What Liberal Admonishers of Left Psychiatry Critics Get Wrong

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While it is unsurprising that mainstream publications mischaracterize Left critics of psychiatry, it is a touch disappointing to see Jacobin accepting the mainstream liberal narrative that goes like this: If one cares about alleviating emotional suffering, one must defend psychiatry.

Earlier in 2022, in the Jacobin piece “What the Anti-Psychiatry Movement Got Wrong About Mental Illness, Madeleine Ritts begins by telling us, “The anti-psychiatry movement advanced a radical critique of the role that capitalism and power play in the medical profession. Its motives were noble, but it ended up closing the door to understanding, and properly treating, psychological suffering.”

“On the Left,” Ritts tells us, “common criticisms seek to explain how psychiatry can inadvertently medicalize injustice.” While Ritts is correct that this is a common criticism, it is by no means the only criticism, and for most Left critics, it is not even the most heartfelt one.

The primary reason why there are today so many Left-identified ex-psychiatric patients and practitioners such as myself—along with research scientists and investigative journalists—who are critical of the institution of psychiatry is that psychiatry has done an increasingly lousy job in helping people.

While many Left critics of psychiatry see merit in the analyses of Marx, Fromm, and Foucault, it is not any Left political-philosophical analysis that has energized most of us to become critics and activists. Instead, we have been energized by our  personal experiences along with the empirical research—both of which have informed us that psychiatry’s diagnoses and treatments routinely do more harm than good, and that psychiatry’s “disease like any other” anti-stigma campaign has essentially been a pro-stigma campaign (more later on this research).

It is simply untrue, as Ritts implies, that Left critics of psychiatry are disconnected from the “on-the-ground” reality that she and “boots-on-the-ground mental health workers, or anyone who’s ever experienced or observed someone struggle with debilitatingly obsessive behavior, incomprehensibly horrific visual and auditory disturbances, or radically out-of-character and dangerous decisions in the throes of a manic state.”

I know of no Left critic of psychiatry who has not had first-hand experience of severe emotional suffering and behavioral disturbances, and I know no Left critic who minimizes such suffering and disturbances. The overwhelming majority of Left critics of psychiatry are not ivory-tower academics, nor are they practitioners such as Ritts and myself; they are ex-psychiatric patients, some calling themselves “psychiatric survivors,” many of whom have had years and even decades of their lives made miserable by their psychiatric treatments.

Ritts implies that Left critics’ attachment to a “socialist critique of capitalist society” has subverted the “scientific attempt to remedy unnecessary misery.” The reality is that every Left critic of psychiatry I know is deeply committed to science, and one of our major criticisms is the lack of science behind psychiatry’s proclamations—which has only worsened with drug companies’ corruption of the profession.

While Ritts acknowledges psychiatry’s “high-profile scandals, failed reforms, grand pronouncements, and public defeats,” she provides us with the rationalizations for these failures offered by psychiatry and mainstream media—as “all stages along the familiar scientific path of incremental progress.” The reality is that research reveals an unscientific path of incremental worsening.

Worsening Outcomes with Increased Treatment

In A Profession Without Reason: The Crisis of Contemporary Psychiatry—Untangled and Solved by Spinoza, Freethinking, and Radical Enlightenment (2022), I detail how today even leading figures in establishment psychiatry acknowledge psychiatry’s failure with respect to treatment outcomes, and how even the mainstream media now reports that outcomes have worsened despite increased treatment.

In 2011, Thomas Insel, director of the National Institute of Mental Health (NIMH) from 2002-2015, 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, 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 his 2022 book Healing, former NIMH director Insel, notes: “While we studied the risk factors for suicide, the death rate had climbed 33 percent.” 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.”

Unacknowledged by Insel and the rest of establishment psychiatry is the growing empirical evidence that psychiatric treatments—which are predominantly drugs—may chill out some people in the short term but have made things worse for many people in the long term.

