Laura Delano and I met sometime around 2012 at a Mad in America film festival. I was immediately drawn to her fierce intelligence and, as I got to learn more about her, was struck by some of the interesting similarities and contrasts between our lives. We had both been academically successful teens whose drive and competence had been rewarded with admission to Harvard. We had both struggled from our early teens with somewhat similar existential worries that centered on the dilemma of being a certain kind of girl in a culture that was wary of our more assertive traits; achievement was celebrated but with an ambivalence that left us confused, alienated, and angry.
Years later, we both happened upon Anatomy of an Epidemic shortly after its publication. We both ended up writing to Robert Whitaker and posting blogs on Mad in America. In time, Laura and I were each asked to speak at conferences in the US and abroad. But Laura is 30 years my junior and approached the book from the perspective of someone whose early struggles had led to the years of psychiatric treatment that are the subject of her memoir. I was a psychiatrist of the generation of many of those who had treated her.
Laura’s struggles began in the mid-1990s, which was the zenith of the application of the “broken brain paradigm” to children. Being older, I escaped that, but my sojourn into psychiatry was related to my own struggles; as an unhappy medical student, I discovered psychoanalysis and thought for a while that it would help me to make sense of my problems. Despite our differing paths, our experiences led us both to develop deep critiques of my profession.
Laura and I remain friends. We once traveled together to the bookstore in Middlebury, Vermont where she first happened upon Anatomy. I was thus eager to read her book, Unshrunk: A Story of Psychiatric Treatment Resistance, and while I expected to find it interesting, I was not prepared for the powerful effect it has had on me. Whereas there was a time in my life when blogs just seemed to flow out of me, I have experienced much greater difficulty writing in recent years. Yet, to honor my friend, I would like to share some reflections on her book.
In 1996, when Laura met her first psychiatrist, she was encountering a profession that had undergone radical change over the previous decade. Many new drugs came to the market during that time. When I was a psychiatric resident in the early 1980s, psychopharmacotherapy was more conservative. Polypharmacy was generally discouraged and drugs were considered indicated only in more extreme cases. Even in the field in which I worked—treating people who had been diagnosed with schizophrenia—where drugs were considered essential, the most respected psychiatrists in the US were urging us to use the lowest doses possible.
That changed as newer, purportedly safer, drugs were approved and intensely promoted. Living through that shift in perspective and observing the disjunction between the academic and promotional literatures is what set me down the path to critical psychiatry.
Laura was diagnosed with bipolar disorder. Along with the proliferation of new drugs, there was a proliferation of new diagnoses. While previously bipolar disorder, formerly called manic-depressive illness, was applied to a narrow group of people who experience dramatic extremes of mood and energy level interspersed with periods of fairly normal function, it was now applied to a much broader range of people.
Multiple types of bipolar disorder were proposed: bipolar II disorder, rapid-cycling bipolar disorder, and childhood-onset bipolar disorder. I still remember the first time, as a medical student, I encountered a person who was experiencing mania. It did not require any sort of training to observe that this person was speaking so fast, with thoughts flitting from one topic to another, that I could not make sense of what she was saying.
However, years later as an experienced psychiatrist, I never grasped rapid-cycling bipolar disorder or bipolar II disorder. Humans have moods that fluctuate. Discerning between the vicissitudes of mood that are considered “normal” versus the alterations of mood that might warrant a diagnosis with one of these newer versions of bipolar disorder was always hard for me. I am not a child psychiatrist but I remember reading about the criteria for assigning a child a diagnosis of bipolar disorder when my own children were young and wondering how one distinguishes between the intensities of typical childhood anger and frustration and this purported “disorder.”
My point here is about how the psychiatric profession has come to conceptualize human suffering. Laura talks about psychiatry as a cult. While I would argue with this, I do think psychiatry has provided a paradigm that our society has adopted widely. There are benefits to this paradigm but there are also problems and consequences that are worthy of critical examination. Laura’s memoir stands as a testament to those negative consequences.
One compelling theme of her book that I have not seen highlighted in other reviews is Laura’s description of how adopting a medical formulation of her problems led to her loss of agency. She was a “good” patient. She accepted the diagnosis of bipolar disorder and (mostly) adhered to the recommendations of her psychiatrists. She was a product of the era of the “broken brain” and with this came the notion that, due to forces outside of her control, her brain was not functioning properly and that manifested as the problems she was experiencing.
For Laura, that meant that she was waiting for healing to come from an external source. As Laura describes in her book, there was one psychiatrist who tried to challenge this but she was not ready to hear it. She began to find her agency through her participation in AA and over time it continued to grow. Is it fair to blame the entire psychiatric profession when Laura herself was complicit in what happened to her?
In my experience, the intense promotion of the “broken brain” model has become so entrenched in our society that it is hard to consider a counter narrative. It was offered in part to reduce stigma and to relieve people of blame and shame. But that was done, particularly in the 1990s, with a confident triumphalism about the “Decade of the Brain.” I suggest there is another path and this is one where in which the stance of uncertainty and humility is embedded within the profession.
This is one reason why I am drawn to approaches such as Open Dialogue where multiple paradigms—including that of the person seeking care—are not only considered but valued. This is also why I, along with Laura, am drawn to Joanna Moncrieff’s drug-centered approach. It allows one to talk about pharmacotherapies as ways of ameliorating some aspects of people’s experiences without reifying the psychiatric diagnoses whose presence are often (mis)conceived as forming the bases on which the effects of such treatments rest.
I have known a number of psychiatrists who respond to Laura’s story and those of others like her by saying she was misdiagnosed. That suggests that some wise, all-knowing psychiatrist would have made the “correct” diagnosis. Misdiagnosis as the fallback explanation when things do not go as expected constitutes a retrospective correction that assumes there is a way to “get it right” from the beginning. Diagnosis should always be considered a hypothesis, a provisional way of thinking about a person’s problems, a guide that suggests—but does not dictate—potentially effective treatment.
