Why Failed Psychiatry Lives On

American madness. Image: JSC and AI Art Generator.

How can psychiatry maintain its authority and influence despite its repeated scientific failures and lack of progress—now even acknowledged by key members of the psychiatric establishment and the mainstream media?

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 Healingstating: “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 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 meet 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 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-volume 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, that 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 through 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 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.

This essay originally appeared in Mad in America.

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