While one explanation for top psychiatrists’ exuberance unchecked by reality is their financial conflicts of interest with Big Pharma, historically, not all leading psychiatrists have been drug-company shills. So, what are other explanations for this phenomenon? Before examining these other reasons, a look at two high-profile examples of this exuberance.

In the twenty-first century, there has been no higher-level psychiatrist then Thomas Insel, director of the National Institute of Mental Health (NIMH) from 2002-2015. Insel left NIMH to lead the mental health team at Verily (formerly Google Life Sciences); then in 2017, co-founded Mindstrong Health, where he promoted digital phenotyping (which, for example, includes the monitoring of patient smartphone text messages to gauge mental illness).

Insel is a prime example of a top psychiatrist with exuberance about psychiatry regardless of his awareness of the reality of its repeated failures.

“I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”—Thomas Insel, quoted in 2017.

“To be clear, I have no regrets about NIMH funding for genomics and neuroscience.” —Thomas Insel, in Insel’s 2022 book Healing, xxvi.

“Whatever we’ve been doing for five decades, it ain’t working . . . . When I look at the numbers—the number of suicides, the number of disabilities, the mortality data—it’s abysmal, and it’s not getting any better.” —Thomas Insel, quoted in 2013.

“The scientific progress in our field was stunning, but while we studied the risk factors for suicide, the death rate had climbed 33 percent.” —Thomas Insel, Healing, xvii.

“. . . current treatments are as effective as some of the most widely used medications in medicine.” —Thomas Insel, Healing, xxiv.

The history of psychiatry is replete with ultimately discarded psycho-babble, bio-babble, and techno-babble. The discarding of the DSM, psychiatry’s diagnostic manual, was actually called for by Insel in 2013, and in his 2022 book Healing, he acknowledged that the chemical imbalance theory of mental illness has now been discarded. Today, he is techno-exuberant not only for digital phenotyping but for brain-circuit explanations of mental illness and for more electroconvulsive therapy (ECT), commonly called electroshock:

“The idea of mental illness as a ‘chemical imbalance’ has now given way to mental illnesses as ‘connectional’ or brain circuit disorders.” —Thomas Insel, Healing, 138.

“The approach [ECT], which induces a seizure across the full cortex in an anesthetized patient, might be akin to rebooting a computer. . . Simply zapping the cortex with electricity may seem like a Hail Mary pass, and yet it actually is effective. . . .” —Thomas Insel, Healing, 55.

Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb, Stanley Kubrick’s 1964 satirical film, ridicules nuclear war planning and the Cold War ideology of “mutually assured destruction.” The film also mocks nuclear war expert Dr. Strangelove, who is unfazed by the horrific consequences of nuclear weapons.

Analogous to the fictional Dr. Strangelove, Insel is aware of the adverse effects of ECT, noting that “there are serious adverse effects, including headache and memory loss” (Healing, 55); however, he is unfazed by these adverse effects. Rather, Insel is upset that “only 0.25 percent of people with depression [are] treated with ECT,” telling us that the stigma of ECT has occurred because “antipsychiatry groups have demonized it” (Healing, 146-147).

The scientific reality of ECT? As is the case historically with every psychiatric treatment, including bloodletting, there are positive anecdotal testimonials for ECT, however, ECT has not met the scientific criteria for effectiveness. A 2019 review of the research on ECT effectiveness for depression reported that there have been no randomized placebo-controlled studies since 1985, and those studies that were done prior to 1985 are of such poor quality that conclusions about efficacy are not possible. Moreover, it has been consistently shown that ECT results in serious adverse effects such as “persistent or permanent gaps in life memories, including of weddings and birthdays, somewhere between 12 and 55 per cent,” as reported by psychologist John Read in 2021, who also reported that “one in 50 patients experience ‘major adverse cardiac events.’”

When I think of Insel’s exuberance for psychiatry undaunted by abysmal outcomes and horrific adverse effects, I think of Major Kong (Slim Pickens) riding the bomb in Dr. Strangelove.

High-profile psychiatrists’ exuberance over psychiatric treatments regardless of scientific realities is not new.

In the late-eighteenth and early-nineteenth century, the most well-known American physician who treated the “mad” was Benjamin Rush, a signer of the Declaration of Independence. Rush is often referred to as “the father of American psychiatry,” and his image long adorned the seal of the American Psychiatric Association (APA), the guild of American psychiatrists. Rush proclaimed himself a slave abolitionist though he had owned a slave, and his views on race included the idea that blackness in skin color was caused by leprosy, and so he advocated “curing” skin color.

Based on an earlier bio-babble theory that irregular convulsive action of the blood vessels was the cause of madness (and other diseases), Rush was an enthusiastic proponent of what was called “depletion therapy,” which included aggressive bloodletting, notes Gerry Greenstone in “The History of Bloodletting” (BC Medical Journal, 2010). Greenstone tells us: “Dr. Benjamin Rush (1745–1813) was one of the most controversial phy­sicians in his time. He was arrogant and paternalistic . . . and devoted much time to the problem of mental illness.” Greenstone reports that Rush removed “extraordinary amounts of blood and often bled patients several times,” and he maintained his exuberance about bloodletting even when other physicians were beginning to doubt its wisdom. “Some doctors,” Greenstone notes, “referred to his practices as ‘murderous.’”

How to Explain Top Psychiatrists’ Exuberance Unchecked by Reality

In “What Can Physicians Learn from Benjamin Rush, Blood, and the Red Cross?” (Hektoen International: A Journal of Medical Humanities, 2020), Ryan Hill notes, “Despite the adamant opposition he encountered from many of his contemporaries, Dr. Benjamin Rush was undeterred.” Hill points out, “During Rush’s day . . . many began to look at the practice with great skepticism, if not rejecting it outright . . . . It was obvious to many of Rush’s contemporaries, who took a much more objective view of bloodletting, that the practice was doing more harm than good.”

Hill then asks and attempts to answer two questions that are highly relevant to contemporary psychiatry:

“So, given this shift in thinking, why did Dr. Rush, one of the most brilliant and educated men of his day, hold on to this near-obsolete practice so unswervingly, even in the face of opposing evidence? Taking the question a bit further, is there anything physicians can learn from his apparent intransigence today?”

One answer, Hill tells us, is provided by Thomas Kuhn’s The Structure of Scientific Revolutions (1962), which explains why many scientists do not abandon their current paradigm even in the face of data showing the paradigm is incorrect. Hill concludes, “Perhaps Rush was stubborn, and maybe even self-righteous, but it was likely his inability to comprehend the shifting paradigm, rather than sheer stubbornness that tethered him so closely to the age-old belief in depletion therapy.”

Another explanation offered by Hill is that overconfidence is a “common human bias” against questioning outdated techniques. In the history of psychiatry, from Rush to Insel, psychiatrists who can project extreme confidence are more likely to move into leadership roles. This phenomenon exists in other areas of life, including the military leaders and political advisors satirized in Dr. Strangelove, and it also exists in business, as described by Susan Cain in Quiet (2012). Cain reports how the Harvard Business School information session on how to be a good class participant instructs: “Speak with conviction. Even if you believe something only fifty-five percent, say it as if you believe it a hundred percent.” Projecting confidence that is unjustified by reality can make one a leader in many areas of US society.

Hill also offers the explanation of confirmation bias for why Rush would not let go of bloodletting. Hill defines confirmation bias as: “when people form a hypothesis and then gather information to support it, rather than looking at data objectively before forming a conclusion.” Specifically, Rush was animated by those patients who survived and somehow improved after bloodletting, stating, “Never before did I experience such a sublime joy as I now felt in contemplating the success of my remedies.” Owing to confirmation bias, Hill notes, “Despite the fact that he had seen countless deaths, he claimed that he had never lost a patient he had bled. . . . His confirmation bias, a natural human tendency, clouded his views, creating an affirming interpretation of the evidence.” Confirmation bias is a major explanation for why contemporary psychiatrists won’t let go of their treatments despite evidence of ineffectiveness and troubling adverse effects.

Why Psychiatrists Not in Denial Stay Quiet

Why don’t more psychiatrists who are aware of scientific realities call out those exuberant top psychiatrists who continue to be unchecked by reality?

One explanation is the culture of psychiatry. This is evidenced by the 2010 article “Bloodletting 1854,” published by the American Journal of Psychiatry (AJP), the official journal of the APA. Authored by psychiatrist Marshall Garrick, this article provides a window to the cultural values of psychiatry, and how self-serving rationalizations are considered artful diplomacy.

Specifically, Garrick tells us, “I came across an April 1854 article in the American Journal of Insanity (forerunner of AJP) that made me feel much pride as a psychiatrist.” This 1854 article, “Bloodletting in Mental Disorders” was authored by Pliny Earle, one of the founders of the group that would become the APA. In 2010, Garrick explains why this article provided him with pride as a psychiatrist:

“It is striking how delicate and diplomatic Dr. Earle was in showing respect for the memory of Benjamin Rush while expressing disagreement with Dr. Rush’s advocacy of bloodletting. Dr. Earle artfully allowed that maybe the causes of some mental disorders were different during Dr. Rush’s era, compared with the mid-19th century, and that that had led to different treatment practices. Dr. Earle, I believe, demonstrated skill as a leader trying to improve the treatment of mental health disorders while avoiding unnecessarily tarnishing the memory of Benjamin Rush, a founding father of the country and an esteemed physician who published the first textbook on mental illness in the United States.”

This begs the following question: Was Pliny Earle’s excuse for Rush—“the causes of some mental disorders were different during Dr. Rush’s era, compared with the mid-19th century”—admirably “delicate and diplomatic,” or was it self-serving bullshit? In other words, Pliny Earle, Marshall Garrick, and all politically astute psychiatrists are concerned about tarnishing the memory of the father of American psychiatry because that tarnishes their profession of psychiatry.

Finally, how much progress has psychiatry made since Rush’s era? Rush actually invented two mechanical devices to treat madness: a “tranquilizing chair” to slow down the fluid movement of agitated patients, and a “gyrator” in which patients were strapped down, immobilized, and spun to stimulate blood circulation. While Rush’s exuberant attachment to bloodletting resulted in the unnecessary deaths of many patients, Rush’s own inventions to treat mental illness, though barbaric, likely resulted in less long-term physical damage than psychiatry’s treatments, not only in the late twentieth century but today.

Specifically, while no doubt Rush’s devices were physically unpleasant and psychologically traumatizing for many patients, these treatments likely resulted in far less irreversible physical damage than the twentieth century treatments of insulin coma therapy and lobotomy. Furthermore, in contrast to twenty-first century ECT and selective serotonin reuptake inhibitors (SSRIs), it is likely that after patients were freed from Rush’s tranquilizing chair and gyrator, they could still, unlike many ECT patients, remember their birthday, and unlike many former SSRI patients, they did not suffer from iatrogenic permanent sexual dysfunction, today called post-SSRI sexual dysfunction (PSSD).

Leading psychiatrists appear to be unfazed that their mental illness theories and treatments are repeatedly proven to be scientifically invalid and discarded. However, politically astute psychiatrists will forever be concerned that the general public will finally catch on that their claim that “psychiatry is a young science making great progress” is nothing more than exuberance unchecked by reality.

The post How to Explain Top Psychiatrists’ “Dr. Strangelove Exuberance” Unchecked by Reality appeared first on Mad In America.

Before getting to those questions, a summary of the discrediting of psychiatry’s chemical-neurobiological theories of depression and of its so-called “antidepressant” drugs.

Psychiatry’s Chemical-Neurobiological Theories of Depression

More than 25 years ago, researchers disproved the serotonin-imbalance theory of depression. In Blaming the Brain (1998), Elliot Valenstein, professor emeritus of psychology and neuroscience at the University of Michigan, detailed earlier research showing that it is just as likely for people with normal serotonin levels to feel depressed as it is for people with abnormal serotonin levels, and that it is just as likely for people with abnormally high serotonin levels to feel depressed as it is for people with abnormally low serotonin levels. Valenstein concluded, “Furthermore, there is no convincing evidence that depressed people have a serotonin or norepinephrine deficiency.”

While researchers had discarded the serotonin and other chemical imbalance theories by the 1990s, the first unequivocal declaration by establishment psychiatry of the invalidity of these imbalance theories was in the Psychiatric Times in 2011, when psychiatrist Ronald Pies stated: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.”

Then in 2022, psychiatrist Joanna Moncrieff and her co-researchers published a review in Molecular Psychiatry of hundreds of different types of studies attempting to detect a relationship between depression and serotonin that concluded that there is no evidence of a link between low levels of serotonin and depression; this resulted in the mainstream media finally reporting on the jettisoning of the serotonin-imbalance theory of depression.

Less publicized in 2022 was another powerful discrediting of psychiatry’s neurobiological disease model. Published in Neuron, Raymond Dolan—one of the most influential neuroscientists in the world— and his co-authors, reflecting on the more than 16,000 neuroimaging studies published during the last 30 years, concluded, “Despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition.”

Genes and depression? An investigation, published in 2021 in the Journal of Affective Disorders, of 5,872 cases and 43,862 controls that examined 22,028 genes, reported that the study “fails to identify genes influencing the probability of developing a mood disorder” and “no gene or gene set produced a statistically significant result.”

In summary, researchers have found no serotonin nor any other neurotransmitter association with depression, no neurobiological associations, and no genetic associations.

With the fall of the serotonin-imbalance theory, there was no scientific explanation for the mechanism of antidepressants. However, psychiatry assured the general public that antidepressants are still very effective medications, and The New York Times, trusting establishment psychiatry sources, published a 2022 article titled, “Antidepressants Don’t Work the Way Many People Think,” in which it reported that “nearly 70 percent of people had become symptom-free by the fourth antidepressant.” What is the scientific reality of antidepressant effectiveness?

Antidepressant Drugs

As is the case with any treatment for depression—including bloodletting—there will always be patients who offer positive testimonials. However, in science, such testimonials are called “anecdotal reports” and are not considered sufficient evidence for effectiveness. Scientific effectiveness is assessed by comparing a treatment to a placebo control and to the natural course without any treatment. Moreover, scientific effectiveness is gauged not simply by short-term drug-company studies but by long-term outcomes, and by evaluating whether benefits outweigh adverse effects.

In 2002, the Journal of the American Medical Association (JAMA) published a study comparing depression remission outcomes of a placebo to the herb St. John’s wort and to Zoloft. The placebo worked better than both St. John’s wort and Zoloft, as a positive “full response” occurred in 32% of the placebo-treated patients, 25% of the Zoloft-treated patients, and 24% of the St. John’s wort-treated patients.

Later in 2002, a leading researcher of the placebo effect, Irving Kirsch, examined 47 drug company studies on various antidepressants. These studies included published and unpublished trials, but all had been submitted to the Food and Drug Administration (FDA), so Kirsch used the Freedom of Information Act to gain access to all data. He reported that “all antidepressants, including the well-known SSRIs . . . had no clinically significant benefit over a placebo,” describing antidepressants as “clinically negligible” with respect to depression remission.

A 2022 large study, lead-authored by Marc Stone at the FDA’s Center for Drug Evaluation and Research, examined 232 drug-company trials on antidepressants submitted to the FDA between 1979 and 2016. Even in these drug-company studies, Stone and his co-researchers found that only “15% of participants have a substantial antidepressant effect beyond a placebo effect.”

Moreover, such drug-company antidepressant trials are dice-loaded in favor of the antidepressant (for example, using an inactive placebo rather than an active placebo which would more truly blind subjects); and drug studies submitted to the FDA are routinely short-term, usually around six to eight weeks.

In the long-term, outcomes are worse. In 2017, the journal Psychotherapy and Somatics published, “Poorer Long-Term Outcomes among Persons with Major Depressive Disorder Treated with Medication,” which found that controlling for depression severity, the outcomes of 3,294 subjects over a nine-year period showed that antidepressants may have had an immediate, short-term ben­efit for some people, but at the nine-year follow-up, antidepressant users had significantly more severe symptoms than those individuals not using antidepressants.

Another important question for scientists is: What is the natural course of depression without any medication? Published in 2006 was the National Institute of Mental Health (NIMH) study, “The Naturalistic Course of Major Depression in the Absence of Somatic Therapy,” which examined depressed patients who had recovered from an initial episode of depression, then relapsed but did not take any medication following their relapse. One year later, the recovery rate of these non-medicated depressed patients was 85%.

In evaluating any drug treatment, scientists also examine whether its benefits outweigh its adverse effects. In antidepressant studies, depression remission is routinely reported for 25% to 35% of the subjects. However, the journal Drug, Healthcare and Patient Safety, in a 2010 examination of several studies, reported that the percentage of sexual dysfunction for SSRI antidepressants runs from 25%–73%; and in one study of 344 patients who had a history of normal sexual function before SSRI treatments, there was an overall incidence of 58% sexual dysfunction. Furthermore, post-SSRI sexual dysfunction (PSSD), in which sexual dysfunction exists even after discontinuation of the SSRI, was first reported to regulators in 1991.

Psychiatry acknowledges that the majority of patients do not remit with a single antidepressant, but it has insisted that if patients are treated with enough different antidepressants, nearly 70% of them will achieve remission. They justify this with the 2006 reported results of the NIMH-funded “Sequenced Treatment Alternatives to Relieve Depression (STAR*D).

In the year-long STAR*D study of 4,041 patients, there were four stages. In each stage patients who did not remit with one antidepressant were prescribed a different one or augmented with another drug. STAR*D investigators claimed a 67% cumulative remission rate, however, from the very beginning this rate was published, it was challenged as being unjustified by the data.

The first challenge of STAR*D appeared as an editorial in the same 2006 issue of the American Journal of Psychiatry in which the STAR*D study had been reported. In this critique, psychiatrist J. Craig Nelson notes that 67 percent remission rate did not account for relapse, noting the following: “Among those achieving remission, relapse rates were 33.5% [in Step 1], 47.4% [in Step 2], 42.9% [in Step 3], and 50.0% [in Step 4] . . . . I found a cumulative sustained recovery rate of 43% after four treatments, using a method similar to the authors but taking relapse rates into account.”

Further analyses of STAR*D data revealed even worse news. Ed Pigott and his co-researchers published an analysis in 2010 that showed of the 4,041 patients who entered the study, only 108 remitted, stayed well, and remained in the study to its one-year end. Thus STAR*D could only document a get-well/stay-well rate at the end of a year of only 3%. This in contrast to the previously mentioned 2006 NIMH-funded study that documented a one-year remission rate of non-medicated depressed patients of 85%.

Despite all this, STAR*D’s “nearly 70% recovery” rate has not only been trusted and reported by the mainstream media but taught to psychiatry students, including in the 2018 textbook 50 Studies Every Psychiatrist Should Know.

Then in 2023, Ed Pigott and his co-researchers, utilizing the Restoring Invisible and Abandoned Trials initiative, conducted a reanalysis of STAR*D, which was published in BMJ. Pigott reported that among the 4,041 subjects, only 3,110 actually had met the depression criteria, and so 931 patients who should have been excluded from the calculation of a remission rate had not been excluded, which inflated the remission rate. STAR*D remission rate was also inflated through violating research protocol by switching the primary outcome measures, and by reversing the protocol on dropouts so that they were no longer viewed as treatment failures. And then results were further inflated by creating a “theoretical” remission rate based on the notion that if the drop-outs had stayed in the trial through all four stages of treatment, they would have remitted at the same rate as those who did stay in the trial to that end—this not justified by what is known from previous research about dropouts.

If STAR*D investigator’s original protocol been adhered to, Pigott concluded, “In contrast to the STAR*D-reported 67% cumulative remission rate after up to four antidepressant treatment trials, the rate was 35%.” Furthermore, that original protocol did not account for relapse.

Perhaps one day, a jury will decide whether the shenanigans of STAR*D investigators were merely “scientific misconduct” or rise to the level of “fraud.” However, even according to establishment psychiatry’s Psychiatric Times, standard drug treatment for depression may no longer be simply circling the drain but half-way down it. The cover of the December 2023 Psychiatric Times issue announced: “STAR*D Dethroned? Since 2006 It Stands Out As An Icon Guiding Treatment Decisions Of Major Depressive Disorders. But What If It’s Broken?” In this cover story, the editor-in-chief of the Psychiatric Times acknowledged that Pigott and his co-researchers reanalysis is “well-researched,” and he concluded: “For us in psychiatry, if the BMJ authors are correct, this is a huge setback, as all of the publications and policy decisions based on the STAR*D findings that became clinical dogma since 2006 will need to be reviewed, revisited, and possibly retracted.”

A Model of Depression That Actually Fits the Facts

To repeat, no associations have been found between depression and serotonin (nor with any other neurotransmitter), nor with any neurobiological mechanism, nor with any gene or gene set. What then is associated with depression and suicidality? The answer is overwhelming life pains. Specifically:

Financial Poverty: Personal and Family Challenges to the Successful Transition from Welfare to Work (1996) reported that Americans on public assistance have at least three times higher rate of depression. A 2013 national survey, issued by the U.S. government’s Substance Abuse and Mental Health Services Administration (SAMHSA), reported that among American adults, serious suicidal thoughts occurred in 6.6% of those with family incomes below the Federal poverty level, which is more than double the 3.1% serious suicidal thoughts of those adults with annual family incomes at 200% or more of the Federal poverty level.

Unemployment: According to that SAMHSA report, these are the following percentages for adults having a major depression episode: 9.5% for the unemployed; 7.8% for part-time employed; and 5.3% for full-time employed. The unemployed were more than twice as likely as those who were full-time employed to have serious thoughts of suicide (7% for unemployed vs. 3% for the employed); and the unemployed were more than four times likely to attempt suicide (1.4% for the unemployed vs. 0.3% for the employed).

Involvement with the Criminal Justice System: SAMSHA also reported that the percentage of American adults with serious suicidal thoughts was 10.7% for those on parole or a supervised release from prison in the past 12 months, and 9.2% among those who were on probation.

Childhood Trauma: Adverse childhood experiences include physical and emotional abuse, physical and emotional neglect, and family trauma (such as a parent in prison, or witnessing a parent physically abused by the other parent). A 2004 study, “Adverse Childhood Experiences and the Risk of Depressive Disorders in Adulthood,” reported that exposure to such traumatic experiences is “associated with increased risk of depressive disorders up to decades after their occurrence”; and that childhood emotional abuse increased risk 2.7 fold for lifetime depressive disorders. In multiple studies linking childhood trauma to depression, The Truth About Depression (2003) reports that depression was from 1.6 to 12.2 times more common in individuals with a history of significant childhood trauma than in controls who did not report such trauma.

Miserable Significant Relationship: The Interactional Nature of Depression (1999) reports hundreds of studies documenting the interpersonal nature of depression. In one study of unhappily married women who were diagnosed with depression, 70% of them believed that their marital discord preceded their depression, and 60% believed that their unhappy marriage was the primary cause of their depression. In another study, the best single predictor of depression relapse was found to be the response to a single item: “How critical is your spouse of you?”

Lack of Social Support: Bowling Alone (2000) reports, “Low levels of social support directly predict depression, even controlling for other risk factors.” In 2004, the British Medical Journal reported that postpartum depression occurs in 10 to 20% of women in the United Kingdom and the United States but is considered rare in Fiji and some African populations with structured social supports after childbirth.

Critical Thinking: Ironically, while a denial of painful realities can cause problems, an awareness of painful realities can fuel depression and anxiety. Several classic studies indicate that depressed people actually deceive themselves less than nondepressed people. In 1980, the Journal of Abnormal Psychology reported that depressed subjects judge other people’s attitudes toward them more accurately than nondepressed subjects; as the nondepressed perceived themselves more positively than others saw them, whereas the depressed saw themselves as they were actually seen by others. In 1979, the Journal of Experimental Psychology reported that nondepressed subjects overestimated their contribution to winning a rigged game, while depressed subjects more accurately evaluated their lack of control when losing or winning.

The pain of shame and anxiety are routinely associated with depression, and painful losses—from the loss of a loved one and the loss of physical capacities, to existential losses of meaning and purpose—are routinely associated with depression.

Association and correlation don’t necessarily mean causality, as one can argue, for example, that it’s not clear whether unemployment results in depression, or depression results in unemployment; however, studies show nondepressed individuals become depressed after unemployment. Moreover, it is farfetched to argue that childhood depression causes adverse childhood experiences rather than such trauma fueling later depression; and as noted, in the study about unhappily married depressed women, the majority of these women believed that their unhappy marriage preceded their depression.

A variety of overwhelming pains are consistently associated with depression, and a more sensible model of depression would take this into account. One such model of depression is to view this phenomenon not as a disease, disorder, or pathology, but rather as a problematic “strategy” to reduce and shut down overwhelming pain.

Consider the “symptoms” of what is commonly called “depressive disorder.” These include the diminishment of energy, pleasure, interest, sexual desire, concentration, decisiveness, and appetite, accompanied by self-reproach, worthlessness, shame, and suicidal thoughts. The strategy of shutting down overwhelming pain is problematic because it is not selective for only pain but also shuts down our energy, pleasure, and cognitive functions. This shut down can result in complete immobilization or a fear of such immobilization, both of which are psychologically painful, and this can result in the pain of self-loathing and shame. In a vicious cycle, all of this results in more overwhelming pain, resulting in greater efforts to shut down pain.

Perhaps another model could fit the data better; however, unlike psychiatry’s chemical-neurobiological medical model, at least this model has some empirical evidence and rationality.

A More Sensible Approach

Overwhelming pains—including financial and legal pains, childhood trauma, relationship pain, and a variety of losses—are clearly associated with depression, and there is significant evidence that such overwhelming pain precedes depression, though in a vicious cycle, depression and immobilization can result in further overwhelming pain.

Some overwhelming pains are the result of societal policies, and thus political activism can be a solution. And while trauma and relationship pain can also be created, in part, by societal policies, talented therapists can help individuals heal from trauma, extricate from toxic relationships, and find community. Nowadays, however, depressed people are primarily treated with drugs.

Psychoactive Drugs: Psychoactive or psychotropic drugs are drugs that affect neurotransmitters. Such drugs include antidepressants and other prescription psychiatric drugs, as well as alcohol, cannabis, cocaine, and heroin, along with psychedelics such as LSD and psilocybin, and the dissociative anesthetic ketamine. Unlike medications such as antibiotics or insulin, psychoactive drugs don’t kill the source of infection or correct biochemical deficits. Instead, psychoactive drugs can, for some individuals, reduce, shut down, or dissociate them from overwhelming pains. However, each of these psychoactive drugs comes with a set of adverse effects as well as tolerance and withdrawal problems. While there are individuals who report that psychoactive drugs have helped them function, the question is how sustainable are these drugs? As noted, Psychotherapy and Somatics reported that among subjects equally depressed, at the nine-year follow-up, antidepressant users had significantly more severe symptoms than those individuals not using antidepressants; and as Robert Whitaker documented in Anatomy of an Epidemic (2010), while short-term use of psychoactive drugs may be beneficial for some individuals, long-term use often makes matters worse, not only for depression but for other crises.

Thus, it should be uncontroversial that depressed individuals deserve a truly informed choice and dialogue about the use of psychoactive drugs. It should also be uncontroversial that a sustainable approach to depression would include (1) changing societal policies to reduce avoidable overwhelming pains; and (2) dramatically changing the selection and training of mental health professionals so there would be more talented therapists.

Activism to Change Societal Policies: At the most obvious level, this would include:

(1) Eliminating, reducing or at least mitigating the effects of financial poverty. Some examples of social policy changes: significantly subsidizing housing costs; providing a guaranteed basic income; eliminating student-loan debt; and otherwise creating greater financial justice.

(2) Eliminating, reducing or at least mitigating the effects of unemployment. This would include increasing and extending unemployment benefits; and prohibiting CEOs of giant corporations from making 400 times more than the average worker while cutting jobs to raise stock prices.

(3) Preventing unnecessary involvement with the criminal justice system; for example, abolishing societal hypocrisy by decriminalizing all psychoactive drugs.

(4) Recognizing that alienating jobs that are vulnerable to layoffs are among the many reasons why so many people experience ever-increasing anxiety, powerlessness, resentment, and rage, which creates parents who in their interactions with their children have little frustration tolerance, making traumatic adverse childhood experiences more likely.

(5) Implementing policies at every level of society that build and maintain community.

Selecting and Training More Talented Therapists: Many depressed people today are immediately prescribed an antidepressant drug (more often from a primary care physician than a psychiatrist). Along with an antidepressant, or prior to taking one, some depressed people will try psychotherapy, but only with great luck will they find a talented therapist.

In The Great Psychotherapy Debate (2001), Bruce Wampold notes that while therapists tend to believe their therapy techniques—such as cognitive-behavioral therapy (CBT)—are significant, patients believe having someone who understands them and is interested in them is most important. Wampold documents research confirming that “belief in approach,” “relationship alliance,” and “therapist personal characteristics” are more important factors than any therapy techniques.

It has long been known that the variable of therapy technique has little effect on outcome. In 2008, the Journal of Consulting and Clinical Psychology (“Psychotherapy for Depression in Adults: A Meta-Analysis of Comparative Outcome Studies”) reported seven meta-analyses on 53 studies comparing psychotherapy techniques (CBT, psychodynamic, behavioral-activation, social skills training, problem-solving, interpersonal, and nondirective), and concluded: “This study suggests that there are no large differences in efficacy between the major psychotherapies for mild to moderate depression” (interpersonal therapy was slightly more effective, and CBT had a significantly higher dropout rate). In 2024, a Journal of Clinical Psychology study, “The Equivalence of Psychodynamic Therapy (PDT) and Cognitive Behavioral Therapy (CBT) for Depressive Disorders in Adults: A Meta-Analytic Review,” reported equivalent effectiveness of PDT and CBT.

Vital for helping depressed people are therapist “personal characteristics” that produce a collaborative “relationship alliance,” which facilitates healing and energizes and motivates patients to take constructive actions. Unfortunately, such personal characteristics are difficult to quantify, making standard empirical research difficult. However, as others have pointed out (probably misattributed to Albert Einstein), not everything that can be counted counts, and not everything that counts can be counted.

My experience is that talented therapists who facilitate healing are authentic and able to be fully present. They have a gentle presence, and they are superior listeners. They are not reactive to negativity; and the overwhelming pain of another does not make them anxious, so they are less likely to try to control “symptoms,” but instead focus on the whole person. Their lack of fear of emotional pain allows them to have a special kind of humor that is extraordinarily sensitive to pain, and adept at knowing how to lighten its burden. The personal characteristics of talented therapists create conditions for healing, which enable depressed people to experience being cared about; and this results in becoming more open to caring about others and becoming less self-absorbed—opening them up to the entirety of nature beyond themselves, which results in healing.

When I was in my training around many psychiatrists while interning in hospitals and other institutional settings, it was only those rare disgruntled resident psychiatrists whose company I enjoyed; and so I found myself rephrasing Charles Bukowski, saying, “I don’t hate psychiatrists, but I feel better when they are not around.” Helpful therapy with depressed people means dealing with painful aspects of their life—such as childhood trauma and toxic relationships—and obviously, it is not a great idea for a depressed person to be pained by the personal characteristics of a therapist while dealing with their own pain.