It is hard to have these conversations without also conveying to a person they “have” something you have positively identified. The only way to mitigate this is to be very clear from the outset that psychiatric diagnoses are labels that are intended to serve certain purposes. They might point the way to helpful treatments but fundamentally they are heuristic constructs rather than definitive descriptions and understandings of clinical problems. In my experience, the act of providing a diagnosis is so influential on a person’s sense of self that its limitations need to be repeated again and again and again.
We observe this in Laura’s story where, in retrospect, some of the psychiatrists claimed (and even documented at the time) their diagnostic uncertainty. Both things can be true: psychiatrists might have mentioned this and Laura did not hear it. This is not in any way intended to blame Laura; it is meant to emphasize how potent diagnostic labels can be and how important it is repeatedly to explore their meanings and effects on the people to whom they have been assigned.
Laura stopped her medications and learned at least two things: they can be hard to stop and there is limited knowledge about this within the medical establishment. Millions of people turn to the internet to find answers because their psychiatrists do not acknowledge the validity of their experiences withdrawing from these drugs; Laura is not an outlier. After many years of advocacy, there are now guidelines for tapering drug doses in the UK. As Laura writes, this topic remains largely unrecognized in the US. Why?
In a New York Times article detailing the work Laura and her husband, Cooper Davis, are doing with Inner Compass, Allen Frances, a renowned American psychiatrist, is quoted:
What makes tremendous sense for Laura and millions of people who are over-diagnosed and over-treated makes no sense at all for people who can’t get medicine. … Laura does not generalize to the person with chronic mental illness and has a clear chance of ending up homeless or in the hospital. … Those people don’t wind up looking like Laura when they are taken off medication.
I believe there are people who do better when taking medications. I still work as a psychiatrist and I prescribe psychotropic drugs. But Allen Frances concedes there are millions like Laura. Where Frances and I part ways is that I do not think we can easily distinguish between those who benefit from them and those who don’t. First of all, the alarmism embedded in his statement risks halting the discussion; most people who stop taking psychiatric drugs do not end up homeless or in the hospital.
Also, drug tapering does not need to be synonymous with drug discontinuation. In my experience, approaching this using a harm reduction model can work well—one tries to minimize the risks of drug therapy by minimizing doses but not necessarily discontinuing treatment. Laura discusses the hyperbolic shape of drug-receptor binding curves, which explains why the final increments of drug discontinuation tend to be the most difficult. I have worked with people who get to low doses (sometimes, likely erroneously, considered “subtherapeutic”); on such doses adverse effects are greatly diminished.
Continuation of drug therapies at low doses might be warranted for a host of reasons, not least of which is the ongoing uncertainty of the extent to which it reduces relapse risk. But this is a choice made best in partnership between the individual taking and the person prescribing the drug where the knowns and unknowns are frankly acknowledged.
The psychiatric profession needs to reckon with the consequences of its broadened applications of diagnostic categories and the resulting expanded use of drug therapies. We need to reckon with the fact that alarms were raised—and then largely ignored—at least thirty years ago about the problems that occur as a consequence of drug discontinuation. Mistakes were made. By us.
We live in a time when expertise is devalued and in which scientific methods of inquiry are viewed with suspicion. I continue to uphold the importance of scientific investigation as a process whose greatest strength is recognition of the provisional nature of its formulations. When socially powerful professional institutions do not acknowledge their manifest limitations and seek to remedy their evident failures—thereby violating the fundamental spirit of scientific methodology—we contribute to the erosion of public confidence in expert opinion.
Too little too late, which doesn’t really matter given the unsurprisingly detached nature of this author’s critique…although it does (unintentionally?) lay bare psychiatry’s deeply systemic lack of self-awareness and self-restraint.
My critique of the critique: Time for quibblers to pick a lane.
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Good to see you here again Sandra.
We started around the same time in the industry. Early 1980’s my unit director’s continual question Where are the biomarkers?
There aren’t any though you could have gone into medical co dictions that involve the brain and gut neurons like Pellagra and Diabetes and Lupus and others. At one time nutritional issues created massive problems for people throughout life. This may be seen again with the USAID closures . Words forgotten like Rickets might come back.
So I understand what you are saying and it is the great dilemma of humanity. How to handle crisis? And crisis is an impact for each organ in our bodies and again how to handle ?
Obviously separating psych from the mind from the body and using snake oil advertising and marketing only good for those who gain profits from stock holdings in the companies.
And by diving psyche from the body and only having one tool in the healing g supposed healing tool box makes for not great helping straggles. It’s been a mess and trauma for you and those in front of the desk or wearing the white coat.
And trauma for those is who are or have been in the supposed helping system. And construes random luck or every now and then folks who try to help actually help.
We need a new way to understand human crisis and a multilayered framework so that psyche and mind and body and environment in all its multilayered framework can be seen and understood in as map or pathways of cause and affects.
I can only see a team approach being able to handle this complicated but so do necessary change . Take Care.
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Delano told her life story in a meaningful and understandable way, while also weaving in a the history of psychiatry and a scientific understanding of psychiatric drugs. I’m enjoying the fact that it is making the psychiatric establishment really squirm.
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I agree that Delano’s book is beautiful and powerful. Thank you!
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It’s about time somebody did. Psychiatry’s been getting away unscathed for far too long.
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Let’s hope and pray, Chris.
No offense, Sandra, but I think MiA’s film festival was in 2014. Sorry to always be pointing out psychiatrists’ flaws.
But, hey, my young son pointed out that Jesus’ theology had a “trick” to it, when he was only 7. That “trick,” of course, is I do have a right to treat others, as they have treated me (of course, with respect for God’s laws). And, my personal experience is that all psych workers “conspire” against their clients, especially mothers of child abuse survivors and child abuse survivors. And every “mental health” worker I’ve ever personally met, and mentioned that I have medical evidence of child abuse in my child’s medical records, has told me they want to neurotoxic poison my well behaved, intelligent, multiple award winning child.
