Overland describes itself as Australia’s only radical literary magazine. It was founded in 1954, and publishes a quarterly print journal (essays, stories, and poetry) and an online magazine (cultural commentary).
In the current issue, Winter 2020, there is an excellent article by Samuel Lieblich, a consultant psychiatrist working in the Greater Melbourne Area. The essay is titled Ignorance is Bliss.
Here are the first two paragraphs:
“By now there is enough criticism of the mental health business out there that it seems to me most engaged readers have been informed about the problems: psychiatry makes a false equivalence of the brain and the person, psychiatry pathologises some of the normal problems of human life, psychiatrists enforce highly constrained norms of thought and behaviour, and psychiatrists don’t value patients’ autonomy. There is still however a lot of confusion about the status of the things that psychiatrists treat. These are by no means illnesses, and the medications doctors use to treat them are by no reasonable measure effective. I am going to have to risk setting up a straw man here, but the majority of people don’t believe the claims I’ve just made, even though they have been exposed to the same claims many times. Marcia Angell when she retired as head of the New England Journal of Medicine wrote a pair of scathing reports in the New York Review of Books to the effect that psychiatry is a pseudoscience; and these same claims are repeated in bestselling books like The Emperor’s New Drugs, and magazine articles too numerous to mention. If one moves carefully through the scientific evidence one finds too that a ‘chemical imbalance’ has never been substantiated for any of the things that have been called a ‘mental illness’, and that the prescription of medications for psychiatric problems is always tendentious. The abundance of scientific support for these claims is only equalled by the total absence of their accommodation in the practice of psychiatry and the lay discourse about mental health. Although science does not really support the use of many psychopharmaceuticals in the ways they are represented to be supported, and although there is no acceptable measure by which most of the things treated by psychiatrists qualify as illnesses, the cultural position of the medical profession and their medicines is such that even a scientific refutation of a medical claim appears unscientific. This position of the doctor as super-scientific is perpetuated and co-opted by pharma for profit, and by the state for the purposes of social control. Capital aggrandises the psychiatrist, whose job is to condition the citizens to their labour, or to excise a tax in the form of pharmaceuticals payments. Either way capital wins and we all play along because we have been so immiserated by budget austerity, social precarity and casualised over-employment that the only comfort we can afford is to indulge in a fantasy.
Around one in six Americans, and one in eight Australians is currently prescribed an ‘anti-depressant’; and what the profession calls ‘Major Depressive Disorder’ is one of the most common diagnoses today. This diagnosis in particular has grown to assimilate a large number of human experiences, and the drugs supposed to treat it have also proliferated, because patients are strung-out and desperate, and because there has been a determined marketing campaign – to the effect that all despair is an illness – by the pharmaceutical industry which has insinuated itself into the state and into academia so thoroughly that to find a research project or piece of regulation untouched by their money is almost impossible.”
Here’s the final paragraph:
“Mental Health is broken; it has been broken by psychiatrists who are not scientists but who have scientific pretensions; patients who are desperate, who for reasons of expediency may prefer not to confront the truth of their symptoms, and who have no-one more trustworthy to turn to; and corrupt businesses that have snake oil to sell. The diagnosis of ‘Major Depressive Disorder’ (as representative of many psychiatric diagnoses) has grown malignant and come to subsume myriad forms of human experience into a monolithic and compromised diagnosis.37 It happened because of covert drug-marketing and drug-boostering driven by the powerful but unscientific forces to be found on government committees, professional panels, and in other places of power, and because doctors and patient-consumers have turned a blind eye to this corruption despite it being quite obvious and well publicised. Each and every person will have their own reason for ignoring or accepting information about ‘anti-depressants’ and ‘Major Depressive Disorder’ but one can’t deny that these things have proven eminently marketable (by pharmaceutical companies), billable (by doctors), and their horoscope like inclusiveness has offered patients the illusion of an explanation for their distress.25, 26, 38 There is an emancipatory and compassionate potential within psychiatry, but it has not found its expression in the reification of certain culture bound states of distress as ‘illnesses’ nor in the prescription of toxic and useless ‘medications’; rather it finds its expression in listening to patients, and in providing patients with the opportunity, not much afforded them elsewhere, to listen to themselves.”
And here are some gems from the body of the essay:
“Because by the 1970s validity in psychiatric diagnoses was already considered an unachievable dream, Robert Spitzer who led the production of the DSM-III10–12 said his aim was to improve the validity of mental health diagnosis by improving reliability.10, 13 To that end he gathered consensus from eminent clinicians and researchers in order to compose seemingly precise checklists of symptoms to define diagnoses. Notably in the checklist for ‘major depressive disorder’ there is no item that would require a psychiatrist to ask a patient ‘Why are you depressed?'”
“If you consider this abysmal reliability alongside the fact that no feature of the body has ever been shown to be awry in depression, that is no ‘chemical imbalance’ has ever been demonstrated even though people have been looking extremely hard for nearly a hundred years, how can a scientist set about determining whether the drug they are testing ‘cures depression’ when they have nearly no idea whether the people they are testing it on have ‘Major Depressive Disorder’ or whether that construct has any meaningful use in the first place?”
“It’s not clear to us exactly why ‘anti-depressants’ have so consistently been associated with an increase in suicidality. Some have proposed that it is to do with the common side-effect of severe restlessness, also known as ‘akathisia’, that – in combination with whatever got them prescribed the drug in the first place – drives people mad enough to kill themselves. I believe this is inflected by the fact that patients go to psychiatrists to have the singularity of their distress heard, understood and ministered to, and what they get instead is a mix of pharmaceutical salesmanship, cookie-cutter doctor-splaining about non-existent chemical imbalances, and a prescription for a useless chemical that demoralises them further. Patients are so saturated in advertising by ‘advocacy’ groups like Beyond Blue to the effect that only a doctor can help them that when they leave the doctor’s office with their hopes freshly dashed they are quite confused as to what has happened and promptly relocate the blame within themselves.”
“I would ask also: As a patient what is the use of having this or that diagnosis for whatever condition of sadness, distress, loneliness, loss, heart-ache, pain, weakness, guilt, demoralisation, degradation, destitution, unhappiness, balefulness, moodiness, irritation, frustration, powerlessness, imprisonment, hopelessness, or melancholy that you or a loved one is or was experiencing? Assimilating into the word ‘depression’ the infinity of ways the human being can find itself in darkness can only get in the way of understanding the unique experience of each new patient who deserves to be heard fully.”
“The so-called ‘anti-depressants’ should be re-classified as either poisons or research chemicals, and then people may do what they will with them, without believing them to be supported by medical science.”
COMMENTARY
Although Dr. Lieblich’s critique of psychiatry is precise, hard-hitting, and uncompromising, he closes his essay by pointing out that psychiatry has the potential to emancipate itself from its present indefensible position and to become a compassionate, listening profession.
In my view, however, this particular option was seriously compromised in the 1840s when Dorothea Dix’s “reforms” dehumanized and medicalized the American asylum system. It was revived briefly by Adolf Meyer in the 1940’s, but was finally killed off by Robert Spitzer’s DSM-III (1980) and Allen Frances’ DSM-IV (1987).
Nevertheless, Dr. Lieblich’s article is a superb and compelling summary of the case against psychiatry. The essay provides thirty-eight references for readers who want to pursue any of the topics in further detail. Definitely a must-read piece.