Talented therapists not only help facilitate healing but are also energizing and motivating, which is extremely important for depressed people. Seriously depressed people routinely lack the energy for constructive behaviors such as physical exercise. In 2000, Psychosomatic Medicine reported a study that compared outcomes for patients with depression in three treatment groups: (1) Zoloft, (2) Zoloft + exercise, and (3) exercise only. At the end of four months, there were no significant differences in the remission rates of these groups; however at 10 months, exercise only had the lowest relapse rates: depression symptoms returned for 38% of the Zoloft group and for 31% of the Zoloft + exercise group, but depression symptoms returned for only 8% of the exercise only group. While there is no better antidote to depression than physical exercise, depressed people routinely need to be energized and motivated to take constructive actions.

The personal characteristics of energizing therapists are, in many ways, the opposite of the traits routinely selected for in professional training programs. Virtually all medical schools and most graduate psychology programs select future professionals based primarily on their academic achievements, much of which requires a great deal of compliance. People with a talent for energizing and motivating are authentic, spontaneous, playful, risk taking, and find a way to have fun even with people who are seriously depressed.

The socialization process in training programs for virtually all psychiatrists and most psychologists routinely results in psychiatrists and psychologists who are so terrified of being judged by their superiors as “inappropriate” that they are afraid to be authentic, spontaneous, playful, and risk taking. So, even when a program applicant has not only sufficient grades and test scores to gain entrance into a professional program but also the personal characteristics to be a talented therapist, these programs routinely extinguish these talents, and so many gifted people quit when they recognize how hard they will have to fight to retain their authenticity and integrity.

Thus, there are only a handful of professionals I have met who have the talent to help depressed people. These talented therapists are usually anti-authoritarians who have fought off their professional socializations, and they often have had backgrounds outside of academia that have nurtured rather than squashed their talents. One such talented clinical psychologist—who has received high praise from my referrals—is an anti-authoritarian with a background as a personal trainer and in improv comedy who, in her graduate training, fought to maintain her authenticity and integrity.

Psychiatry’s depression outcomes are poor because its bio-chemical-electrical treatments are based on a depression model that science has flushed down the toilet. It should be obvious that new models of depression based on facts rather than fiction need to be created. With such models, hopefully, it will become obvious that when it comes to helping depressed people, societal policies and the talent level of therapists are damn important.

The post Depression: Psychiatry’s Discredited Theories and Drugs Versus a Sane Model and Approach appeared first on Mad In America.

As I documented in CounterPunch earlier this year, it is now mainstream to acknowledge that: (1) psychiatry’s treatment outcomes are “abysmal” and “not getting any better”; (2) the serotonin imbalance theory of depression is untrue; and (3) psychiatry’s diagnostic manual, the DSM, is scientifically invalid.

Thomas Insel, director of the National Institute of Mental Health (NIMH) from 2002-2015, acknowledged in 2011, “Whatever we’ve been doing for five de­cades, it ain’t working. When I look at the numbers—the number of sui­cides, the number of disabilities, the mortality data—it’s abysmal, and it’s not getting any better.”

In 2021, New York Times reporter Benedict Carey, after covering psychiatry for twenty years, concluded that psychiatry had done “little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health—rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use—went the wrong direc­tion, even as access to services expanded greatly.”

In 2023, Time reported, “About one in eight U.S. adults now takes an antidepressant”; however, Time continued, “Mental health is getting worse by multiple metrics. Suicide rates have risen by about 30% since 2000. . . . As of late 2022, just 31% of U.S. adults considered their mental health ‘excellent,’ down from 43% two decades earlier.”

Among the many examples that shatter the myth that “psychiatry is a young science making great progress” is the fate of Prozac and other selective serotonin reuptake inhibitors (SSRIs), ushered in during the late 1980s as “miracle drugs.” During the last three decades, SSRIs have been repeatedly linked to higher suicide risk; found to create a far higher percentage of sexual dysfunction than to positively affect depression (with SSRI success rates no different than placebo rates or even lower than placebo rates); and result in withdrawal reactions that can be severe and persistent.

In addition to treatment outcome failures, it has long been known by researchers that there is no scientific basis for psychiatry’s serotonin imbalance theory of depression—this now acknowledged by establishment psychiatry, and finally reported by the mainstream media in 2022. Furthermore, key members of establishment psychiatry have also acknowledged the scientific invalidity of psychiatry’s DSM diagnostic manual, with Insel in his 2022 book Healing stating: “The DSM had created a common language, but much of that language had not been validated by science.”

How can psychiatry retain its authority and influence despite its scientific failures? That’s been the question posed to me in 2023 by interviewers such as Nick Fortino on “Psychology Is” and Mollie Adler on “Back from the Borderline.” In these interviews, I have talked about the components of the psychiatric-pharmaceutical-industrial complex, along with how psychiatry meets the political needs of the ruling class and dysfunctional families. However, in addition to these financial and political explanations, a fundamental cultural reason why psychiatry lives on is Western society’s worship of technology—but I’m getting ahead of myself.

The Psychiatric-Pharmaceutical-Industrial Complex

Readers familiar with the military-industrial complex will recognize that the psychiatric-pharmaceutical-industrial complex follows the same institutional-corruption “playbook.”

The psychiatric-pharmaceutical-industrial complex is fueled by the profits of Big Pharma, which have made a staggering amount of money from psychiatric drugs. By 2005, Eli Lilly had amassed over $22 billion in sales from its SSRI Prozac; and Lilly’s antipsychotic drug Zyprexa, at its peak, grossed more than $5 billion in annual sales. That’s just two psychiatric drugs from one drug company. When an industry is grossing billions of dollars, it is easy to spread around millions to make many more billions.

Big Pharma has spread its money around to psychiatric institutions such as the American Psychiatric Association (APA), the guild of psychiatrists, and to so-called “patient advocacy” groups such as the National Alliance on Mental Illness (NAMI).

Big Pharma has also spread millions of dollars around to individual psychiatrists, especially so-called “thought leaders.” One of many psychiatrists exposed by 2008 Congressional hearings on psychiatry’s financial relationship with drug companies was Harvard psychiatrist Joseph Biederman—credited with creating pediatric bipolar disorder—who received $1.6 million in consulting fees from drug makers from 2000 to 2007. Federal legislation in 2013 required drug companies to disclose their payments to physicians, resulting in the creation of an Open Payments database; and in 2021, utilizing this database, journalist Robert Whitaker reported: “From 2014 to 2020, pharmaceutical companies paid $340 million to U.S. psychiatrists to serve as their consultants, advisers, and speakers, or to provide free food, beverages and lodging to those attending promotional events.” Whitaker noted that approximately 75 percent of the psychiatrists in the United States “received something of value from the drug companies from 2014 through 2020.”

As in other industrial complexes, there is also “regulatory capture,” which includes rewarding friendly government officials with high-paying jobs after they leave regulatory agencies. In June 2019, two months after stepping down as the Food and Drug Administration (FDA) director, Scott Gottlieb joined the board of directors of Pfizer (whose products include the SSRI Zoloft and the benzodiazepine Xanax). By rewarding Gottlieb, Pfizer sent a clear message to high-level officials currently at the FDA. This message—along with drug companies funding the research evaluated by the FDA in its approval process—majorly increases the likelihood of drug approval.

Mainstream media is another major player in the psychiatric-pharmaceutical-industrial complex. In the late 1990s, following the FDA’s loosening of restrictions on direct-to-consumer advertising, Big Pharma became a huge revenue source for mainstream media. By 2019, Big Pharma’s $6.6 billion yearly spending on TV advertising ranked it as the fourth-largest spender of TV ads in the United States. Mainstream media is very much aware that drug companies can pull their advertising if their reporters are too critical of Big Pharma’s institutional corruption of psychiatry. This has resulted in mainstream media serving as stenographers for the psychiatric-industrial-complex, not reporting the major failures of psychiatry—including the fraud of serotonin-imbalance theory of depression and the STAR*D scandal (the 2006 study that inflated antidepressant effectiveness, which The New York Times in 2022 continued to uncritically accept).

Meeting the Political Needs of the Ruling Class and Dysfunctional Families

The individual-defect/pathologizing of emotional suffering and behavioral disturbances meets the political needs of those who wish to remain in denial of their connection with emotional suffering and behavioral disturbances.

Psychiatry’s biochemical/brain disease explanations for emotional suffering and behavioral disturbances clearly meets the needs of the ruling class. If a population believes that its suffering is caused not by social-economic-political variables but instead by individual defects, this belief undermines political rebellion and maintains the status quo. Psychiatry’s mental illness theories are a major component of what Antonio Gramsci described as cultural hegemony—the prevailing cultural beliefs of a society that are social constructs implemented by the ruling class through favored institutions so as to maintain domination.

The political implications of biological individual-defect theories—promulgated by the psychiatric-pharmaceutical-industrial complex—have been obvious to many prominent scientists. Evolutionary geneticist R.C. Lewontin, neurobiologist Steven Rose, and psychologist Leon Kamin, in their 1984 book Not in Our Genes: Biology, Ideology, and Human Nature, make clear the political ideology implicit in the individual defect theory of biochemical/genetic determinism: “Biological determinism (biologism) has been a powerful mode of explaining the observed inequalities of status, wealth, and power in contemporary industrial capitalist societies. . . . Biological determinism is a powerful and flexible form of ‘blaming the victim.’”

At the family level, psychiatry meets the needs of families that prefer to stay in denial of their dysfunctionality. Prior to the ascendency in the 1980s of the psychiatry-pharmaceutical-industrial complex—and its promotion of a biochemical/brain disease perspective—it was not radical to consider the possibility that severe emotional and behavioral disturbances could sometimes be a product of a dysfunctional family. In family-systems theory, the “mentally-ill” labeled family member is considered to be the “identified patient” (IP), enabling the family to stay in denial of its dysfunctionality; and family therapists view the IP as a kind of “emissary,” calling out for help for the dysfunctional family. Family therapists recognize that family members (including sometimes even the IP) are often attached to the belief that their family is a normal and loving one, and such an attachment results in family members needing to believe that the only problem in the family is the “mental illness” of the IP, who is essentially scapegoated. Shame-based families that would rather stay in denial of their dysfunctionality have an ally in psychiatry’s individual-defect medicalization of emotional suffering and behavioral disturbances.

For societal and family authorities, psychiatry has another political role, an “extra-legal police function.” Specifically, a major political role of psychiatry is to control individuals—via involuntary drug and hospitalization “treatments”—who have done nothing illegal but who create tension for authorities. David Cohen, UCLA professor of social welfare, notes: “This coercive function is what society and most people actually appreciate most about psychiatry.” Cohen explains how the societal need for psychiatry’s extra-legal police function compels society to be blind to psychiatry’s complete lack of scientific validity: “Because of psychiatric coercion, society gives psychiatric theories a free pass. These theories never need to pass any rigorously devised tests (as we expect other important scientific theories to pass), they only need to be asserted.”

Technology Worship

For quite some time in the United States, and now in much of the world, technology progress has served as a soteriology—a doctrine of salvation from pain and discomfort. And so rather than thinking critically about the value of a technology, anything labeled as technological is uncritically accepted, and anything considered to be a new technology is celebrated.

Psychiatry’s technology history is one of repeated failures. However, in a society that worships technology, psychiatry has cleverly positioned itself as forever embracing the latest and most popular technology—be it surgical, chemical, electrical, or digital.

With each failure of psychiatry’s technologies—some now viewed as barbaric, such as lobotomy and insulin coma therapy—psychiatry seeks new technologies or revives and tweaks older ones. In former NIMH director Thomas Insel’s 2022 book Healing, he acknowledges that psychiatry has discarded its “chemical imbalance theory” of mental illness, however, he promotes another theory lacking scientific proof: “The idea of mental illness as a ‘chemical imbalance’ has now given way to mental illnesses as ‘connectional’ or brain circuit disorders”; and he pushes for more electroconvulsive therapy (ECT), commonly referred to as electroshock. While one can find anecdotal testimonials for any treatment, including ECT, there is no scientific evidence (randomized controlled trials) that ECT is effective, and a great deal of evidence that it results in adverse cognitive effects.

Psychiatry is undeterred by its repeated technological failures. In 2017, Insel candidly acknowledged: “I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.” Yet in his 2022 book Healing, Insel is unrepentant, “I have no regrets about NIMH funding for genomics and neuroscience,” and he now pushes digital technologies.

Psychiatry’s thought leaders such as Insel are well aware that in contemporary society, anything labeled as a new “digital technology” gets attention, and so upon Insel’s 2015 exit from NIMH, he joined a company focusing on something called “digital phenotyping,” which includes using smartphone signals for measuring behavior and mood.

Technology critics, in general, are often accused of being Luddites who want to eliminate all technology. However, as technology critic Kirkpatrick Sale notes in his history of the Luddites, Rebels Against the Future, even the Luddites were not against technology per se—they in fact used technology. Rather, the Luddites rebelled against a new technology that would destroy their autonomy, create boring work, lower their standard of living, and diminish the quality of their lives.

Similarly, critics of psychiatry are routinely mischaracterized by psychiatry apologists as “anti-drug.” However, I know of no psychiatry critic who is “anti-drug,” but rather for informed choice and autonomy. I don’t know any psychiatry critic who does not recognize the value of the temporary use of a sleep-aiding drug in order to prevent the type of extensive sleep deprivation that may result in psychosis. Rather than being “anti-drug,” such critics expose falsehoods that psychiatric drugs correct nonexistent chemical imbalances, and these critics bring to light research showing that for many people the long-term daily use of psychiatric drugs has resulted in more and not less suffering.

Technology criticism, for anti-authoritarian thinkers such as Peter Kropotkin, Rudolf Rocker, Murray Bookchin, and Lewis Mumford, is “a central component of a broader critique of society and modernity,” notes technology historian Zachary Loeb. These critics were concerned about how technologies would be used, and who would be in control of them. Loeb notes: “The emphasis that Bookchin put upon the opposition between ‘authoritarian’ and ‘libertarian’ technics was not an accidental echo of Mumford’s ‘authoritarian’ and ‘democratic’ technics.”

In the twentieth century, Lewis Mumford was a well-known critic and historian of architecture, urban planning, literature—and of technology (or what he called technics). As a young man, Mumford was fascinated by electrical engineering, and his first published articles were in Modern Electrics. In the 1930s, he wrote Technics and Civilization about the effects of the machine age. Later, Mumford became increasingly troubled by the irrational and dehumanizing use of technology, and he wrote the two-volumed The Myth of the Machine, which includes Technics and Human Development (1966) and The Pentagon of Power (1970). Instead of using technology to promote greater autonomy, community, and culture, Mumford’s concern was that technology was being employed to transform human beings into what he called “a passive, purposeless, machine-conditioned animal.”

With a worship of technology comes an exclusive focus on the quantifiable and the measurable. However, by eliminating life’s subjectivity and its non-quantifiable dimensions, Mumford recognized, many of life’s most interesting and significant attributes are ignored or turned into second-rate phenomena, resulting in a culturally impoverished society that is obsessed with power and control.

The worship of power and control is at the heart of the worship of technology. For psychiatrists and other mental health professionals to gain prestige and influence, they need society to see them as technological and powerful. As I detailed in Mad in America earlier this year in “Psychiatry’s Control-Freak Medical Model Versus Healing and Healers,” psychiatry’s fundamental paradigm is a technical-mechanical model in which behaviors and emotions that cause tension and discomfort are manipulated with various technologies. In this model, the psychiatrist is a technician who fixes what is defective. While a technical-mechanical medical model works in some parts of medicine (such as for removing a malignant tumor), this mechanical model has failed when it comes to emotional suffering and behavioral disturbances.

In the training of psychiatrists, a large effort is made to socialize them to be scientist-technicians. They are socialized to accept a medical/mechanical model that views human beings as essentially genetic-biochemical-electrical machines, in which techniques can be applied, and outcomes can be quantifiably assessed. In return for deleting the subjective and non-quantifiable human experiences—leaving these to the Philosophy and English departments—the profession of psychiatry gains prestige and influence.

However, with such deletions, psychiatrists became psychotic—literally losing contact with the non-quantifiable dimensions of humanity that are vital to reducing emotional suffering. Psychiatry’s technologies (such as its drugs) can temporarily blunt the pain of emotional suffering; however, trauma—the root cause of much emotional suffering—is healed though kindness, empathy, curiosity, compassion, and love, which are subjective and non-quantifiable.

In summary, psychiatry lives on despite repeated failures and lack of progress not only because of the psychiatric-pharmaceutical-industrial complex, and not only because it meets the political needs of both the ruling class and shame-based dysfunctional families. On another level, psychiatry lives on despite repeated failures and lack of progress because it embraces the worship of technology and the belief that salvation from emotional suffering will come with a new technology. So, no matter how many times psychiatry’s theories are proven scientifically invalid, and no matter how many times its treatments are proven nonproductive and counterproductive, by its embracing the widely popular technology-worship “religion,” psychiatry is permitted to ignore the reality that its repeated failures are evidence that its fundamental paradigm is misguided, and psychiatry is permitted to claim that its repeated failures are part in parcel of the road to progress.

The post Why Failed Psychiatry Lives On: Its Industrial Complex, Politics, & Technology Worship appeared first on Mad In America.

If one has a dark sense of humor, psychiatry’s medical model can be seen as the root cause of a comical farce in which an institution charged by society to decrease suffering actually increases it. In 2022, I described how psychiatry’s medical model traumatizes, re-traumatizes, and perverts healing, and I am often asked: What then is a helpful alternative to psychiatry’s medical model?

The simplest answer is its complete opposite. Here, I will spell out exactly what that means. Specifically, I will discuss: (1) how psychiatry’s control-freak medical model fits into contemporary society; (2) how only with rebellion can professionals be healers; (3) emotional wounds and healing; and (4) how genuine healers help create healing conditions.

How Psychiatry’s Control-Freak Medical Model Fits into Contemporary Society

Psychiatry’s medical model is a technical-mechanical model, in which behaviors and emotions that cause tension and discomfort are subject to various manipulations. The medical-model psychiatrist is a technician who views healing as synonymous with fixing.

While the medical model may work for suturing a laceration or removing a malignant tumor, it routinely exacerbates emotional suffering and behavioral disturbances.

Much of what makes life tragic or comical comes from applying a manner of thinking that is appropriate in one mode to a completely different mode. This is the case with psychiatry’s medical model, which is essentially a model for mechanics. While it is silly for a car mechanic to try to create the healing conditions for a rusted-out muffler to naturally heal and become whole, it is tragic to treat individuals who are emotionally suffering like rusted-out mufflers.

Emotional suffering, including what we commonly call “depression” and “anxiety,” is routinely fueled by trauma and the pain of disconnection, including breaks to personal wholeness in which people disconnect from the truth of what happened to them and who they are. Emotional suffering is also fueled by the absence of genuinely supportive community, resulting in many of us becoming terrified that we cannot survive without becoming compulsively controlling, which creates suffering for ourselves and others.

In saner cultures—those that value wholeness and community more than consumerism, comfort, and control—it is widely known that a compulsively-controlling ego is a major source of misery. However, in our insane society, those designated to reduce emotional suffering and behavioral disturbances—psychiatrists and other mental health professionals—are trained to be control freaks who create even more emotional suffering and behavioral disturbances.

Control-freak psychiatrists are reflections of our control-freak culture. With each failure of its control techniques, some now viewed by much of society as barbaric—such as lobotomy and insulin coma therapy—control-freak psychiatrists seek new techniques to reduce discomfort, but all these techniques ultimately increase discomfort and misery.

Ushered in during the late 1980s as a “miracle drug,” SSRI antidepressants have been repeatedly linked to higher suicide risk; found to create a far higher percentage of sexual dysfunction than to positively affect depression (with SSRI success rates no different or even lower than placebo rates); and create tolerance and dependency resulting in painful withdrawal.

Following psychiatry’s repeated failures, a sane society would not give it increased status and power. However, our insane society so worships technology—including surgical, chemical, electrical, and digital technologies—that rather than thinking critically about the value of any technology, it uncritically accepts and celebrates anything promoted as technological.

So while a sane society would view electroconvulsive therapy (ECT), commonly known as electroshock, as barbaric—given that there is no scientific evidence that it is effective, and a great deal of evidence that it results in adverse cognitive effects—our insane society continues to buy psychiatry’s promotion of ECT as “the gold standard for treatment of severe depression.”

In the twentieth century, there were prominent mental health professionals, even some psychiatrists, who recognized that what is helpful are not control-freak “treatments,” but the opposite—acceptance. Carl Jung in 1932 pointed out:

“We cannot change anything unless we accept it. Condemnation does not liberate, it oppresses…. If a doctor wishes to help a human being he must be able to accept him as he is. And he can do this in reality only when he has already seen and accepted himself as he is.”

Many humanistic theorists came to Jung’s conclusion, and the idea that manipulation and force only make emotional suffering worse has long been held in Eastern philosophies such as Taoism and Buddhism. In contrast, by the 1980s, psychiatry began to be completely dominated by anti-humanistic control freaks who were clueless that their “diagnoses” such as “borderline personality disorder” and “schizophrenia” were, in effect, condemnations; and rather than acceptance, they manipulated their patients with behavioral, biochemical, and electrical technologies.

How Only With Rebellion Can Professionals Be Healers

One can “treat” emotional suffering and behavioral disturbances with a mechanical-technical model, or one can recognize that manipulations subvert natural healing. Depending on one’s approach, one is going to be a very different type of doctor—and likely a very different type of person.

Most people who enter the mental health profession truly want to help others, but they are often naïve to the reality that the selection, socialization, and training processes are fear based, aimed at creating control freaks who then become unhelpful. Most mental health professionals, especially psychiatrists, are naïve to the reality that those professionals who are helpful have rebelled against their socialization and training. Sadly, the majority of professionals do not rebel, and so only a minority of professionals are truly helpful.

While most professionals want to believe that their intelligence allowed them to achieve the grades and test scores necessary for degrees and credentials, the reality is that these achievements were mostly the result of their fear of academic failure and compliance with authorities’ demands.

Owing to their fear-based compliance, psychiatrists and other mental health professionals suffer a loss of wholeness in their training. They are routinely so afraid of not appearing “professional” that they are intimidated into shedding core aspects of their personality, as many readily incorporate professional jargon at the expense of their own authentic language. This disconnect from their authentic being renders them impotent as healers.

Professional demands create even more fear. Psychiatrists are charged by society with evaluating whether or not a person is mentally ill, and whether that person poses a threat to themselves or others. There are multiple fears attached to this role. At one level, there is the fear of making an incorrect assessment, not diagnosing a person as mentally ill and a threat to themselves or others who then acts self-destructively or is violent with others. Moreover, there are legal fears of being sued over their actions, and career fears that their actions can jeopardize their professional license.

Fear is obviously an unpleasant emotional experience, and professionals can privately become angry with patients for creating a condition that results in fear for them. When professionals have anger and don’t acknowledge it, they are vulnerable to coercive retaliations that increase the suffering of their patients.

Most individuals who choose the mental health profession—this includes those who become medical-model control freaks as well as those who become genuine healers—have been emotionally wounded when young. Often the wounds were from abusive or neglectful parenting, and from various types of dysfunctional family violence. Among professionals who buy into the medical model and become control freaks, these wounds have never been healed; and so they compulsively react to all pain and discomfort by trying to control it. Professionals who have not actively attempted to recover their own wholeness cannot possibly actively care about their patients’ wholeness.

Genuine healers have acknowledged their wounds and opened themselves to healing; and so their wounds become a formative positive experience, creating a deep connection and compassion for the pain of others that results in acceptance and not manipulations.

Emotional Wounds and Healing

In order to physically survive, it may have made sense to shut oneself down and numb oneself when on the battlefield—whether that battlefield was Vietnam or Iraq, one’s parents’ alcoholic brawls, or one’s sexual molestations. Such shutdowns may well have helped one to survive, but when people are no longer on the battlefield, they often cannot let go of what helped them survive, and their defense becomes a burden that interferes with healing.

When it comes to healing, one must be emotionally open. Healing requires an openness to the truth of one’s pain and confusion. However, having been assaulted, humans are understandably often afraid to be open emotionally, as they fear that such openness makes them vulnerable to further assaults.

The unhealed and unwhole can be so terrified by emotional pain that they move quickly to defenses, protections, and shutdowns. And those very defenses, protections, and shutdowns block the process of healing. People who need healing most are in the most pain, and they are most likely to defend and protect themselves. They can block healing in many ways, including by a guarded attitude of defensiveness; by reflexively disagreeing; by distrusting others’ motives; and by compulsively predicting and controlling.

It is difficult to be open if one is being diagnosed, judged, compartmentalized, and condemned. If mental health professionals are diagnosing and “treating” via controlling, their patients likely stay in a protective rather than a receptive mode. Emotional suffering and behavioral disturbances are only made worse by judgmental diagnoses and technological manipulation.

Our emotional wounds heal naturally when we are not in a state of defensiveness. Healing occurs when there are healing conditions which encourage openness. These conditions allow us to naturally move toward wholeness. If we can create the conditions for healing, healing will naturally occur.

How Genuine Healers Help Create Healing Conditions

What sets genuine healers apart is their wholeness and their lack of fear of individuals experiencing emotional suffering and behavioral disturbances.

The very presence of genuine healers—in contrast to control-freak technicians—has a soothing quality. Genuine healers’ facial expressions are easy on the eyes, and their speech is equally easy on the ears. They are not only good listeners, but go beyond that. In sharp contrast to control freaks, they are not reactive to negativity. If others are hurt, angry, frustrated, or pained in some way, this does not make them anxious. Genuine healers are uncontrolled by someone else’s pain—not detaching with coldness but with warmth, and others feel that they care about their pain. This wholeness and lack of fear allows genuine healers to have a special kind of humor that is extraordinarily sensitive to pain, adept at knowing how to lighten its burden.

Genuine healers, unlike medical-model control freaks, recognize that their job is not to manipulate “symptoms” but to help create conditions for natural healing. When such healing conditions are in place, the barriers and defenses to healing are more likely to disappear. This allows us to become open to feeling cared about; and this results in us being more likely to become open to caring about others, and open to the entirety of nature beyond ourselves—and this results in healing.

Genuine healing is a phenomena that cannot be quantified and scientifically measured, and so it does not fit into a mechanical model. Healing conditions are created by kindness, gentleness, and love, and one cannot pass an objective exam to evidence proficiency in these areas.

Kindness includes generosity, the giving or sharing of what one has of value, such as time. Kindness is warmheartedness, a turning toward rather than away from suffering. It is tolerance, an acceptance that those in pain are often unpleasant.

Gentle speech, gentle movements, and gentle touch are healing. When one is noisy, erratic, and rough, others stay in a protective mode, which is not amenable to healing. Gentleness is knowing that people who are suffering have difficulty tolerating much discord. And gentle people have patience; if one feels the pressure of time, one cannot heal.

Love is the opposite of fear. If we fear that the pain of another will overwhelm us, we cannot love that person. Love is a deep affection for the uniqueness of another. It is a union that maintains the integrity of each individual, and a valuing and respect for another. It is a heartfelt concern for another’s pain, and an experience of resonation to another’s being.

Healing is not a technical-mechanical controlling process but a natural one, with the goals of the healer being to help remove the barriers to this natural process.

Such natural healing, unlike repairing, is not a top-down, vendor-to-customer kind of process. It is not unidirectional. In the natural healing process, both helper and helpee can receive healing.

In our insane society, we are told that we must seek experts to fix all of our problems—and this results in missed opportunities. People, by virtue of being alive, can heal and be healed. There are all kinds of roles in which healing can take place. This truth is often denied because it plays havoc with capitalism and consumerism.

Our increasingly control-freak society creates—directly and indirectly—emotional suffering and behavioral disturbances. Insanely, those charged with reducing our emotional suffering and behavioral disturbances are trained to be control-freaks who then increase our emotional suffering and behavioral disturbances. Thus, healing can only occur with rebellion from such insanities.

The post Psychiatry’s Control-Freak Medical Model Versus Healing and Healers appeared first on Mad In America.

Bigotry is defined by Merriam-Webster as: “obstinate or intolerant devotion to one’s own opinions and prejudices.” Racism is one type of bigotry, but not the only type. The fuel of all bigots is the same: the belief that their discomfort over others different from themselves justifies declarations of defectiveness in others.

While discomfort over racial differences fuels racial bigotry, the discomfort over other human differences fuels psychiatry’s opinions and prejudices with respect to all its diagnostic declarations as to which behaviors evidence “mental illness” and which are “normal.” All bigots reduce their discomfort by declaring others different from themselves as defective in some manner.

The APA’s Political Apology for Structural Racism

Just as it has been long known to Black Americans that being Black makes them more vulnerable to police violence, being Black also makes one more vulnerable to psychiatric violence.

Why, in 2021, did the APA finally issue the APA’s Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psychiatry (followed by its Historical Addendum to APA’s Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psychiatry)? The APA makes clear what precipitated their apology: “Events in 2020 have clearly highlighted the need for action by the APA to reverse the persistent tone of privilege built upon the inhumanity of past events.”

While the APA has a long history of ignoring science and perpetuating social injustices, it has just as long a history of attempting to be politically in step with mainstream U.S. society. Following the 2020 murder of George Floyd by police, the APA recognized that the U.S. political climate had dramatically changed. In this new climate, not only would there be no political cost for the APA to acknowledge psychiatry’s racism, the APA recognized that it may well be a political win for them to proclaim their historical racism as loudly as possible. The APA recognized that in this new climate, to acknowledge racism is evidence of “virtue,” so virtue signaling the APA did. The politically astute APA knows that in today’s political climate, institutions will not lose status for acknowledging their historical racism because the mainstream consensus now acknowledges that most U.S. institutions have been historically racist. A loss of status will only result from not acknowledging racism, and the APA has always been extremely concerned about their status.

The political strategy of acknowledging one type of wrongdoing to evidence an institution’s capacity for “self-correction” without acknowledging its essential moral criminality is a long-time institutional strategy to maintain status. For much of U.S. history, massacres by the U.S. government of Native Americans, such as at Wounded Knee, were simply buried; and when these massacres were finally acknowledged, the U.S. government ignored the fact that such massacres were only one component of a policy of genocide of Native Americans (which included destroying their food supply, forced sterilization, and other components that meet the United Nations definition of genocide).

Similarly, during the Vietnam War, owing to investigative journalism, the U.S. government was forced to acknowledge the My Lai massacre of Vietnamese women, children, and the elderly; but the U.S. government has never acknowledged that the Vietnam War was based on politically motivated lies—and that those U.S. leaders who orchestrated it are war criminals.