All DSM “bible” deluded psych workers should get out of the schools and churches, especially until they may bill to help child abuse survivors, which they still may NOT do today.
https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1
Best wishes on your book sales, Laura.
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Thanks for the correction! No doubt this is one of my many flaws. And to you and others, I hope it was clear that I thought this is an extremely well written and compelling book.
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It was clear enough to me. I appreciated the article and found it well-written and thoughtful. Nuance is something I do appreciate when I find it, and it’s hard enough to find these days. I thank you for your nuanced opinion.
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The “it’s nuanced” excuse is wearing pretty thin.
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“Is it fair to blame the entire psychiatric system when Laura herself was complicit in what happened to her?”
First of all, it’s not fair for anyone – including Laura – to suggest complicity, especially since psychiatry itself intentionally crafted a narrative that caused harm—and failed to meaningfully correct it.
It’s irritating the way this author (seemingly?) hesitates to more directly confront psychiatry’s pervasive avoidance of accountability which remains the key barrier to genuine reform. Without acknowledging and addressing these systemic failures, the profession risks continuing its cycle of harm and negligence.
Furthermore, Allen Frances’ statement INTENDS to inspire fear more than meaningful reform. It’s also the typical way psychiatry manages to evade accountability.
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It was the intent of this blog to point out the failure to account for these harms.
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I understand that, but it sounds more like you’re trying to make excuses for psychiatry’s misdeeds.
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“Neutrality helps the oppressor, never the victim.”, Elie Wiesel, Holocaust Survivor
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Treatment resistance isn’t treatment resistance, ever – what we call treatment resistant is treatment that doesn’t actually work to solve the root problem but may or may not provide some kind of apparent and superficial amelioration of symptoms, almost always only for a limited time if at all and then followed by inevitable deterioration – this for pharms and therapies alike. Pharms of course cause deteriorating long term outcomes in all classes of medication and this obviously isn’t treatment resistance although the psychiatrist often misdiagnosis as much.
I cannot bare how brain dead our mental health treatment systems are, and how enormously costly and harmful they are and how much they burry the actual problems in conceptual fantasies and illusions. Today there was a new story on how British girls were among the least physically healthy in Europe, with the highest rate of adolescent mental health out of the 44 countries studied. And the authors stated, quite as a matter of fact, that a number of factors contributed to this – fairly tough lockdown methods, increased social media use and increased cyber bullying – what absolute nonsense and what profound idiocy to think you can understand the phenomena of the emotional collapse of our youth through these kind of talking point explanations. Obviously one needs to understand the actual collapse of our children with the same care and urgency you would if it was your own children. Only then will you reject all these inadequate psuedo-explanations which satisfy computer brained academics intellectually, but could never satisfy someone who loves and needs to understand what is happening to our children. So only love can illuminate what actually is, and these academics bring only the intellect to bare on the problem, and their psuedo-activity gives the illusion of a society determined to understand the problem. If that illusion was not there we would all realize the deficit and our sense of urgency would perhaps be the stimulus behind a true solution, which is our own urgency, passion and care to find out and to understand. But to me the collapse of emotional, psychological, spiritual and physical health is not the thing that is difficult to understand at all. Your absolute inability to understand reality directly and your absolute blindness to all the horrors that face you is the thing that I would like to grasp completely, but if we did grasp this truth completely perhaps you’d start babbling incoherently and raving at the moon. I don’t know. Maybe it would be fun to find out, or maybe not fun, as the case may be.
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Is it a cult? Depends on which circles you move in. Thomas Szasz identified two forms of psychiatry: people voluntarily seeking help, and people involuntarily exposed to ‘help.’ In the latter case the entire enterprise is about eroding a persons self trust and autonomy and eliciting complete submission to external control. Sounds an awful lot like a cult! But id add another category in there, which is the category of people voluntarily seeking help who are then told the same thing as the involuntarily subjected lot: you must submit and you cannot trust yourself. Oftentimes this leads to more involuntary measures one is expected to be grateful for. Bottom line, if the psychiatric relationship is based on and embedded in a system designed to erase a persons autonomy and create a ‘compliant patient’ who will readily agree that they must never trust themselves and always submit, it’s a cult.
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Indeed. No other branch of medicine operates like a cult the way psychiatry does—which tells you all you need to know about psychiatry.
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Dear Ryan and Birsong,
I am presenting an analysis based on a twelve-point checklist developed by Cult Recovery 101, specifically focusing on the psychiatric field. Below are my responses to the relevant criteria:
1. **Leadership and Commitment**: Psychiatry exhibits a strong allegiance to established dogma, with practitioners and institutions demonstrating unwavering commitment to its doctrines, often equating to excessive zeal towards specific figures or theories within the discipline.
2. **Recruitment Practices**: There is a notable emphasis on expanding the membership base within psychiatry. This is facilitated by multiple entities—including families, educational institutions, healthcare services, legal frameworks, and governmental bodies—actively promoting or even coercing individuals into psychiatric treatment.
3. **Financial Motivation**: The field demonstrates a significant focus on financial gain. Psychiatrists receive funding from diverse sources such as private individuals, governmental allocations, institutional backing, and substantial investments from pharmaceutical companies, creating potential conflicts of interest.
4. **Suppression of Dissent**: The environment within psychiatric treatment often discourages, or outright penalizes, questioning and dissent. This is evident through practices such as involuntary confinement, physical restraints, forced drugging, and social isolation.
5. **Use of Mind-Numbing Techniques**: Various interventions, including neurotoxic drugs and electroconvulsive ‘therapy’ (ECT), are employed frequently, contributing to cognitive impairment and serving to suppress doubts regarding the legitimacy of the treatment.