In Anatomy of an Epidemic (2010), journalist Robert Whitaker (whose co-written series for the Boston Globe on the abuse of mental patients in research settings was named as a finalist for the Pulitzer Prize in 1998) brought attention to several studies showing that antipsychotic drug treatment may well be the source of chronic difficulties, and that the huge increase in Americans diagnosed with serious mental illnesses is in large part due to the adverse effects of psychiatric drugs, which can transform episodic conditions into chronic ones.

In an NIMH-funded study, Martin Harrow and Thomas Jobe followed the long-term outcomes of patients diagnosed with schizophrenia. They 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 and Jobe continued to follow up these individuals, and at twenty years, they 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 another study, 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.

Psychiatry’s Pro-Stigma “Mental Illness” Campaign

Ritts mischaracterizes criticism of the “mental illness” construct. When critics challenge the “mental illness” conceptualization, we are in no way denying the existence of severe emotional suffering and behavioral disturbances. Criticism of the concept of “mental illness” has to do with (1) how this “illness” or “disease” conceptualization actually increases stigma, and (2) how it legitimizes psychiatrists to be societal authorities in charge of reducing emotional suffering and behavioral disturbances when they have had a history of failure.

Among both psychiatry apologists and its critics, there is agreement that those who have been diagnosed with serious mental illness such as schizophrenia are stigmatized by society—viewed in a variety of unfavorable ways, including being seen as unpredictable and dangerous, resulting in difficulties finding housing and gaining employment.

The rationale behind establishment psychiatry’s anti-stigma campaign of “an illness like any other” is that since people with medical diseases such as diabetes are not routinely stigmatized, then if there is parity for mental illness with physical illness, the stigmatization of the mentally ill would be reduced. However, the empirical research rejects this belief.

Researchers have focused on the following questions: Does such mental illness labeling increase or decrease stigma? Has viewing individuals with severe emotional suffering and behavioral disturbances as brain disease victims created more or less stigmatization, or would they be less stigmatized if their conditions were seen as having different causes? Does viewing people as “ill” or “diseased” increase or decrease stigma compared to viewing them as “in crisis” or “experiencing extreme states”?

In “Myth: Reframing Mental Illness as a ‘Brain Disease’ Reduces Stigma,” the Canadian Health Services Research Foundation (CHSRF) reported in 2012: “Despite good intentions, 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.” The CHSRF concludes, “Biological explanations can also instill an ‘us vs. them’ attitude, defining individuals with mental illness as fundamentally different.”

In 2006, Acta Psychiatrica Scandinavica published “Prejudice and Schizophrenia: A Review of the ‘Mental Illness is an Illness Like Any Other’ Approach,” lead authored by psychologist John Read. The review examined several studies that looked at whether labeling someone with “schizophrenia” rather than describing them as “in crisis” was associated with more or less negative attitudes. These studies conclude that labeling behaviors as “schizophrenia” increases the belief in biological causality and increases the perceived seriousness of the person’s difficulties, which produces a more pessimistic view about recovery. If a person is seen as having the serious mental illness of schizophrenia, the public more desires to keep their distance from them rather than if the person is seen as “in crisis.”

A critical question with regard to establishment psychiatry’s anti-stigma efforts is whether or not biological causal beliefs are associated with more or less negative attitudes. Read examined twenty-one studies, and he summarizes the findings: “From 1970, studies in several industrialized countries have found that biogenetic causal beliefs are related to negative attitudes. This has been demonstrated among patients and professionals as well as general populations. Biogenetic beliefs are related to perceptions of dangerousness and unpredictability, to fear, and to desire for social distance.” The research clearly shows that the brain disease conceptualization and the “an illness like any other” anti-stigma campaign have resulted in greater stigmatization.

Researcher Shelia Mehta examined how our beliefs about the cause of mental disturbances translate into behaviors. In Mehta’s 1997 study, “Is Being ‘Sick’ Really Better? Effect of the Disease View of Mental Disorder on Stigma,” she found that the biochemical disease belief can result in less blame but provokes crueler behavior from other people. Mehta concludes, “Biochemical aberrations make them almost a different species.”