The APA begins its 2021 apology for racism with a self-congratulation: “Today, the American Psychiatric Association (APA) . . . is taking an important step in addressing racism in psychiatry.” The APA then apologizes first to its own members—then to patients, their families, and the public: “The APA Board of Trustees (BOT) apologizes to its members, patients, their families, and the public for enabling discriminatory and prejudicial actions within the APA and racist practices in psychiatric treatment for Black, Indigenous and People of Color (BIPOC).” The APA acknowledged that their racism is not simply historical but exists presently, giving the example of “variations in schizophrenia diagnosis between white and BIPOC patients.”

The APA apology also includes the following: “Since the APA’s inception, practitioners have at times subjected persons of African descent and Indigenous people who suffered from mental illness to abusive treatment, experimentation, victimization in the name of ‘scientific evidence’. . .” Note that this is an apology for the APA’s cruelty to individuals who suffered from mental illness—not an apology for labeling people as mentally ill.

Psychiatry’s Essential Bigotry

Understanding psychiatry’s essential bigotry means examining psychiatry’s criteria for “mental illness.” The key question is: What is the actual criteria that psychiatry uses to decide whether we are “mentally ill” or “normal”?

Psychiatry’s “mental illnesses” and their “symptoms” are voted in by the APA and listed in their diagnostic manual, the DSM, which the APA regularly revises. On rare occasions, when there have been dramatic socio-cultural changes—such as those with respect to homosexuality—a “mental illness” has been voted out of existence. More often, socio-cultural changes have resulted in “mental illness” additions.

Homosexuality as a mental illness was abolished by an APA vote in 1973, and it was no longer catalogued as a mental illness in the APA’s 1980 DSM-III. However, in that same DSM-III, we see the addition of so-called “child disruptive behavioral disorders” of attention deficit disorder (later renamed attention deficit hyperactivity disorder or ADHD) and oppositional disorder (later renamed as oppositional defiant disorder or ODD).

“Symptoms” of ODD include: often argues with authority figures, actively defies or refuses to comply with their requests or with rules, loses temper, and easily annoyed and angry. Eventually, these young “disruptors” would be heavily drugged, including with antipsychotic drugs; as the Archives of General Psychiatry reported in 2012, “From 2005 to 2009, disruptive behavior disorders were the most common diagnoses in child and adolescent antipsychotic visits.”

Psychiatry’s illness abolitions and additions are a window to psychiatry’s actual criteria for its “mental illness” declarations—the criteria being those behaviors that the APA believes create discomfort, tension, and inconvenience in society.

By the 1980s, U.S. society was growing more tolerant of homosexuality, which was creating less discomfort. However, U.S. society had grown increasingly intolerant of young people who weren’t cognitively and behaviorally complying with academic demands and adult authorities, and the APA believed that these young people were creating increasing discomfort, tension, and inconvenience in U.S. society.

By the 1980s, academic success was increasingly seen as so vital in U.S. society that psychiatry was able to exploit the parental fear that children who did not cognitively and behaviorally comply with school demands and go on to college would be financial failures. With such fear, there was little thought as to whether illness diagnoses and drug treatments would in fact help these noncompliant children in the long run. There was even less thought as to whether or not it is desirable to have a society in which those children who don’t comply with standard schooling should be considered mentally ill. In contrast to the 1960s and ‘70s, an era in which authoritarianism was routinely challenged, there has been decreasing efforts to provide truly diverse education for the large group of children who are not, by their nature, compliant and conforming.

Once U.S. society took ADHD and ODD seriously, and once drugging of school-aged disruptive children was deemed “appropriate,” it was a simple matter to move on to pathologizing preschoolers and drugging them. In recent years, socio-economic variables have resulted in parents becoming increasingly stressed by the demands of survival, with decreasing time and community support to help them be patient and loving in the face of normal frustrating behaviors by their children. Financial survival for parents demands pre-school daycare, and parents are anxious about the prospect of their disruptive child not being able to cut it there. Enter preschool ADHD and pediatric bipolar disorder.

What are some of the “symptoms” of preschool ADHD and pediatric bipolar disorder that can result in a three-year old being heavily drugged? “Symptoms” for preschool ADHD include: talks a lot and makes more noise than peers, doesn’t pay close attention to details, fails to follow instructions, unable to wait their turn, and interrupts others often. The “symptoms” of pediatric bipolar disorder include: acting hyper, exuberantly happy or incredibly silly behavior, talking quickly or switching topics mid-sentence, and erupting in extreme upset when obstacles arise or they are told “no.”

In 2007, even the mainstream media was appalled by one tragedy ensuing from these preschool ADHD and pediatric bipolar diagnoses. The 2006 death of four-year-old Rebecca Riley was reported on 60 Minutes by Katie Couric in her September 30, 2007 story: “What Killed Rebecca Riley?” When Rebecca was 28 months old, following complaints by her mother that she had difficulty sleeping, seemed hyperactive, and was “constantly getting into things, running around, not being able to settle down,” psychiatrist Kayoko Kifuji, at the Tufts-New England Medical Center, diagnosed Rebecca with ADHD; and Kifuji prescribed clonidine, a hypertensive medication with significant sedating properties. When Rebecca was three years old, Kifuji added the diagnosis of pediatric bipolar disorder and prescribed two additional drugs, the antipsychotic Seroquel and the anticonvulsant Depakote.

At age four, primarily due to clonidine intoxication, Rebecca died. Rebecca’s parents were convicted of murder (viewed as sedating her to make her easier to manage, and attaining a psychiatric diagnosis to garner dis­ability payments); however, a juror, who voted for the second-degree murder conviction of Rebecca’s mother, spoke for her fellow jurors: “Every one of us was very angry. Dr. Kifuji should be sitting in the defendant’s chair, too.” However, Kifuji’s treatments were defended by Tufts-New England Medical Center, whose spokesperson told 60 Minutes the following: “The care we provided was appropriate and within responsible professional standards.”

Mental Health Professionals and Bigotry

The essential fuel of psychiatry’s bigotry is the arrogant belief by psychiatrists that their discomfort over humans different from themselves justifies declarations as to which human behaviors are deemed “mental illnesses.”

Bigots don’t routinely believe that they are bigoted, and this is certainly the case for psychiatrists and other mental health professionals. Bigots tend to view their own personal traits as either “normal” or “superior,” and they see their discomfort over others different from them as justification for their declarations of the defectiveness of others.

What are the characteristics of the majority of mental health professionals? The process of gaining acceptance into medical school or graduate school and becoming a psychiatrist or psychologist requires a great deal of cognitive and behavioral compliance. Both the selection and socialization process results in obedience to demands of authorities—an obedience that many professionals label positively as “adjustment.” Thus, for many of these professionals, noncompliance appears to be “maladjustment” and evidence of “mental illness.”

My experience is that most mental health professionals are unaware of how this selection and socialization process results in extraordinary compliance, and so few of them rebel against the arrogant assumption that noncompliant individuals are “mentally ill.”

If, in an imagined society, the noncompliant and disobedient were in charge of deciding who are “mentally ill” and who are “normal,” they could make the case that submissive compliance by one parent can enable emotional and physical child abuse by the other parent; and they could make the case that ass-kissing by subordinates can enable disastrous societal policies.

In contrast to this imagined society of authorities having respect and affection for the noncompliant, existing U.S. society has had mostly very different authorities—from psychiatrists to presidents. Former president Lyndon Johnson, who deceived the American public about the Gulf of Tonkin incident that set in motion the Vietnam War tragedy, discussing a prospective assistant, stated: “I don’t want loyalty. I want loyalty. I want him to kiss my ass in Macy’s window at high noon and tell me it smells like roses. I want his pecker in my pocket.”

In the world we live in, submissive compliance and ass-kissing not only don’t create discomfort for most authorities but are pleasurable for them—including for psychiatrist authorities. No wonder then that there are no mental illnesses called “submissive-compliant disorder” and “ass-kissing disorder.”

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Co-optation here refers to the process by which a powerful institution attempts to preserve its control by incorporating a popular element of a radical movement while burying the radical ideology of that movement.

Once again, the institution of psychiatry is in crisis and desperately seeking to excite a general public that is increasingly disenchanted by psychiatry’s repeated failures. As I document in A Profession Without Reason (2022), psychiatry’s treatment outcomes were acknowledged in 2011 by former National Institute of Mental Health (NIMH) director Thomas Insel as “abysmal” and “bleak.” Since then, in 2021, the New York Times concluded that psychiatry had done “little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health—rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use—went the wrong direc­tion, even as access to services expanded greatly.”

Has psychiatry contributed anything positive to society? SSRI antidepressants—psychiatry’s last heralded “miracle drug”—are now known to create a far higher percentage of sexual dysfunction than to positively affect depression, with success rates no different or even lower than placebo rates. Psychiatry’s serotonin imbalance theory of depression, discarded by researchers three decades ago, is now finally known to the world to have no merit; and psychiatry’s attempt to gaslight the general public into believing that it is blameless for this theory’s perpetuation has made it vulnerable to a potential class-action lawsuit. Psychiatry’s DSM diagnostic manual has now been acknowledged even by high­-ranking members of the psychiatry establishment to be invalid and even “bullshit.” The Open Payments database reveals 75% of psychiatrists are on the take from drug companies. And research shows psychiatry’s idea that “serious mental illness” is a brain disease has resulted in a perception of greater dangerousness and a desire for social distance—in other words, increased stigmatization.

The history of psychiatry is one of consistent scientific failure, but it is also one of remarkable political success through a variety of tactics, which include partnering with financially powerful drug companies so as to control the mainstream media—and co-opting attractive radical movements. Thanks to well-meaning psychedelic advocates, including Michael Pollan (bestselling author of How to Change Your Mind, 2018), psychedelics today have a mainstream respectability and a popular allure. Politically astute establishment psychiatrists recognize that psychiatry desperately needs to excite the general public, but that with no new Big Pharma “magic bullet” on the horizon, psychiatry has no choice but to attempt to co-opt psychedelics from an underground radical subculture.

Before detailing the current co-optation of the psychedelic underground, first some history of the co-optation of peer-to-peer support and Alcoholics Anonymous (A.A.). Then, some thoughts on why such co-optation is not only critical for the self-preservation and expansion of psychiatry, the medical establishment, and drug companies, but why this is also welcomed by those atop the societal hierarchy, who know full well that successful and attractive anti-authoritarian, non-hierarchical mutual-aid models threaten its control.

Peer-to-Peer Support

Darby Penney (1952-2021) was a longtime activist in the human rights movement for people with psychiatric histories. She was not only a leading force in the implementation of the type of peer support that is peer-developed and peer-run, but she was also a historian of this movement’s development and its co-optation. Some years ago, I had a lengthy conversation with her, one in which she was deeply troubled about how the creation of something so empowering was being co-opted to be disempowering.

Peer-developed peer support, as Penney defined it in 2018:

In 2019, Darby Penney, together with dissident psychiatrist Peter Stastny, authored “Peer Specialists in the Mental Health Workforce: A Critical Reassessment.” They document how peer-developed peer support has increasingly been co-opted and bastardized since the growth of “peer specialist” employees in traditional mental health settings. While providing paid employment for ex-psychiatric patients, it has come with a serious cost.

The essence of true peer-to-peer support is non-hierarchical empowerment, but in these traditional mental health settings, Penny and Stastny document research showing (1) peer specialists “are often used to carry out paraprofessional and even menial tasks within traditional mental health programs, rather than provide genuine peer support”; (2) in contradiction to the horizontal relationships of grassroots survivor-developed peer support, relationships between peers and patients in these traditional mental health settings are routinely hierarchical; (3) peer specialists are increasingly being “employed in situations where people are being coerced into ‘treatment,’ secluded and restrained, and forcibly medicated”; and (4) peer specialists are performing tasks “such as pressuring clients for medication compliance, reporting clients’ behavior to clinicians, and enforcing adherence to outpatient commitment orders.”

In our conversation, Darby Penney made clear that while empowering peer-developed and peer-run peer support continues to exist, she was worried. What she detailed reminded me of how the Nazis in their concentration camps used Jewish “prisoner functionaries,” commonly called kapos, to control other Jewish prisoners, and I asked Darby if that analogy sounded hyperbolic. With a pained expression, she responded, “I think about exactly that all the time.”

Alcoholics Anonymous (A.A.)

What psychiatric survivor activists today call “peer-to-peer support” has a longer history of being termed by anarchists as “mutual aid.” In mutual-aid groups, joining and participation is voluntary and an absence of coercion is a central value. Mutual-aid groups are non-hierarchical and egalitarian, distinguished by consensus decision making and participatory democracy, all of which is the essence of the political philosophy of anarchism.

The term mutual aid was popularized in the early twentieth century by the Russian anarchist Prince Peter Kropotkin (1842–1921) with his 1902 book Mutual Aid. A.A. co-founder Bill Wilson (1895-1971), referred to in A.A. circles as “Bill W.,” greatly esteemed Kropotkin and nonviolent anarchism. In Alcoholics Anonymous Comes of Age, Wilson pointed out how attractive the noncoercive nature and freedom of A.A. is for anti-authoritarian newcomers:

Wilson, prior to his co-founding A.A., had been repeatedly failed by the medical establishment. His multiple 1930s commitments at Charles B. Towns Hospital for Drug and Alcohol Addictions had no effect on his alcohol abuse—a habit which only was broken following a deep spiritual experience. In the 1950s, Wilson experimented with LSD, and he was enthusiastic about its potential for quieting the ego and allowing for the kind of spiritual experience that he believed was necessary to exit from the drinking life.

Anarchist writer Logan Marie Glitterbomb points out that A.A.’s Twelve Traditions are replete with anti-authoritarian anarchist principles that stress mutual aid, self-support, non-hierarchical organization, and autonomous groups. Wilson knew that these elements were attractive to anti-authoritarian alcoholics such as himself, and while he believed that it is a spiritual conversion that opens one up to a new way of life, he was concerned that an authoritarian interpretation of God would turn off many anti-authoritarian problem drinkers. So, Alcoholics Anonymous Comes of Age recounts A.A. founders’ consideration of not using the word God in A.A.’s “Twelve Traditions” and their “Twelve Steps.” They ultimately chose to use God but to make clear that the term was open to individual interpretation.

A.A. founders attempted to preempt A.A.’s co-optation and bastardization by hierarchical capitalistic institutions via A.A.’s “Twelve Traditions.” Specifically, Tradition #6 states: “An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.” This tradition has been subverted by the for-profit rehab industry which uses A.A. groups and Twelve Steps as part of a money-making enterprise. Furthermore, when court systems coerce people to attend A.A. meetings, the non-coercive mutual-aid A.A. culture is destroyed.

A.A. founders envisioned A.A. to be fellowship, not a medical technology. Owing to its co-optation, A.A. has lost its anti-authoritarian underground subculture allure, and many people today are surprised when they hear about its co-founder Bill Wilson’s affection for anarchism.

Psychedelics

There is an increasingly loud drumbeat today for the use of psychedelic drugs such as LSD and psilocybin in psychiatric treatment of depression, anxiety, post-traumatic stress disorder (PTSD), drug addiction, and despair over terminal illness.

While European-American culture became excited by synthetic psychedelics such as LSD in the twentieth century, plant-based psychedelics such as mescaline and psilocybin have long been a spiritual component of indigenous cultures. In the United States, psychedelics were legal until Richard Nixon’s “War on Drugs” in the late 1960s. One major political reason for Nixon’s war was to criminalize and eliminate a large anti-authoritarian subculture who were generally no fans of the authoritarian Nixon. The psychedelic subculture was comprised of individuals with varying ideologies and philosophies, but was an anti-authoritarian subculture.

Anti-authoritarians reject an unquestioning obedience to authority, and they believe in challenging and resisting illegitimate authority. “Turn on, tune in, and drop out”—the catchphrase of psychedelic advocate Timothy Leary (1920-1996)—was much about rejecting the conformist and oppressive nature of society. A control-freak culture perpetuates a control-freak ego, and psychedelics were seen as a vehicle to quiet that ego and allow for a connection with the universe—and an experience of the joy of being alive.

Ken Kesey (1935-2001), author of the anti-authoritarian 1962 novel One Flew Over the Cuckoo’s Nest, along with his “merry pranksters,” championed LSD parties (or “acid tests”), and this anti-authoritarian subculture is visible today in Grateful Dead and Phish scenes. Within this psychedelic subculture, there are libertarian-socialist-anarchist anti-authoritarians, fuck-government-libertarian anti-authoritarians, and anti-authoritarians who eschew any political identity.

Today, the Drug Enforcement Administration (DEA), terming psychedelics as “hallucinogens,” continues to remind Americans that these drugs are classified as “Schedule I under the Controlled Substances Act, meaning that they have a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision.” In contrast to Schedule I drugs, Schedule II drugs (such as the ADHD amphetamine drugs including Adderall), while also seen as having a high potential for abuse, are considered by the DEA to have medical use and so can be prescribed by physicians. Thus, an increasing number of members of the medical establishment want psychedelics to be classified as Schedule II drugs so these too can be legally prescribed by them, and of course several drug companies see high-profit potential in such a re-classification.

How can psychiatry co-opt the psychedelic underground subculture, discard its radical anti-authoritarian message of rejecting a dehumanizing society, retake psychiatry’s lost power and authority, and make both drug companies and the ruling elite happy?

A key insight to begin to unravel how this is being orchestrated is provided by Joanna Moncrieff, co-chairperson of the Critical Psychiatry Network, in her 2021 essay, “Psychedelics—The New Psychiatric Craze!”:

The use of psychedelics to quiet the ego and open oneself up to liberating insights is a very different use than psychedelic microdosing three to five times per week with a standardized “subthreshold” dosage to adjust to society with less emotional suffering.

People certainly do have breakthrough ego-quieting experiences while using psychedelics. On such a trip, they may for the first time in their life take seriously previously discarded insights about their depression being caused by self-absorption and a lack of love in their life. “But,” as Moncrieff points out, “these benefits are not medical or health effects. They are akin to the personal development that people achieve through other sorts of activities.” People have achieved similar breakthrough benefits through near-death experiences, through authentic sweat lodge ceremonies, through fasting, or through a variety of extraordinary altered states that quiet ego controls and enable liberating insights to be taken seriously.

Psychedelic advocates such as Pollan conclude that the psychedelic renaissance requires a trustworthy cultural “container,” and psychiatry and organized medicine desperately would like to convince society that they are the safest and most effective container. Pollan is a critical thinker with an anti-authoritarian sensibility and a reverence for indigenous cultures’ use of psychedelics, and he understands the concerns of psychedelic underground guides who fear marginalization from medicalization. However, there is a political trap that even well-meaning psychedelic advocates get caught in when they embrace “brain evidence” as a major way of legitimizing the ego-quieting capacity of psychedelics.

Pollan, in “The Big Think” and other presentations viewed by millions of people on the Internet, routinely highlights Robin Carhart-Harris’s 2012 study “Neural Correlates of the Psychedelic State as Determined by fMRI Studies with Psilocybin,” which concludes that functional magnetic resonance images (fMRI) show that psychedelics quiet one particular part of the brain—the “default mode network” (DMN), which is active when one is self-critical and ego driven; and so for Pollan, psychedelics can induce an “uprising” by the rest of the brain against the now quieted “dictator” DMN—a revolt against one’s own tyrannical ego. However, while fMRI colorful pictures are visually quite compelling, such a faith in fMRI research with respect to psychological functioning needs be critically examined—both scientifically and politically.

First, scientifically. A 2022 Neuron review co-authored by Raymond Dolan (considered one of the most influential neuroscientists in the world) of more than 16,000 neuroimaging articles published during the last 30 years, concluded, “Despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition.” Detecting brain activity and its absence with respect to psychological states via fMRI research is replete with methodological problems. A 2016 study, published in the Proceedings of the National Academy of Sciences, reported that the methods used in fMRI research can create the illusion of brain activity where there is none up to 70% of the time. Perhaps the most famous example is when Dartmouth researchers placed a dead salmon into an fMRI machine and “showed” it photographs depicting humans in social situations, and the resulting fMRI data made it appear as though the dead salmon was thinking about the pictures that it had been shown.

Second, politically. Of course, psychedelic use has biochemical correlates, but is the psychedelic trip to be seen as primarily a medical procedure or a spiritual activity? That is a political question, with ramifications for who are considered by society as psychedelic authorities.  Whether or not neuroscientists can overcome the historic methodological problem that make scientists skeptical about fMRI announcements with respect to psychological states, and whether or not neuroscientists have in fact located the biological site for “ego quieting,” the idea that this is true has political consequences. A societal “brain focus” for ego quieting helps facilitate its medicalization by psychiatry—enabling it to seize the top tier of the psychedelic hierarchy; and this enables psychiatry and its drug company partners to control both the narrative and use of psychedelic chemicals.

Enter microdosing, which has exploded in popularity in the last decade and which drug companies and their investors are betting on, but which is being slated for use in a very different way than ego quieting so as to allow for a greater connection with the universe.

What exactly is microdosing? The webzine Psychedelic Spotlight reports in 2022: “The common definition is that it is a ‘subthreshold’ dose of a psychedelic substance that has no noticeable effects. . . . For typical psychedelics it might be as little as 1/10th to 1/20th the normal dose, which would be around 10-20 micrograms of LSD or 0.25-0.3 grams of psilocybin mushrooms.” Drug companies will be able to guarantee to doctors standard and reliable dosages. Psychedelic Spotlight continues, “Advocates and anecdotal reports claim that microdosing increases energy, increases focus, decreases anxiety, relieves depression, helps sleep, reduces alcohol or drug craving, reduces food craving, and promotes a positive attitude. However, clinical research has not come anywhere near to demonstrating any of these benefits.” Specifically, a 2022 Psychopharmacology study, “Psilocybin Microdosing Does Not Affect Emotion-Related Symptoms and Processing,” used a double-blind, placebo-controlled, within-subject crossover design, and the authors reported:

However, with publicly traded companies such as MindMed and Compass Pathways betting heavily on psychedelic microdosing, and with capitalist investors such as Kevin O’Leary (from “Shark Tank”) excited about his investments in these companies, along with psychiatry’s desperation to have the next “miracle drug” replacement for their failed SSRIs, I have little doubt we will hear about new studies showing microdosing is a “safe and effective” treatment for depression, anxiety, and a host of other ills. Furthermore, it would be in the interest of psychiatry and these drug makers that microdosing becomes FDA-approved for a dosing regimen similar to SSRI use (or perhaps with less frequency but with an extremely expensive product and procedure). And following the path of all psychiatric drugs, eventually psychedelic microdosing will be seen as “safe and effective” for children and every other population in which current psychiatric drugs are now failing. No wonder Kevin O’Leary is excited.

But what about those medical treatments that seek to emulate the ego-quieting breakthroughs? What about psychedelic-assisted therapy (PAT), in which a certified therapist replaces an underground guide? PAT will certainly become increasingly more available but, unlike microdosing, there is no big money for drug companies with PAT, and so PAT will likely become a secondary phenomenon. Moreover, stripped from an underground anti-authoritarian subculture—one that recognizes that a control-freak dominant culture incites a control-freak ego—mainstream-medicine PAT will be a component of mainstream society, not a defiance of it. Furthermore, the power of any ego-quieting trip—whether or not it is chemically induced—has a great deal to do with its experience as sacred; and in the mainstream medical environment, what is routinely found is the sterile rather than the sacred.

Using the classic co-opting tactic, a popular element of an underground movement is extracted from its anti-authoritarian subculture. To strip psychedelic use down to its chemicals is to de-radicalize what is most threatening to a control-freak authority structure. While Nixon was able, via criminalization, to drive the anti-authoritarian psychedelic subculture more deeply underground, the current co-optation by the medical establishment of the psychedelic underground subculture will de-radicalize psychedelic use. Politically, one can argue that the medicalization of psychedelics is the only way to decriminalize its use; however, the question for society is this: Given psychiatry’s history of treatment outcome failure and its ethically compromising financial relationships with Big Pharma, is it really a good idea to make psychiatry the societal authority in charge of psychedelic use?

Victory for Those Atop the Societal Hierarchy

To the extent that any anti-authoritarian, non-hierarchical, mutual-aid organization is not only successful but pleasurable for participants, it serves as an attractive model. The greatest fear of those atop the societal hierarchy—the “power elite”—is that once people see this type of attractive model succeed anywhere, increasingly more people will want this elsewhere, including their workplace, which would mean that there would no longer be a ruling class.

The vision of an anti-authoritarian, non-hierarchical, mutual-aid society is intoxicatingly attractive to many people—and this terrifies the ruling elite. An effective and satisfying non-hierarchical mutual-aid model is so threatening for various authoritarians that it can become their common enemy. For example, during the Spanish Civil War in the 1930s, Nazi Germany, fascist Italy, Stalinist Soviet Union, Western capitalist nations, and the Catholic Church all played a role in destroying a successful non-hierarchical, mutual-aid, anarchist society.

Simple logic tells us that those atop a societal hierarchy will provide rewards for professionals who promote an ideology that maintains the status quo of a hierarchical coercive society. If a population believes the roots of its emotional suffering are in an un-quieted DMN and un-activated 5-HT_2A receptors that can be medically treated with psychedelics, rather than such suffering being rooted in a control-freak, dehumanizing, frightening culture that incites a control-freak ego that can be spiritually illuminated with psychedelics, this or any biochemical individual-defect belief system can be a more powerful and less expensive way of maintaining the status quo than a heavily armed police force.

The post From Peer Support to Psychedelics: Psychiatry’s Co-Optation & De-Radicalization appeared first on Mad In America.

Baruch Spinoza (1632-1677) is regarded by the eminent historian Jonathan Israel as a key member of the “radical Enlightenment” because he refused to compromise his thinking to appease religious authorities. Spinoza scholar Beth Lord notes that for Spinoza, “The aim of science, philosophy, and reason is to get at the truth,” but “the aim of religion is rather different . . . its aim is not to tell the truth or even to discover the truth, its aim is to make people behave better and to keep people obedient.” She adds, “The role of religion is really helping to manage people’s feelings and images when they’re in this irrational state.”

Such a religious role in psychiatry has been acknowledged by top insider psychiatrists with respect to two major constructs: (1) the DSM, psychiatry’s diagnostic manual published by the American Psychiatric Association (APA), the guild of American psychiatrists; (2) and the “chemical imbalance theory of mental illness,” which has long served as the rationale behind the use of selective serotonin reuptake inhibitor (SSRI) antidepressants for depression. Today, leading psychiatrists have acknowledged the scientific invalidity of both the DSM and the chemical imbalance theory, with some of them arguing that these constructs have been useful fictions.

The DSM and Religion

For the last decade, declaring that the DSM is scientifically invalid has not been a radical claim. The National Institute of Mental Health (NIMH) is the lead U.S. government institution that funds research on mental illness, and psychiatrist Thomas Insel was the NIMH director from 2002 to 2015. In 2013, Insel stated that the DSM’s diagnostic categories lack validity, and he announced that “NIMH will be re-orienting its research away from DSM categories.” More recently, in his 2022 book Healing, Insel stated: “The DSM had created a common language, but much of that language had not been validated by science.”

Even more bluntly than Insel, the chair of the DSM-IV (1994) task force, psychiatrist Allen Frances, stated in 2010 that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” However, Frances argued (in Gary Greenburg’s 2013 book about the DSM-5, The Book of Woe) that these labels are still crucial to treatment, and he warned, “If you puncture that noble lie, you’ll be doing a disservice to our patients. . . . A lot of false beliefs help people cope with life.”

For Spinoza, religion is a fiction; however, he believed it can have utility for society if its stories inspire “justice and charity.” For Spinoza, Lord explains, “Useful fictions are those that promote tolerance and community.” However, there are also malevolent fictions, which Lord describes as “ones which people are controlled, oppressed, and enslaved.”

Frances’s argument that “A lot of false beliefs help people cope with life” is an argument that psychiatric diagnoses can be useful in a religious sense, not a scientific one. Religion can be useful in helping managing people’s emotions when they’re in an irrational state, and Frances is essentially arguing that psychiatry’s diagnoses function as a benevolent religion.

Just how unscientific is the DSM? Not only does it lack validity, DSM diagnoses lack reliability. The APA conducted field trials on its DSM-5 to assess the degree of agreement between clinicians diagnosing the same individuals. A standard statistic used to assess reliability is called kappa. A kappa value of 0 means zero agreement and no reliability; a kappa of 1.00 means perfect reliability; and a kappa of less than .59 considered weak reliability. DSM-III task force chair, Robert Spitzer, had proclaimed with respect to assessing the reliability of the DSM that a kappa of less than .40 indicated “poor” agreement and .70 was “only satisfactory.” For the DSM-5 field trials, here (reported in The Book of Woe) is a sample of kappa results: .20 for generalized anxiety disorder; .32 for major depressive disorder; .41 for oppositional defiant disorder; and .46 for schizophrenia.

If an instrument is either invalid or unreliable, it is not scientifically useful, and the DSM is neither valid nor reliable, and so it has no scientific value.

Another leading psychiatrist, Michael First, text editor for the DSM-IV, gives us a sense of how psychiatry, at its highest levels, thinks. “The good news about the DSM-5 is also the bad news,” states First in The Book of Woe, “[The DSM-5] relies on categories that facilitate clinician communication but have no firm basis in reality. So I think it’s an improvement, but it’s also an acknowledgment that psychiatry, especially in its understanding of mental illness, is still in its infancy.”

First’s acknowledgment that DSM categories “have no firm basis in reality” would be striking for Spinoza or for any modern scientist. However, apparently, First cared less about the implications of this acknowledgment than echoing the notion that psychiatry “is still in its infancy,” a variation of psychiatry’s shibboleth that it is a “young science with much to discover but making great progress.”

A shibboleth is a word or phrase used by adherents of a sect or tribe, but regarded by others as empty of real meaning. “A shibboleth,” notes linguist Suzanne Kemmer, “is a kind of linguistic password: A way of speaking . . . that is used by one set of people to identify another person as a member, or a non-member, of a particular group. The group making the identification has some kind of social power to set the standards for who belongs to their group: who is ‘in’ and who is ‘out.’”

Given that leading psychiatrists have termed the DSM, a fundamental construct of psychiatry, as “bullshit,” “false beliefs,” “invalid,” and having “no firm basis in reality,” the notion that psychiatry is a “young science” or a science “in its infancy” is empty of meaning. However, using such shibboleths identifies one as a member of a particular group with social power. While shibboleths have no value for scientists, shibboleths are important in religious and tribal organizations.

If the DSM is a type of fiction, the question is whether it is a useful fiction or a malevolent one? My experience is that for different types of personalities, psychiatric diagnoses produce different results. Some people believe that their DSM diagnoses provide them with a relieving explanation for their troubling emotions and behaviors; however, others believe that their DSM diagnoses have been stigmatizing and have resulted in them being controlled and oppressed. Religion is helpful to some people but not all people; and different religions are suited for different types of people.