6. **Behavioral Control**: Psychiatrists exert significant influence over patients, dictating their thoughts, emotions, and actions through diagnostic labels, pharmacological interventions, and the threat of involuntary hospitalisation.
7. **Elitism and Special Status**: The psychiatric profession often positions itself as a saviour group, asserting that their medical interventions—diagnosis and pharmacotherapy—are critical for societal salvation, rather than endorsing holistic approaches that include housing, nutrition, education, and relational well-being.
8. **Us-versus-Them Mentality**: There’s a pronounced dichotomy fostered by psychiatry, promoting an ‘us versus them’ mindset. Individuals or groups who critique or oppose psychiatric practices are frequently marginalized or ridiculed.
9. **Accountability**: Accountability within the field is limited. Psychiatrists often operate with minimal oversight for actions that involve the misuse of scientific evidence, leading to harmful treatment practices.
10. **Ethical Justification of Means**: Psychiatry often promotes the idea that the ends—typically the management of ‘mental health’—justify the means, which include practices many would generally deem ethically dubious before engaging with the field.
11. **Induction of Guilt**: The practice frequently instils feelings of guilt in individuals, a mechanism employed to maintain control over patients through stigmatization and the imposition of diagnostic labels.
12. **Isolation from Personal Networks**: Membership within psychiatric treatment often results in individuals severing ties with family and friends. Neurotoxic medications create barriers to sustaining relationships, while involuntary hospitalisation forcibly isolates individuals, exacerbating the disconnection.
Additionally, members are often encouraged to interact solely with other individuals within the psychiatric framework, particularly during hospitalisation or as a result of societal stigma directed at them.
Upon evaluating these criteria, psychiatry scores 12 out of 12, qualifying it as a cult. As Peter Breggin aptly states, “The worst thing a person can do is see a psychiatrist.”
The question remains: how do we effectively dismantle a system that is intricately intertwined with every facet of our society? One powerful strategy is to launch counter-educational campaigns that challenge the status quo. We must actively promote and support non-invasive alternatives. Furthermore, the focus should not be on the myth of mental health but on providing affordable housing and organic nutrition. We can take inspiration from successful models like Soteria House and advocate for the implementation of universal basic income.
So, how do we fund these transformative initiatives? By redirecting financial resources from psychiatry towards these innovative alternatives, we can invest in a more compassionate and effective system that truly supports individuals in need.
Kind regards,
Cat
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Why not just practice “Buyer Beware”???
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“Buyer beware” places responsibility on unsuspecting individuals, a suggestion that is both immoral and ignorant in the context of psychiatry. Even minor material purchases come with cautions, change-of-mind policies and a warranty. Without critical discourse and demands for viable alternatives, significant reform is unlikely.
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“Buyer Beware” is neither immoral nor ignorant, it’s remembering to use the agency God gave you.
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Dear Birdsong,
Given the manipulative and coercive practices prevalent in psychiatry, coupled with the lack of definitive evidence for any deities, I feel a strong urge to contest your perspective.
Have you ever truly felt the impact of being drugged by psychiatrists? Did you genuinely give ‘consent’ to take neurotoxic substances, or were you subtly pressured through deceit and reassurances of safety? Have you ever been confined, drugged, and mistreated in a psychiatric facility? I know I have. It’s astonishing that my refrigerator includes a warning label, while my prescriber and the hospital did not. The philosophy of “buyer beware” is particularly brutal, especially in a world devoid of divine intervention to protect us from the horrors of psychiatry.
Kind regards,
Cat
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“Buyer Beware” is not a reprimand. It’s meant as a precaution to make you think twice before placing doctors on pedestals.
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I agree, the DSM “bible” billing industries function as a “cult.” A “cult,” seemingly hell bent, on functioning to “maintain the status quo,” which is a “status quo” that is based upon bad systems, thus it is dysfunctional, and unjust.
I mean, in the US, we’re all supposed to believe “we are all created as equal,” yet the psych industries want to create and maintain a greed only inspired caste system, which protects the “professionals” while putting everyone else through a literal iatrogenic living hell, and steal more than everything from them … at least according to my medical, financial, and legal records, and research.
More ways to point out how the psych industries are un-American, thank you, Cat.
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I appreciate your insights, Someone Else. The psychiatric cult not only opposes international human rights but also exhibits a lack of rudimentary science in its practices.
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Human beings are naturally drawn to those who claim to have all the answers.
Paradoxically, that’s exactly the way psychiatry became a cult.
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“When socially powerful professional institutions do not acknowledge their manifest limitations and seek to remedy their evident failures—thereby violating the fundamental spirit of scientific methodology [and justice within society]—we contribute to the erosion of public confidence in expert opinion.”
I agree.
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Oi mates, I’m on my death bead. I’m lying here with his face and hands tied like from Gulliver’s travels by these demons I created, my desires, and now I lie there dying as his ego-self. I was just the world consciousness trying to destroy him, because we didn’t want him to get up and live, this terrible thing, but he has outlasted me the tyrant of his body, and so in him I die, this tired old ego of the whole Earth, for in trying to slaughter him I enlivened him, and now he’s strong enough to take on the whole Earth. Woe betide you though who ever tried to tie him down with thought and judgment, for you never knew what he was, and now you will be the soil in which his roots are sunk deep for eternity, sucking you dry in your regret and confusion, you’re wasted soil on his bare feat. They go on to live the perfect life.
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“One compelling theme of her book that I have not seen highlighted in other reviews is Laura’s description of how adopting a medical formulation of her problems led to her loss of agency. She was a “good” patient. She accepted the diagnosis of bipolar disorder and (mostly) adhered to the recommendations of her psychiatrists. She was a product of the era of the “broken brain” and with this came the notion that, due to forces outside of her control, her brain was not functioning properly and that manifested as the problems she was experiencing.”
