Marx, Spinoza, and the Political Implications of Contemporary Psychiatry

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July 7, 2022
Marx, Spinoza, and the Political Implications of Contemporary Psychiatry

Spinoza and the Rabbis by Samuel Hirszenberg (1907) – Public Domain

Simple logic tells us that those atop a societal hierarchy will provide rewards for professionals—be they clergy or psychiatrists—who promote an ideology that maintains the status quo, and that the ruling class will do everything possible to manipulate the public to believe that the social-economic-political status quo is natural.

If a population believes that its financial and emotional suffering are caused not by social-economic-political variables but instead by individual defects—be it noncompliance with religious dogma or faulty biochemistry—this “individual-defect” belief system can be a more powerful and less expensive way of maintaining the status quo than a heavily armed police force.

That organized religion has a great deal in common with organized psychiatry would be apparent to both Karl Marx (1818-1883) and Baruch Spinoza (1632-1677), two of history’s most famous critics of the political implications of organized religion.

Karl Marx, in A Contribution to the Critique of Hegel’s Philosophy of Right (1843), famously said: “Religion is the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions. It is the opium of the people. The abolition of religion as the illusory happiness of the people is the demand for their real happiness. To call on them to give up their illusions about their condition is to call on them to give up a condition that requires illusions.”

Baruch Spinoza, in his Theological-Political Treatise (1670), somewhat less famously but perhaps more courageously given his era, said: “Granted, then, that the supreme mystery of despotism, its prop and stay, is to keep men in a state of deception, and with the specious title of religion to cloak the fear by which they must be held in check, so that they will fight for their servitude as if for salvation.”

Today, a handful of professors teach their students about Antonio Gramsci (1891-1937) and cultural hegemony, however, a century ago, the working class did not need scholars to explain to them how prevailing cultural beliefs are often social constructs implemented by the ruling class through favored institutions so as to maintain domination. Back then, workers immediately got IWW activist Joe Hill’s (1879-1915) song “The Preacher and the Slave” (1911) about how preachers from the “starvation army” attempt to get them to buy the lie: “Work and pray, live on hay. You’ll get pie in the sky when you die.”

If alive today, Hill may well write something along the lines of: “Alienate . . . Medicate. You’ll get pie in the sky with your SSRI.”

A generation ago, the political implications of biological individual-defect theories were obvious to many prominent scientists with a left perspective, for example, 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, Lewontin, Rose, and Kamin make clear the rightwing 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.’”

Marx and Spinoza highly valued science, but it would be obvious to them that simply calling oneself scientific does not make one so.

Should psychiatry be seen as a science? Or should it be seen—no different than organized religion— as simply a belief system with its own social constructs that are promoted by the ruling class to convince people that their suffering is due to individual defects, rather than a defective social-economic-political system that results in alienation from one’s own humanity, from others, and from the rest of the natural world?

The Scientific Failure of Contemporary Psychiatry

Within the highest levels of establishment psychiatry, there are today three acknowledged areas of scientific failure that contradict the myth of psychiatry’s scientific progress: (1) the jettisoning of psychiatry’s chemical imbalance theory of mental illness; (2) worsening treatment outcomes despite increased treatment; and (3) the scientific invalidity of its diagnostic system.

First, the jettisoning of psychiatry’s chemical imbalance theory of mental illness. Crucial to psychiatry’s value to the ruling class is some kind of “individual-defect theory of mental illness.” Much of the public and even many doctors remain unaware that researchers had disproven psychiatry’s chemical imbalance theory of mental illness by the 1990s, and that more recently, even establishment psychiatry has publicly acknowledged this theory’s invalidity.

In 1998, in Blaming the Brain, Elliot Valenstein, professor emeritus of psychology and neuroscience at the University of Michigan, 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, and he concluded, “Furthermore, there is no convincing evidence that depressed people have a serotonin or norepinephrine deficiency.”

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.” Thomas Insel, National Institute of Mental Health (NIMH) director from 2002-2015, recently acknowledged the jettisoning of the chemical imbalance theory in his 2022 book Healing, 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 individual-defect theory as there was for the now discarded chemical imbalance theory. Spinoza knew, 350 years ago, that the new and not yet unproven is useful in keeping the public hoodwinked, as he remarked: “Indeed, as the multitude remains ever at the same level of wretchedness, so it is never long contented, and is best pleased only with what is new and has not yet proved delusory.”

Second, worsening treatment outcomes despite increased treatment.

