychiatric appointments.

The medical model’s five-decade long “chemical imbalance” marketing campaign (to sell psych diagnoses and drugs) may be the most expensive and successful public relations campaign in all of human history. Today, medical doctors and medical websites all over the internet still repeat the myth of “chemical imbalances” (causing “mental illnesses”) despite overwhelming scientific consensus completely discrediting this theory. Moreover, America is one of only two countries in the world that allow direct-to-consumer drug advertising.

All this expensive advertising has been hugely successful at controlling the public narrative around the medical model, even in the face of the very formidable scientific opposition. Unfortunately, even some of the most erudite critical thinkers and social justice activists in the world, including some socialist thinkers that I respect, have been fooled to some degree by this mass propaganda campaign.

The U.S. Capitalist System Rebounds from Its Vietnam Defeat

A more complex answer for why the medical model remains steadfast and unmovable today requires an examination of how the U.S. capitalist system rebounded from its losses and weakened state following the tumultuous 1960s and early 1970s. The U.S. empire had been shaken to its core by its huge defeat in Vietnam and by multiple forms of political uprisings, both internally (in particular, among minority groups and youth), and in several imperialist-dominated third world countries around the world. These rebellions included the first emergence of a psychiatric survivor movement that described the capitalist system and all its stressors and inequalities as both “insane” and “crazy making,” and exposed the system’s “treatment” responses for being guilty of violating human rights with its forced hospitalizations and forced drugging, etc.

Out of the upheavals of the 1960s emerged a strong intellectual current looking at systemic root causes (like the trauma of poverty, patriarchy, racism, and other forms of systemic inequality) as the main source for most forms of intense psychological distress, alienation, and personal angst. There was even a form of therapy (called Radical Therapy) that arose in that period that helped potential clients link up their current psychological distress to real-world events from a troubling environment. Out of the early 1970s, there was also a very active and dynamic movement among victims of psychiatric abuse fighting against forced hospitalizations in locked units, forced psych drugging, and brain damaging ECT “treatments.” One such organization was the Mental Patients Liberation Front (MPLF), which organized psychiatric survivors to fight their abuse, protect civil rights, and promote self-determination.

On a mass scale, young people especially were questioning the common belief that a class-based form of capitalism was somehow the highest pinnacle of human social organization. All these struggles and radical societal critiques deeply worried the capitalist class and all their corporate beneficiaries. They have spent decades (and billions of dollars) trying to reverse and suppress certain verdicts learned by a section of the masses during this volatile period in American history.

As the crest of the wave of these 1960s rebellions began to subside in the mid-1970s, the ruling classes moved with great speed and intentions to co-opt some former charismatic leftist leaders (especially from the Civil Rights movement) into urban renewal programs and other reformist-type endeavors. Over time many of these programs and leaders settled for small token reforms, and became lost within the fabric of the very system they once critically opposed. This co-optation strategy has always been a favorite tactic used quite successfully by powerful elites desperate to regain control against threatening societal narratives and organizations challenging their power and financial profitability.

A similar form of co-optation also occurred within the psychiatric survivor movement. Part of a once radical anti-psychiatry agenda would soon devolve (over many years) into the development of state-funded “peer work” forces that now (with few exceptions) function completely within an overall oppressive medical model framework.

Psychiatry Finds a Pseudoscience and Launches a New DSM “Bible”

In the late ‘60s and early ‘70s, the institution of psychiatry had been in serious decline, as exemplified by the huge popularity of the 1975 movie One Flew Over the Cuckoo’s Nest. Psychiatry was a weak quasi–medical organization in search of a science to rebuild its “medical” reputation and professional guild interests. Big Pharma was, at the same time, in search of more patients, more drugs to sell, and more ways to maximize profits. It would soon become a match made in (DSM) heaven.

