This year has been an especially nightmarish one for psychiatry defenders.
Receiving widespread attention in the mainstream media was the July 2022 article “The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence,” published in the journal Molecular Psychiatry. In it, Joanna Moncrieff, co-chairperson of the Critical Psychiatry Network, and her co-researchers examined hundreds of different types of studies that attempted to detect a relationship between depression and serotonin, and concluded that there is no evidence of a link between low levels of serotonin and depression, stating: “We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.”
Psychiatry apologists tried to convince the general public that Moncrieff’s findings were not newsworthy, as psychiatrist David Hellerstein, professor of clinical psychiatry at Columbia University Medical Center and director of Columbia’s Depression Evaluation Service, attempted to belittle Moncrieff in this manner: “Wow, next she’ll tackle the discrediting of the black bile theory of depression.” However, given the reality that the vast majority of society had heard nothing from psychiatry about the discarding of this serotonin theory of depression, what followed has been public mockery of psychiatry and its Big Pharma partners for their duplicity.
Then, in August of 2022, receiving less attention was an even more devastating blow to psychiatry, so damaging and so indefensible that psychiatry’s only response was to ignore it. Published in the journal Neuron, Raymond Dolan—considered one of the most influential neuroscientists in the world—co-authored “Functional Neuroimaging in Psychiatry and the Case for Failing Better,” concluding, “Despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition.”
Reflecting on the more than 16,000 neuroimaging articles published during the last 30 years, Dolan and his co-authors concluded: “It remains difficult to refute a critique that psychiatry’s most fundamental characteristic is its ignorance. . . . Casting a cold eye on the psychiatric neuroimaging literature invites a conclusion that despite 30 years of intense research and considerable technological advances, this enterprise has not delivered a neurobiological account (i.e., a mechanistic explanation) for any psychiatric disorder, nor has it provided a credible imaging-based biomarker of clinical utility.”
So in 2022, research reviews published in prestigious journals have made it clear that there is no neurobiological evidence—no chemical imbalance, no brain structure evidence—for any psychiatric condition.
But that’s not the end of psychiatry’s 2022 nightmare.
From one of the most prominent establishment psychiatrists in the world, we heard in 2022 that the DSM (psychiatry’s diagnostic manual, published by the American Psychiatric Association) lacks validity. Thomas Insel, when National Institute of Mental Health (NIMH) director in 2013, had quietly stated in his NIMH blog that the DSM’s diagnostic categories lack validity, and he announced that “NIMH will be re-orienting its research away from DSM categories”; then, in 2022, he informed the general public about DSM invalidity in his book Healing, which has received mainstream media attention. In this new book, Insel states: “The DSM had created a common language, but much of that language had not been validated by science.” In plain language, Insel is calling the DSM, in a scientific sense, bullshit.
In 2022, increasing numbers of Americans also heard about psychiatry’s abysmal treatment outcome record. Insel, as NIMH director in 2011, had quietly 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, the New York Times 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.” And in 2022, in Healing, Insel repeated to the general public what he had previously acknowledged about psychiatry’s history of abysmal outcomes, noting: “While we studied the risk factors for suicide, the death rate had climbed 33 percent” despite increased treatment, reporting that, “Since 2001, prescriptions for psychiatric medications have more than doubled, with one in six American adults on a psychiatric drug.”
Psychiatry’s Defense: “Don’t Throw Out the Baby with the Psychiatric Bathwater”
Earlier in 2022, responding to Robert Whitaker in a Mad in America dialogue, psychiatrist Jim Phelps, in his article “The Baby in the Psychiatric Bathwater,” stated the following: “Don’t throw out the baby with the psychiatric bathwater. Mr. Whitaker, I fear you’re doing harm while trying to do good.”
The idiom “Don’t throw out the baby with the bathwater” is an admonition against discarding something valuable along with something not wanted. However, the question for any critical thinker is—especially given what has been made public about psychiatry in 2022—what exactly is valuable about psychiatry?
A rational critical analysis of an institution—in contrast to a theological defense of it— would evaluate whether that institution is in fact valuable and can be reformed to be better. Such an analysis of a professed medical institution would evaluate whether (1) its fundamental paradigm and core tenets have scientific merit, and whether with reform in its practices, it can be improved, or (2) its fundamental paradigm and tenets are scientifically invalid, and thus, no matter how many of its practices are reformed, it will continue to do more harm than good.
Critical freethinkers—in contrast to theologians attached to their institution—would be open to all possible conclusions of this analysis, including (1) not discarding an entire institution because it is fundamentally sound and valuable, and needs only to improve its practices, or (2) discarding an entire institution because it is fundamentally invalid and unsound, as its core principles are unscientific and unjust.