This notion of agency needs to be explored in greater depth. Yes, Laura has raised this issue – clearly, where none of us have seen it addressed anywhere else. This loss of agency is disabling! So even if the pharmaceuticals worked (corrected whatever the mystery problem is), once a human is DSM diagnosed – nothing that diagnosed human ever says again, is believed. This is a problem, for everyone.
There are apparently professionals writing for MIA and reading and posting in the comments. Help me out here. I don’t exactly know what the source of this loss of agency is? Was it taught in medical school (don’t believe the patient)? Is it “stigma”? (they’re crazy, they don’t know what they are saying)? Is the DSM symptom “poor judgment”? Is the liability insurance providers preaching “deny any adverse side effects”?
Sure – some people diagnosed or otherwise, can’t see the forest for the trees, or the nose in front of their faces, but once a human becomes a “good” patient – nothing that they say is believed, ever again. What has been created here? The most dangerous issue is the innate instinct to detect “red flags” goes ignored. Sure, it might be paranoia, but it is not paranoia, if it is true.
Once out of the professionals office – who is looking after this totally numbed out / sedated individual? Many “patients” are streeted to survive unsheltered, where predators abound. Report a rape? Report an assault? Report an adverse effect? Why bother?
I have regained my agency. A lone “aging adult life coach” believed me. I then began the long road back to agency. It began very small, and has snowballed into a full throated “Always, always, always Trust myself”. This had always been true in my life, but after having been “psychiatrized” had become nearly dormant.
Why don’t we believe the people refusing psychiatric medication? I would bet, the vast majority of them, know their own minds and bodies better than anyone else.
I remember long ago (20 years or so) speaking to a neurologist, and to my disbelief – had to tell him “I know when I have a headache and when I don’t”. (hormonal migraine) Think about it, folks. Here he sat in judgment of me, with no biomarkers – denying the truth of my experience.
This subject of “loss of agency” needs to be explored. It impacts the health care providers when adverse side effects go denied, and it impacts patients who are defenseless in a world of predators.
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Yes, yes, and yes. It’s a classic Catch-22.
I’m 64 and was one of the early guinea pigs for Prozac, going on it in just before it was on the cover of Time as the new miracle depression drug. Was on and off it for the next thirty years. Finally off it for good in 2015 or so and so many things have become so clear to me now. I weep for my younger self. I weep for all of us, swept up in a tide of PR that has left us with lifelong consequences.
This is not just capitalism: this is capitalism on drugs.
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It’s really not that complicated. The “loss of agency” comes from having too much faith in psychiatry and not enough in oneself.
*Aggressive ad campaigns make this dynamic almost a foregone conclusion.*
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“A person loses all credibility.” from RegisteredForThisSite below in the comments.
Thank you Alexandra and Birdsong for your comments. From them, I experienced a wider ah-ha moment.
The expert class, no doubt, harbors the notion that this “loss of agency” is part of the mystery brain disease, just as the accusation of “lack of insight” leads to forced complicity (not of one’s own volition).
Do-gooders require “the down-trodden” to feed their sense of superiority. Those of us DSM labeled, and thus permanently discredited – are no different than those accused of witch craft in a different era. It is human nature.
I’m even older than you, Alexandra – rounding the corner towards 70. “We can’t change the times we live in”, and thus – no reason to take it personally. Just the luck of the draw. We are human.
Since walking away from the entire Healthcare Industry (8 years ago), I have travelled widely, in both red states and blue states. I have alluded the EHR by moving. By far – this garbage (seeing everything through the lens of the DSM) is worse in some locales, than in others. Not necessarily by political leaning, but there is some correlation to the sheer quantity of “experts”.
I will never be able to home again, but I live free and it’s a good life. Sometimes I am homesick, but the truth is more like, the home that I long for, hasn’t been in that locale, since the ‘80’s.
Thanks for the discussion.
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I am so grateful for being in a nation where there is no nationwide EHR (there is internal EMR in hospital chains like Apollo Hospitals where I never consult Psychiatry guys in). The existence of EHR would have destroyed my life even more than it has been destroyed.
And they’re bringing it all here. Everything’s becoming very Americanised in terms of healthcare. EHR is okay for physical medical problems of the body. Psychiatry? A life of DSM dirt following you everywhere. You might as well euthanise the person. That would be kinder.
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Thank you for the opportunity to correct my word mistake. I eluded the EHR by moving (not alluded).
This is the danger.
Like many others posting here, I have been subjected to dosing of Lithium (or perhaps you have prescribed Lithium). It is widely known that Lithium can damage the kidneys. Damaged kidneys often do not filter anything as expected. Not pharmaceuticals, not food (micronutrients), and in the end – not even water. In particular, electrolyte imbalances are common. One symptom of electrolyte imbalances is confusion – which may manifest as hallucinations. If your EHR contains the diagnosis of mental illness, a busy ER (emergency room) may conclude that you are in need of more psychotropics, rather than even look for an electrolyte imbalance. In other words – healthcare as it stands today, is more of a danger, than of any help to me, personally. You decide for yourself.
As I figured this out for myself, I had the opportunity to chauffeur a pair of old ladies (closer to 90, than anything else). I asked them – was it modern medicine – health care and doctors – that extended your lives? They couldn’t stop laughing. We are human, and short of needing to be patched up from a car accident – we each our allotted “our time”.
No. Euthanasia is not for me! I absolutely love being alive. Every day is a new surprise. And from the distance of decades, I take particular joy in watching those younger than I, discover their world.
It is “not right” what is going on. It is not personal. It is happening at scale. Everyone has a story. My greatest achievement in life, is just as Laura’s has been. I managed to extract myself from “being the target of the psychiatric story”.
There is life after polypharmacy. Perhaps, not all that mainstream, but spring comes for all to enjoy. I will go bird watching this morning, followed by the gym and shooting hoops. I have my “bingo” friends. Tomorrow is April’s birthdays.