The “Chemical Imbalance Theory of Mental Illness” and Religion

The second major construct in psychiatry now regarded as a fiction—or in the words of one leading psychiatrist, an “urban legend”—is the “chemical imbalance theory of mental illness,” which includes the serotonin deficiency theory of depression. This theory is not simply one more proposed hypothesis that was refuted by the research. Rather, it is a theory that, long after it was disproven, has functioned as a religious idea.

In July 2022, garnering mainstream media headlines, the journal Molecular Psychiatry published “The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence.” In it, psychiatrist Joanna Moncrieff, co-chairperson of the Critical Psychiatry Network, and her co-researchers examined hundreds of different types of studies that attempted to detect a relationship between depression and serotonin, and concluded that there is no evidence of a link between low levels of serotonin and depression, stating: “We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.”

In response to the review’s widespread attention, leading figures in psychiatry, rather than rebutting Moncrieff’s conclusions, attempted to convince the general public that her findings were not newsworthy, even belittling her. Psychiatrist David Hellerstein, professor of clinical psychiatry at Columbia University Medical Center and director of Columbia’s Depression Evaluation Service, stated: “Wow, next she’ll tackle the discrediting of the black bile theory of depression.”

However, the vast majority of society had heard nothing from psychiatry about the discarding of this serotonin deficiency theory of depression. In a 2007 survey, 84.7 percent of 262 undergraduates believed it “likely” that chemical imbalances cause depression. While I cannot locate a more recent survey, my experience—with patients, the media, and even many doctors—is that the majority of them have continued to believe in the serotonin deficiency theory of depression, and that is why Moncrieff’s findings were newsworthy.

Researchers had discarded the chemical imbalance theory of depression by the 1990s. In Blaming the Brain (1998), psychologist Elliot Valenstein detailed research showing that it is just as likely for people with normal serotonin levels to feel depressed as it is for people with abnormal serotonin levels, and that it is just as likely for people with abnormally high serotonin levels to feel depressed as it is for people with abnormally low serotonin levels.

The first unequivocal acknowledgment by a leading figure in psychiatry of the discarding of this theory that I am aware of was in 2011, when psychiatrist Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times, stated: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” However, Pies’s statement was not widely publicized.

In 2012, the invalidity of the chemical imbalance theory of depression was news to National Public Radio correspondent Alix Spiegel, who is the granddaughter of psychiatrist John Spiegel, a former president of the APA. Her 2012 NPR story provides us with the explanation as to why—even after the research had clearly disproven the theory—most of the general public have continued to be unaware that it had been discarded. What Spiegel discovered was that the theory was maintained by psychiatry so as to manage patients’ feelings and make them more comfortable accepting treatment.

Spiegel began her story by recounting how as a depressed teenager, she and her parents were told the following by a Johns Hopkins Hospital psychiatrist about her depression: “It’s biological, just like diabetes, but it’s in your brain. This chemical in your brain called serotonin is too, too low. There’s not enough of it, and that’s what’s causing the chemical imbalance. We need to give you medication to correct that.” Then, Spiegel tells us, the psychiatrist handed her mother a prescription for Prozac.

As a journalist, Spiegel discovered the truth about the serotonin imbalance theory, and she tried to discover why psychiatry had not made greater efforts at publicizing that it had been disproven and discarded. Spiegel sought explanations from Alan Frazer, professor of pharmacology and psychiatry and chairman of the pharmacology department at the University of Texas Health Sciences Center, as well as from Pedro Delgado, chairman of the psychiatry department at the University of Texas, who had actually helped debunk the serotonin deficiency theory of depression in the 1990s. In Delgado’s 1999 review of the research, “Antidepressants and the Brain,” he and his co-author detailed how, in serotonin depletion studies, “depletion in unmedicated patients with depression did not worsen the depressive symptoms, neither did it cause depression in healthy subjects with no history of mental illness.”

Frazer told Spiegel that by framing depression as a deficiency—something that needs to be returned to normal—patients feel more comfortable taking antidepressants. Frazer stated, “If there was this biological reason for them being depressed, some deficiency that the drug was correcting, then taking a drug was OK.”

Delgado told Spiegel that the fiction of the chemical imbalance theory has benefits, pointing to research showing that uncertainty can be harmful; and so simple and clear explanations, regardless of how inaccurate, can be more helpful than complex truthful explanations.

Similarly, following the 2022 publication of Moncrieff’s review, psychiatrist Daniel Carlat, chair of psychiatry at Melrose Wakefield hospital, told NPR that doctors don’t know exactly how antidepressants work but “Patients do want to know that there is an explanation out there. And there are times when we do have to give them a shorthand explanation, even if it’s not entirely accurate.”

Prior to Prozac—the first of the SSRIs, entering the market in 1988—a poll in 1986 revealed that “only 12 percent of respondents were willing to take medication for depression and that 78 percent of people would be willing to live with the depression until it passed,” according to the Psychiatric News in 2002. However, this reluctance to take antidepressants changed dramatically; the rate of antidepressant use in the United States increased nearly 400 percent between 1988 and 2008. The chemical imbalance theory resulted in many people, such as Alix Spiegel and her parents, believing that SSRIs could correct the serotonin deficit that was causing depression.

The chemical imbalance theory of depression, long known by researchers to be untrue, is a fiction that has been retained by psychiatry to make people more comfortable taking antidepressants. Some people believe strongly it is simply unethical for doctors to use any disproven and discarded theory to persuade patients to accept treatments; however, others, including leading psychiatrists, believe that doctors should be able to employ useful fiction. The case for the usefulness of this fiction rests in large part on the answer to this question: Exactly how effective are antidepressant medications?

Antidepressants and Faith

Ironically, the effectiveness of antidepressants has much to do with another religious construct, faith—or what scientists call “expectations” and “the placebo effect.” The power of expectations with respect to the effectiveness of all substances used as antidepressants is uncontroversial—which is why, in drug studies, scientists use a placebo control group to tease out how much of a positive outcome is due simply to expectations and not the drug itself. While the placebo effect is uncontroversial, what is controversial is just how powerful the placebo effect is.

In April 2002, the Journal of the American Medical Association (JAMA) published a study that investigated whether the herb St. John’s wort, purported to be an antidepressant, was more effective than a placebo. In this study, in addition to one group given St. John’s wort and a second group given a placebo, there was a third group that received the SSRI Zoloft. The results? The placebo worked better than both St. John’s wort and Zoloft. Specifically, a positive “full response” occurred in 32 percent of the placebo-treated patients, 25 percent of the Zoloft-treated patients, and 24 percent of the St. John’s wort-treated patients.

A leading researcher of the placebo effect is psychologist Irving Kirsch. In 2002, Kirsch examined forty-seven drug company studies on various SSRIs and other antidepressants. These studies included published and unpublished trials, but all had been submitted to the Food and Drug Administration (FDA), so Kirsch used the Freedom of Information Act to gain access to all data. He discovered that in the majority of the trials, antidepressants failed to outperform placebos, and he reported that “all antidepressants, including the well-known SSRIs . . . had no clinically significant benefit over a placebo.” While in aggregate, antidepressants slightly edged out placebos, the difference is so unremarkable that Kirsch and others describe it as “clinically negligible.”

Moreover, drug companies are not required to do long-term outcome studies to acquire FDA approval. The FDA’s “Major Depressive Disorder: Developing Drugs for Treatment Guidance for Industry” states the following: “Antidepressants in established classes (e.g., SSRIs, SNRIs) typically need studies of 6 to 8 weeks duration to demonstrate efficacy.” Thus, the general public is unaware of studies that show antidepressants, over the long term, may result in more, not less, depression. In 2017, “Poorer Long-Term Outcomes among Persons with Major Depressive Disorder Treated with Medication,” published in Psychotherapy and Psychosomatics, reported that, after controlling for depression severity, the outcomes of 3,294 subjects over a nine-year period showed that antidepressants may have had an immediate, short-term ben­efit for some people, but at the nine-year follow-up, antidepressant users had significantly more severe symptoms than those individuals not using antidepressants.

Useful and Malevolent Fictions

So, where does this leave us? Leading figures in psychiatry acknowledge that DSM psychiatric diagnoses and the chemical imbalance theory of mental illness are not scientifically valid, but are useful fictions that help people manage their emotions and comply with their medication treatments. However, we have a great deal of evidence that casts doubt on the scientific value of antidepressants, especially in the long term; and even drug companies, in their antidepressant ads, acknowledge the adverse effects of these drugs, while there is now little controversy that there are debilitating withdrawal reactions for many individuals who stop taking their antidepressants.

For Spinoza, as Lord explains, fictions such as religion can be “hugely useful in structuring our experience and helping us to decide how to behave and how to live our lives.” She notes, “Spinoza’s aim is always for people to become more rational and to be able to govern themselves through their own true knowledge about the world. But he’s kind of realistic about the prospects of that happening, and since he doesn’t see humanity becoming enormously rational any time soon, he tends to think that structures like religion are necessary to keep people in line.”

Reason informed Spinoza and his radical Enlightenment friends of the value—both for an individual and for society—of justice and charity; and so to the extent that some Bible stories inspire people not inclined to rationality to act with justice and charity, these stories are useful fictions. However, as Lord points out, “Spinoza certainly thinks that there is potential for these fictions, whether they be political or religious fictions, to be used in negative ways.” Spinoza saw the idea of afterlife rewards and punishments from an anthropomorphic deity as a fiction that was necessary for those not ruled by reason to act with justice and charity; however, it was also clear to him that the fictions of heaven and hell were used by some clergy authorities as a means to control and exploit their congregants.

Some leading psychiatrists believe that that DSM diagnostic manual and the chemical imbalance theory of mental illness have functioned as useful fictions that help promote wellbeing. However, many patients have experienced damage from these constructs, which they see as malevolent fictions. People differ in their opinion on the usefulness or malevolence of all organized religions, and so it should be no surprise that there are differences of opinions about psychiatry.

Once we recognize the religious nature of psychiatry—unwittingly acknowledged even by leading psychiatrists—the following concerns about psychiatry become clear and compelling: (1) if a society does not distinguish science from religion, this subverts critical thinking and scientific inquiry; and (2) if a society declares any religion to have the authority of science, this results in oppressive intolerance for individuals who reject that religion.

The post Leading Psychiatrists Unwittingly Acknowledge Psychiatry Is a Religion, Not a Science appeared first on Mad In America.

Receiving widespread attention in the mainstream media was the July 2022 article “The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence,” published in the journal Molecular Psychiatry. In it, Joanna Moncrieff, co-chairperson of the Critical Psychiatry Network, and her co-researchers examined hundreds of different types of studies that attempted to detect a relationship between depression and serotonin, and concluded that there is no evidence of a link between low levels of serotonin and depression, stating: “We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.”

Psychiatry apologists tried to convince the general public that Moncrieff’s findings were not newsworthy, as psychiatrist David Hellerstein, professor of clinical psychiatry at Columbia University Medical Center and director of Columbia’s Depression Evaluation Service, attempted to belittle Moncrieff in this manner: “Wow, next she’ll tackle the discrediting of the black bile theory of depression.” However, given the reality that the vast majority of society had heard nothing from psychiatry about the discarding of this serotonin theory of depression, what followed has been public mockery of psychiatry and its Big Pharma partners for their duplicity.

Then, in August of 2022, receiving less attention was an even more devastating blow to psychiatry, so damaging and so indefensible that psychiatry’s only response was to ignore it. Published in the journal Neuron, Raymond Dolan—considered one of the most influential neuroscientists in the world—co-authored “Functional Neuroimaging in Psychiatry and the Case for Failing Better,” concluding, “Despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition.”

Reflecting on the more than 16,000 neuroimaging articles published during the last 30 years, Dolan and his co-authors concluded: “It remains difficult to refute a critique that psychiatry’s most fundamental characteristic is its ignorance. . . . Casting a cold eye on the psychiatric neuroimaging literature invites a conclusion that despite 30 years of intense research and considerable technological advances, this enterprise has not delivered a neurobiological account (i.e., a mechanistic explanation) for any psychiatric disorder, nor has it provided a credible imaging-based biomarker of clinical utility.”

So in 2022, research reviews published in prestigious journals have made it clear that there is no neurobiological evidence—no chemical imbalance, no brain structure evidence—for any psychiatric condition.

But that’s not the end of psychiatry’s 2022 nightmare.

From one of the most prominent establishment psychiatrists in the world, we heard in 2022 that the DSM (psychiatry’s diagnostic manual, published by the American Psychiatric Association) lacks validity. Thomas Insel, when National Institute of Mental Health (NIMH) director in 2013, had quietly stated in his NIMH blog that the DSM’s diagnostic categories lack validity, and he announced that “NIMH will be re-orienting its research away from DSM categories”; then, in 2022, he informed the general public about DSM invalidity in his book Healing, which has received mainstream media attention. In this book, Insel states: “The DSM had created a common language, but much of that language had not been validated by science.” In plain language, Insel is calling the DSM, in a scientific sense, bullshit.

In 2022, increasing numbers of Americans also heard about psychiatry’s abysmal treatment outcome record. Insel, as NIMH director in 2011, had quietly acknowledged: “Whatever we’ve been doing for five de­cades, it ain’t working. And when I look at the numbers—the number of sui­cides, number of disabilities, mortality data—it’s abysmal, and it’s not getting any better.” In 2021, the New York Times concluded that psychiatry had done “little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health—rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use—went the wrong direc­tion, even as access to services expanded greatly.” And in 2022, in Healing, Insel repeated to the general public what he had previously acknowledged about psychiatry’s history of abysmal outcomes, noting: “While we studied the risk factors for suicide, the death rate had climbed 33 percent” despite increased treatment, reporting that, “Since 2001, prescriptions for psychiatric medications have more than doubled, with one in six American adults on a psychiatric drug.”

Psychiatry’s Defense: “Don’t Throw Out the Baby with the Psychiatric Bathwater”

Earlier in 2022, responding to Robert Whitaker in a Mad in America dialogue, psychiatrist Jim Phelps, in his article “The Baby in the Psychiatric Bathwater,” stated the following: “Don’t throw out the baby with the psychiatric bathwater. Mr. Whitaker, I fear you’re doing harm while trying to do good.”

The idiom “Don’t throw out the baby with the bathwater” is an admonition against discarding something valuable along with something not wanted. However, the question for any critical thinker is—especially given what has been made public about psychiatry in 2022—what exactly is valuable about psychiatry?

A rational critical analysis of an institution—in contrast to a theological defense of it— would evaluate whether that institution is in fact valuable and can be reformed to be better. Such an analysis of a professed medical institution would evaluate whether (1) its fundamental paradigm and core tenets have scientific merit, and whether with reform in its practices, it can be improved, or (2) its fundamental paradigm and tenets are scientifically invalid, and thus, no matter how many of its practices are reformed, it will continue to do more harm than good.

Critical freethinkers—in contrast to theologians attached to their institution—would be open to all possible conclusions of this analysis, including (1) not discarding an entire institution because it is fundamentally sound and valuable, and needs only to improve its practices, or (2) discarding an entire institution because it is fundamentally invalid and unsound, as its core principles are unscientific and unjust.

In any given time in U.S. history, there have been institutions that have had a central role in U.S. society that were eventually—with great struggle—discarded, and which today most Americans are embarrassed ever existed. Thus, any critical freethinker who has knowledge of American history will not be intimidated to consider the possibility that any current institution may need to be completely discarded. That is part of the essence of being a critical freethinker.

Perhaps the most obvious example in U.S. history of a dominant institution that was ultimately discarded—and which today most Americans are embarrassed by its past existence—is the institution of slavery.

I bring up the institution of slavery not to hyperbolically equate psychiatry with slavery—though there are certainly many Mad in America readers who have been involuntarily forced into ruinous psychiatric treatment, and who would not view such a reference as hyperbolic. However, for the majority of psychiatric patients, it is hyperbolic to equate psychiatry with slavery in terms of cruelty. I bring up slavery as a reminder of the historic reality of (1) the longtime existence in the United States of a shameful institution, and (2) that when it was being attacked by slavery abolitionists, slavery’s supporters used several defenses of it, including the “don’t throw out the baby with the bathwater” defense.

The various defenses of slavery included: how the abolition of slavery would destroy the Southern economy; how slavery has existed throughout history and thus is quite normal; that slavery is not viewed as immoral in the Bible; and that slavery is legal. Another major defense of slavery was that it was beneficial for slaves, and that it would be bad for slaves to throw out the baby with bathwater. Specifically, this argument went like this: If slaves were freed, there would be widespread unemployment and chaos, and that in comparison to workers in the Northern states, slaves were better cared for, especially when sick or aged. In 1837, as senator from South Carolina, John C. Calhoun (formerly a vice president of the United States) stated: “Never before has the black race of central Africa, from the dawn of history to the present day, attained a condition so civilized and so improved, not only physically, but morally and intellectually.”

Again, I review this history not to equate psychiatry with slavery in terms of cruelty but to remind readers that in U.S. history, (1) there have been institutions that have had a central role in society that were eventually—with great struggle—discarded, and which today are a source of embarrassment for most Americans; and that (2) among the many defenses of such now discarded shameful institutions, one defense was not to throw out the baby with bathwater.

Slavery is not the only such shameful institution in U.S. history. Another more recent example is the House Committee on Un-American Activities (dubbed the House Un-American Activities Committee or HUAC), which was an investigative committee of the U.S. House of Representatives created in 1938 to investigate the disloyalty and subversive activities of American citizens and institutions. After HUAC destroyed the careers of many Americans who had broken no laws but were targeted for their political beliefs, HUAC eventually came to be denounced even by former President Harry Truman in the late 1950s as the “most un-American thing in the country today.” HUAC changed its name to the House Committee on Internal Security, which itself was abolished in 1975.

Slavery and HUAC are by no means the only examples of powerful institutions in U.S. history that we are now ashamed to have allowed to exist. What slavery and HUAC have in common is that they were based on invalid paradigms. Slavery was based on the invalid paradigm of racial inferiority of African Americans, and HUAC was based on the invalid paradigm of what it meant to be “un-American.” If an institution’s essential paradigm is scientifically invalid and unjust, then all attempts at reform will be pointless. To put it idiomatically, “You can put lipstick on a pig, but it is still a pig.”

Is Psychiatry’s Self-Defense Hysterical?

While most of establishment psychiatry simply ignores critical freethinking about psychiatry, there are a handful of psychiatrists who respond to psychiatry critics, and I can only speculate as to why. Perhaps their role is to make psychiatry appear to be open to criticism while in reality imposing limits as to what is allowable criticism; or perhaps their role is to co-opt truly critically freethinking publications such as Mad in America. In any case, along with psychiatrist Jim Phelps, I would include in this group psychiatrists Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times, and Awais Aftab, who has an interview series in the Psychiatric Times.

In 2020, Pies told Aftab that he distinguishes between two quite different groups of critics. There are, he tells us, “sincere and well-intentioned critics of psychiatry—many of whom are psychiatrists—whose aim is to improve the profession’s concepts, methods, ethics, and treatments.” However, Pies then goes on to say that there are also critics whose “hostile and vituperative rhetoric is clearly aimed at discrediting psychiatry as a medical discipline.” For Pies, it is simply unallowable to question the legitimacy of the institution of psychiatry, and to do so is inexcusable.

Aftab, like Pies, makes clear that he believes there are critiques of psychiatry that are responsible and useful versus critiques that are irresponsible and dangerous. In August, Aftab tweeted, “Holy shit. . . Whitaker at Mad in America is calling for a class-action lawsuit against the American Psychiatric Association & scientific advisory boards of orgs such as NAMI, alleging that the infamous serotonin hypothesis paper reveals these entities engaged in ‘medical fraud.’” Earlier, in his July 2022 tweets, Aftab admonished, “Anyone not attuned to the emerging intersection of psychiatric critique & far-right politics is not paying attention. We’ve already seen previews of this relationship when it comes to gender critical ideology & anti-vaccine sentiment; it’s going to become more explicit with time”; and then offered this warning: “Those engaged in a Faustian bargain will realize too late, if they realize at all, what ugly forces they have unleashed.”

Phelps, Pies, and Aftab are open to criticism of psychiatry as long as it stops short of acknowledging the increasingly well-documented reality that psychiatry lacks any scientific merit, which logically results in the questioning of the legitimacy of psychiatry.

To be a critical freethinker, one need not conclude that psychiatry should be abolished. One need only be open to questioning psychiatry’s legitimacy, as a critical freethinker would be open to questioning the legitimacy of any institution.

A critical freethinker may even conclude that while there is no scientific merit to psychiatry, given the nature of modern society and psychiatry’s role in it, psychiatry’s abolition might result in an even more problematic institution taking psychiatry’s societal role of controlling inconvenient people and providing fictional explanations for unhappiness.

While being a critical freethinker does not necessarily mean coming to the conclusion that it would be a good idea for psychiatry to be abolished, it does mean being open to any and all facts, and being open to any and all logical conclusions from such facts. In their lack of openness, Phelps, Pies, and Aftab make clear that they are not critical freethinkers.

Webster’s Dictionary offers both a formal and informal definition of hysterical. The formal definition of hysterical is “feeling or showing extreme and unrestrained emotion.” The informal definition is “very funny.”

Maybe it’s just me, but with respect to both the formal and informal definition of hysterical, I find Hellerstein’s equating Moncrieff’s recent review to “the discrediting of the black bile theory,” Phelps’s “don’t throw out the baby with the psychiatric bathwater” defense, Pies’s good-and-evil categorization of psychiatry critics, and Aftab’s apocalyptic fear mongering of what will be unleashed by freethinking critics of psychiatry all to be… hysterical.

The post Psychiatry’s Nightmarish 2022 & Its Hysterical Defense Against Criticism appeared first on Mad In America.

The challenge then is this: How can psychiatry be examined in a novel way that might intrigue freethinkers and critical thinkers of science, philosophy, politics, and history who would not ordinarily read a book about psychiatry because they are turned off by dogma? A fresh approach to examining psychiatry’s crisis of failure that I thought might interest them is utilizing the philosopher Baruch de Spinoza along with historian Jonathan Israel’s distinction between moderate and radical Enlightenment thinkers.

Today, even some key members of establishment psychiatry acknowledge three areas of failure of their profession: (1) worsening treatment outcomes despite increased treatment; (2) the invalidity of its DSM diagnostic system; and (3) the invalidity of psychiatry’s chemical imbalance theory of mental illness.

Unacknowledged by establishment psychiatry but reported even in the mainstream media is Big Pharma’s corruption of psychiatric research and treatment, and how this creates widespread conflicts of interest.

Unacknowledged by both psychiatry and the mainstream media is how virtually all of psychiatry’s policies and practices —not simply its treatments, diagnoses, and illness theories—are doing more harm than good on both an individual and societal level. In A Profession Without Reason (2022), I discuss several of psychiatry’s harmful policies and practices—including its “disease like any other” anti-stigma campaign which actually increases stigma; its “caring coercion” forced treatments which result in resentment and rage; and its individual-defect theories of mental illness that serve as diversions from socio-economic-political sources of suffering.

Among psychiatrists, there are those who are completely clueless, in denial, or dishonest about psychiatry’s record of failure. They repeatedly tell us that psychiatry is a young science that has made great progress. Promulgating the myth of progress is the historic role of the leadership of the American Psychiatric Association (APA), the guild of American psychiatrists. One of many examples is psychiatrist Paul Summergrad, who during his APA presidency (2014-2015) began a talk with the following: “We have made great improvements in many areas of psychiatric care in recent years, but there is still a lot of room for improvement in our country’s mental health system,” and he then tells us that the problem is not enough access to psychiatric treatment.

Not all psychiatrists are completely clueless, in denial, or dishonest. Among those who are not completely unenlightened there are two groups: the moderately enlightened, and the far smaller radically enlightened. The moderately enlightened acknowledge some of psychiatry’s failures but, in common with the unenlightened, desperately attempt to preserve the institution of psychiatry. In contrast, the radically enlightened care only about the truth, and have no attachment to institution preservation.

The Moderately and Radically Enlightened in the Enlightenment

In Spinoza’s era, 350 years ago, ruling religious and state institutions fought against science, freedom, and other human rights, and this resulted in a rebellion that we now term the Enlightenment. What intrigued me—and I hoped would interest others—is that among Enlightenment thinkers, there was a clash between the moderately and the radically enlightened, and today this same clash exists with respect to psychiatry.

In Radical Enlightenment (2001), historian Jonathan Israel explains this distinction between moderate versus radical Enlightenment thinkers. While the term radical can be used in many ways, for both Israel and myself, radical means a complete break with past tradition, including the dissolution of control by powerful societal institutions; and moderate refers to criticism and reform but no complete break from past traditions.

While all of the original Enlightenment thinkers embraced reason and science, and strove for greater tolerance, freedom and an improved society, moderate Enlightenment thinkers aimed to accomplish this, Israel observes, “in such a way as to preserve and safeguard what were judged essential elements of the older structures.” In contrast, radical Enlightenment thinkers such as Spinoza, Israel tell us, “rejected all compromises with the past,” denying the Judeo-Christian view of God, miracles, afterlife rewards or punishments; and they scorned theologians’ God-ordained hierarchies that sanctioned monarchies.

During Spinoza’s seventeenth century, much of society—including virtually all ecclesiastic authorities, most civil authorities, and much of the public—was unenlightened; they sought to maintain the status quo of faith in traditional authorities, and they rejected freethinking, religious tolerance, and democracy. Moderately enlightened thinkers saw value in science and tolerance, but they sought to limit the Enlightenment so as not to pose a threat to ecclesiastic and state institutions. The radical Enlightenment was an underground movement that included Spinoza and his friends—and which threatened institutions holding power.

This contrast between moderate and radical has persisted throughout history. In the 1850s in the United States, with regard to the institution of slavery, if one was moderately enlightened, one was troubled by slavery and opposed its spread to new states but did not call for the abolition of slavery. In contrast, if one was radically enlightened, one fought for the immediate abolition of slavery—this advocated by the “Radical Republicans.”

Today, we see a moderate-radical contrast with regard to psychiatry.

Psychiatry’s Moderately Enlightened

Many psychiatrists, including some key members of establishment psychiatry, are not completely clueless, in denial, or dishonest about psychiatry’s record of failure with respect to (1) worsening treatment outcomes despite increased treatment; (2) the invalidity of its DSM diagnostic system; and (3) the invalidity of psychiatry’s chemical imbalance theory of mental illness.

In A Profession Without Reason, an example of a moderately enlightened psychiatrist I offer is Thomas Insel, National Institute of Mental Health (NIMH) director from 2002-2015. Disappointingly, in his recently published book Healing (2022), Insel omits some of his previous acknowledgments of psychiatry’s failures that I had given him credit for, and he offers illogical rationalizations for other failures.

While Insel remains consistent in his acknowledgement of psychiatry’s record of “abysmal” treatment outcomes, his rationalizations for it in Healing are illogical, unscientific, and thus pre-Enlightenment thinking. As I detail in my review of Healing (“Former NIMH Director’s New Book: Why, With More Treatment, Have Suicides and Mental Distress Increased?“), while Insel continues to acknowledge that treatment outcomes are worsening despite increasing numbers of people in treatment, at the same time, he proclaims that modern psychiatric treatments are very effective.

The invalidity of psychiatry’s chemical imbalance theory of mental illness has increasingly been acknowledged by the moderately enlightened members of Establishment psychiatry—including Insel. In 2011, establishment psychiatrist Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times, stated: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” In Healing, Insel acknowledged the jettisoning of the chemical imbalance theory, stating: “The idea of mental illness as a ‘chemical imbalance’ has now given way to mental illnesses as ‘connectional’ or brain circuit disorders.”

With respect to this “brain circuit disorder” theory, there is as little evidence for this new biological-defect theory as there was for the now discarded chemical imbalance theory. However, crucial to psychiatry’s usefulness for the ruling class—which values any explanation for emotional suffering that does not include an increasingly alienating and dehumanizing society—is some kind of “individual-defect theory of mental illness.” Thus, moderate institutional preservationists such as Insel know that if they cannot provide such an individual-defect theory—be it chemical-imbalance defects, brain-circuit defects, or some kind of genetic defects—the ruling class will turn to some other profession who will provide a diversion from the socio-economic-political causes, perhaps providing more power to clergy.

With respect to the invalidity of the DSM, Insel (unlike the APA) evidenced enlightenment when, as NIMH director in 2013, he stated that the DSM’s diagnostic categories lack validity and announced that “NIMH will be re-orienting its research away from DSM categories.” In his 2022 Healing, Insel states: “The DSM had created a common language, but much of that language had not been validated by science.” In plain language, Insel is calling it bullshit.

As NIMH director, Insel pushed for replacing the DSM with something called RDoC, upsetting the APA who publishes the DSM (which is the major money maker for the APA). Even though Insel has declared the DSM to be invalid and unscientific, the DSM continues to be used by psychiatry for patient diagnosis and treatment.

Thus, even though high-ranking moderately enlightened psychiatrists know that the DSM is scientifically invalid bullshit, they wish not to offend the APA and derail the institution of psychiatry. And so, the moderately enlightened engage in what philosophers call “reconciliatory theism,” compromising between the truth and acceptable dogma, and they caution us, as psychiatrist Jim Phelps did in a recent post on Mad in America, not to “throw out the baby with the bathwater.”

In contrast, for Spinoza and contemporary radically enlightened thinkers, if reason and science make clear that any conceptualization is invalid—or what Spinoza called an inadequate idea that results in models and paradigms based on confused and false concepts—radically enlightened thinkers would not compromise their position for the sake of maintaining an institution.

Perhaps Insel’s most disappointing deterioration is his omission from Healing of his previous assertion as NIMH director about the treatment of individuals whom psychiatrists label with “serious mental illness” (SMI). Absent from Insel’s 2022 Healing is any reference to his 2013 NIMH commentary “Antipsychotics: Taking the Long View” (that has recently been removed from the NIMH website but remains republished on other sites), in which Insel surprised establishment psychiatry by agreeing, in large measure, with psychiatry critics such as journalist Robert Whitaker that standard psychiatric medication treatments for some individuals diagnosed with SMI are counterproductive.

Insel actually acknowledged in 2013: “It appears that what we currently call ‘schizophrenia’ [which Insel puts within quotation marks] may comprise disorders with quite different trajectories. For some people, re­maining on medication long-term might impede a full return to wellness. For others, discontinuing medication can be disastrous.”

This assertion was part of why I had considered Insel to be an example of a moderately enlightened psychiatrist. However, sadly, nowhere in his new book (which extensively discusses this so-called SMI population) does Insel repeat it and reference the Harrow-Jobe and Wunderink research—which Whitaker had brought attention to—that Insel had referenced in 2013 to back up his assertion: “For some people, re­maining on medication long-term might impede a full return to wellness.”

While in A Profession Without Reason I gave Insel credit for being moderately enlightened, with his recent omissions and rationalizations in Healing, I can understand why some might now diagnose him with diminishing enlightenment, a milder form of the unenlightenment that routinely characterizes APA presidents.

The Radically Enlightened

While the moderately enlightened acknowledge some of psychiatry’s failures, they—no different than those APA leaders who are completely unenlightened—do everything possible to preserve the institution of psychiatry.