From the early 1970s until today, psychiatry has successfully colluded with the pharmaceutical industry to promote “genetic theories of original sin” culminating in their DSM-III “bible” of psychiatric diagnoses published in 1980. This modern form of eugenics was not only very necessary and useful to psychiatry to help re-brand itself as being a real scientific medical specialty, but it also conveniently merged with the ruling classes much-needed political movement to the right—trying to cancel out advances made in societal narratives by the left during the 1960s and early ‘70s upheavals. This upsurge in genetic theories basically declares that it is “defective genes” and “broken brains,” not a traumatizing and unfair environment, that causes severe psychological distress in the world. This becomes a valuable distraction shifting people’s attention away from the innate inequalities and daily stressors experienced while living in a class-based capitalist system.

This rightward political march reached a major nodal point with the election of Ronald Reagan to the presidency in 1980, and then again in 1984. This set the stage for several very real conspiracies to uproot and eventually end many hard fought for social service programs and other reforms won during the ‘60s movement, which included certain welfare benefits, wider access to abortion services, and feminist and Black studies type programs developed on many college campuses, etc.

At the same time the “deinstitutionalization” (the emptying of psychiatric hospitals) that had started in the 1960s had promised that better care could be provided within the community. It was now nearly complete, and the locus of social control of those diagnosed as “mentally ill” had moved into the community.

It is here in the community mental health system where I witnessed firsthand (working as a therapist in the early ‘90s) the complete takeover of the medical model. Psychiatric diagnoses and psych drugging grew exponentially every year in my 22 years in the single largest clinic in New Bedford, MA. In 1993 we had one psychiatrist prescribing drugs; by the time I left the clinic in 2015 there were 13 prescribers—and they were still looking for more!

This newly emerging medical model was conveniently backed up by the corrupted pseudo-science of the “chemical imbalance” theory, and hundreds of drug company-funded studies (with manipulated outcomes) for the very low bar of FDA approval. These studies (which have since been rigorously deconstructed and discredited) allegedly proved the so-called benefits of pathologizing human psychological distress, and then, at the same time, drugging vulnerable individuals into believing that they had brain “diseases,” and were hopelessly and permanently sick. Again, “don’t examine or blame the system, blame your body-blame yourself.” It is important to note here that their endless search (costing hundreds of millions of dollars in research funding) for biological or genetic markers allegedly causing “mental illnesses,” has consistently come up empty.

The Medical Model’s Valuable Role of Social Control

In a post-1960s world where the U.S. Empire had emerged in a weakened position, the rise of various forms of hyperbolic individualism, including the medical model’s own form of vulnerable narcissism (“I am mentally sick, defective, and helpless”) were a welcomed addition as a new means of social control of the previously more unstable and volatile sections of society, such as people labeled mentally ill, minorities, women, veterans, and disaffected youth. These same sectors of our society are now a big part of the sizable numbers (over 20%) of our population that are most often psych diagnosed and drugged. What harm this extremely negative view of self (that is so deeply embedded in the DSM diagnoses) was unable to accomplish by psych labeling, was then left to all the mind-numbing psych drugs. If that was not enough, then the oppressive (often forced) incarcerations in the locked units of psych hospitals and/or ECT would often finish the job.

The medical model’s use of psych diagnoses, psych drugs, ECT, and forced hospitalizations was not some worked out conspiracy, or diabolical strategy, developed by the capitalist class (and their political apologists) as a new means of controlling the masses. Like many other historical forms of social control, such as various addictive behaviors—drugs, alcohol, and gambling for example, they sometimes simply arise spontaneously out of capital’s intrinsic need to grow and expand its profit; eventually turning more and more human beings into another alienated form of commodity relationship.

In this case, the medical model’s true value (to those in power) as a means of social control might only have been realized (and then more actively promoted) a period of time after its first emergence in society. In the early stages of the medical model, the U.S. prison system would often let psych diagnosed individuals suffer withdrawal without their psych drug prescriptions. Now they encourage prisoners to take their mind-numbing psych drugs to help stifle any potential rebellious behaviors.