Insel, as NIMH director in 2011, 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” (reported by Gary Greenberg in The Book of Woe, 2013).

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.”

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.”

Third, scientific invalidity of psychiatry’s diagnostic system.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA), the guild of American psychiatrists, and it is routinely referred to as the “bible of psychiatry.” In 2010, the chair of DSM-IV task force, Allen Frances, candidly acknowledged that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” In 2013, the same year that the newly revised DSM-5 (foregoing Roman numerals) was published, Insel, as NIMH director, stated that the DSM’s diagnostic categories lack validity and announced that “NIMH will be re-orienting its research away from DSM categories.” Frances was so appalled and embarrassed by the APA’s DSM-5 revision that he published Saving Normal: An Insider’s Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (2013).

Not only is there a growing consensus among establishment psychiatry that DSM disorders are scientifically invalid, DSM diagnoses cannot be reliably assessed. To assess the reliability of the current DSM-5, the APA conducted field trials assessing 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, and a kappa of 1.00 means perfect reliability). A previous DSM task force chair, Robert Spitzer, had stated that with respect to assessing the reliability of the DSM that a kappa of less than .40 indicates “poor” agreement and .70 was “only satisfactory.” For the DSM-5 field trials, here 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 a construct lacks validity and cannot be reliably measured, it has no scientific value, and so research that attempts to associate such constructs with biochemical-genetic variables is simply “garbage in, garbage out” research.

What Would Spinoza Think of the Political Implications of Psychiatry?

There have been many efforts at applying a Marxist analysis to psychiatry, most recently by psychiatrist Joanna Moncrieff, co-chair off the Critical Psychiatry Network, who references several such Marxist analyses in her 2022 “The Political Economy of the Mental Health System: A Marxist Analysis.” Moncrieff concludes, “The concept of mental illness has a strategic role in modern societies, therefore, enabling certain contentious social activities by obscuring their political nature, and diverting attention from the failings of the underlying economic system.”

In contrast to Marxist analyses of psychiatry, Spinozist analyses of psychiatry are uncommon. I believe that Spinoza would see both the overt and insidious political implications of contemporary psychiatry.

The overt institutional corruption of psychiatry would be immediately obvious to Spinoza. Observing the financial relationships between drug companies and psychiatry, Spinoza or any critical thinker would not take seriously psychiatry’s proclamations (or those of any institution that has a blatant disregard with respect to conflicts of interest that compromise and corrupt science).

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. One of many psychiatrists exposed by these Congressional hearings was Harvard psychiatrist Joseph Biederman, Director of the Johnson & Johnson Center for Pediatric Psychopathology Research at Massachusetts General Hospital. Biederman is credited with creating pediatric bipolar disorder, and due in great part to his influence, the number of American children and adolescents treated for bipolar disorder increased forty-fold from 1994 to 2003. Congressional investigations revealed that Biederman had received $1.6 million in consulting fees from drug makers from 2000 to 2007.

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, 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.” 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.”

Spinoza was scrupulous about not allowing any financial conflicts of interest to interfere with his free thought and expression. In one of many examples of how he conducted his life, in 1673, Spinoza’s fame overseas garnered him an offer for a prestigious job, as he received a flattering letter from a professor at the University of Heidelberg inviting him to be a professor there; however, he turned it down, one major reason being a stipulation that could compromise his freedom of thought. Spinoza knew that it is difficult enough without conflicts of interest to discover truths; and so he would likely conclude that only the naïve and delusional would trust researchers and doctors who are financially dependent on giant pharmaceutical corporations.

More insidiously, Spinoza would see, as would Marx, Gramsci, and other critical thinkers, how organized psychiatry—similar to organized religion—serves the ruling class by having a population focus on their individual defects rather than societal ones. It would be clear to Spinoza, as a keen analyst of the political implications for belief systems, that a focus on biochemical individual defects rather than socioeconomic variables is a political win for the following factions: (1) pharmaceutical companies; (2) drug prescribers; (3) mental illness institutions whose survival is tied to biochemical causality; and (4) those atop the societal hierarchy who prefer social and economic causes for emotional difficulties and behavior disturbances be unexamined.