In contrast, the radically enlightened care only about scientific truths, not institutional preservation.

The radically enlightened look at the evidence for the “medical model of mental illness,” and seeing no justification for it, they advocate discarding it, unbothered by the consequences for psychiatry as an institution within medicine. Similarly, seeing no evidence that professional credentials are associated with superior outcomes, the radically enlightened proclaim this reality, unbothered by the fact that this costs prestige, power, and money to psychiatrists and other mental health professionals.

While the moderately enlightened are critical of psychiatry’s poor performance, the DSM, and psychiatry’s chemical imbalance theory of mental illness, and they may even believe in moderate reforms—for example, seeing value in peer-to-peer support as long as this doesn’t reduce professional authority—they do not challenge the legitimacy of psychiatry as a societal institution, and they do not challenge the current mental illness industry hierarchy with psychiatrists at the top of it.

In contrast, if science and reason dictate so, the radically enlightened are open to a complete break with past tradition and its institutions. With respect to psychiatry, this includes: eliminating the power that the APA has over civil society through its mental illness declarations; abolishing institutional hierarchies in which individuals with extensive experience in recovery but lacking professional degrees have little or no power; and prioritizing societal variables and social policies that affect emotional well-being.

For those who think radical means something “too extreme” and “bad,” it is important to keep in mind that as radical a thinker as Spinoza was in his day, there is nothing in what he said that is today considered by progressive thinkers to be too politically radical; and in fact, modern progressive thinkers actually view Spinoza as not progressive enough in some matters. Similarly, in the 1850s, as radical as the Radical Republicans were in their views of African Americans and the abolition of slavery, there is nothing about their views that today would be considered too radical by most Americans; and in fact many progressives would today view the Radical Republicans as not progressive enough.

This should provoke psychiatry’s critics to consider the possibility that as radical as their views about contemporary psychiatry are considered today, in the future, these views may well be seen as not progressive enough.

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What Exactly is Psychiatry’s “Medical Model”?

Psychiatry’s medical model is essentially a disease model. While there are controversies about its definition—which I will return to—in common practice, psychiatry’s medical model consists of (1) diagnosing a person with a mental illness if the person has been assessed to have enough qualifying behaviors termed by psychiatry as symptoms, and (2) treatment consisting of eradicating as quickly as possible these symptoms. Unlike illnesses and symptoms in the rest of medicine, mental illnesses and their symptoms are voted in as such by the American Psychiatric Association (APA), the guild of American psychiatrists and publisher of the DSM.

Ignoring the voting issue—as well as the absence of any objective diagnostic tests—psychiatry’s imagined medical model approximates the model of the rest of medicine. In psychiatry’s medical model, attention deficit hyperactivity disorder (ADHD) and schizophrenia are—like gonorrhea and cancer—seen as pathological conditions which are diagnosed based on symptoms, and medical treatment consists of eradicating the condition, with the idealized goal being the eradication of the cause of the pathology, and the practiced goal of eradication of its symptoms.

So, what then are controversies about the definition of psychiatry’s medical model?

Perhaps the most significant one is whether or not the medical model means an exclusive focus on biological causality and biological treatments. While psychiatry generally views mental illnesses as biological in nature—be it chemical imbalances (now a discarded theory), defective circuitry (current theory), or other theories involving brain and genetic defects—psychiatry’s medical model does not preclude the effect of psychological and social factors on biological functioning. Just as oncologists embrace the idea that genetics predisposes a person to cancer but psychological and social variables can trigger the cancer, so too does psychiatry’s medical model embrace the idea that psychosocial variables can trigger DSM mental illnesses.

The essential aspect of the medical/disease model is the designation of a phenomenon as a pathological one with treatment consisting of eradication of the pathological phenomenon or, at the very least, eradication of its symptoms.

It would surprise many people who are hostile to psychiatry’s chemical and electrical “treatments” to discover that they too may embrace a medical model if their approach accepts inattention, depressed mood, anxiety, substance abuse, and hearing voices as “illness symptoms.” Whether the treatment be antidepressants, electroconvulsive therapy (ECT), vitamins, or cognitive-behavioral therapy (CBT), these are not departures from the medical model as long as the goal is the eradication of the “symptoms” of “illness”/“disease”/“disorder”/“pathology” (or some other such term connoting defect). This is not to say that all “treatments” have equal potential for traumatization, as certainly ECT—which damages the brain and disconnects a person from memories—is going to have a more traumatizing effect than CBT (I will return later to the essence of trauma).

In one of the oddest wrinkles of psychiatry’s medical model, psychiatry officialdom tells us that their medical model does not necessarily mean that all DSM symptoms should count as illness symptoms. Specifically, psychiatrist Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times, in his article “Hearing Voices and Psychiatry’s (Real) Medical Model” writes: “Psychiatry also recognizes the cultural and religious context in which some people ‘hear voices’—and the non-pathological nature of such experiences.” Pies continues, “Thus, DSM-5 notes, ‘In some cultures, visual or auditory hallucinations with a religious content (eg, hearing God’s voice) are a normal part of religious experience.’”

Thus, similar to the medieval Catholic Church with respect to selling indulgences to expunge sins from one’s “heaven-hell record,” psychiatrists can declare an individual with DSM symptoms of pathology as not evidencing pathology. In practice, such “get-out-of-mental illness cards” are handed out with regard to (1) the political consequences of declaring individuals with such symptoms to be mentally ill (for example, preempting an attack on psychiatry by that group of people who hear God’s voice); and (2) if psychiatrists themselves have experienced DSM symptoms (for example, declaring their own inattention to a boring lecture as not a symptom of ADHD, though diagnosing their patients’ inattention to them as ADHD).

Curiously, despite Pies’ declaration that in certain instances hearing voices such as God’s voice are not evidence of mental illness, he next states: “That certain human experiences or perceptions (eg, ‘voices’) have a discernible ‘meaning,’ symbolism, or psychological significance for the patient does not mean they have no neuropathological etiology.” So, according to Pies, hearing God’s voice can be meaningful and “non-pathological” but still have a “neuropathological etiology.” The logic here, if there is any, escapes me.

On an intellectual level, psychiatry’s medical model is hypocritical and confusing, so much so that psychiatrists’ explanations can appear to non-psychiatrists as “grossly disorganized speech” (a DSM symptom of schizophrenia).

However, on a political level, psychiatry’s medical/disease model can be summed up rather easily: Psychiatry believes it knows the symptoms of mental illness, and when psychiatrists declare that individuals have a mental illness, psychiatry’s ideal goal is to eradicate the cause of the illness, and its practiced goal is to eradicate the symptoms of the illness.

How Does Psychiatry’s Medical Model Insidiously Retraumatize?

While psychiatric “treatments” such as ECT, surgical lobotomies, and chemical lobotomies are overtly traumatizing, the focus in this article is on the traumatizing effects of psychiatric “diagnoses.” And while it is obviously traumatizing to pathologize—as psychiatry has done—normal sexualities (such as homosexuality and bisexuality), normal temperaments (such as introversion and anti-authoritarianism), or other aspects of people’s essential nature, there is a more insidious way that all psychiatric “diagnoses” routinely traumatize.

When healthcare professionals—and this includes not only psychiatrists but primary care physicians, psychologists, and other mental health professionals—communicate to their patients the idea that their patients’ inattention, depressed mood, anxiety, substance abuse, hearing voices are “symptoms” of “mental illness,” and when patients accept a mental illness/disorder/pathology/defect label, they will be traumatized or retraumatized.

I say retraumatized because these so-called “symptoms” are not evidence of an illness/disease/disorder/pathology/defect but often are simply coping mechanisms for traumatic events; in other words, fight/flight/freeze mechanisms in reaction to violations—coping mechanisms that have become habituated and become counterproductive and dissatisfying with respect to current navigation and enjoyment of life.

The definition of trauma is controversial, but I believe that the essence of trauma is in the disconnection reaction to an event. The event may be an obviously horrific violation such as rape or lobotomy, but a physical violation is not necessary for traumatization. While a child can develop the coping mechanism of inattention in response to an abusive family, I have talked to many young people whose inattention was a coping mechanism in response to their coercive schooling which was oppressive for them. We are traumatized to the extent that the event results in the reaction of disconnection, specifically a disconnection from essential truths—including the truth of who or what violated our being, from the truth of our being, and from other truths including sociopolitical ones.

Owing to many variables—including the absence or presence of support and protection—we will be more or less vulnerable to disconnection.

If I were ten years old and a psychiatrist told me that my often arguing with adults, often refusing to comply with adults’ requests or rules, often irritating adults, and often being irritated by adults were symptoms of the mental illness of oppositional defiant disorder (ODD), and if I had no support or capacity to protect myself from this “diagnosis”—and then internalized this pathology identity—I would be traumatized. If I accepted the idea that I was mentally ill, I would be disconnected from the truth of exactly what was threatening me, the truth of my being, and the truth of why I was engaging in those behaviors that psychiatry calls “symptoms” of a “disorder.” If I accepted the psychiatrist as a legitimate scientific authority, I would also be disconnected from the truth of the essence of psychiatry. In contrast, if I was told today as an adult by a psychiatrist that because I refused to comply with illegitimate authorities that I had ODD or “authority issues,” I would be too busy laughing to be traumatized by such bullshit.

Psychiatry traumatized millions of homosexual individuals who accepted psychiatry’s “diagnosis” that they were mentally ill because of their homosexuality (with many of these individuals also traumatized via “treatments” that included ECT, castration, lobotomy and, more commonly, “aversion therapy,” in which electric shock to the genitals and/or nausea-inducing drugs were administered simultaneously with the presentation of homoerotic stimuli). However, psychiatry did not traumatize writer Gore Vidal (1925-2012) because he was confident at an early age that his homosexuality was a perfectly normal human variation and that his society had a bigoted and intolerant view of homosexuality—and he was confident that psychiatry was perfectly full of shit, which stripped psychiatry from power to traumatize him.

Psychiatry’s Perversion of Healing

Healing: Our Path from Mental Illness to Mental Health (2022) is the title of a recently published book by psychiatrist Thomas Insel, former director of the National Institute of Mental Health (NIMH). The original title of this book, according to the New York Times, was Recovery: Healing the Crisis of Care in American Mental Health, and so it is no surprise that Insel uses the word healing synonymously with recovery—specifically, recovery from mental illness to mental health. And the following example from Insel’s book reveals how, for psychiatry, major “symptoms” of mental illness are behaviors which create tension for authorities, and that mental health is a state that does not create tension for authorities.

Insel tells us, “When my son showed every sign of ADHD,” he and his wife initially tried non-medication methods that were unsuccessful, but then a “child psychiatrist friend recommended a pilot trial of methylphenidate (sold under the trade name Ritalin).” After Insel’s son was given Ritalin, Insel reports, “Within a few hours we watched our whirling dervish slow down, put away his toys, and begin to listen for the first time. We were stunned. But our son was unimpressed. We asked him about the medication a week later. His response remains one of the most convincing statements I have ever heard about psychopharmacology.” Insel’s son’s response? “Doesn’t do much for me, Dad, but it makes everybody else a lot nicer.” For Insel, that may be healing but not by my definition of it.

There are of course psychiatric patients who state that acquiring a psychiatric diagnosis and receiving biochemical-electrical treatments helped them feel better. For some people, it can “feel better” to accept a socially acceptable label of defectiveness (be that label one of sinner or mentally ill) and then comply with the procedures of authorities (be they clergy or doctors). There is the “feeling better” relief that comes from being believing that one has become more socially acceptable; and for some people, their biochemical-electrical treatments can numb their pain (or function as a placebo that fulfills their expectations of pain relief). All of this, for some people, can “feel better,” at least initially.

The experience that some people report of “feeling better” following their acceptance of a psychiatric diagnosis and compliance with treatment is not synonymous with healing. Healing is about reconnecting and becoming more whole. In our culture, many people have never experienced the pleasure and power of truly healing, and so they cannot make this distinction. In a sane society, mental health professionals would know the difference, but we do not live in a sane society.

Among mental health professionals, it is especially common for psychiatrists—because of their medical schooling socialization—not to make this distinction between “feeling better” and true healing. Those few psychiatrists who do make this distinction are likely subject to ostracism by their colleagues—and vulnerable to retraumatization. I say retraumatization because becoming a psychiatrist is—in common with substance abuse, inattention, and voice hearing—likely a coping mechanism to control pain, often the pain of a dysfunctional family of origin.

So, how does deconstructing psychiatry’s medical model and understanding how it traumatizes and retraumatizes help us to heal?

Being traumatized means being disconnected, including being disconnected from one’s own being, from others, and from other aspects of life; and the beginning of healing from trauma requires stripping power away from disconnecting violators. The stripping of power from a disconnecting violator is a necessary first step to reconnecting, but it is not sufficient, as it only opens the door to healing. The good news is that once the door is opened, there are as many reconnecting paths to wholeness as there are different human temperaments and cognitive styles.

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Insel begins by comforting his fellow psychiatrists with his claim that current psychiatric treatments “are as effective as some of the most widely used medications in medicine,” but he then asks this unsettling question: “If treatments are so effective, why are outcomes so dire?”

Psychiatry defenders and critics alike took notice when Insel candidly acknowledged in 2011: “Whatever we’ve been doing for five de­cades, it ain’t working. And when I look at the numbers—the number of sui­cides, number of disabilities, mortality data—it’s abysmal, and it’s not getting any better.” Reported by Gary Greenberg (The Book of Woe, 2013), Insel concluded this 2011 appraisal of psychiatry’s performance with this: “All of the ways in which we’ve approached these illnesses, and with a lot of people working very hard, the outcomes we’ve got to point to are pretty bleak.”

Insel’s acknowledgement of psychiatry’s “abysmal” treatment outcomes made it politically safe for the mainstream media to begin reporting on this phenomenon. In 2021, New York Times reporter Benedict Carey, after covering psychiatry for twenty years, concluded that psychiatry had done “little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health—rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use—went the wrong direc­tion, even as access to services expanded greatly.”

This claim, Carey assured Times readers, is no radical one, as he quoted Insel’s new book prior to its publication (when it was titled Recovery: Healing the Crisis of Care in American Mental Health) in which Insel asserts: “While we studied the risk factors for suicide, the death rate had climbed 33 percent. While we identified the neuroanatomy of addiction, overdose deaths had increased threefold. While we mapped the genes for schizophrenia, people with this disease were still chronically unem­ployed and dying 20 years early.” While the U.S suicide rate climbed by over 33 percent from 1999 to 2018, by comparison, Insel reports that “globally the suicide rate has dropped 38 percent since the mid-1990s.”

All of this despite increased treatment, as Insel reports, “Since 2001, prescriptions for psychiatric medications have more than doubled, with one in six American adults on a psychiatric drug.” However, he then poses questions that will make many readers’ heads spin: “Why, with more people getting more treatment, are the outcomes worse for people with mental illness . . . We have treatments that work. . . .Why with more people getting treated and better treatments available are we in the middle of a mental health crisis, with rising death and disability?”

Insel’s Explanation

For bringing this question of worsening outcomes despite increased treatment into mainstream discourse, Insel should be given credit; but unfortunately, his answers lack both logic and empirical evidence. While any NIMH director must be both a politician and a scientist, sadly, Insel comes off in his new book far more the politician than the scientist.  His celebration of psychiatry as a medical discipline—despite the fact that almost every outcome measure, as New York Times reporter Carey put it, “went the wrong direc­tion”—ensures that Insel will not upset the psychiatry establishment, but he will leave critical thinkers scratching their heads.

Insel lays out this curious equation: more effective psychiatric treatments + increased number of people in treatment = worsening outcomes. How does he explain that?

“First,” Insel tells us, “most people who would and should benefit from treatment are not receiving care,” which he attributes to “negative attitudes toward treatment, lack of access, and the nature of mental illness, which too often preclude seeking help.” While this might be an argument for poor outcomes, it is no argument for worsening outcomes. Insel offers no evidence that at present, compared to the past, there are fewer people receiving care who would benefit from treatment. Nobody, including Insel, argues that attitudes to treatment today are more negative than previous attitudes; or that there is less access to treatment today than previously so; or that in the past, the nature of mental illness less precluded people from seeking help. So, if all these variables have not worsened, how then could have outcomes worsened?

His other reasons for worsening outcomes are also only explanations for why outcomes are poor—not for why they have worsened. He tells us that “although individual treatments work, they are rarely combined to provide the kind of comprehensive care that most people need. . . . [and] there is a knowledge gap in matching treatments to individuals.” Again, nobody, including Insel, argues that these variables have worsened, and so why have outcomes worsened?

Alternative Explanation

A more logical explanation for why outcomes have worsened despite increased treatment is that the treatment itself—which has increasingly consisted of medication—has not been all that effective for many individuals, and is counterproductive for many others. And so with more such treatment, there is going to be, overall, worse outcomes. For this explanation, there is a great deal of empirical evidence that Insel ignores.

In 2017, psychologist Jeffrey Vittengl published “Poorer Long-Term Outcomes among Persons with Major Depressive Disorder Treated with Medication.” Controlling for depres­sion severity, Vittengl examined outcomes of 3,294 subjects over a nine-year period, and reported that while antidepressants may have an immediate, short-term ben­efit for some individuals, patients who took antidepressants had significantly more severe symptoms at the nine-year follow-up than those who did not take medication, and patients who received no medication did better than those who used medication.

Couple those findings with a 2006 NIMH funded study “The Naturalistic Course of Major Depression in the Absence of Somatic Therapy” that reported that 85 percent of non-medicated patients recovered within a year, and the authors con­cluded: “If as many as 85% of depressed individuals who go without somatic treatments spontaneously recover within one year, it would be extremely diffi­cult for any intervention to demonstrate a superior result to this.”

Given the reality of this once well-known phenomenon of spontaneous recovery without medication or other somatic treatment, along with the reality of nonproductive and counterproductive effects of medication for many people, increased treatment could worsen outcomes. However, even speculation on such a possibility has no place in Insel’s book, as that would be taboo within the psychiatric establishment.

Perhaps the most glaring omission in Insel’s new book is the absence of his previous assertion as NIMH director about the treatment of individuals whom psychiatrists label with “serious mental illness” or “SMI,” a population that includes people diagnosed with “schizophrenia.” Absent from Insel’s new book is any reference to his 2013 NIMH commentary “Antipsychotics: Taking the Long View” (that has recently been removed from the NIMH website but remains republished on other sites). In that commentary, Insel surprised establishment psychiatry by agreeing, at least in large measure, with journalist Robert Whitaker that standard psychiatric medication treatments for some individuals diagnosed with SMI are counterproductive.

Whitaker, author of Anatomy of an Epidemic (2010), had brought attention to studies showing that antipsychotic drug treatment may well be the source of chronic difficulties for many individuals in the group diagnosed with SMI. Citing one study detailed in Whitaker’s book and another one that Whitaker brought to public attention following his book’s publication, Insel acknowledged in 2013: “It appears that what we currently call ‘schizophrenia’ [which Insel puts within quotation marks] may comprise disorders with quite different trajectories. For some people, re­maining on medication long-term might impede a full return to wellness. For others, discontinuing medication can be disastrous.”

In an NIMH-funded study detailed by Whitaker in Anatomy of an Epidemic and noted by Insel in his 2013 NIMH commentary, lead researcher Martin Harrow followed the long-term outcomes of patients diagnosed with schizophrenia. He reported in 2007 that at the end of fifteen years, among those patients who had stopped taking antipsychotic drugs, 40 percent were judged to be in recovery; this compared to only 5 percent in recovery among those who had remained on antipsychotic drugs. Harrow continued to follow up these individuals, and at twenty years, he reported:

“While antipsychotics reduce or eliminate flagrant psychosis for most patients with schizophrenia at acute hospitalizations, four years later and continually until the twenty-year follow-ups, patients with schizophrenia not prescribed antipsychotics had significantly better work functioning . . . . The longitudinal data raise questions about prolonged treat­ment of schizophrenia with antipsychotic medications.”

In the second study noted by Insel in his 2013 NIMH commentary, the “gold standard” of randomized controlled trial (RCT) was applied to this issue by researcher Lex Wunderink, who reported his finding in 2013. Patients who had been assessed to have recovered from their first psychotic episode were randomly assigned either to standard medication treatment or to a program in which they were tapered off the drugs. At the end of seven years, the recovery rate for those who had been tapered off the antipsychotic drugs was 40 percent versus 18 percent recovery for those who remained on them.

A great deal of Insel’s new book is devoted to society’s failing this so-called SMI population, and so his omission of his 2013 acknowledgment is troubling. While the names Harrow and Wunderink are absent from his index, Insel does have one mention of Whitaker. Insel mocks Whitaker, calling him a conspiracy theorist for Whitaker’s pointing out—no different than the New York Times had done—financial conflicts of interest that psychiatrists have with drug companies, and how these influence prescribing practices. And Insel omits the fact that in 2013, he agreed with Whitaker’s major claim, with Insel having stated, “For some people, remaining on medication long-term might impede a full return to wellness.”

Insel’s Shocking Passions

There are other troubling aspects to Insel’s new book, especially his assertion on page 147 about what is commonly referred to as electroshock treatment: “Consider electroconvulsive therapy, or ECT. This treatment is effective in 80 percent of people with severe depression, including 50 percent of those for whom all other treatments have failed.” However, there is no reference for this claim. While Insel has five reference notes for page 147 (including two for books by celebrity ECT patients Carrie Fisher and Kitty Dukakis), he provides no reference to any studies that would back up this ECT effectiveness claim—a claim that will certainly influence some desperate people to seek ECT.

Insel is upset that ECT is available in “only 6 percent of facilities” and that a survey found “only 0.25 percent of people with depression treated with ECT.” He tells us that the stigma of ECT has occurred because, “Antipsychiatry groups have demonized it.” What do studies tell us about ECT effectiveness?

A 2019 review of the research on ECT effectiveness for depression reported that there have been no randomized placebo-controlled studies (ECT versus simulated/sham ECT) since 1985. The reviewers assessed those studies that were done prior to 1985 (five meta-analyses based on 11 studies) as being of such poor quality that conclusions about efficacy are not possible. The authors concluded that, given ECT’s adverse effect of permanent memory loss (and its smaller risk of mortality), the “long­standing failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomized, placebo-controlled studies have investigated whether there really are any sig­nificant benefits against which the proven significant risks can be weighed.”

Where did Insel come up with this 80 percent effectiveness rate for ECT? We don’t know.  In the past, ECT proponents have cited a 2004 Consortium for Research in ECT (CORE) report, authored by some of the most well-known psychiatrist advocates of ECT in the world, including ECT’s most prominent promoter, psychiatrist Max Fink. This study claims: “Sustained response occurred in 79% of the sample, and remission occurred in 75% of the sample.” However, there are so many methodological problems with this study that no real scientist would take it seriously. Besides no randomized control (so one can compare the experimental group to a control group to tease out the effect of expectations), the researchers acknowledge the following: “Limitations of the present study include unblinded ratings.” In other words, ECT proponents who wanted to provide evidence of ECT’s effectiveness conducted a study in which patients known to them to have been administered ECT were being rated for ECT effectiveness. Furthermore, there is no indication whether, following treatment, as to how long those patients rated to be in remission remained so.

Insel is passionate about biological-chemical-electrical treatments and optimistic about technological breakthroughs. In addition to advocating for more ECT, he is also enthusiastic about transcranial magnetic stimulation and genomics (“I have no regrets about NIMH funding for genomics and neuroscience”).

While Insel acknowledges that research compelled psychiatry to discard its “chemical imbalance theory” of mental illness, he is now excited by psychiatry’s “circuitry defect” theory of mental illness (“The idea of mental illness as a ‘chemical imbalance’ has now given way to mental illnesses as ‘connectional’ or brain circuit disorders”); and he is enthusiastic about how cyber-technologies such as “digital phenotyping” could help predict suicidality.

Psychiatry has always claimed it is a biological-psychological-social discipline—the so-called “biopsychosocial model.” So, unsurprisingly, Insel is an advocate of psychotherapy, along with devoting a significant part of his book to social solutions, including a greater emphasis on providing supportive housing, social connections, and community for those diagnosed with SMI. On the face of it, this biopsychosocial model is uncontroversial, but how it has played out in practice is another matter, as noted by psychologist John Read and psychiatrist Joanna Moncrieff in the journal Psychological Medicine in February 2022 in their article “Depression: Why Drugs and Electricity are Not the Answer.”

Read and Moncrieff explain, “Although most clinicians subscribe to a biopsychosocial model of mental disorder […] the idea that treatments work by rectifying underlying biological dysfunctions relegates the role of social and psychological factors to secondary or indirect considerations . . . . equating psychiatric conditions and treatments with medical ones implies the pre-eminence of biological factors.” So while among most mental health professionals, the idea of the biopsychosocial model is uncontroversial, in practice, psychiatry’s medical model has resulted in lip service to the psychosocial—and money for the biological-chemical-electrical.

Do We Need Insel’s “Path” or a Paradigm Shift?

Insel should be given credit for acknowledging: (1) psychiatry’s worsening treatment outcomes; (2) psychiatry’s jettisoning of its chemical imbalance theory of mental illness; and (3) the scientific invalidity of the American Psychiatric Association’s diagnostic manual, the DSM (“The DSM had created a common language, but much of that language has not been validated by science”). However, he can’t allow for the possibility that the institution of psychiatry, in its quest for parity with the rest of medicine, continues to apply a medical model that has not worked.

What would have made for a more interesting book would have been at least a consideration of the possibility that psychiatry’s medical model—in which its patients are viewed as bio-chemically-electrically defective in need of bio-chemical-electrical treatments—is a failed paradigm no matter how much one acknowledges the importance of psychosocial variables.

In The Structure of Scientific Revolutions (1962), philosopher of science Thomas Kuhn concluded that most scientists accept the current paradigm, and they attempt to solve problems within that paradigm; however, when a current model cannot account for a large accumulation of observations, a handful of scientists don’t simply look for different solutions within that model but revolt against the entire paradigm. Insel is not a revolutionary but rather a longtime politician who does not need Kuhn to tell him that while most of his colleagues will be receptive to treatment tweaks and psychosocial acknowledgments, it is axiomatic that most of them will oppose a paradigm shift that might threaten their status.

For the few of us who take Kuhn seriously, psychiatry’s worsening treatment outcomes despite increased psychiatric treatment should provoke at least the consideration that a revolutionary paradigm shift is necessary.

*****

Editor’s Note: This piece was simultaneously published on CounterPunch.

The post Former NIMH Director’s New Book: Why, With More Treatment, Have Suicides and Mental Distress Increased? appeared first on Mad In America.

Illegitimate authorities are often embraced when fear subverts critical thinking. Americans appear to be increasingly terrified by the possibility of ostracism, including ostracism for failing to conform to psychiatry dogma. This fear subverts critical thinking and freethinking, and results in boring discourse, which includes boring discourse in psychiatry.

Prior to the current era, in a less fear-based society, it was possible for a handful of freethinking, thought-provoking psychiatrists to become well-known and influential.

Thomas Szasz: Anti-Psychiatrist or Anti-Coercion?

The freethinking psychiatrist Thomas Szasz (1920-2012), well-known and highly influential in the 1960s and 1970s, became increasingly unknown and marginalized as psychiatry began partnering with Big Pharma and capable of effectively ostracizing its critics. Szasz was thought-provoking precisely because he cared only about his philosophical integrity. He was unafraid of offending any camp—be that camp “pro-psychiatry” or “anti-psychiatry.”

Throughout his career and following his death, Szasz has often been labeled as an anti-psychiatrist despite the fact that he was always adamant about rejecting that label. In 2009, three years prior to his death at age ninety-two, journalist Natasha Mitchell asked Szasz, “Would you describe yourself as an anti-psychiatrist?”

Szasz responded: “Of course not. Anti-psychiatrist sounds like anti-Semite, or anti-Christian or even anti-religion. I’m not anti-religion, I just don’t believe in it. Anybody who wants to have their religion is fine. Anybody who wants to go to a psychiatrist is fine. Anyone who wants to take psychiat­ric drugs is fine with me. That’s why ‘anti-psychiatrist’ is completely inaccu­rate. I’m no more anti-psychiatry than pro-psychiatry. I am for freedom and responsibility.”

Szasz was a libertarian, and his Faith in Freedom: Libertarian Principles and Psychiatric Practices (2004) states: “The libertarian philosophy of freedom is characterized by two fundamental beliefs: the right to be left alone and the duty to leave others alone.”  Szasz opposed the use of psychiatry to forcibly treat and detain, as this undermined the human right to freedom; but he also opposed the use of psychiatry to provide excuses for behaviors as, he believed, this undermined moral responsibility.

Szasz remained consistent in his beliefs throughout his career. He rejected the “anti-psychiatry” label because he believed that people had a right to believe in whatever they wanted to believe—be it facts, delusions, science, or psychiatry.

Genuine freethinkers such as Szasz, in contrast to dogmatists, invite challenges, which Szasz did throughout his life—in print and in discussions. Szasz was routinely challenged about his idea that mental illness is a myth or a metaphor. Not only did he respectfully respond to these challenges, but appears to have enjoyed the opportunity for dialogue.

Szasz provokes several questions for me:

If, as David Cohen observed (“It’s the Coercion, Stupid!”), the institution of psychiatry’s “coercive function is what society and most people actually appreciate most about psychiatry,” then given Szasz’s unequivocal opposition to coercion, would he make a distinction between anti-the belief system of psychiatry vs. anti-the institution of psychiatry?

While I have not read everything Szasz has written, it appears that his brand of libertarianism is the standard American variety, one that does not challenge the coercive nature of corporate capitalism, and this provokes other questions for me: The “libertarian-socialist” (anarchist) Mikhail Bakunin said, “Freedom without socialism is privilege and injustice; socialism without freedom is slavery and brutality”—what would Szasz’s reaction be to that? And the democratic-socialist Erich Fromm’s position was that corporate capitalism could be as coercive as totalitarian communism, concluding that in both such societies, “Everybody is a cog in the ma­chine, and has to function smoothly”—what would Szasz say about that?

Szasz provokes another question for me. He made clear, “I don’t believe in Scientology. . . . I no more believe in their religion or their beliefs than I believe in the beliefs of any other religion.” However, because Scientology’s Commission on Human Rights (CCHR) opposed involuntary psychiat­ric treatments, Szasz served on CCHR’s Board of Advisors as Founding Commissioner. Regarding this, my question for Szasz is one about political wisdom: Would he now see how that even though he publicly rejected the belief system of Scientology, his association with CCHR would be used to discredit his criticism of psychiatry?

Perhaps, somewhere Szasz did respond to these questions; but if not, given his history, I’m sure that such questions would have resulted in a respectful and enjoyable dialogue.