I write here, on the odd chance that it might help point the way. Eat healthy. Go outside and get some exercise. Appreciate what you have, and let the rest of it go.
I don’t blame anyone. “They” didn’t know. “They” (collectively) still don’t know. Even “the kidney doctors” don’t know. They know more than they did 20 years ago, but they don’t know what they will know 20 years from now.
FWIW
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Haha. I didn’t literally mean it when I said “you might as well euthanise a person”. It was just me trying to express how horrible it is for that rubbish to follow you around forever.
Good to know that your spirit is alive and well and you take life head on.
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I was surprised they interrupted me being euthanised in the E.D. rather than allow me to make a complaint about being tortured and kidnapped. That’s how thin the line is between ‘treatment’ and torture….. the status of “patient”. (the shifting of the line of what constitutes “life unworthy of living” very instructive in this regard. DNR)
It seemed the better method of covering up their problem. How silly to leave me running around with the documented proof after the State had “edited” the legal narrative and set in motion the process of ‘fuking destroying’ me for trying to complain.
The problems that I caused by turning up in a Police station with the documented proof of not only the torture and kidnapping (with police procured for the crimes), but that the Chief Psychiatrist had used documents produced via an act of torture and forged for the purpose of concealing human rights abuses and crimes.
Had they not interrupted the doctor in the E.D. with the midazolam/morphine (harvested from another patient) ‘chemical restraint’ I would have been dead and the problem for Police to find out ‘who else had seen the documents?’ (and thus the State sanctioned torture, kidnappings), would not have existed.
What an absolute mess with everyone trying to cover their ar&^s, Police threatening ‘mental health workers’ and trying to have them ‘treat’ me for being the victim of these high level public servants. (there’s the reason Police always fail to act against the organised criminals within this industry, the benefits they gain by having people laid out should they require it) Failing in that and no knowing who was watching….. having to threaten the mental health workers to ensure that the attempt to harm me “never happened”.
Must say that euthanasia is certainly not off the cards given the total lack of accountability being provided by our political elites. Our Chief Justice even recognising the threat to our ‘democracy’ that comes from these very people.
“We live at a time when in other Western democracies with whom we share a common heritage, public institutions such as ours are under significant threat, and where public confidence in those institutions is deliberately sought to be undermined,” he said.
“Often, those threats come from the very people who have been entrusted with responsibility to uphold those institutions.
“It is a stark reminder of the sometimes fragility of our institutions of government: either the parliament, the executive or the court.”
With a Chief Psychiatrist who is prepared to commit acts of deliberate neglect and dereliction of duty to enable arbitrary detentions and torture (the euthanising is done under the guise of General Medicine, not psychiatry) is there any wonder our C.J. makes such comments?
The Community Nurse abusing a few patients (and lying to police to violate human rights) is one thing, the C.P. enabling mass human rights violations with his neglect is entirely another.
Still, the Premier thinks that asking him about the “editing” of legal narratives by hospitals and his euthanasia laws is an illness (or at least enough to slander someone rather than address the question)…….. and he should know, his father was a psychiatrist. Raised himself one hell of a narcissist there. Manipulation rather than address the facts.
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Dr. Steingard,
Thank you for this reflective and generous piece. I found your take on *Unshrunk* both thoughtful and courageous. You offer a rare blend of humility and accountability in how you trace psychiatry’s evolution—something I deeply appreciate.
I did want to gently push on one point, or maybe just broaden it. Laura Delano is thirty years your junior, and as you noted, came of age in the full tide of the “decade of the brain” era. What struck me reading both her memoir and your reflections was how completely the medical model had saturated not just the profession, but the broader cultural waters we all swim in. I agree that her complicity is worth noting, but we also have to recognize how limited her choices were within the dominant framework she was given. In many ways, she didn’t just internalize a diagnosis—she was raised within a system where that diagnosis felt inevitable.
Your piece also got me thinking about the longer arc of psychiatry itself. When I began my clinical training, I encountered psychoanalysis at the tail end of its institutional reign—right as Menninger was closing, largely due to reimbursement challenges. There were aspects of psychoanalytic thought I found useful, but also troubling—particularly its embedded misogyny and its dependence on a patriarchal, Eurocentric worldview. And stepping even further back, we can’t forget that psychiatry itself emerged from a kind of professional insecurity. Freud’s ideas were not initially welcomed by the medical establishment, and psychiatry has long struggled to assert itself as “real medicine.” That history still echoes today in the form of overcorrection—an almost desperate clinging to biologically reductionist models to gain legitimacy.
You write powerfully about the broken brain narrative—how it relieved people of blame and shame, and yet ended up stripping many of their agency. That paradox is key. For many of us in behavioral health, especially those of us who’ve straddled clinical work and systems leadership, this tension is not just theoretical—it plays out in the lives of clients, families, and staff every day.
I’m especially moved by your call for psychiatry to adopt a stance of uncertainty and humility. That resonates deeply. I’ve long felt that the most healing environments are those where professionals are allowed—and even encouraged—to admit what they don’t know. That creates space for the client’s story to have power, and for new models of care to emerge.
Thank you for offering a way forward that honors both critique and care.
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Indulging in endless nuances sidesteps the core issue of FRAUD.
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“Indulging in endless nuances sidesteps the core issue of FRAUD.”
To be expected in a society where ‘coin clipping’ has gone from a hangable offence to a business model?
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Grift is therapy’s bread and butter.
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In what way is Laura’s “complicity” worth noting???
All this does is shift accountability away from psychiatry—where it rightfully belongs.
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“Complicit” means “Associated with or participating in an activity, especially one of a questionable nature”. Maybe she could have chosen a less loaded word, but when we take the drugs that psychiatrists prescribe, we are complicit. When we ignore our own doubts and questions and defer to their “expertise”, we are complicit.
