On Twitter yesterday, Robert Stamatakis commented:
“I have to ask, I don’t understand. Do you work in the UK? Your descriptions of psychiatry are nothing I recognize. These descriptions of psychiatry are nothing like the practice I see on a daily basis.”
I am certainly a very outspoken critic of psychiatry, and in that regard Robert’s question/challenge is a fair one, to which I will try to respond.
My primary criticism of modern psychiatry – and indeed the criticism that underpins all the others – is that its fundamental concepts are spurious.
The most fundamental concept in psychiatry is the notion that almost every significant behavioral or emotional problem is an illness. These putative illnesses are presented and actively promoted by psychiatry as explanations of human problems, in exactly the same way that regular medicine offers a diagnosis of pneumonia, say, as an explanation for a particular set of symptoms. The critical difference, however, is that pneumonia (i.e. an infection of the lung) really is the cause of its symptoms (e.g. coughing up bloody phlegm). Psychiatric diagnoses, although routinely presented as having the same kind of ontological existence and explanatory significance, are in fact nothing of the sort.
If a client asks a psychiatrist why he is depressed, he gets the answer: because you have an illness called depression. If the client follows through with this and asks: how do you know I have this illness? – the only possible reply is: because you are depressed. The “diagnosis” of depression is just a rewording of the presenting problem. It explains nothing. And in fact, it does a great deal of harm, because it militates against any real exploration of why the person actually is depressed. Over the years, I’ve worked with hundreds of individuals who were feeling despondent for one reason or another. But I don’t recall a single one who couldn’t give me a reasonably coherent reason for these negative feelings. Within the psychiatric system, these reasons never get explored because psychiatrists believe they already know the answer. They also believe they have the solution – drugs.
The putative brain illnesses would, of course, have saved this explanatory system. “Why am I depressed?” “Because you have such and such wrong in your brain.” But despite four decades of extremely motivated and well-funded research, these brain illnesses have not been identified or described. Nevertheless, psychiatrists continue to tell their clients that they have real illnesses “just like diabetes” and they must take the pills for life.
Recently the illness rhetoric has come under a great deal of criticism, and some psychiatrists are re-defining the word “illness,” in a desperate attempt to save their sacred theory.
This is not quantum physics. It is logic 101. If psychiatrists can’t understand these matters, then they have no business practicing any profession. And if they do understand them, then they are lying to their clients.
Some psychiatrists have even articulated the notion that this lie is justified because it encourages the clients to take the pills!
Even childhood temper tantrums are conceptualized by psychiatrists as an illness, and they are prescribing neuroleptic drugs for children as young as 2 and 3 years of age!
When I say that psychiatry is flawed and rotten, I’m not actually saying that individual psychiatrists are ogres. I know that many of them are personable, take care of their families, pay their taxes, and would, if the occasion demanded, help a little old lady across the street.
What I am saying, however, is that the philosophy to which almost all psychiatrists subscribe is spurious and also destructive. It’s destructive on three counts. Firstly, the drugs do a great deal more harm than good. Antidepressants are minimally effective in the short term and actually make things worse in the long term. Neuroleptics destroy brain tissue and reduce life expectancy drastically. The side-effects are devastating. Anti-anxiety pills are addictive, etc… Secondly the psychiatric philosophy is disempowering. In the old days, the prevailing ethos was that problems were things to be solved, and all the natural support systems nudged troubled individuals in that direction. Today, the spurious illness theory is almost universally accepted, and troubled individuals are encouraged to take pills. Psychiatry’s message is: you can’t help yourself – you need us experts and you need our pills. Thirdly, despite psychiatry’s protestations to the contrary, the illness theory is stigmatizing, and individuals with these labels are viewed as less competent than people with similar problems were viewed prior to psychiatry’s campaign to medicalize every conceivable human problem.
All of this is bad enough, but we should also factor in psychiatry’s corrupt relationship with the pharmaceutical industry. This has been adequately documented and needs no repetition here.
What should be stressed, however, is that the driving force behind this spurious medicalization of all human problems is money. It’s not the fact that psychiatry has just made a huge error. They and their pharma allies created this fiction in order to expand psychiatric turf, and to sell drugs. And there is no indication of any slowing down in this process. On the contrary, DSM-5 makes it clear that as far as they are concerned, there is no limit. Their goal – as far as I can see – is to have everyone on the planet taking pills (or at least the ones who can pay for them).
And all of this, in my view, is flawed and rotten. Psychiatrists bought this spurious rubbish and became the shills of the pharmaceutical industry because it suited their purpose. They found that they could make a great deal more money without having to bother too much about helping clients with their problems. And for their trouble, they were wined and dined and generally made to feel cozy and important by pharma. And some were paid very large sums of money.
Psychiatrists push drugs under the guise of practicing medicine. And in my view, that’s rotten and flawed.
The damage that psychiatry/pharma does is not confined to the personal level. There is also a cultural dimension. The psychiatric notion that human problems are illnesses that need to be treated with drugs has been widely accepted in America and to a growing extent in other parts of the world. This development is largely due to pharmaceutical marketing expenditures and the willingness of “eminent” psychiatrists and prestigious hospitals to lend their names to this spurious philosophy. The result, I suggest, is widespread disempowerment. Prior to the psychiatry/pharma upheaval, people tended to see their problems as solvable through effort and the help of family, friends, etc… Today – they go to a psychiatrist for pills. This is not to my mind a positive development, but it does put a great deal of money into psychiatry/pharma coffers. Trading the resilience and confidence of the many for the profits of the few strikes me as a particularly rotten and flawed arrangement.
There is widespread concern on this side of the debate – and increasingly in mainstream circles – that SSRI’s are causing an increase in suicides and in acts of violence. If you have reservations with regards to this theory, I recommend Prozac Backlash by Joseph Glenmullen, MD.
I can understand the pharmaceutical companies not wanting to touch this. They’re in it for the money. But what I can’t accept is the inaction of the psychiatric community on this matter. Dr. Glenmullen’s book was published in 2000, and in my view it should have triggered an immediate cry from psychiatrists for a definitive study of this issue – a study that would resolve the matter beyond all doubt. To the best of my knowledge, nothing of this sort has occurred, and no study has been done. It’s very difficult to avoid the perception that the victims of these suicides and acts of violence are being written off by psychiatry/pharma as “cost-of-doing business.” And this – to my mind – is flawed and rotten. Meanwhile, psychiatry/pharma and their allies at NIMH are busy instead researching the “biological basis of mental illness” – still!
Robert, I could go on and on. As I said, most individual psychiatrists don’t come across as villainous ogres, but they are intimately associated with the invalidity and the damage, and with very few exceptions, they play along.
Please come back if you want to challenge or question anything I’ve said, or if you just want to discuss. Not on Twitter, though. I can’t have a serious conversation in 140 character segments. Come in with a comment here on the post.