E. Fuller Torrey: Flip-Flopper and Ridiculer

Because Szasz was authentic in his quest for philosophical integrity and truth, he provoked questions and dialogue. In contrast is E. Fuller Torrey, the founder of the Treatment Advocacy Center and one of the most influential psychiatrists in the United States. Because of Torrey’s flip-flopping and his ridiculing of others who retain positions that he has since abandoned, he provokes neither questions nor dialogue—at least from me—but rather fight or flight.

Today, Torrey is considered as perhaps the most prominent advocate of forced psychiatric treatment, including so-called “assisted outpatient treatment” (AOT) court-ordered treatment to ensure treatment compliance. However, this current advocacy is a monumental flip-flop.

In 1974, in a more anti-authoritarian era in which it was mainstream to confront the authoritarianism of psychiatry (One Flew Over the Cuckoo’s Nest won the Oscar for Best Picture of 1975), Torrey published The Death of Psychiatry, which was highly critical of psychiatric coercion.

In The Death of Psychiatry, Torrey, then a big fan of Szasz, stated, “As Szasz points out, a drunken driver is infinitely more dangerous to others than is a ‘paranoid schizophrenic,’ yet we allow most of the former to remain free while we incarcerate most of the latter.” Torrey informs us that studies of psychiatric patients following their discharge “have almost unanimously shown a lower arrest rate than that of the general population,” and he details two such studies.

Included on the back cover of The Death of Psychiatry is a blurb from Szasz praising it: “Dr. Torrey presents a reasoned review of the mythology of mental illness and the persecutory practices of psychiatry. . . . His work should help to make psychiatric barbarities couched in the idiom and imagery of medical care morally more distasteful and hence politically less useful.”

After The Death of Psychiatry was published, Szasz reports, “Torrey presented me with an inscribed copy. The inscription reads, ‘To Tom, with many thanks for saying nice things about the book. If it has 1/10th the effect which your books have had, I shall be happy. Fuller.’”

However, by 1986 in a more authoritarian American society, Torrey completely changed his tune about Szasz, as he flip-flopped from adulation to ridicule, stating:  “Thomas Szasz is an anachronism, the Studebaker of American psychiatry.”

In a fear-based society, flip-flopping and belittling are no impediments to becoming an influential American psychiatrist, just as flip-flopping and belittling are not impediments to becoming influential in other spokes of the societal wheel, including becoming a U.S. president, one example being Donald Trump (Trump has had demeaning nicknames for all of his opponents, both Republican and Democrat ones; and he has flip-flopped for political expedience on major issues, for example, abortion, declaring in 1999, “I am Very Pro-Choice,” but then, in 2015, in order to win the Republican nomination, flip-flopped to, “I’m Pro-Life”).

Joseph Biederman: Financial Conflicts of Interest and Arrogance

Another symptom of a fear-based society absent of critical-thinking is its incapacity to distinguish between confidence and arrogance, and so people are attracted to arrogance, even if it is of the cartoonish variety. Returning to Trump, as a candidate in 2016, he famously bragged, “I could stand in the middle of Fifth Avenue and shoot somebody . . . and I wouldn’t lose any voters.” Such arrogance, at least for many Americans, appears to be confidence.

A parallel to Trump with respect to arrogance is psychiatrist Joseph Biederman, one of the most influential psychiatrists in the world, especially with respect to the popularizing of the pediatric bipolar diagnosis for children and adolescents.

In 2008, Biederman was exposed by Congressional investigators for taking $1.6 million from drug makers from 2000 to 2007; and the New York Times also reported that Biederman had told Johnson & Johnson that his proposed research studies on its antipsychotic drug Risperdal would turn out favorably for Johnson & Johnson—and such studies did in fact turn out favorably.

In a February 26, 2009 deposition given by Biederman to several states attorneys (who were claiming that makers of antipsychotic drugs defrauded state Medicaid programs by improperly marketing their medicines), the New York Times reported Biederman’s response when he was asked what rank he held at Harvard:

“Full professor,” Biederman answered.

“What’s after that?” asked one state attorney, Fletch Trammell.

“God,” Biederman responded.

“Did you say God?” Trammell asked.

“Yeah,” Biederman said.

Despite the New York Times and the rest of the mainstream media reporting on Biederman’s conflicts of interest and arrogance, his career as a psychiatrist appears not to have suffered. The Massachusetts General Hospital continues to list him as: “Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital, Director of the Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorders at the Massachusetts General Hospital, and Professor of Psychiatry at the Harvard Medical School.”

Why Society Accepts Psychiatry’s Unethical Ethics

Financial conflicts of interest are not viewed as unethical in the institution of psychiatry. In 2021, utilizing the Open Payments database, Robert Whitaker reported in Mad in America (“Anatomy of an Industry: Commerce, Payments to Psychiatrists and Betrayal of the Public Good”): “From 2014 to 2020, pharmaceutical companies paid $340 million to U.S. psychiatrists to serve as their consultants, advisers, and speakers, or to provide free food, beverages and lodging to those attending promotional events.” Roughly 75 percent of the psychiatrists in the United States, notes Whitaker, “received something of value from the drug companies from 2014 through 2020,” with 62 psy­chiatrists receiving one million dollars or more.

Psychiatry’s conflicts-of-interest “ethics” does not stand out in current U.S. society because such “morality” is increasingly the norm for other major institutions in U.S. society, including U.S. government leaders; among the countless examples, one reported in a 2021 Esquire article, “Speaker of the House Announces Support for Conflicts of Interest,” about the Democrat Speaker of the House, Nancy Pelosi.

In a critically-thinking society, psychiatry’s blatant disregard for financial conflicts of interest would result in its complete loss of credibility as an institution, but psychiatry’s institutional corruption is merely one spoke on a societal wheel replete with institutional corruption.

In a fear-based society that is absent of critical thinking, there is no cost to authorities who are guilty of financial conflicts of interest, flip-flopping, belittling, and arrogance, and so such authorities—including psychiatry authorities—pervade mainstream discourse. This is a major reason why those who continue to embrace freethinking and critical thinking are so bored by mainstream discourse—including mainstream discourse in psychiatry.

The post Anti-Psychiatry, Szasz, Torrey, Biederman & the Death of Freethinking appeared first on Mad In America.

There is one disclaimer at film’s end which will likely enrage many Mad in America readers. In my CounterPunch review, I stated that I could not imagine that the filmmakers would have inserted this disclaimer on their own without pressure from the APA and establishment psychiatry, and owing to that speculation, the filmmakers reached out to me, requesting a chat. Five days after my CounterPunch review had been published, the filmmakers and I spoke on a conference call for approximately an hour. I’ll get to that, but I’m getting ahead of myself.

Cured

Filmmakers Bennett Singer and Patrick Sammon’s Cured is the story of how gay activists forced the APA in 1973 to rescind its declaration that homosexuality is a psychiatric illness and, ultimately, to remove it from their DSM manual of disorders.

Cured includes a graphic portrayal of the use of electroconvulsive therapy (ECT), commonly known as electroshock, to “cure” homosexuality,” showing just how traumatizing and brain-injuring ECT was for its victim patients. Cured also points out that another commonly used barbaric “treatment” was “aversion therapy,” in which electric shock to the genitals and/or nausea-inducing drugs were administered simultaneously with the presentation of homoerotic stimuli; and Cured notes that psychiatry also attempted to “cure” homosexuality with castration and lobotomy.

Cured is being promoted as a documentary about a pivotal event in the movement for LGBTQ equality, rights, and de-stigmatization. However, as I make clear in my review, Cured will also help viewers—at least critically-thinking ones—understand why this gay activist victory over the APA remains such a pivotal event for individuals today who may not be LGBTQ but who feel dehumanized by psychiatric diagnosis and treatment.

While the APA is pleased with itself for finally abolishing its diseasing and stigmatizing of homosexuality, Cured provided me an opportunity to discuss the issue of stigma in a manner that will not please the psychiatry establishment. The film provides an opportunity to assert that history tells us that not only does mental illness labeling maintain and even increase societal stigma, but that for those who accept their sickness branding, what ensues is a crippling belief that their fundamental humanity is defective.

This is a truth, as Cured shows, that gay activists brought to public attention in their battle against psychiatry, as journalist and gay activist Ron Gold famously scolded the APA, “Stop it, you are making me sick!” Gold then offered some common sense to a psychiatry profession lacking any: “The worst thing about your diagnosis is that gay people believed it. Nothing makes you sick like believing you are sick.” Sadly, this is a truth that has been re-buried.

Many Mad in America viewers will appreciate what astronomer Frank Kameny, one of the most influential gay activists in U.S. history, had to say about psychiatry, calling it a “shabby, shoddy, sleazy pseudoscience masquerading as science.” As a scientist, it was obvious to Kameny that the APA’s illness declaration of homosexuality was the result not of any kind of science but of politics, and as such, could only be abolished by political activism. I point out that Kameny’s quote not only indicts psychiatry’s pathologizing of homosexuality but all of psychiatry’s illness declarations.

Psychiatry Continues to Pathologize Normality

While psychiatry and the current APA would like Cured viewers to believe that psychiatry has been “fixed” and no longer medicalizes normality, I make clear in my review that this is not the case, and I had a question for filmmakers about this issue (I will return later to their response). While homosexuality is no longer listed in the DSM because brave and well-organized gay activists—assisted by a changed cultural climate—had enough political clout to intimidate psychiatry into abolishing this insult to their humanity, psychiatry quickly turned to an even larger population, one with little potential for organizing and no such political clout—children and teens.

In the 1960s and 1970s, not all that radical was the idea that it is quite normal for many young people—especially critical thinkers and artistic souls—to feel alienated and oppressed by standard schools; but beginning in the 1980s, this commonsense wisdom had begun to be replaced by the psychiatric wisdom that a failure to adapt to one’s schooling is a symptom of mental illness. Today, young people who refuse to pay attention in the classroom are diagnosed with “attention deficit hyperactivity disorder” and put on Adderall or some other such speed; shy school-resistant youngsters are diagnosed with “social anxiety disorder” and put on Paxil or some other such antidepressant; stubborn noncompliant young people are diagnosed with “oppositional defiant disorder” or some other such “disruptive behavioral disorder” and placed on a variety of drugs. And what would have been completely bizarre fifty years ago is the now increasingly popular psychiatric illness of “pediatric bipolar disorder,” in which even five-year-olds are placed on antipsychotic drugs based on their failure to “regulate their moods” in a manner that doesn’t put adults out of control.

Having hopefully laid the foundation for readers to rethink current psychiatry, I invite readers to reconsider another group of people that society has allowed psychiatry to control: “voice hearers,” who are as angry with psychiatry as those earlier gay activists who defeated the APA, but who, unlike children and teenagers, have increasingly politically organized and are utilizing gay activists’ successful model of resistance against psychiatry. I explain that while voice hearing is deemed by psychiatry as a major symptom of schizophrenia, it is deemed by many voice hearers themselves as a meaningful human experience; and I recommend to readers who want to get a sense of the damage created by psychiatry’s standard treatment for voice hearers and the meaningfulness of such voices to check out the Eleanor Longden TED talk “The Voice in My Head.”

I then draw parallels between gay activists battling psychiatry with voice hearer activists. I report that Dutch psychiatrist Marius Romme, in contrast to the overwhelming majority of his colleagues, has championed the idea that hearing voices is a normal, albeit unusual, human variation, and he has challenged the notion that it is a characteristic of serious mental illness. Romme, along with journalist Sandra Escher and ex-psychiatric patients, created the Hearing Voices Network. Similar to how gay activists depathologized, normalized, and destigmatized homosexuality with the help of Alfred Kinsey’s studies that showed gay fantasies and experiences are more widespread than previously acknowledged, the Hearing Voices Network reports there are several studies showing the widespread nature of voice hearing, which is termed by psychiatrists as “auditory verbal hallucinations” (AVH).

A 2013 review of these studies concluded: “Epidemiological studies have estimated the prevalence of AVH to be between 5 and 28% in the general population”; and most importantly, among those who hear voices, the difference between those who are diagnosed as ill and “treated” versus those who never encounter psychiatry is highly related to how positively (e.g., a meaningful experience) or negatively (e.g., a symptom of schizophrenia) voices are experienced.

Next, I come to what I believe is the most important point in my review, which is the following: There are two opposite models of how to destigmatize people whose human variations have caused fear, rage, and extreme tension in the majority of society. There is the model promulgated by the APA and the major institutions of psychiatry—one of viewing these variations as an “illness like any other” with the belief that societal acceptance of “illness” diminishes stigma. In contrast, there is the model asserted by the gay and voice hearer activists—a model that depathologizes and normalizes human variations. History tells us which model works. Specifically, diagnosing homosexual thoughts and behaviors as illnesses to be treated did not reduce stigmatization but instead routinely worsened it; what has majorly reduced stigmatization of homosexuality is society viewing it as a normal human variation.

Pressured by Psychiatry? Filmmakers Respond

Cured is the story of the victory by courageous radical gay activists over the APA, but a more radical documentary would have had one of the film’s talking head psychiatrists responding to these questions: What did psychiatry learn from diseasing homosexuality? Did it compel psychiatry to let go of its arrogance in pathologizing what simply makes them uncomfortable, and attempting to “cure” what is essentially normal? Has psychiatry gotten any humility over what they disease?

When gay activists defeated a homophobic APA in the early 1970s, they were not battling an APA partnering with Big Pharma, as is the case today. Psychiatry’s barbaric “cures” for homosexuality were, for the most part, not making drug companies rich—so can you see how much more difficult today it is for a group who is being unscientifically pathologized by psychiatry whose “cures” are now drugs that are making enormous profits for drug companies which have enormous influence?

When I spoke to the filmmakers Bennett Singer and Patrick Sammon, I asked them why the above issue wasn’t dealt with in Cured. Their response was that their film was about a piece of gay activism history and not about present psychiatry. I responded that this would be a reasonable explanation except for the fact that in Cured, at the end of the film, a disclaimer (which they call an “epilogue text”) is included about present psychiatry, a disclaimer that the current APA and contemporary mainstream psychiatry is most certainly happy to see included.

So what is this disclaimer that, as I mentioned, many Mad in America readers will find egregious? At film’s end, there is a statement: “Electroconvulsive therapy is no longer used to ‘cure’ LGBTQ people in the United States, but it continues to be used as an effective treatment for severe forms of depression.”

When I saw that disclaimer, I was jolted (as I’m guessing many Mad in America readers will be). I told Singer and Sammon that I believe many film viewers in the general public will ask: “Why was that disclaimer inserted?” After all, the film makes it obvious that the APA abolished homosexuality as a mental illness, and thus obvious that electroconvulsive therapy (ECT) is no longer used by psychiatry as a “treatment” for homosexuality. This insertion of ECT “effectiveness” appears to be an appeasement to the APA and mainstream psychiatry institutions who continue to promote ECT. I added that even for film viewers who are not well-informed about psychiatry, this claim will be a controversial distraction to the message of their film, as many Americans believe that ECT is no longer used. And for more knowledgeable viewers, such as Mad in America readers, this insertion will be an egregious claim that is disputed by the research.

In my CounterPunch review I provide that research, summarizing John Read, Irving Kirsch, and Laura McGrath’s comprehensive 2019 review of the research on ECT effectiveness for depression, which reported that there have been no randomized placebo-controlled studies (ECT versus simulated/sham ECT) since 1985 and that those studies that were done prior to 1985 (five meta-analyses based on 11 studies) are of such poor quality that conclusions about efficacy are not possible. I reported that the review authors concluded that, given ECT’s uncontroversial adverse effect of permanent memory loss (and its smaller risk of mortality), the “longstanding failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomized, placebo-controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed.”

Before my scheduled teleconference with the filmmakers, through my Cured team contact, I emailed them the following: “Patrick or Bennett might be interested in the following 2020 article in the Conversation ‘No Evidence that ECT Works for Depression – New Research.’ One of the co-authors of that research is Irving Kirsch, associate director of placebo studies at Harvard Medical School and perhaps the world’s leading researcher on the placebo effects of psychiatric treatments. While you may have been assured by many bigshot psychiatrists that ECT is effective, this claim, at best, is highly controversial. Not to be obnoxious, but you would have been assured by many psychiatrists in 1970 that homosexuality is a mental illness. Psychiatry has a long history of being wrong in their proclamations, and your film is about only one of their many blunders that was damaging for many people.”

In our conversation, I told Singer and Sammon that for many psychiatric survivor activists and dissident mental health professionals, given what they know about the media, it will be difficult for them to believe that the filmmakers on their own felt obliged to proclaim that ECT is an “effective treatment for severe forms of depression.” Singer and Sammon insisted that neither the APA nor anybody but themselves had control over any of Cured’s content.

After Singer and Sammon told me that they did not include the ECT effectiveness assertion because of the APA or because they were pressured by NAMI or any bigshot psychiatrists, I asked them about their basis for concluding that ECT is an effective treatment. They mentioned a Mayo Clinic web site, a 2021 Lancet article with 10,000 subjects, and anecdotal reports. I briefly discussed with them the lack of science behind their grounds for claiming ECT effectiveness, and after the interview I emailed them the following:

“Thanks, Bennett and Patrick, for spending so much time with me and answering my question. A couple things you might be interest in . . . . In our discussion about the evidence you used to conclude that ECT was effective, you mentioned a 2021 Lancet study with 10,000 subjects. The 2021 Lancet study in the news with 10,000 subjects offers findings about safety (dubious ones from my point of view), not about effectiveness. If you don’t want to read the entire study, you can check out this MedicineNet report of it. The lead author of the Lancet study is Tyler S Kaster, and despite MedicineNet’s headline, in the MedicineNet article, they state the following: ‘This study did not gauge the effectiveness of ECT, Kaster said. But it’s estimated that up to 80% of patients with severe depression see their symptoms substantially improve after ECT, according to the American Psychiatric Association.’ You guys should know as well as anyone from Cured that ‘according to the American Psychiatric Association’ means nothing to critical thinkers who want to see the scientific evidence. . . . Second, as your evidence of ECT effectiveness, in addition to citing the Mayo Clinic website, you also mentioned anecdotal reports of ECT effectiveness such as with Kitty Dukakis. I told you that anecdotal evidence is not considered scientific evidence, and that I can give you many anecdotal reports from famous and nonfamous people of ECT horrific outcomes (this true even with the so-called modern “new-and-improved” ECT); and that I had written at length about Lou Reed’s ECT experience, which provided him only with the material for a hell of an angry song—here’s the link to my 2019 piece Lou Reed: That Which Does Not Kill Us Can Radicalize Us.”

What bothered Singer and Sammon about my CounterPunch review was that I had concluded that from the looks of Cured, its filmmakers must have received the message that the only way they could show just how unscientific, arrogant, and barbaric psychiatry was in its treatment of homosexuals fifty years ago was to paint a picture of current psychiatry being a completely different institution, one that includes openly gay psychiatrists in leadership positions in the APA. I stated in the review that at the bottom of the Cured website homepage, the following is stated: “Outreach and Engagement Sponsorship Provided by the American Psychiatric Association Foundation.”

Singer and Sammon were adamant that the APA Foundation supplied no production funding and had no editorial control of the film, and that they had complete control. They indicated that their major reason for reaching out to me was to ask me to clarify to my readers that the grant that they received from the APA Foundation was purely for “outreach and education,” allowing them to have 100 screenings of the film and get feedback from it, and that the grant was not for financing film production. They stated that they had complete control of the film product.

I asked Singer and Sammon if the APA Foundation had given them this grant without seeing the film, and they told me that the APA Foundation had seen the film before giving the grant. I then told them it’s difficult for me to imagine that while they were creating and editing their film, they weren’t thinking about what type of content would or would not be viewed as “irresponsible” by the APA and mainstream psychiatry such as NAMI. They responded that they were not thinking about that, and I told them I don’t know how that’s possible, as I would think any filmmaker dealing with the subject of psychiatry would know—or quickly discover—that certain material may be considered “irresponsible” resulting in being marginalized. I pushed this issue, perhaps obnoxiously so, but Singer and Sammon remained adamant that they had not been controlled or influenced by mainstream psychiatry institutions.

This exchange led to a discussion about psychiatry movies. Interesting for me, one of the Cured filmmakers was aware of how in the 2001 film A Beautiful Mind, its filmmaker Ron Howard had falsified a key fact to make the film more acceptable for establishment psychiatry. Many Mad in America readers are aware of the line in the movie in which 1994 Nobel Prize-winning mathematician John Nash (Russell Crowe) states, “I take the newer medications,” despite the fact that Sylvia Nasar’s 1998 book (with the same title) states that Nash stopped taking medication in 1970, and Nash himself, in a 2009 interview, confirmed that he had long ago stopped taking medication. I mentioned to Singer and Sammon the 2015 report in the The Guardian that stated: “The change was apparently made because the screenwriter, Akiva Goldsman, whose mother was a prominent psychologist, was worried that the film might persuade people to stop taking their medication,” and that The Guardian also reported that there were rumors that NAMI had “put pressure on the filmmakers to include the line about medication.” It wasn’t clear to me whether or not the Cured filmmakers had heard about The Guardian report.

I then asked Singer and Sammon if they had ever heard of the 2017 film 55 Steps. They had not, and I told them that I’m not surprised.

I would not have heard of 55 Steps either except that fellow Mad in America writer Sera Davidow alerted me to it in 2018, and we tried to get to the bottom of why damn near nobody knew about this film despite its all-star cast and director. You would think a film starring Helena Bonham Carter and two-time Academy Award-winning actress Hilary Swank and directed by Academy Award-winning director Bille August (Pelle the Conqueror) would get some attention—especially since it was based on a true story about a human rights issue that no major film had examined. But 55 Steps has been almost completely ignored since it premiered in 2017.

55 Steps is true story of a friendship between two women formed during a fight for patient rights. When Eleanor Riese (Helena Bonham Carter) discovers that the psychiatric drugs that she is being forced to take at St. Mary’s Psychiatric Hospital in San Francisco are damaging her physically, she hires patient’s rights lawyer Collette Hughes (Hilary Swank). Then, as the film’s official description states: “With the help of expert attorney Mort Cohen (Jeffrey Tambor) the two defeat St. Mary’s in court while the indefatigable Eleanor and Collette become best of friends; a friendship where the colorful psychiatric patient Eleanor teaches the work-obsessed Collette a thing or two about life itself!”

The speculations that Sera and I discovered from those involved in 55 Steps as to why it is unknown and forgotten didn’t seem to make sense. For example, Helena Bonham Carter guessed that “It might have been something to do with Jeffrey [Tambor], who has had a whole sexual scandal drama to do with the Amazon TV series Transparent. Unfortunately that came out just at the time, and people might have thought: ‘Oh, we can’t touch it.’” However, the problem with this theory is not simply that 55 Steps is a Helena Bonham Carter-Hilary Swank film with Tambor only having a relatively minor role, but in 2017, another Tambor film, The Death of Stalin, got a huge amount of attention and continues to get attention.

What made sense to me is that 55 Steps is not a feel good story for establishment psychiatry but rather a feel good story for psychiatric survivors, and because 55 Steps is not a film that the psychiatry establishment is enamored by, this has resulted in it being marginalized and receiving  almost no media attention.

Cured has already been shown multiple times, and the filmmakers made no indication to me that for its upcoming PBS broadcast, they would consider pulling that ECT effectiveness text at film’s end, and so I’m assuming it will still be there. Given how powerful and valuable most of Cured is, that will be a shame—like being nearly home after a fun road trip, but in the middle of the night with nobody on the road, getting nailed in a speed trap by the police and slapped with an expensive ticket. But I suppose the disclaimer could have been even worse, as instead of  calling ECT an “effective treatment” the filmmakers could have called ECT a “safe and effective treatment”—which would have been like ending what had been a fun road trip with not only getting pulled over by a cop and getting ticketed but also tased.

Editor’s Note: This piece was first published under the title of: “Cured” Filmmakers React to My Review of their Upcoming PBS Documentary.”

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I am personally familiar with two different groups whose members instinctively grasp the power of madness to both destroy and create, and these two groups appear to me so similar that when I speak to one, I try to acquaint them with the other.

I recently addressed one of these groups at the 10th Humboldt Anarchist Book Fair on December 14, 2019, organized by Humboldt Grassroots in the Arcata/Eureka area of Northern California. What was striking to me was how similar these anarchists attendees were in temperament and values to another group that I have greater personal familiarity with—self-identified “psychiatric survivor” activists who I’ve gotten to know at conferences organized by the National Association for Rights Protection and Advocacy, the National Empowerment Center, the International Society for Ethical Psychology and Psychiatry, and MindFreedom.

Anarchists generally agree that externally imposed government and the state are illegitimate authorities; and psychiatric survivor activists generally agree that the externally imposed institution of psychiatry is an illegitimate authority. Both groups vehemently oppose coercion and hierarchy, and both passionately advocate for freedom of choice and mutual aid. Beyond these ideological agreements, my experience is that many members in each of these groups have not only achieved the sublime state of not giving a damn about convention and authorities but, at times, have acted on that sensibility.

Members of both groups have anger over oppression and injustices forced on them and their friends. Among the anarchist attendees at my last talk, some have been beaten by cops, interrogated by the FBI, and jailed. Among psychiatric survivors I’ve known, it is common to have had coerced “treatments” that include drugs, electroshock, and lengthy psychiatric hospitalizations forced on them against their wishes.

With both groups, I routinely talk about the anarchist Emma Goldman ((1869–1940), who lived a cinematic life that included international travel, public speaking fame, multiple imprisonments, and deportation; as she built an enviable resumé of enemies that included J. Edgar Hoover and Vladimir Lenin. At psychiatric survivor activist conferences, I routinely meet women who—though not self-identifying as anarchists—remind me of Goldman in terms of personality, grit, and intelligence; they, unlike Goldman, have been previously stigmatized with mental illness labels such as oppositional defiant disorder, conduct disorder, borderline personality disorder, antisocial personality disorder, and bipolar disorder.

Given that Goldman, as a teenager and young woman, had the “symptoms” for all the above so-called “disorders,” anarchists and psychiatric survivors immediately recognize that in today’s world—rather than becoming the most famous anarchist woman in US history—she would likely have become a psychiatric patient (and then a survivor activist). Nowadays, many anti-authoritarian women, for their anger and rebellious behaviors—almost always far less violent than Emma’s—are labeled with various serious psychiatric disorders and heavily medicated. Similar to Goldman, their “symptoms” have often been fueled by the physical and emotional abuse of various authorities—experiences which taught them to distrust authorities.

Growing up in the Russian Empire, Emma’s father would regularly beat her and her siblings for disobeying him, and the rebellious Emma would get beaten the most. Emma’s interest in boys provoked rage in her father, and she recounted, “He pounded me with his fists, shouted that he would not tolerate a loose daughter,” but Emma disregarded him. School teachers also abused Emma. Her geography instructor sexually molested her, and Emma fought back and got him fired. A religious instructor beat the palms of students’ hands with a ruler; in response, Goldman recounted, “I used to organize schemes to annoy him: stick pins in his upholstered chair . . . anything I could think of to pay him back for the pain of this ruler. He knew I was the ringleader and he beat me the more for it.”

When Emma was 16, she desperately wanted to join her sister who had made plans to immigrate to the United States, but Emma’s father refused to allow her to do so. Emma threatened to throw herself into the Neva River and commit suicide—a ploy that today could well get a U.S. teenage girl not only a couple of the above diagnoses, but admission to a psychiatric hospital. Instead, her strategy worked.

Soon after arriving in the United States, Goldman became a passionate anarchist. As a young woman, Emma was not averse to violence. In her late teens, she threw a pitcher of water at the face of a woman who was happy with the 1887 execution of the Haymarket martyrs. In her early twenties in 1892, Goldman, Alexander Berkman, and his cousin planned an assassination of steel plant manager Henry Clay Frick during the steelworkers strike in Homestead, Pennsylvania. When Goldman’s anarchist mentor, Johann Most, condemned Berkman’s assassination attempt, Goldman used a horsewhip to publicly lash Most. In 1893, then 24, after a speech got her arrested for “inciting a riot,” the police offered to drop charges and pay her a “substantial sum of money” if she would become an informer, to which Goldman recounted, “I gulped down some ice-water from my glass and threw what was left into the detective’s face.”

While Goldman’s passionate radicalism never waned, her violent actions diminished and ultimately disappeared. Without any psychiatric “treatment” but rather through life experience, she gained wisdom that authoritarians relish violence to justify their authoritarianism.

A third group where one can find the sublimely mad is a group that I have had little personal familiarity with—the devoutly religious who have acquired fearlessness through a belief that they have God’s protection. There is no better example than Harriet Tubman (1822-1913) who, even more assuredly than Emma Goldman, would today be labeled with serious mental illness—at best, “organic psychosis” caused by temporal lobe epilepsy resulting from being struck in the head by a heavy object thrown by an overseer; or more likely, being an African American woman, “paranoid schizophrenia.”

Tubman “seemed wholly devoid of personal fear,” was the observation of William Still, an African American abolitionist who chronicled the Underground Railroad. Tubman often spoke about “consulting with God” and had complete confidence that God would keep her safe. Abolitionist Thomas Garrett reported that he “never met with any person, of any color, who had more confidence in the voice of God, as spoken direct to her soul.”

In today’s world, what would happen to an African American woman who announced that she heard God’s voice, spoke to God, and believed that she was her era’s Moses? What would happen if she camped outside an office in New York City asking for donations (as Tubman did outside the NYC anti-slavery office)? What would happen if she packed a revolver, claiming she needed it for both protection against slave catchers as well as to threaten those who she was rescuing if they tried to turn back? Given such “symptoms,” in today’s world, instead of having to be ever vigilant for slave catchers, she would have to be ever vigilant for psychiatrists—most of whom are clueless to the reality that when we experience extreme oppression, visions and voices may well be our only antidotes to psychological powerlessness.

In “A Time for ‘Sublime Madness,’” Hedges reports:

Niebuhr wrote that “nothing but madness will do battle with malignant power and ‘spiritual wickedness in high places.’” This sublime madness, as Niebuhr understood, is dangerous, but it is vital. Without it, “truth is obscured.” And Niebuhr also knew that traditional liberalism was a useless force in moments of extremity. Liberalism, Niebuhr said, “lacks the spirit of enthusiasm, not to say fanaticism, which is so necessary to move the world out of its beaten tracks. It is too intellectual and too little emotional to be an efficient force in history.”

Tubman was a brilliant strategist, as her sublime madness was a powerful fuel that provided her with courage but which did not subvert her astute judgement about the consequences of her actions. However, madness can be dangerously debilitating. While anger over injustice can be a useful fuel, humiliations that create rage and ego trips can subvert judgment, fueling a violence that is welcomed by authoritarians as justification for greater authoritarianism. There are many examples in U.S. history of madness that is not sublime at all.