Most of us are familiar with the feeling of going along with something we don’t really subscribe to. When we do that we are complicit. It’s not blaming: it’s recognizing that reality is complex and accountability, in this case, must involve both the psychiatric industry and its customers.
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“It’s [complicit] is not blaming: it’s recognizing that reality is complex and accountability, in this case, must involve both the psychiatric industry and its customers.”
Nice try, but “complicit” implies culpability. Just ask AI.
P.S. There’s a big difference between complicity and compliance.
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Nice try, but “complicity” has two meanings. Both stem from the idea that someone is participating in something. One meaning is simple description, the second implies criminal or otherwise anti-social activity. You read the second meaning. I read the first meaning. Both of us are correct.
[BTW, I don’t support the use of AI over of the perfectly good sources of information that already exist. AI does not offer anything you can’t get from Merriam-Webster or Roget’s.]
I agree the author should have chosen a less loaded word that would still communicate the idea that Laura participated as an agent in her own psychiatric treatment. She was not involuntarily committed. That’s really the point.
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Saying that Laura was an “agent” in her own psychiatric treatment dismisses the impact of a paradigm that, as Laura suggests, often strips individuals of their sense of autonomy.
Her narrative emphasizes reclaiming agency over time, and implying complicity detracts from that profound journey of empowerment.
P.S. You might be mistaking compliance for complicity.
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For the record, Laura was involuntarily committed—but that’s really not the point.
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I am not able to respond to your comment below but I appreciate it and, in retrospect, would have chosen a different word.
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Your claim that “there are people who do better when taking medications” raises concerns, particularly in light of the substantial research demonstrating the harm caused by psychiatric drugs (Breggin, P., Burstow, B., Whittaker, R., et al.). All psychiatric drugs are neurotoxins that lead to brain atrophy, resulting in a range of emotional, physical, and behavioural symptoms, while also accelerating cognitive and neurobehavioral decline (Jackson, G., 2008, Psychrights.org).
How do you justify the prescription of neurotoxins for conditions that lack a biological basis?
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I’m not a professional, I’m a patient. My own bipolar disorder has been a 40 year journey, but the diagnosis only came 10 years ago when I could no longer manage my symptoms without help.
I despise the drugs and managed to get to minimum doses over the period of 2 years. One morning they stopped working. I can honestly say without immediate intervention and a change in dosage I wouldn’t have survived, the pain was unbearable. I was rapid cycling in hour, the mind and body simply aren’t equipped for it.
That is the justification, at least for some of us. My mind would kill me long before the drugs will.
Also, this runs in my family, so I’d wager there is a biological component.
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Dear Tim,
I am curious as to how your ‘diagnosis’ of ‘bipolar disorder’ is substantiated. What are you referring to when you state that “it runs in my family”?
Are you aware that there are no known biological causes for any of the psychiatric ‘disorders’, nor are there any tests to provide independent objective data in support of any psychiatric diagnosis (Council for Evidence Based Psychiatry, http://www.cepuk.org)? Each ‘diagnosis’ is merely a description of behaviour voted into existence by psychiatrists (Greenberg, G.).
Kind regards,
Cat
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I can understand how Laura might feel that her emotional suffering was atypical of most others labeled “mentally ill” but I agree with Szasz that psychiatry is pseudoscience pathologizing natural human suffering.
I also understand “vested interests” so I understand why you two accept the pseudoscience of psychiatry. However, while you’ve been supportive of Laura’s article, she seems to be taking the brunt of the push-back. You’ve made bank with a psychiatry career while Laura is being mocked as an outsider while struggling to make a business work.
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The Decade of The Brain enlightened me a great deal, having read and studied, without the pursuit of an actual degree, about what could have been the root causes of my lifelong struggles, with depression, anxiety, unspecified processing problems and emotional regulation.
My journey began in November 1990, with plenty of labels, initial criticism that I had “swept everything under the carpet” and overt patronization. To summarize an extremely arduous, painful and lengthy process more succinctly, the labels, outright power struggles and inability to arrive at an accurate diagnosis and treatment modality, continued to almost this day. Now, I endure age shaming and being treated as though my eyes were not opened, at the ripe old age of 22.5 years old, which they actually were, all along.
I have studied the factual information and implications of what had always been present. I have autism, tendencies, probably, but fought through all of the extreme criticism, threats and bullying, since a very small child, both of my own doing and of that of my late mother. This condition had been unheard of, misunderstood and even lesser studied, but at that time, medications for co-morbid symptoms; I have ADHD, and so did my late brother, were not overly prescribed, as can be the case, currently. Cue in the opioid crisis, and I cannot now obtain needed anxiety medication, even though I took it, responsibly, for more than thirty years, and did not become addicted to it, or develop a physiological dependence.
These generational nuances merely serve as a predicament, which can be a Catch-22. Both labelling and well-intentioned, psychopharmacological treatment can contribute to further stigma, stress and a lifetime of self doubt, as well as to a lack of faith, in the world at large.
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Dear Liz,
It’s crucial to acknowledge that the DSM defines ‘disorders’ primarily through observable behaviours instead of biological tests or brain imaging—methods that currently cannot validate any of the 297 recognized ‘disorders’ (Ross, C., Szasz, T, et al). With this in mind, how can you assert with confidence that you “have” “Autism tendencies” and “ADHD,” given the absence of a biological basis for these conditions?
Kind regards,
Cat
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Consciousness isn’t rooted in the brain and therefore isn’t limited to what can be seen or observed through biological testing or brain imaging.
The “Nun Study’ which looked at the brains of a group of nuns after death showed even nuns whose brains showed obvious signs of Alzheimer’s or other vascular issues didn’t always or even necessarily result in significant cognitive decline: https://www.atlasobscura.com/articles/the-neurologists-who-fought-alzheimers-by-studying-nuns-brains
A doctor did a scan of my elderly mother’s brain and told me her Alzheimer’s was so advanced her cognitive abilities were seriously impaired and that she only had a few months to live. Neither turned out to be true. In the end, it was the diagnosis itself in combination with the drugs they prescribed and lack of good options that did the most harm.