Through the early 1970s, psychiatry believed that terming homosexuality an illness to be treated rather than a sin to be punished would increase tolerance for homosexuals. However, gay activists did not view “illness” as an upgrade over “sin,” and they fought to abolish homosexuality from psychiatry’s diagnostic bible, the DSM, succeeding in 1973. History makes clear that what has majorly reduced stigmatization of homosexual thoughts and behaviors is society viewing these as normal human variations, not as illness.

While psychiatry, not that long ago, was certain that homosexual thoughts and behaviors were symptoms of mental illness, today psychiatry claims that hearing voices is a symptom of the serious mental illness called schizophrenia. The idea that voice hearing is not a symptom of illness but a meaningful experience, while rejected by establishment psychiatry, is accepted by millions of people, as evidence by the reception to the 2013 TED talk, “The Voices in My Head,” presented by Eleanor Longden (named by the Guardian as one of “The 20 Online Talks That Can Change Your Life”).

Longden tells us that after making the mistake of telling others about her voice hearing, “A hospital admission followed, the first of many, a diagnosis of schizophrenia came next, and then, worst of all, a toxic, tormenting sense of hopelessness, humiliation and despair about myself and my prospects.” She recounts how a psychiatrist told her, “Eleanor, you’d be better off with cancer, because cancer is easier to cure than schizophrenia.” At her lowest point, she reports, “I’d been diagnosed, drugged and discarded, and was by now so tormented by the voices that I attempted to drill a hole in my head in order to get them out.” Ultimately, she rejected standard treatment and came to believe “that my voices were a meaningful response to traumatic life events, particularly childhood events, and as such were not my enemies but a source of insight into solvable emotional problems.” Today, Eleanor Longden is a psychologist, and active in the Hearing Voices Movement, which aims to destigmatize by normalizing voice hearing.

The “mental illness” construct is also problematic for many critics of psychiatry for another reason. If society accepts the idea that individuals with severe emotional difficulties and behavioral disturbances are suffering illnesses and diseases, then this results in medical doctors such as psychiatrists being the societal authorities in charge of reducing emotional suffering and behavioral disturbances; however, as noted, the research has shown that psychiatrists have, for the most part, done a lousy job.

By “demedicalizing” emotional suffering and behavioral disturbances—and terming these instead as either “problems in living,” “emotional crises,” “altered states” or with some other non-medical language—the idea is (1) this will reduce stigma, (2) that psychiatrists will lose their unearned authority and treatment power,  and (3) instead, individualswho themselves have recovered from these experiences will gain authority and power—and not simply be, as they are now, “peer” handmaids at the bottom of the mental healthcare hierarchy.

Psychiatry’s Crisis of Legitimacy

While it is correct that one criticism by Left critics is that psychiatry can medicalize injustice, in A Profession Without Reason, only one of my 18 chapters includes a discussion of how psychiatry diverts Western societies from the alienation and dehumanization caused by neoliberal capitalism. The remaining 17 chapters are devoted to other aspects of the crisis of contemporary psychiatry.

Two components of the crisis that I’ve already mentioned are: (1) worsening treatment outcomes despite increased treatment; and (2) how psychiatry’s anti-stigma campaign has created more stigma and intolerance. However, there are many other elements to psychiatry’s crisis of legitimacy—two of these acknowledged by members of the psychiatry establishment: (1) the invalidity of psychiatry’s diagnostic manual, the DSM; and (2) the invalidity of psychiatry’s theory of the cause of mental illness, the so-called “chemical imbalance theory.”

Even key members of establishment psychiatry now acknowledge that the DSM, published by the American Psychiatric Association, lacks validity. Thomas Insel, when NIMH director in 2013, stated that the DSMs diagnostic categories lack validity, and he announced that “NIMH will be re-orienting its research away from DSM categories.” In 2010, the chair of the 1994 DSM-IV task force, Allen Frances, acknowledged that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” Insel, in his 2022 book Healing, stated: “The DSM had created a common language, but much of that language had not been validated by science”—essentially calling the DSM, in a scientific sense, bullshit.

The invalidity of psychiatry’s chemical imbalance theory of mental illness has increasingly been acknowledged by establishment psychiatry.  In 2011, 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.