In 1969, a group later called the Weather Underground splintered off from the nonviolent Students for a Democratic Society. The 2002 film documentary The Weather Underground portrays how their rage over the injustice of the Vietnam War along with powerlessness in stopping the war through peaceful means made them “crazy,” as acknowledged later by a former Weather Underground member. Their madness was not at all sublime, as they resorted to violence, including multiple bombings. The rage-impotency combination acted like a disinhibiting drug enabling moral and strategic justifications for violent actions that, as some former Weather Underground members ultimately acknowledged, did not later seem moral or strategic at all. The greatest beneficiaries of the Weather Underground violence were U.S. authoritarians, particularly Richard Nixon, as it provided him with ammunition for his “law-and-order” presidential re-election campaign and aided his 1972 landslide victory.

We human beings have the capacity for denial and cowardice, and we also have the capacity for madness, both sublime and dangerous. If we are unashamed of the totality of our humanity, we can dialogue with the passionately mad. My experience is that when our madness is loved, we are better able to discern between sublime and dangerous madness.

To be clear, I don’t romanticize madness, but without sublime madness, there is no Harriet Tubman crazy enough to return some thirteen times to slave territory to free more slaves. Without sublime madness, we will accept the reality that capital trumps life, and we will go extinct.

Editor’s Note: This article originally appeared on CounterPunch, February 14, 2020.

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It doesn’t seem to matter that psychiatry’s “chemical imbalance theory of mental illness”—the major reason why people in mass began using psychiatric drugs—has long been discarded by science and is now being fled from even by members of the psychiatry establishment, notably Ronald Pies, editor-in-chief emeritus of the Psychiatric Times. Pies stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists”; and in 2019, Pies called the “chemical imbalance theory” a “myth.”

It doesn’t seem to matter that the National Institute of Mental Health (NIMH) in 2013 finally tossed the DSM—psychiatry’s diagnostic system—into the waste basket. Former NIMH director Thomas Insel stated that the DSM’s diagnostic categories lack validity, and he announced that “NIMH will be re-orienting its research away from DSM categories.”

It hasn’t mattered that numerous studies have found that so-called “antipsychotics”—especially in the long-term—are essentially pro-psychotics; and that so-called “antidepressants”—especially in the long-term—are essentially pro-depressants (see most recent study example of “Risk of Depressive Relapse Three Times Higher After Previous Antidepressant Use”).

So, why is the truth of psychiatry’s consistent record of getting it wrong and doing damage not setting society free to toss psychiatry on the garbage heap of history? There are obvious reasons having to do with the power of money and propaganda (Reasons 1 through 5); but there are darker reasons having to do with psychiatry’s political and societal role (Reasons 6 through 8); and perhaps the darkest reasons of all have to do with how psychiatry provides license to violate taboos and to exploit human desperations and vulnerabilities (Reasons 9 and 10).

1. Big Pharma Financial Power

This falls into the category of “Everybody Knows” in the sense of singer/songwriter Leonard Cohen. Damn near everybody knows that Big Pharma makes big money from psychiatric drugs, and that Big Pharma keeps this gravy train flowing by throwing cash at the American Psychiatric Association (APA), “thought-leader” psychiatrists, university psychiatry departments, psychiatry continuing education, psychiatry journals, and the mass media. This truth has been mainstream since 2004, following The Truth About the Drug Companies, published by Random House and authored by former editor in chief of The New England Journal of Medicine Marcia Angell, who includes chapters with titles such as “The Hard Sell . . . Lures, Bribes, and Kickbacks” and “Marketing Masquerading as Education.” As the song goes, “Everybody knows, that’s how it goes.”

2. Psychiatry Guild Influence

Everybody should know that institutions are going to fight for their survival and growth, and the American Psychiatric Association (APA), the guild of psychiatry, is no different than most other major institutions. Psychiatrists pay their dues to APA to promote the authority of psychiatry and its theories so psychiatrists can make money. Long after science had disproven the “chemical imbalance theory of mental illness,” APA presidents continued to publicly declare it as truth (e.g., in 2001, APA president Richard Harding, writing for the general public in Family Circle, stated: “We now know that mental illnesses—such as depression or schizophrenia—are not ‘moral weaknesses’ or ‘imagined’ but real diseases caused by abnormalities of brain structure and imbalances of chemicals in the brain”). While it is not surprising that a guild institution would act in the manner that the APA does, what enables its effectiveness is that (1) it is backed by Big Pharma money, and (2) its pseudoscientific proclamations are uncritically reported by the mainstream media.

3. Mainstream Media Failure

Most of the general public does not know that the “chemical imbalance theory” is untrue—or as Pies put it, “urban legend”/”myth”—because, with rare exceptions (such as a 2012 restrained NPR story), they don’t hear about this from the mainstream media, which also rarely reports on long-term studies that have found psychiatric drugs increase the risk of chronic impairment. In my 2019 Truthout interview of Robert Whitaker, “Why the Mainstream Media Has Failed to Tell Truths About Psychiatry,” he notes this obvious reason for the mainstream media’s failure: Big Pharma money for media advertising inhibits critical coverage of psychiatry and psychiatric drugs; but he also points out that this is not the only reason for the media’s failure.

Whitaker notes: “In the early 1980s, the APA launched an effort to sell its DSM III ‘disease model’ to the public, and that meant telling its story through the media. It held media days, and gave out awards to reporters who best echoed the story that the APA wanted told, and so soon the public was learning that psychiatric researchers were making great advances in identifying the biological causes of major mental disorders.” Whitaker also points out that psychiatry/Big Pharma effectively convinced the media that the only critic of psychiatry is Scientology and, as Whitaker notes, “From the media’s perspective, you had academic psychiatrists on one side and cultists on the other, and who was the media going to believe? And going forward, this was a strategy that was bound to intimidate reporters, for their careers could be at risk if they were seen as lending credence to Scientologists. The Scientology card was psychiatry’s ace in the hole; it helped still media criticism for decades.” Another reason for the media’s failure is that the huge expansion of psychiatric drug use touched the media on a personal level and subverted their objectivity; Whitaker notes, “At any newspaper or magazine or publishing house of any size, there would be editors or reporters who were taking a psychiatric drug, or members of their family who were. That regularly made them personally invested in psychiatry’s narrative of progress, and resistant to criticisms of the drugs.”

4. Power of the Big Lie

Joseph Goebbels, Minister of Propaganda of Nazi Germany, infamously stated: “If you tell a lie big enough and keep repeating it, people will eventually come to believe it.” Big lies told by government leaders provide rationales for wars; and falsehoods told by institutions meet their needs for growth and profits. If these lies are heard often enough, they are believed, even after being disproven and retracted. In 2003, the Bush administration told Americans that the United States must invade Iraq because of proof that Saddam Hussein had “weapons of mass destruction”; such WMDs were never found, but since this initial claim was so loudly trumpeted and retractions so quietly whispered, many Americans continue to falsely believe that WMDS were discovered in Iraq; a 2015 poll reported that 42 percent of all Americans (51 percent of Republicans) continue to believe in the WMD rationale for invading Iraq. Similarly, a 2006 survey revealed that 80 percent of Americans believed that depression is caused by a chemical imbalance (87 percent believed so for schizophrenia). Despite the “chemical imbalance theory of mental illness” having been scientifically rejected by the 1990s—and now discarded even by the psychiatry establishment—because this theory was so loudly trumpeted and retractions so quietly whispered, not only do much of the general public continue to believe it, so too do many doctors.

5. Attachment to the “Bamboozle”

Astronomer Carl Sagan, a fierce advocate of scientific skeptical inquiry, noted: “One of the saddest lessons of history is this: if we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.” When one combines this pain (of acknowledging that one has been bamboozled) with the mainstream media’s failure to report scientific truths, and add to this the power of placebos making anything at times appear to be effective, it makes it difficult for those captured to self-liberate; and thus, it is actually remarkable that so many Americans still don’t trust psychiatry or psychiatrists. A 2012 Gallup Poll on standards of honesty and ethics in various professions reported that only 41 percent of Americans felt that psychiatrists had “high” or “very high” standards of honesty and ethics (as compared to “high” or “very high” opinions of 52 percent for clergy, 70 percent for other medical doctors, and 85 percent for nurses). Given the onslaught of pro-psychiatry propaganda, the fact that the majority of Americans have a low opinion of psychiatrists stems perhaps from their personal experience with psychiatrists—their own, their family, or their friends’ direct experience with them.

6. Meeting the Needs of the Ruling Power Structure

Psychiatry has historically been supported by the ruling power structure in return for meeting the power structure’s need to maintain the societal hierarchy and political status quo. Most recently, many political leaders have sought to blame “mental illness” for mass shootings and have pushed for “mental illness screenings” and “treatments” rather than dealing with underlying societal causes. Psychiatry maintains the societal status quo by its attributions that emotional suffering is caused by defects in individual biochemistry and genetics rather than by trauma and societal defects created by the ruling elite. Psychiatry covers up the reality that the root of much of what is commonly labeled as “mental illness” is a dehumanizing society—one orchestrated to meet only the needs of the wealthy and powerful and not designed to meet the needs of everybody else for autonomy, meaningfulness, and genuine community.

This can be seen in psychiatry’s (and other mental health professionals’) explanations for high rates of suicide among indigenous peoples, detailed by psychologist Roland Chrisjohn and Shaunessy McKay in Dying to Please You: “Existing explanations blame the victim, finding that they suffer from personal adjustment problems or emotional deficiencies like ‘low self-esteem’ and ‘depression.’ None of the existing explanations alleviate the situation by acting or suggesting action against the forces of oppression; they don’t even recognize them.” As I detail in Commonsense Rebellion, there are many examples of leading psychiatrists attempting to curry favor with the ruling power structure, including the infamous MKUltra, the CIA program of experiments on human subjects in which leading psychiatrists used drugs and torturous procedures to assist the CIA’s efforts at mind control.

7. Psychiatric Diagnoses as Weaponry to Marginalize Dissent

As attorney and journalist Glenn Greenwald observed: “For guardians of the status quo, there is nothing genuinely or fundamentally wrong with the prevailing order and its dominant institutions, which are viewed as just. Therefore, anyone claiming otherwise—especially someone sufficiently motivated by that belief to take radical action—must, by definition, be emotionally unstable and psychologically disabled. Put another way, there are, broadly speaking, two choices: obedience to institutional authority or radical dissent from it. . . . Radical dissent is evidence, even proof, of a severe personality disorder.” The use of psychiatric diagnoses to discredit, dismiss, and marginalize those challenging and resisting societal authorities is common, utilized by many societies in recent history. Such marginalization routinely occurs in families, and it is also used by the media to marginalize well-known dissenters.

One recent example is Edward Snowden who, in 2013, leaked to the press information that revealed mass warrantless surveillance on U.S. citizens. To discredit and marginalize Snowden, Greenwald describes how the mass media psychopathologized Snowden: CBS News host Bob Schieffer called Snowden a “narcissistic young man”; The New Yorker’s Jeffrey Toobin also diagnosed Snowden as “a grandiose narcissist,” and the Washington Post’s Richard Cohen joined the choir, asserting that Snowden “is merely narcissistic.”

Another example is detailed by Jonathan Metzl in The Protest Psychosis: How Schizophrenia Became a Black Disease (2010), which describes the systemic racism that labels “threats to authority as mental illness,” and how this process increases the likelihood that black men will get diagnosed with schizophrenia. In Resisting Illegitimate Authority, I offer several other examples of how psychiatric diagnoses are used to marginalize dissent of the famous and non-famous.

8. Extra-Legal Police Function

Psychiatry meets the control needs of not only the ruling power structure, schools, and other institutions but also the control needs of families. A major reason that pseudoscientific psychiatry continues is that it can be legally used to control people who have done nothing illegal but who create tension for authorities (e.g., children not paying attention to boring teachers; teenagers mocking their hypocritical parents; adults so alienated from society that they stop participating in it).

David Cohen, professor of social welfare, wrote: “This coercive function is what society and most people actually appreciate most about psychiatry.” In his 2014 article, “It’s the Coercion, Stupid!” Cohen explains how the societal need for psychiatry’s “extra-legal police function” compels society to be blind to psychiatry’s complete lack of scientific validity: “Because of psychiatric coercion, society gives psychiatric theories a free pass. These theories never need to pass any rigorously devised tests (as we expect other important scientific theories to pass), they only need to be asserted.”

9. License for Punishment, Revenge, and Assault

Even for those who continue to buy into their psychiatric diagnoses, psychiatric treatment can feel like punishment. This is apparent in the series “Living Well with Schizophrenia” in which Lauren, an attractive young woman who self-identifies as having “schizoaffective disorder,” compares her psychiatric hospitalization to what she imagines “jail might be like.” In in her video “What a Psychiatric Hospital is Like,” Lauren reports that after being placed in isolation, “I was stripped naked of all my clothes and I was pinned to the ground by six hospital staff.” She notes how this and other such dehumanizations “fed my opinion of always wanting to get out as early as I could.”

Beyond psychiatric “treatment” being so miserable that it can serve as a deterrent, it can also be used for revenge. One of the darker aspects of human nature is the capacity for a perverse pleasure through revenge; this includes getting back at people who have created unpleasant tensions by their altered states or suicidality. Of course, it is taboo to admit this desire for revenge; and it is even more taboo to admit that such revenge can be tinged with perverse pleasure and sadism; and it is shameful to admit that society allows for legalized assault. But if you doubt all this can occur, I’d suggest you watch Lauren telling how “I was stripped naked of all my clothes and I was pinned to the ground by six hospital staff.”

Tellingly, even though Lauren has embraced her schizoaffective diagnosis, YouTube has recently demonetized her videos which have been flagged for not being “advertiser friendly.” This penalty is likely due to Lauren’s lack of sufficient enthusiasm for her own psychiatric hospitalization, electroshock (ECT), and psychiatric drugs, which likely flags her videos as “controversial”—even though she repeatedly states that other people have positive experiences with these procedures. Thus, even though Lauren embraces her schizoaffective diagnosis and does not condemn any psychiatric treatment, because she is not totally compliant with psychiatry’s dogma, she is being punished via her videos being demonetized. In contrast, not being flagged for being “controversial” and not being demonetized by YouTube are videos that promote the biochemical brain imbalance theory of mental illness (YouTube is a subsidiary of Google, part of the ruling power structure).

10. The Empty Promise of Compassion and Love

Human beings want compassion and love, which is often difficult to find in a contemporary Western society which prioritizes efficiency and productivity. And people who are extremely depressed, anxious, alienated, and dissociating often find it even more difficult to receive genuine compassion and love because they behave in tension-producing manners, throwing “monkey wrenches” in family/school/workplace assembly lines. And so, tragically, this group who needs compassion and love the most because it is crucial to healing, receives the least. This results in such people being highly vulnerable to empty promises of how they may get compassion and love.

The false promise of psychiatry and its apologists is that if one accepts one’s psychiatric illness and the idea of biochemical causality, one can gain compassion and love from “enlightened members of society.” The false promise is that compassion and love will be gained with “medicalization parity”; e.g., if society is compelled to say, “People with delusions and hallucinations have the biochemical-genetic illness of schizophrenia, and they deserve the same compassion as anyone with a medical illness.” However, in reality this biochemical/medical parity stigmatizes even more.

The Canadian Health Services Research Foundation (CHSRF), in “Myth: Reframing Mental Illness as a ‘Brain Disease’ Reduces Stigma,” reported in 2012: “Evidence actually shows that anti-stigma campaigns emphasizing the biological nature of mental illness have not been effective, and have often made the problem worse.” One example is a 2010 study in Psychiatry Research that reported that for the general public, the acceptance of the “biogenetic model of mental illness” was associated with a desire for a greater social distance from the mentally ill. The CHSRF review states: “The evidence shows us that while the public may assign less blame to individuals for their biologically-determined mental illness, the very idea that their actions may be beyond their conscious control can create fear of their unpredictability and thus the perception that those with mental illnesses are dangerous. . . . leading to avoidance.”

Attempting to exact compassion and love through compelling the belief in “mental illness as biochemical medical illnesses” has not only failed but has created more stigmatization. Furthermore, coerced compassion from “enlightened members of society” routinely results in fake compassion, and such incongruent reactions can be “crazy making” for those experiencing it. Yet, people are so desperate for compassion and love, they cling to empty promises.

Because of the above 10 reasons, no matter how clearly the scientific case is made that psychiatry is a pseudoscientific institution meriting no scientific authority, psychiatry will continue to retain power. When we recognize that scientific truths alone are not setting society free, we begin to shift our energy to strategies that take into consideration the above reasons.

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ACE findings produced two areas of unexpected results for its researchers Vincent Felitti and Robert Anda. The first area was the prevalence of adverse childhood experiences in a relatively well-off population in the United States. The second area was the strength of the relationship between adverse childhood experiences with adult emotional problems and physical health issues—while unsurprising for many ACE victims, this has been groundbreaking for medical authorities.

With respect to prevalence, more than a quarter of subjects grew up in a household with an alcoholic or a drug user; 23% had experienced severe physical abuse; and 28% of women had been sexually abused as children (16% of men). More than half of the subjects reported at least one adverse childhood experience of abuse, neglect, or other household traumatizing exposure; and one-quarter reported two or more such adverse childhood experiences.

It is important to keep in mind that the ACE Study examined middle-to-upper-middle-class subjects (74% had attended college, and all had higher-end medical insurance), and we know from other research that abuse and neglect is far higher for children from financially impoverished households (see the National Incidence Study of Abuse and Neglect).

Marginalizing and Ignoring U.S. Childhood Trauma

The finding that abuse and neglect are so common in well-off U.S. households—where, for example, 28% of girls are sexually abused—is so unpleasant that some defenders of the U.S. societal status quo have attempted to marginalize the ACE study by arguing that it is unreliable because it relies on the memory and credibility of respondents. The reality, Felitti and Anda have responded, is that underreporting of trauma is more likely than overreporting. Common sense tells us that Felitti and Anda are correct as, for example, a woman would be reluctant to discuss her childhood sexual abuse, and that underreporting is far more likely than overreporting.

While ACE findings of the prevalence of household dysfunction in well-off American households is embarrassing for apologists of the U.S. societal status quo, even more taboo—and uncounted in the ACE Study—are adverse childhood experiences outside the household. Such adverse experiences outside the household and uncounted in the ACE Study include childhood trauma created by U.S. societal authorities and institutions with regard to: (1) schooling; (2) psychiatric treatment; and (3) state coercions.

In their schooling, my experience is that what has driven adolescents to feel stressed, hopeless, and suicidal even more often than peer bullying are school authorities’ coercions and threats of dire consequences for academic noncompliance and failure.

Oppressive psychiatric treatment (e.g., the use of drugs to control bothersome behaviors instead of receiving caring for the emotional pain fueling such behaviors) is also a major adverse childhood experience, as Mad in America readers are well aware of.

The adverse childhood experience that dominated my adolescence was the U.S. state terrorism of the Vietnam War and the draft, which filled me with a chronic fear that I was going to get maimed or killed in Vietnam unless I became a fugitive. Today, many adolescents are overwhelmed with anxiety owing to a range of societally generated terrors—e.g., they are all pressured to go to college but well aware that a college degree may result only in a low-paying job, crippling student-loan debt, and failure to avoid becoming one of life’s “losers.”

For a sane society, the most obvious implication of the ACE Study would be prioritizing the prevention of preventable adverse childhood experiences. A sane society would be asking questions about the very nature of a society and culture that creates so much trauma for children.

However, we do not live in a sane society. We live in a society that prioritizes profits for large corporations and power for large institutions. We live in a society in which, for example, the cause of depression and suicide has been, for decades, falsely attributed by psychiatry and Big Pharma to a chemical imbalance theory long known to be untrue—an untruth that has made billions of dollars for drug companies and increased power for psychiatry through increased use of antidepressants which are known to actually increase suicide. This is just one of many examples that we do not live in a sane society.

U.S. Politicians’ Response vs. A Sane Society’s Response

Owing to the great efforts of Felitti, Anda, and others (including those in the Mad in America orbit) getting the word out on the ACE Study, twenty years after its publication, it is no longer possible for politicians to simply ignore its finding of the powerful relationship between childhood trauma and later adult emotional difficulties and physical health problems.

In June of 2019, the RISE From Trauma Act was introduced with bipartisan support in the U.S. Senate, its stated purpose: “To improve the identification and support of children and families who experience trauma.” It allocates $50 million in grants, spread over 2020 to 2023, for institutions such as child welfare agencies, hospitals, and schools for research, building awareness, and to assess, prevent, and treat youth and their families who have experienced trauma or at risk of experiencing it.

In her Mad in America report about the RISE From Trauma Act, Leah Harris provides examples of how states have created initiatives in schools to be more “trauma sensitive.” In response to the idea of creating more trauma sensitive schools, one young man I know with an extremely high ACE score  (8 of a possible 10)—but who feels as traumatized by his school experience as by his household ones—was cynical, rhetorically asking me: “Are schools going to include ACE screening day with lice screening day? Are they going to report ACE scores to parents—parents who will then abuse the kid even more for talking to authorities about their shit parents?”

In response to Harris’s Mad in America report, there were many comments by MIA readers who had negatively experienced psychiatric treatment and were concerned that the legislation would result in more such treatment that would be re-traumatizing. Felliti himself has concerns about typical mental health services that primarily treat traumatized patients with drugs, noting, “Back when I was at Kaiser Permanente, I was afraid to send patients to psychiatrists.”

In a sane society, treatment for traumatized young people would be quite different than the treatment routinely provided. A sane society would not equate treatment with drugging the symptoms of trauma; and it would not be self-satisfied with quick-and-easy behavioral “trauma informed focused treatments” (such as “cognitive processing therapy” and “prolonged exposure”). A sane society would recognize that real healing involves providing safe, caring, and loving relationships, which may or may not be possible within a paid therapeutic relationship; and so all efforts would be made to re-make society so that safe, caring, and loving relationships could be found in daily life.

A sane society would also be asking: What is it about U.S. society that creates so many abusive and neglectful adults? A sane society would acknowledge that such adults have themselves likely not only been traumatized as children but continue to be traumatized in their adult lives—e.g., alienated and humiliated in their jobs; and given the general message that they are simply objects and tools, and to the extent that they cannot be used to make some rich asshole even richer or some powerful institution more powerful, they will be discarded. A sane society would not be surprised that such adults often have little patience for normal but sometimes frustrating behaviors of children, and react with abuse and neglect.

It is good that the general public is finally hearing about the ACE Study, but should we be hopeful now that U.S. politicians are “trauma informed”? I’m not.

U.S. politicians, for the most part, create and enable insanity—from insane psychiatric treatments to insane wars. When, for example, U.S. politicians finally acknowledged that the U.S. lost the Vietnam War and that Americans were reluctant fight another war, their “diagnosis” was that Americans suffered from “Vietnam Syndrome,” a reluctance to support wars —the “treatment” for which has obviously not been the end of senseless wars but rather multiple senseless wars with weaker opposition.

So I do not count on U.S. politicians to address the core implications of the ACE findings—the need to re-make U.S. society so as to (1) prevent preventable adverse childhood experiences, and (2) create a society in which healing from trauma can more easily occur—where safe, caring, and loving relationships could be more readily found in daily life. Rather than count on self-serving politicians to challenge the status quo and re-make society, we can only count on ourselves.

The post U.S. Politicians Now “Trauma Informed”—Should We Be Hopeful? appeared first on Mad In America.

Early in The Age of Reason, Paine attacks the hypocrisy of religious professionals: “When a man has so far corrupted and prostituted the chastity of his mind, as to subscribe his professional belief to things he does not believe, he has prepared himself for the commission of every other crime. He takes up the trade of a priest for the sake of gain, and in order to qualify himself for that trade, he begins with a perjury.”

If alive today, Paine may well have been even rougher on psychiatrists. Paine revered science, and he would have been enraged by professionals who pretend to embrace science by using its jargon but in fact make pseudoscientific proclamations that purposely deceive suffering people. “To subscribe his professional belief to things he does not believe” is exactly what many modern psychiatrists are routinely guilty of—this by their own recent admissions. Before detailing this “perjury,” a little bit about Paine and his compulsion to confront all illegitimate authorities.

Beginning in 1776, both Common Sense and then The American Crisis made Thomas Paine a hero for insurgent American colonials. Following the successful American revolt against British rule, the globetrotting revolutionary Paine returned to England where his Rights of Man enraged William Pitt. Narrowly escaping arrest by Pitt’s goons, Paine fled to revolutionary France, where Paine then narrowly survived the disloyalty of his “friend” George Washington—a betrayal that kept Paine (a victim of the Jacobins-Girondins gang war) rotting in Luxembourg Prison. Only with great luck would Paine avoid Robespierre’s guillotine so as to return to the United States.

Bertrand Russell (the English philosopher, mathematician, historian, and social critic) observed that Paine “incurred the bitter hostility of three men not generally united: Pitt, Robespierre, and Washington. Of these, the first two sought his death, while the third carefully abstained from measures designed to save his life. Pitt and Washington hated him because he was a democrat; Robespierre, because he opposed the execution of the King and the Reign of Terror.”

No one could intimidate Paine into shutting up, but he could be marginalized. By the end of his life, owing to his The Age of Reason and its disparagement of Christianity, Paine was ostracized, even refused service by many innkeepers. Historian Eric Foner notes: “Paine slipped into obscurity. His final years were ones of lonely, private misery.” Moreover, for many years after his death, Paine was either ignored or attacked by the American political and cultural elite; as even in 1888, Theodore Roosevelt scored political points by calling Paine a “filthy little atheist.”

Paine, in truth, was not an atheist but a deist. He states at the beginning of The Age of Reason: “I believe in one God, and no more.” While it was Paine’s trashing of Christianity in The Age of Reason that made him an outcast, he also made clear in it that “all national institutions of churches, whether Jewish, Christian or Turkish, appear to me no other than human inventions, set up to terrify and enslave mankind, and monopolize power and profit.”

Paine had respect for Jesus (noting that “He was a virtuous and an amiable man”); however, Paine had no respect for Christianity, for which Paine pulled no punches: “Of all the systems of religion that ever were invented, there is none more derogatory to the Almighty, more unedifying to man, more repugnant to reason, and more contradictory in itself, than this thing called Christianity. Too absurd for belief, too impossible to convince, and too inconsistent for practice, it renders the heart torpid, or produces only atheists and fanatics. As an engine of power it serves the purpose of despotism; and as a means of wealth, the avarice of priests; but so far as respects the good of man in general, it leads to nothing here or hereafter.”

As maddening as Christianity was for Paine, unlike psychiatry, Christianity didn’t pour salt into Paine’s wounds by pretending to embrace his beloved science. It is quite possible that Paine would be even more appalled by today’s psychiatrists who claim the authority of science but who, in reality, have debased it. Paine’s rebuke of clergy—“to subscribe his professional belief to things he does not believe”—perfectly fits psychiatrists with regard to both (1) their Diagnostic and Statistical Manual of Mental Disorders (commonly known as the DSM), and (2) their doctrine that has the greatest effect on treatment, the “chemical-imbalance theory of mental illness.”

The DSM is a publication of the American Psychiatric Association (APA), which is psychiatry’s guild organization; and the DSM is often referred to as the “diagnostic bible” of psychiatry. The initial DSM (1952) has been followed by several “new testaments”: DSM-II (1968), DSM-III (1980), DSM-III-R (1987), DSM-IV (1994), DSM-5 (2013, foregoing Roman numerals).

Many mental health professionals have long recognized the lack of scientific validity of the DSM, and its pseudoscience has at times become so obvious so as to be a public embarrassment for psychiatry. Prior to 1973, owing clearly to prejudice and not science, homosexuality was a DSM mental illness. Since what enters and exits the DSM has nothing to do with science (the actual criteria for DSM “illness” being what behaviors make an APA committee uncomfortable enough), homosexuality could only be eliminated as a DSM illness by political activism, which occurred in the early 1970s; and homosexuality was omitted from the 1980 DSM-III.

In that same DSM-III, however, again owning to prejudice and not science, a new mental illness for kids was invented by psychiatry: “oppositional defiant disorder” (ODD), the so-called symptoms including “often argues with authority figures” and “often actively defies or refuses to comply with requests from authority figures or with rules.” ODD is categorized as a “disruptive disorder,” and today disruptive-disordered kids are being increasingly medicated.

Thomas Paine would have immediately seen the political/pseudoscientific nature of the DSM; and given how oppositional and defiant Paine was with illegitimate authorities, I think it’s safe to say that he would have mocked specifically ODD and generally the entire DSM, perhaps even more so than he derided the Bible and the New Testament.

What may have inflamed Paine even more than pseudoscientific DSM mental illness proclamations would be psychiatry’s perjury about it. “To subscribe his professional belief to things he does not believe” is exactly what has been the case for psychiatry with respect to the DSM. Psychiatrist Allen Frances had been the lead editor of DSM-IV, but in 2010 when the APA was in the process of creating DSM-5, Frances stated in an interview in Wired that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” Frances, who lost his DSM-IV royalty share ($10,000 per year) once DSM-5 was available, published Saving Normal in 2014, a book trashing the new DSM-5.

With respect to treatment, even more influential than the DSM has been psychiatry’s “chemical imbalance theory of mental illness,” the doctrine which has convinced emotionally suffering patients that taking psychiatric drugs is as responsible as taking insulin for diabetes.

The lack of science behind the “chemical imbalance theory of mental illness” is no longer controversial. In 2014 in CounterPunch, I documented acknowledgements by establishment psychiatrists of this theory’s lack of scientific validity, including psychiatrist Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times who stated in 2011: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” In my 2014 article, I also reviewed how psychiatrists justified their promulgating this mythology by rationalizing that it would make it easier for patients to accept their emotional difficulties as illnesses and to take psychiatric medication. Leading psychiatrists actually confessed to pushing a theory that they don’t believe.

There is, however, something even worse than bullshitting about bullshit—that is attempting to bullshit us that one has never bullshitted us about bullshit. The previously mentioned psychiatrist Ronald Pies, whose position makes him sort of a Cardinal Emeritus in psychiatry, is now telling us that his profession of psychiatry is not responsible for the fact that damn near everyone believes in an untrue chemical imbalance theory of mental illness.

On April 30, 2019, Pies told us in the Psychiatric Times that “anti-psychiatry groups are quite right in heaping scorn on the ‘chemical imbalance theory’ of mental illness, but not for the reasons they usually give.” Pies expects us to believe that “psychiatry as a profession and medical specialty never endorsed such a bogus ‘theory.’” For Pies, people wrongly believe in this theory because of drug companies’ mendacity and because psychiatry critics have falsely accused psychiatry of promoting it.

But there is a problem with Pies’s alibi for his profession—the truth. In 2001, the American Psychiatric Association (APA) president Richard Harding, writing for the general public in Family Circle, stated: “We now know that mental illnesses—such as depression or schizophrenia—are not ‘moral weaknesses’ or ‘imagined’ but real diseases caused by abnormalities of brain structure and imbalances of chemicals in the brain.”