Souls aren’t science. It’s something I’ve always intuitively known to be true but have sometimes forgotten.
I’m not defending the DSM which describes characteristics or traits and not the soul’s capacity for greater self-reflection, awareness and change . . . to a greater or lesser extent, depending on the individual and their unique psycho-spiritual/physical/material challenges.
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The practice of labelling people with bipolar disorder for mania-causing side effects of antidepressants and stimulants has to stop in all psychiatry departments across the world. The problems that people have for which they end up on those meds are bad enough.
“Bipolar Disorder” is an extremely stigmatising term that is associated with violence and psychosis. Labelling people with that, especially if those individuals are coming from violent circumstances in the first place (which is what is a major cause in their initial suffering), for side effects of psych meds, is beyond criminal. All it does it result in even more gaslighting. A person loses all credibility. People use the term as slurs.
That person then goes onto becoming a family history to his/her relatives also. Someone else’s life gets screwed on their account.
Psychiatry graduates of Department of Psychiatry, Christian Medical College, Vellore: I’m looking at you. Stop doing this (especially in a country like India where all this is already super-stigmatised and psychiatry is just weaponised by people). Stop ruining and stigmatising entire families and giving BS excuse after BS excuse, even character assassinating the opposite person, to justify it. This applies to other departments and private practice psychiatry graduates as well.
“Oregon doctor Susan Haney is suing psychiatrist Howard Sampley, alleging that he mistook effects of medication, and pregnancy, for a mental disorder. Haney’s trip to the emergency room for asthma and pain from a burn had resulted in a diagnosis of psychosis, bipolar disorder, mania, potential harm to self and others, and a suspension of her medical practice. The state medical board later reinstated Haney without restrictions; she is suing for for $2.25 million.”
Susan Haney was a doctor herself. She knew what the consequences of being labelled as “bipolar” for drug induced effects was. She lost her medical license. She could sue Howard Sampley and get justice. Most people cannot do anything except shut their mouth and forcibly be labelled. You even have the clientele of psychiatry graduates who behave like kapos for them who try to put them in line.
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I discovered that I was bipolar when I saw it in my chart. My doctor didn’t tell me he had changed my diagnosis, and I could have gone for years without a clue had I not looked at my chart. This was in the mid-1990s. I was on Prozac, prescribed by said doctor.
He never asked me about what he apparently concluded were symptoms of mania. I’d be surprised if he even recognized my face, as he spent the entire fifteen minutes of our appointments looking at his computer while I looked at his back. Any hypomania I had was a direct result of the Prozac, but he wasn’t interested in any of that. Just decided I should go on Lithium, too. Just a small dose, nothing to be concerned about. But I would have to get my blood checked regularly to make sure it wasn’t going to kill me.
It was instantly stigmatizing for me. I was bipolar? The only other person I’d ever known with that diagnosis was a friend from school who had regular psychotic breaks from reality for which she was hospitalized. I’ve never had a psychotic break. I am not, and have never been, “bipolar”. But that casual diagnosis caused me much unnecessary emotional and mental harm.
I did go on Lithium for about six months. Then I stopped the Lithium and after that the Prozac and the psychiatrist. Been free of all that for about ten years now. Having taken full responsibility for my own physical and mental health, and availing myself of natural, plant-based medicines, I feel better than I ever did on Prozac.
I haven’t entirely given up on all Western medicine. I am just very selective now about what parts of it I want to use. But sometimes I do think the entire psychiatric industry is just one, big iatrogenic mess.
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As a clinician who has walked alongside people navigating complex pain, I continue to be deeply concerned about how modern psychiatry has often silenced trauma, reduced meaning to symptom checklists, and prioritized medication over relationship.
The rise of the DSM—from its roots in military classification to its modern role as a billing and diagnostic tool—may have helped psychiatry gain legitimacy as a medical field. But it came at a cost: the over-medicalization of human experience, the erasure of trauma, and a reliance on diagnosis as identity.
Families—especially mothers—were once blamed for everything. Then psychiatry flipped the narrative, externalized pathology into the brain, and gained powerful allies in the process. Parents were relieved of blame, but trauma was also pushed underground. The new message became: there’s no one to blame, so there’s nothing to explore.
What gets lost is the person. Their story. Their history. Their inner world. The system becomes about managing, not meaning.
When a profession cannot hold accountability, it loses its integrity. Psychiatry must wrestle with its own legacy if it ever hopes to truly heal.
The film *Stutz* is one example of what a healing shift might look like. Here we see a psychiatrist embracing transparency, drawing from tools that include Jungian and older integrative frameworks. This is a hopeful direction—one where relationship, reflection, and honesty are centered once again.
As practitioners, we must move toward a model that is relational, trauma-informed, and meaning-centered. Healing is not found in control. It is found in witness, in compassion, and in truth.
As a social worker, I also want to take some responsibility. I wish I had fought harder. I wish our field had pushed back more forcefully against the dominance of the biomedical model and advocated louder for trauma-informed, relational, and community-rooted care. Social work has always held the potential to be a bridge between systems and souls—and I believe we still can be, if we choose to reclaim that voice.
I find this website a beacon of hope and force for change. Please continue to voice your experiences.
and thoughts. It is not in vain.
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It’s a little late for mea culpas.
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Accountability and responsibility from parents, schools, communities, society, relationships, human nature and biology/genetics are so important because these things shape our personality and our whole identity when we are growing up and influence us in our adulthood as well. The biopsychosocial model has to be seen in each individual. See the whole person instead of just a part of the person. I enjoyed reading your post and I agree with everything you said.
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