In the 1960s and early 1970s, a significant number of returning veterans who had experienced all the horrors of the Vietnam War became respected radical activists against the war, and against other societal inequalities. Their anger and related trauma (from being used as pawns to fight an unjust war) provided a path for redirecting enormous emotional angst into fighting injustice and trying to make the world a better place. However, in today’s world, too many returning veterans end up as part of the grim statistics of PTSD diagnoses, on large cocktails of psych drugs, with unconscionable levels of suicide – over 17 each and every day! The medical model’s so-called “treatment” methods bear heavy responsibility for this unbearable reality that is so qualitatively different for today’s veterans.

The institution of psychiatry has evolved into playing more and more of this valuable role of social control, while rapidly expanding its overall cultural influence and power in society. This has become especially true today connected to the increased wealth disparities in the U.S. and the related steep rise in homelessness and drug addiction that often includes many veterans and people labeled as “mentally ill.” In this new role, psychiatry has been granted the power (similar to the executive branch of government) to both forcibly incarcerate people in locked units and forcibly drug people against their will without the normal protections of the U.S. Constitution. All this only requires the mere signature of a pen by a psychiatrist or psychologist after a simple 15 minute interview—the whole process of involuntary psychiatric commitment. They only have to declare that you are “a danger to yourself and others,” and then all your civil rights will disappear in a heartbeat.

The ruling classes have been more than willing to embrace this new and less obvious form of social control. Starting in the late 1980s (with the whole “Prozac Nation” phenomena) the medical model was able to grow its influence very quickly and clearly prove its worth to those in power in dealing with society’s outliers, nonconformists and others struggling to live in the margins. These people could now more easily be labeled as the “losers” in the highly competitive and random “gambling” ethos fundamental to success or failure in a capitalist America. The medical model also added enormous monetary value (for the “winners”) by soon becoming a major catalyst for the beginning of Big Pharma’s massive profit growth. This also helped power the engine of the U.S. economy’s major expansion over the next several decades. All these developments have helped to put their huge defeat in Vietnam and the various 1960s and 1970s rebellions far in the distance of their historical rearview mirror.

The medical model’s valuable social control role (to those in power) has overall helped to stifle dissent among the previously more volatile and radical sectors of our society that would, even in normal times, be actively organizing against capitalism’s various forms of inequality. This same social control role will become even more important and valuable to defenders of the status quo with increased levels of political turmoil, disenfranchisement, and chaos in today’s increasingly more dystopian world. People labeled as “mentally ill” in America are an embarrassment and a potential disruption to those promoting the myth of the so-called “Shining City on the Hill.” They need to be “silenced” and somehow pushed more into the shadows—no longer to be seen or heard from. Currently, the MAGA/MAHA coalition’s cruelty levels towards those disenfranchised in today’s polarized America shows clear signs that the treatment of those labeled as “mentally ill” will only get worse.

If more people begin to question any part of the genetic explanations for so-called mental illness (the underpinnings of the medical model), they may soon begin to see some of the underlying multiple forms of innate (and very damaging) psychological stressors built within a class-based system of capitalism. They might even become agents of social change challenging an unequal and often oppressive status quo.

Both the Republican and Democrat party elites benefit from the medical model’s role in society, and neither has the will nor the desire to end it, and that will never change under a profit based capitalist system. Therefore, I would argue that the medical model cannot be eliminated or rendered obsolete until we move society beyond capitalism to a newly conceived more cooperative and vibrant form of socialism.

In America, psychiatry and the medical model (with all it psych diagnoses, mind numbing drugs, and erroneous genetic theories) has a very direct responsibility for catalyzing the growth of a form of vulnerable narcissism and learned helplessness. This has a clear connection to the higher disability rates that have risen over the past five decades in American society. All this is at the heart of what are some of the core arguments in Whitaker’s Anatomy of an Epidemic and, in a deeper more personal way, in Delano’s Unshrunk. And as to the question of vulnerable narcissism’s connection to social control in society: It’s very hard to challenge a troubling environment and be a radical activist for social change when you’re consumed with negative thought patterns about being permanently defective, and at the same time, sedated (or worse) with a cocktail of mind-numbing psych drugs.