Pies, undaunted by the facts, responded in his 2019 article: “Critics of my thesis are inordinately fond of citing a dozen or so statements by various psychiatric luminaries—yes, including two former APA presidents—that do, indeed, invoke the phrase, ‘chemical imbalance.’ By cherry-picking quotes of this nature, anti-psychiatry groups and bloggers believe they have demonstrated that ‘Psychiatry’ (with a capital ‘P’) has defended a bogus chemical imbalance theory. These critics are simply wrong.”

The reality is that the APA itself, even in recent years, has continued to promote the chemical imbalance theory. In Psychiatry Under the Influence, journalist Robert Whitaker and psychologist Lisa Cosgrove point out: “Even in the summer of 2014, the APA’s website, in a section titled ‘Let’s Talk Facts’ about depression, informed the public that ‘antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain.’”

Noting the obvious, Whitaker and Cosgrove point out: “The pharmaceutical companies couldn’t promote the chemical imbalance story without the tacit assent of the psychiatric profession, as our society sees academic doctors and professional organizations—and not the drug industry—as the trusted sources for information about medical maladies.”

In closing, an odd connection between psychiatry and Thomas Paine in the person of Dr. Benjamin Rush (1746-1813), who is well-known among psychiatrists as “the father of American psychiatry,” his image adorning the APA seal.

After Paine immigrated to Philadelphia in 1774, he and Rush became friends. At first somewhat protective of the audacious Paine, Rush cautioned Paine against his use of the then-taboo word independence in Common Sense, but Paine disregarded Rush, using that word many times in it. Later on, after The Age of Reason made Paine an outcast, Rush refused to see Paine.

In addition to abandoning Paine, Rush attempted to gain favor with the new ruling class in the United States another way. In 1805, Rush diagnosed those rebelling against the newly centralized federal authority as having an “excess of the passion for liberty” that “constituted a species of insanity,” which he labeled as the disease of anarchia—this an earlier version of oppositional defiant disorder (ODD). In this and several other ways, Dr. Benjamin Rush is the perfect person to be the father of psychiatry.

Rush was a progressive of his era, but “liberal” in the same sense that Phil Ochs—nicknamed “Tom Paine with a guitar” —mocked hypocritical liberals. For example, Rush proclaimed himself a slave abolitionist, however, he had purchased a child slave named William Grubber in 1776, continued to own Grubber after he had joined the Pennsylvania Abolition Society a decade later, and would own Gruber until 1794 when he freed him for compensation. Rush’s “progressive” views on race also included his idea that blackness in skin color was caused by leprosy, and Rush advocated “curing” skin color, changing it from black to white. Rush believed he could abolish slavery by curing black people’s blackness.

Rush also invented some frightening treatments. Based on an earlier imbalance theory that improper flow of blood caused madness, Rush devised two mechanical devices to treat madness: a “tranquilizing chair” and a “gyrator,” not any fun for patients unless they enjoyed being strapped down, immobilized, and violently spun.

Rush considered himself as an expert not just on madness but on every illness, and for virtually all of them, Rush utilized bloodletting as his primary treatment, even at a time when bloodletting was falling out of favor. In “Benjamin Rush, MD: Assassin or Beloved Healer?” (2000), physician Robert L. North reports that in Rush’s era, “The majority of the medical community, especially the members of the College of Physicians, rejected Rush and his cures, using terms and phrases like ‘murderous.’”

William Cobbett, a journalist in Rush’s era, mocked Rush’s treatments (which also included mercury) as “one of those great discoveries which have contributed to the depopulation of the earth,” and Cobbett accused Rush of killing more patients than he had saved. (Cobbett is better known today for his ill-fated plan to provide Thomas Paine with a proper heroic reburial by moving Paine’s remains back to England.)

By the early twentieth century, medical historians were viewing Benjamin Rush as one of the most embarrassing figures in the history of American medicine. North quotes the 1929 History of the Medical Department of the United States Army on Rush’s disastrous impact: “Benjamin Rush had more influence upon American medicine and was more potent in propagation and long perpetuation of medical errors than any man of his day. To him, more than any other man in America, was due the great vogue of vomits, purging, and especially of bleeding, salivation and blistering, which blackened the record of medicine and afflicted the sick almost to the time of the Civil War.”

You would think that the American Psychiatric Association would not want such an historical embarrassment as their father figure. But perhaps the APA believes that the prestige of Rush being a signer of the Declaration of Independence trumps both his being a slave owner and his lethality as a physician.

Actually, Rush was not a complete loser, as he sued the journalist Cobbett for libel and won; and perhaps this legal triumph is inspirational for the APA and modern psychiatrists—providing them with hope that they too can triumph over truth tellers.

The post Tom Paine, Christianity, and Modern Psychiatry appeared first on Mad In America.

“All your two-bit psychiatrists are giving you electroshock,” is how Reed begins “Kill Your Sons,” and though in Lou’s case, ECT trauma would fuel his art, such trauma often only destroys; as the ECT that Ernest Hemingway and William Styron received late in their lives only served to hasten their end. And even in Reed’s case, his ECT fueled not just his art but his rage, which sometimes hurt people who cared about him.

As a teenager living in suburban Freeport, Long Island, Lou felt alienated. He became increasingly anxious and “resistant to most socializing, unless it was on his terms,” according to his sister Merrill Reed Weiner, whose parents were overwhelmed by her brother’s behaviors and by his disregard of them, and so they sought treatment for Lou. They would comply with a psychiatrist’s recommendation.

In the summer of 1959, Lou was administered 24 ECT sessions at two-day intervals at Creedmoor State Psychiatric Hospital in Queens, New York. Weiner recalls, “I watched my brother as my parents assisted him coming back into our home afterwards, unable to walk, stupor-like. It damaged his short term memory horribly and throughout his life he struggled with memory retention, probably directly as a result of those treatments.”

Lou Reed loved evocative lyrics—his own and others—and my guess is that he would have appreciated the description of his ECT by Aidan Levy:

The doctor paced back to the machine, then the two trembling orderlies, barely out of high school and only a year older than Lou was, laid across his chest and knees to brace him for the shock to come. He had read Frankenstein;now he was living it. The doctor flipped the switch on the metal box, the size of a small amplifier, and Lou Reed, who had up to that moment in his life been an acoustic being, became quite literally electrified.

Weiner continues to be pained by her brother’s ECT, and she feels sorry for their parents who, she tells us, may have been guilty of much poor parenting but not, as some have suggested, of seeking treatment for Lou’s homosexual urges.

Weiner remains angered by doctors for destroying her family, concluding that “the ‘help’ they received from the medical community set into motion the dissolution of my family of origin for the rest of our lives. . . . My parents were like lambs being led to the slaughter — confused, terrified, and conditioned to follow the advice of doctors. . . . Our family was torn apart the day they began those wretched treatments.”

Levy concludes about Lou’s ECT, “The punishment solidified Lou’s unflappable spirit of rebellion.” While psychiatry rejects Levy’s view of ECT as “punishment,” Lou himself would likely have agreed with this Levy analysis: “His parents and by extension civilized society objected to his defiance—even then, he refused to play by anyone else’s rules, and as punishment for breaking them, he faced an adolescent’s worst nightmare.”

Prior to his ECT, Levy notes, “Lou had already embraced the counterculture, but electroshock secured his allegiance to the underground. If he wanted to escape, he would have to do it himself. No one, not anyone in mainstream society at least, would do it for him. He would later dedicate his life to exposing the seamy underbelly beneath the sanitized reality presented by the mainstream, eternally distrustful of any authority figure, especially any record executive, after he had seen authority be so wrong.”

Lou’s talents enabled his rage over his ECT to be transformed into the kind of art that deeply touched society’s outcasts and victims of illegitimate authority. But while Lou found artistic fuel from his ECT, it scarred him with an unpleasant defensiveness. Throughout much of his life, Lou would protect himself by attacking, and he was often viewed, even by his friends and lovers, as a “jerk” and an “asshole.”

Psychiatry would prefer the general public hear ECT testimonials from advocates such as Kitty Dukakis rather than the ECT realities of Lou Reed as well as of other public figures for whom ECT was a disaster, a lengthy list including Ernest Hemingway and William Styron.

A seriously depressed Hemingway was treated with ECT as many as 15 times in December 1960, then in January 1961, he was “released in ruins,” according to one biographer Jeffrey Meyers. Another biographer and close friend, A. E. Hotchner reported in Papa Hemingway  that Hemingway’s loss of memory caused by the ECT made him even more depressed and hopeless, as Hemingway had stated, “Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business?” In July 1961, shortly before his 62nd birthday and soon after Hemingway had been given still another series of shock treatments, his end came by suicide with a shotgun.

William Styron is another ECT casualty. In a 2019 article “William Styron: His Struggles with Psychiatry and Its Pills,” journalist Joshua Kendall reports that in early 2000, when Styron became even more depressed while on the antidepressant Wellbutrin, he became desperate and vulnerable to quick fix recommendations. Kendall reports:

“The quick fix that Styron settled on was ECT. ‘One of the reasons that he wanted to try ECT was that he had had such a bad experience with drugs, and he didn’t want to take another one,” Rose [Styron’s wife] says. . . . Once when Rose accompanied him to an ECT treatment, he yelled at her, ‘You’re killing me!’ . . . .The ECT was then abandoned, but not before possibly causing the Parkinsonian symptoms that emerged that summer, as Alexandra [Styron’s daughter] notes in her memoir.”

Many Americans are surprised to discover that ECT continues to be used as a psychiatric treatment. Psychiatry is well aware of ECT’s negative public image, so in recent years, its administration is not as painful to observe as it once was. Unlike Lou, patients today are given an anesthetic and oxygen along with a muscle relaxant drug to prevent fractures. However, while ECT no longer appears quite as torturous to observers as it appeared prior to these procedure changes, ECT’s effects on the brain are as damaging as ever. Moreover, as I detailed in 2017 (The Electrical Abuse of Women: Does Anyone Care?), a recent comprehensive review of the research on ECT effectiveness concluded that there is “no evidence that ECT is more effective than placebo for depression reduction or suicide prevention.”

For Lou, it is likely that in addition to his ECT at Creedmoor State Psychiatric Hospital in Queens, simply being a patient there cemented his strong reciprocal connection with society’s “untouchables.” I grew up in Rockaway, Queens, and telling another kid that “you belong in Creedmoor” was one of the greatest of insults that we hurled at one another. And so Lou was handed the choice of either being shamed by his outcast status or celebrating it. He had the courage to celebrate it.

I also spent some time in Creedmoor, but under very different circumstances than Lou. In 1976, a locked ward at Creedmoor served as my first trainee internship, and it was here that I began to be embarrassed by my chosen mental health profession, especially by its dehumanizing attempts to control people. While psychiatrists utilized drugs and ECT to control patients, psychologists’ arsenal of control included “behavior modification,” which included the “token economy.”

During my internship at Creedmoor, I recall one severely depressed man who refused to talk to staff but who chose me for some reason to shoot pool with. Spotting my interaction with him, a clinical psychologist, my boss, told me that I should give him a token—a cigarette—to reward his “prosocial behavior.” I fought it, trying to explain that I was 20 and this man was 50, and that it was humiliating to treat the man in the manner of training a dog. But the psychologist threatened to kick me off the ward. So with staff watching—but not hearing—from behind the nurse’s station window (similar to what I had just seen in the 1975 film “One Flew Over the Cuckoo’s Nest”),  I asked the man what I should do. Fighting the zombifying effects of his heavy medication, he grinned and said, “We’ll win… let me have the cigarette.” In full view of staff, he took the cigarette and then placed it into the shirt pocket of another patient. Next, he shot a look at the staff which clearly expressed: “I may be a patient in Creedmoor but you staff are the truly sick ones.”

While most students training to become mental health professionals are initially jarred by their observations of dehumanizing chemical-electrical-behavioral controls, many of them become numb to these experiences and go on to become professionals who repeat these practices. For other students, these upsetting experiences kill their interest in a career in psychiatry, psychology, and the mental health profession. But for a small handful who do not exit the profession, these observations radicalize them and compel them to resist and speak out.

The post Lou Reed: That Which Does Not Kill Us Can Radicalize Us appeared first on Mad In America.

Obviously, the middle ground can be the correct location for arbitrating some disputes between human beings, but it should be equally obvious that the middle ground is not always the place where truth and justice reside. In the 1850s, was the middle ground between pro-slavery and abolitionist opponents the sacred ground?

With regard to the APA and establishment psychiatry, I doubt that future historians will conclude that truth and justice reside on the middle ground between psychiatrist Jeffrey Lieberman, former president of the APA, and journalist Robert Whitaker, who Lieberman has diagnosed as a “menace to society.”

In my 2015 CounterPunch piece, “Who’s the Real ‘Menace to Society’? Journalist or Leading Psychiatrist?” I noted that Whitaker exposed how Lieberman (along with other prominent psychiatrists), in the 1980s and 1990s, had conducted studies in which patients diagnosed with schizophrenia were given a psychostimulant drug with the experiment expectation that this drug would be “psychotogenic” (induce symptoms of psychosis), and this deterioration in fact did occur. I pointed out that the Nuremberg Code of research ethics, established after the horrific human experiments by doctors in Nazi Germany, states that medical experiments on human subjects “should be so conducted as to avoid all unnecessary physical and mental suffering and injury.”

Yet, the APA made Lieberman their president in 2013, which should tell any journalist what’s most important to understand about the APA.

In the past, I have simply ignored the above-the-fray/middle-grounders, but I now see my ignoring them as a mistake. I now see that they, in their own way, can be as dangerous as APA presidents. I have to thank Gary Greenberg’s recent book review in the Atlantic for my reconsideration. Greenberg’s above-the-fray/middle-ground criteria of truth and justice has awakened me from my slumber. It’s difficult to remain napping when a guy pulls down his pants and takes a giant dump on, by association, my friends and myself.

In Greenberg’s review of historian Anne Harrington’s book Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness, he tells us that Harrington, a fellow above-the-fray/middle-ground author, is committed to restraint. Greenberg tells us, “By presenting a just-the-facts narrative of the attempt to find biological sources of mental suffering, particularly in the brain, she hopes to get the ‘fraught’ enterprise of psychiatry back on the path to progress.” Greenberg quotes Harrington: “Heroic origin stories and polemical counterstories may give us momentary emotional satisfaction” but, for her, this “tunnel vision, mutual recrimination, and stalemate” is not useful. Greenberg then spells out his wholehearted agreement:

“Harrington is right to sigh over what has too often proved to be a yelling match between equally deaf opponents—members of an ambitious profession convinced that psychiatry is making strides toward understanding mental illness, and critics who believe it is at best a misguided attempt to help suffering people and at worst a pseudoscience enabling social control at the expense of human dignity. Indeed, since the sides first squared off, more than half a century ago, they seem to have learned little from each other.”

First, I can only hope that Greenberg is not mocking the idea that psychiatry is a “pseudoscience enabling social control at the expense of human dignity,” a view shared by Erich Fromm, Thomas Szasz, Michel Foucault, R.D. Laing, and Erving Goffman—not exactly a bunch of hysterics. Second, this “match” is not simply an intellectual dispute but a human rights fight; and when the APA listed homosexuality as a mental illness, “yelling” at the APA was actually one effective tactic used by gay activists to abolish this DSM insult to their sexual orientation.

I learned about elitist notions of “reasonableness” and intellectual superiority from school critic Jonathan Kozol, who exposed the negative consequences of elitist schooling. Kozol had attended a prestigious prep school and Harvard, where he gained a healthy contempt for the socialization at these institutions, which he describes in The Night is Dark and I am Far From Home (1975):

“They learn to round off honest judgments, based upon conviction, to consensus-viewpoints, based solely on convenience, and to call the final product ‘reason.’ Above all, they learn how to tone down, cushion and absorb each serious form of realistic confrontation. . . ‘Isn’t that a bit too strong. . . Aren’t we overstating?’ Always the notion that in every case ‘a greater truth’ resides some place in the middle.”

Obviously, the middle ground is not always where truth and justice reside. U.S. history does not tell us that the truth and justice resided between Henry Kissinger and Seymour Hersh or between Joseph McCarthy and Edward R. Murrow, and I doubt that future historians will conclude that truth and justice resided between Jeffrey Lieberman and Robert Whitaker.

Greenberg’s put-downs of the sort of psychiatry criticism that appear in Mad in America are odd because, in addition to having a book trashing the DSM, in the past he has espoused many of the same positions as do MIA authors.

Greenberg gives us a clue as to why he might have become the kind of above-the-fray/middle-grounder who the mainstream media likes to publish when he revealed in an interview with the Sun, “My involvement with the Unabomber was in part an attempt to make a name for myself by writing about someone famous.” At least Greenberg is honest about his commitment to self-promotion, which apparently also includes dumping on everyone who is not named Gary Greenberg.

While there is something strangely interesting about Greenberg’s self-promotion strategy, middle-grounder psychiatrist Allen Frances’s approach is quite boring, as he simply stays in step with what’s most fashionable.

Frances is the former chair of the DSM-4 task force, but with the political winds blowing against the DSM-5, the politically astute Frances, in 2012, was criticizing DSM-5 before its publication. I confess to finding the sight of Frances condemning the DSM-5 quite humorous. It is as if the guy who wrote Leviticus realized that his “abominating” and “sinning” had gotten out of hand.

Frances, predictably, takes the middle ground when it comes to diagnosis and medication. His position is that the problem is simply one of over-diagnosis and over-medication, which he sees as caused by Big Pharma, not the APA. For Frances, many MIA writers are taking extreme positions and thus irrational ones. These “extreme” positions include the ideas that the entire psychiatric diagnostic process is a bad idea; and that given psychiatry’s history of ignorance, denial, and lies about theories of mental illness, drug ineffectiveness, and drug adverse effects, psychiatry as an institution has long ago lost credibility as an authority.

In the past, I have restrained myself with regard to above-the-fray/middle-grounders. In 2013, I even gave Greenberg and Frances and their DSM-trashing books some ink in Salon, listing them along with Paula Caplan’s and Herb Kutchins and Stuart Kirk’s DSM-trashing books. I was, I’m sorry to say, too polite. I neglected to note that Caplan’s and Kutchins and Kirk’s 1990s DSM-trashing books took some career courage, while Greenberg’s and Frances’s books did not. By the time Greenberg’s and Frances’s books were published, the APA’s over-reaching imperialism in creating DSM-5 illnesses had become an embarrassment even for many mainstream shrinks.

Okay, so Greenberg took a dump on my team, and I took a dump on Greenberg and his fellow above-the-fray/middle-grounders. Turning to more important matters, let’s consider the damage created by above-the-fray/middle-grounders, starting with one of the most famous ones, the New York Times.

Malcolm X biographer Manning Marable pointed out, “Malcolm X today has iconic status, in the pantheon of multicultural American heroes. But at the time of his death he was widely reviled and dismissed as an irresponsible demagogue.” Marable quotes the New York Times one day after Malcolm X’s assassination in 1965: “An extraordinary and twisted man, turning many true gifts to evil purpose. . . . Malcolm X had the ingredients for leadership, but his ruthless and fanatical belief in violence . . . set him apart from the responsible leaders of the civil rights movement and the overwhelming majority of Negroes.”

I suppose that for the NYT in 1965, the “reasonable” middle ground was somewhere between Martin Luther King and the KKK, and it was “reasonable” to term Malcolm X’s belief in the validity of African American anger and in self-defense as “violence.” That kind of NYT “reasonableness” can so frustrate nonviolent oppressed people that they consider violence.

Speaking of NYT obituaries, Robert Whitaker may have the misfortune to read a sentence that will one day show up in his NYT obit. Specifically, in her recent story in the New Yorker, above-the-fray/middle-grounder Rachel Aviv inserts the following parenthetic description of his book Anatomy of an Epidemic: “The book has been praised for presenting a hypothesis of potential importance, and criticized for overstating evidence and adopting a crusading tone.” In Aviv’s story on “The Challenge of Going off Psychiatric Drugs,” featuring Laura Delano, the only reason for this otherwise gratuitous crack appears to be an attempt at appeasing the psychiatry establishment—since Aviv could not ignore the positive value that this book and Whitaker had on Laura.

Many of us in the MIA world who are Laura’s friends are very happy to see her receive mainstream media recognition and are pleased to see another mention of the problem of psychiatric drug withdrawal. However, the reality is that, similar to the DSM, psychiatric drug withdrawal is no longer a taboo topic—in no small part because of the hard-fought struggles of many in the MIA orbit who pushed this story out there in spite of psychiatry’s denials.

What’s most troubling is that Aviv omitted the entirety of Laura’s story, which includes not simply Laura being harmed by psychiatric drugs and the denial of the hell of drug withdrawal. Aviv omitted the vital truth that Laura was harmed by psychiatry’s pathologizing and dehumanizing, and how this resulted in Laura becoming an activist helping others so oppressed to liberate themselves from psychiatry. This major part of Laura’s story is made clear in Laura’s talks and writings, including in her pieces published here on Mad in America (as you might expect, this “extremist” MIA website, despite its importance to Laura’s story, goes unmentioned in Aviv’s lengthy article).

When above-the-fray/middle-roaders jump on bandwagons and criticize only those aspects of psychiatry that have become fashionable to criticize but don’t challenge the legitimacy of psychiatry as an authority, they hurt more than they help. They provide the false impression that psychiatry is self-correcting and progressing.

In general, above-the-fray/middle-grounders refuse to ask this important question: How much does an institution have to get wrong for that institution to lose its authority? Because above-the-fray/middle-grounders avoid that question, because they never challenge the very legitimacy of an institution to exist as an authority, these above-the-fray/middle-grounders are never a threat to institutions, even those that have long proven to be far more harmful than helpful. For their generosity to mainstream institutions, above-the-fray/middle-grounders are provided with mainstream rewards, while the rest of us are stuck with the fallout.

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“In every American community you have varying shades of political opinion. One of the shadiest of these is the liberals. An outspoken group on many subjects, ten degrees to the left of center in good times, ten degrees to the right of center if it affects them personally.”

—Phil Ochs, Introduction to “Love Me, I’m a Liberal” on the live album, Phil Ochs in Concert (1966)

Many self-identified liberals are far more than “ten degrees to the right of center” with regard to psychiatry. With the 1980 election of Ronald Reagan, and then even more so following 9/11 in 2001, the United States has swung so far to the right that many self-identified liberals embrace, often unwittingly, a right-wing view in many aspects of society, including psychiatry.

Establishment psychiatry has historically been supported by the ruling elite in return for meeting the elite’s needs to maintain the societal hierarchy and political status quo. Psychiatry has met the elite’s needs by its various attributions—repeatedly proven to be scientifically unfounded—that emotional suffering and odd or frightening behaviors are caused by defects in individual biochemistry and genetics, rather than by trauma and societal defects created by the ruling elite.

In the past, right-wing psychiatry’s individual defect view—in combination with extreme nationalism that requires an entire population to efficiently meet the needs of its state-corporatist rulers—has resulted in policies of sterilization in the United States and, as was the case in Nazi Germany, euthanasia/murder.

In contrast to the individual defect perspective, a left perspective is that the root of much of what is commonly labeled as “mental illness” is a dehumanizing and alienating society—one that has been orchestrated to meet only the needs of the wealthy and powerful and not designed to meet the needs of everybody else for autonomy, meaningfulness, and genuine community. Prior to the 1980s, it was not radical to acknowledge that a right-left ideological battle existed in psychiatry (as it exists in education and many other aspects of society).

In the 1950s, 1960s, and 1970s, the left anti-authoritarian psychoanalyst/social psychologist Erich Fromm occupied a prominent place in U.S. society, even interviewed by Mike Wallace on ABC in 1958. In Fromm’s The Sane Society (1955), he offers an ideological perspective that today would result in his complete marginalization by the mainstream media, as he states: “Nationalism is our form of incest, is our idolatry, is our insanity. ‘Patriotism’ is its cult. . . . by ‘patriotism’ I mean that attitude which puts [one’s] own nation above humanity, above the principles of truth and justice.”

Fromm fiercely criticized the mental health profession: “Today the function of psychiatry, psychology and psychoanalysis threatens to become the tool in the manipulation of man. . . . Yet, many psychiatrists and psychologists refuse to entertain the idea that society as a whole may be lacking in sanity. They hold that the problem of mental health in a society is only that of the number of ‘unadjusted’ individuals, and not that of a possible unadjustment of the culture itself.”

Today, Erich Fromm is virtually ignored, and to the extent that psychology students read anything about him in their textbooks, he is routinely identified only as a “neo-Freudian” not as a democratic-socialist and an anti-authoritarian critic of a dehumanizing society and psychiatry.

The “common denominator” of the term right wing, according to A Glossary of Political Economy Terms, is “enthusiastic support for the main features of the current social and economic order, accepting all (or nearly all) of its inequalities of wealth, status and privilege.” In this sense of demanding compliance with the current order and its hierarchies of status and privilege, Stalinism too is right-wing; though perhaps less confusing would be labeling such a state as totalitarian and authoritarian.

In the industrial world, the extent that unquestioning obedience to authority is the norm in a society is the extent that it utilizes psychiatry’s psychopathologizing of the disobedient. The psychological common denominator of a population willing to be so ruled is, I believe, a fear and hatred of anything which creates conflict and tension—be it diversity, democracy, or defiance. This fear and hatred results in receptivity to rationales for eradication of these sources of tension.

The left anti-authoritarian political climate of the 1960s and early 1970s created the conditions for successful gay activism against the American Psychiatric Association and for the elimination, in 1973, of homosexuality as one of the APA’s psychiatric disorders. However, by 1980, the more right U.S. society accepted the APA’s DSM-3 (1980) proclamation that defiance in children and teenagers was a mental illness that is called “oppositional defiant disorder” (ODD).

The so-called “symptoms” of ODD include “often argues with authority figures” and “often actively defies or refuses to comply with requests from authority figures or with rules.” ODD-labeled young people are not the kids who society once called “juvenile delinquents,” as young people engaged in criminal behaviors are labeled with “conduct disorder” (CD). In psychiatry, ODD and CD both fall under the umbrella classification “disruptive behavior disorder,” which is currently the most common classification of children and teens medicated with antipsychotic drugs.

While ODD kids can produce significant tension in families and schools, many of these young people are exactly the kind of kids who mature into anti-authoritarian adults (including several of the famous anti-authoritarians I profile in Resisting Illegitimate Authority) who have the courage to challenge and resist illegitimate authority.

Phil Ochs’s love-me liberals need to believe that they are completely tolerant and cannot admit that they are intolerant when it comes to certain kinds of defiance “if it affects them personally,” as he observed. His “Love Me, I’m a Liberal” brings this home:

I cried when they shot Medgar Evers
Tears ran down my spine
And I cried when they shot Mr. Kennedy
As though I’d lost a father of mine
But Malcolm X got what was coming
He got what he asked for this time
So love me, love me, love me, I’m a liberal

Since love-me liberals are so self-certain of their tolerance, they believe that what upsets them must be a criminal behavior or a mental illness that requires incarceration or treatment.

A self-identified “psychiatric survivor” once told me, “We all have a bit of a Nazi inside us,” and he wished that love-me liberals would acquire some humility—specifically, if love-me liberals could simply admit that his behavior got them uptight, they might then just stay away from him instead of “treating” him. Often quoted among psychiatric survivor activists seeking either to reform or abolish psychiatry is this observation by C. S. Lewis: “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive.”

Much of psychiatry’s history is embarrassing for psychiatrists, and so they hope the general public believes that the practices of current psychiatry are a complete departure from, for example, one 1940s public policy debate. “The 1942 ‘Euthanasia’ Debate in the American Journal of Psychiatry,” authored by psychologist Jay Joseph, discusses three articles that appeared in a 1942 issue of the prestigious professional journal, the American Journal of Psychiatry. In the first article, neurologist Foster Kennedy argued that ‘feebleminded’ people should be euthanatized, which was rebutted by psychiatrist Leo Kanner, who argued against euthanasia. In the third article, Joseph notes, “An unsigned editorial discussing these positions clearly sided with Kennedy: that ‘euthanasia’ would be appropriate in some cases, and that parents’ opposition to this procedure should be the subject of psychiatric concern.”

Joseph is one of the few U.S. psychologists continuing to debunk the pseudoscience behind twin studies and genetic defect theories of mental illness. However, outside of a small world of dissident psychologists and psychiatrists where Joseph is highly regarded, he is not widely known. In contrast, even in the 1980s, there remained prominent social scientists whose books were published by major publishers and who made clear the connection between what was then called the “New Right” ideology and biochemical-genetic defect theories.

The 1984 book Not in Our Genes: Biology, Ideology, and Human Nature was authored by evolutionary geneticist R.C. Lewontin, neurobiologist Steven Rose, and psychologist Leon Kamin. They begin by making clear the political ideology behind individual defect biochemical/genetic determinism: “Biological determinism (biologism) has been a powerful mode of explaining the observed inequalities of status, wealth, and power in contemporary industrial capitalist societies. . . . Biological determinism is a powerful and flexible form of ‘blaming the victim’.” At the time of its publication, Not in Our Genes received praise from prominent public intellectuals such as anthropologist Ashley Montagu and paleontologist Stephen Jay Gould (who had similarly criticized the pseudoscience behind hereditary determinism of intelligence in his 1981 book The Mismeasure of Man).

While historically, psychiatry’s biochemical individual defect theories have met the needs of the overall power structure by locating the cause of tension-creating behaviors in the defects of an individual rather than the defects of society, psychiatry’s recent chemical imbalance theories have increasingly met the needs of one major force in the ruling elite, Big Pharma.

Beginning in the late 1980s, psychiatry aggressively sold the notion that depression was caused by the individual defect of a chemical imbalance—specifically, not enough of the neurotransmitter serotonin—which could be “corrected” with selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, and Zoloft. It is this theory which convinced depressed Americans that it is irresponsible not to take SSRIs. However, the psychiatry establishment now claims that it has always known that this chemical-imbalance theory was not true and was an “urban legend,” the term used by Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times who stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.”

While this chemical-imbalance theory was in fact discredited by scientists by the 1990s, it has been so aggressively sold by psychiatry and drug companies that this theory continues to be widely believed not only by many patients but even by many physician prescribers.

Since the 1980s, psychiatry has been increasingly colonized by Big Pharma, documented in many books, including Psychiatry Under the Influence (2015). Big Pharma has utilized psychiatry for marketing and sales by controlling it through funding: university psychiatry departments; psychiatry’s professional journals; psychiatrist “thought leaders” who promote new diagnoses and drug treatments; and the American Psychiatric Association itself. Psychiatry’s official diagnostic manual is called the DSM (published by the APA), and each DSM revision adds new mental illnesses that expand the psychiatric medication market. In 2012, PLOS Medicine reported, “69% of the DSM-5 task force members report having ties to the pharmaceutical industry.”

In the version of “Love Me, I’m a Liberal” that is on Phil Ochs in Concert, after Ochs sings its first verse (that I quoted earlier), he briefly interrupts his song to ask his audience, “Get it?” His primarily leftist audience included liberals and more radical anti-authoritarians, and so to pay tribute to Phil, I’ll end by asking, “Get it?”

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