Moreover, given what Spinoza’s Theological-Political Treatise reveals about his thinking, it is likely that Spinoza would see another political implication of psychiatry. Spinoza cared deeply about freedom of thought and expression, and his major motivation for writing that treatise was his concern that clergy’s power over civil society threatened these freedoms; and his radical solution was to strip clergy of political power over civil society. In order to delegitimize the authority of clergy, Spinoza demonstrated that the Bible was not sacred, not revealed by God, and that instead it had numerous human authors over many years. For Spinoza, the Bible is simply a work of literature, a “faulty, mutilated, adulterated, and inconsistent” work. Spinoza knew that if the Bible is seen as God’s word, and if clergy authorities are seen as superior to others in the Bible’s interpretation, then they can exercise control over others.

Spinoza would be interested in the DSM—ironically called the “bible of psychiatry”—because of its political implications. He would see how the DSM, similar to the Bible, provides power for one group of people over others. Spinoza was troubled by how the false idea that the Bible is the word of God provides power for its professional interpreters, and he would likely be troubled by how the false idea that the DSM is scientific provides power for its professional interpreters.

Just as Spinoza saw how clergy derive their authority by positioning themselves to be the interpreters of a pseudosacred Bible, he would see how psychiatrists derive their authority by positioning themselves as the interpreters of a pseudoscientific DSM. And so, just as it was necessary for him to critique the Bible, Spinoza would see it necessary to critique the DSM. Spinoza would recognize that DSM criticism is not simply scientifically important but politically necessary.

If Marx and Spinoza were alive today, it is likely they would consider the following political questions about psychiatry: (1) Is psychiatry a science based on valid and reliable empirical evidence, or is it a religion with political implications? (2) Are psychiatrists and other mental health professionals being used by societal rulers to compel individuals to adjust to a society that is unjust and dehumanizing? (3) Are biological individual-defect theories of mental illness diverting attention from societal ills that cause emotional suffering? (4) Has the ruling class’s reward of status and authority to psychiatrists and other mental health professionals undermined mutual aid, which may well be far more helpful for emotionally suffering people?

Asking these questions today makes one a heretic, but Marx and Spinoza would be unintimidated by the prospect of such a diagnosis.

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

https://www.counterpunch.org/2022/07...ry-psychiatry/

[JamesBond007]

what liberal admonishers of left psychiatry critics get wrong

By Bruce Levine

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 DSM’s 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

https://www.counterpunch.org/2022/09...ics-get-wrong/

[Tongio]

I liked that part:

If a population believes that its financial and emotional suffering are caused not by social-economic-political variables but instead by individual defects.This “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 most violent of the violences , as it is the most effecive.
Chronic depression can be a result of chemical imbalance, but not one to be medicated (with lithium ,lol) , rather, one to be stoped thru the anihilation of its root causes.By having friends, sun exposure , good diet, sleeping well, contact with nature and manual work, everything "academics" keep pretending is meaningless.

[JamesBond007]

I liked that part:

The most violent of the violences , as it is the most effecive.
Chronic depression can be a result of chemical imbalance, but not one to be medicated (with lithium ,lol) , rather, one to be stoped thru the anihilation of its root causes.By having friends, sun exposure , good diet, sleeping well, contact with nature and manual work, everything "academics" keep pretending is meaningless.

You sound like your IQ is 90 are best. Ronald Pies and Thomas Insel et. al. have admitted the chemical imbalance theory to be false. Who the fuck are you to come a long and say it is valid ? I don't have any formal degrees in psychiatry or psychology but at least I have read a shit ton books on the subject unlike Joe SixPack.

[Hexachordia]

I chew on the pork/chicken bones when I can, tired of being a good old weakling. Reason is not for talking about garbages, rather to differetiate: garbages to the rollers, grace to the graces. You gotta simplify the cause for some practical exercises.

[Tongio]

You sound like your IQ is 90 are best.

You seem to be realy inseccure about your own inteligence given that every dialogue i try to start with you (as you actualy bring up intersting
topics) you just project your insecurities on me, obsessivly repeating about how low i score in your amateur iq avaluation.
Just prepare yourself for your next iq test so you can score higher and thus "grow smarter".

Ronald Pies and Thomas Insel et. al. have admitted the chemical imbalance theory to be false.

Yes my bad using the same misleading term as them.The limitations of language realy can cause confusion here, probably on purpose.
A fact is lack of good habits or presence of too many bad ones, realy puts you in a poor mental state, no need of literature to back this easily observable relation.
Just keep locked in your apartment for a month,sleeping 4 hours a night and living of donuts and computer light, then tell me how good and energetic you feel after it.
Also i thought here, for Chemical imbalance theory to be true or false first relies on the premisse of these mental illnesses being a thing.Do they even exist in the way psychiatrists put out?