This unscientific proclamation of a chemical imbalance theory, which continues to have widespread belief, propelled the explosion of selective serotonin reuptake inhibitor (SSRI) drugs such as Prozac, Paxil, Zoloft. Prior to the public’s acceptance of the chemical imbalance cause of depression, many people were reluctant to take antidepressants—or to give them to their children. But the idea that depression is caused by a chemical imbalance that can be corrected with Prozac, Paxil, Zoloft or some other SSRI sounded similar to taking insulin for diabetes—a common analogy used by prescribing physicians to encourage SSRI use. So, as I document in A Profession Without Reason, the use of antidepressants skyrocketed following the entry of SSRIs into the marketplace in the late 1980s, with the rate of antidepressant use in the United States increasing nearly 400 percent between 1988 and 2008.

Today, psychiatry defends its fictions told to patients about the chemical imbalance theory and how antidepressants work. Psychiatrist Daniel Carlat stated about antidepressants on NPR in 2022: “Doctors don’t know exactly how they work. 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.” Leaving aside the issue of the morality behind doctors offering fictitious explanations, can such an explanation even be considered a “noble lie” or a “white lie” if antidepressants are counterproductive in the long term?

In 2017, researcher 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.

Unacknowledged by establishment psychiatry, but reported even in the mainstream media, is Big Pharma’s corruption of psychiatric research and treatment. Financial relationships between drug companies and psychiatry institutions have—similar to other US industrial complexes—increasingly become normalized. Owing to 2008 Congressional hearings on psychiatry’s financial relationship with drug companies, psychiatry’s flagrant conflicts of interest received widespread public attention. Federal legislation was enacted in 2013 that required pharmaceutical companies to disclose their direct payments to physicians, resulting in the creation of an Open Payments database. However, psychiatrists, similar to most US politicians, are not concerned that the transparency of their conflicts of interest will harm their careers. In 2021, utilizing this database, 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.” Open Payments lists 31,784 psychiatrists (roughly 75 percent of the psychiatrists in the United States) who, Whitaker noted, “received something of value from the drug companies from 2014 through 2020.”

In A Profession Without Reason, I also discuss how psychiatry’s “caring coercion” policies of involuntary treatment routinely results in resentment and sometimes even rage, and I document the lack of science behind several other proclamations of psychiatry, including its brain disease and genetic claims.

Is Psychiatry a Scientific or a Religious-Political Institution?

While psychiatry’s explanatory fictions have no place in science, they do have a place in religion. Philosopher and Spinoza scholar Beth Lord explains, “The aim of science, philosophy, and reason is to get at the truth. . . . 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.” For Spinoza, Lord continues, “The role of religion is really in controlling and . . . helping to manage people’s feelings and images when they’re in this irrational state.” Spinoza was not opposed to religion, but he was very much opposed to confusing religion with science—and that is the position of most Left critics with respect to psychiatry.

The current empirical research shows that psychiatry—at least as scientific institution—is a failure, and that it can more accurately be described as a religious-political institution. As is the case with other religious-political institutions, including the monarchies and churches of Spinoza’s seventeenth century era, there are individuals who benefit from such institutions, and there are individuals who suffer from them.

The institution of psychiatry is obviously good for psychiatrists and drug companies. It is also a good deal for those at the top of society who would rather people see their depression, anxiety, substance abuse, and other struggles as caused by their individual biological defects rather than resulting from social-economic-political sources. And it is good for some psychiatric patients who believe that their psychiatric drugs have helped them function—this is why no Left critic of psychiatry I know is in favor of the abolition of psychiatric drugs.

However, the empirical research and the experience of Left critics of psychiatry inform us that psychiatry has been either nonproductive or horribly counterproductive for the majority of its patients. This is why Left critics of psychiatry believe that individuals should no longer be shamed, manipulated, and coerced into accepting a failed paradigm.

Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics, and psychology intersect. His most recent book is A Profession Without Reason: The Crisis of Contemporary Psychiatry—Untangled and Solved by Spinoza, Freethinking, and Radical Enlightenment (2022). His Web site is brucelevine.net