In any given time in U.S. history, there have been institutions that have had a central role in U.S. society that were eventually—with great struggle—discarded, and which today most Americans are embarrassed ever existed. Thus, any critical freethinker who has knowledge of American history will be not be intimidated to consider the possibility that any current institution may need to be completely discarded. That is part of the essence of being a critical freethinker.
Perhaps the most obvious example in U.S. history of a dominant institution that was ultimately discarded—and which today most Americans are embarrassed by its past existence—is the institution of slavery.
I bring up the institution of slavery not to hyperbolically equate psychiatry with slavery—though there are certainly many Mad in America readers who have been involuntarily forced into ruinous psychiatric treatment, and who would not view such a reference as hyperbolic. However, for the majority of psychiatric patients, it is hyperbolic to equate psychiatry with slavery in terms of cruelty. I bring up slavery as a reminder of the historical reality of (1) the longtime existence in the United States of a shameful institution, and (2) that when it was being attacked by slavery abolitionists, slavery’s supporters used several defenses of it, including the “don’t throw out the baby with the bathwater” defense.
The various defenses of slavery included: how the abolition of slavery would destroy the Southern economy; how slavery has existed throughout history and thus is quite normal; that slavery is not viewed as immoral in the Bible; and that slavery is legal. Another major defense of slavery was that it was beneficial for slaves, and that it would be bad for slaves to throw out the baby with bathwater. Specifically, this argument went like this: If slaves were freed, there would be widespread unemployment and chaos, and that in comparison to workers in the Northern states, slaves were better cared for, especially when sick or aged. In 1837, as senator from South Carolina, John C. Calhoun (formerly a vice president of the United States) stated: “Never before has the black race of central Africa, from the dawn of history to the present day, attained a condition so civilized and so improved, not only physically, but morally and intellectually.”
Again, I review this history not to equate psychiatry with slavery in terms of cruelty but to remind readers that in U.S. history, (1) there have been institutions that have had a central role in society that were eventually—with great struggle—discarded, and which today are a source of embarrassment for most Americans; and that (2) among the many defenses of such now discarded shameful institutions, one defense was not to throw out the baby with bathwater.
Slavery is not the only such shameful institution in U.S. history. Another more recent example was the House Committee on Un-American Activities (dubbed the House Un-American Activities Committee or HUAC), which was an investigative committee of the U.S. House of Representatives created in 1938 to investigate the disloyalty and subversive activities of American citizens and institutions. After HUAC destroyed the careers of many Americans who had broken no laws but were targeted for their political beliefs, HUAC eventually came to be denounced even by former President Harry Truman in the late 1950s as the “most un-American thing in the country today.” HUAC changed its name to the House Committee on Internal Security, which itself was abolished in 1975.
Slavery and HUAC are by no means the only examples of powerful institutions in U.S. history that we are now ashamed to have allowed to exist. What slavery and HUAC have in common is that they were based on invalid paradigms. Slavery was based on the invalid paradigm of racial inferiority of African Americans, and HUAC was based on the invalid paradigm of what it meant to be “un-American.” If an institution’s essential paradigm is scientifically invalid and unjust, then all attempts at reform will be pointless. To put it idiomatically, “You can put lipstick on a pig, but it is still a pig.”
Is Psychiatry’s Self-Defense Hysterical?
While most of establishment psychiatry simply ignores critical freethinking about psychiatry, there are a handful of psychiatrists who respond to psychiatry critics, and I can only speculate as to why. Perhaps their role is to make psychiatry appear to be open to criticism while in reality imposing limits as to what is allowable criticism; or perhaps their role is to co-opt truly critically freethinking publications such as Mad in America. In any case, along with psychiatrist Jim Phelps, I would include in this group psychiatrists Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times, and Awais Aftab, who has an interview series in the Psychiatric Times.
In 2020, Pies told Aftab that he distinguishes between two quite different groups of critics. There are, he tells us, “sincere and well-intentioned critics of psychiatry—many of whom are psychiatrists—whose aim is to improve the profession’s concepts, methods, ethics, and treatments.” However, Pies then goes on to say that there are also critics whose “hostile and vituperative rhetoric is clearly aimed at discrediting psychiatry as a medical discipline.” For Pies, it is simply unallowable to question the legitimacy of the institution of psychiatry, and to do so is inexcusable.
Aftab, like Pies, makes clear that he believes there are critiques of psychiatry that are responsible and useful versus critiques that are irresponsible and dangerous. In August, Aftab tweeted, “Holy shit. . . Whitaker at Mad in America is calling for a class-action lawsuit against the American Psychiatric Association & scientific advisory boards of orgs such as NAMI, alleging that the infamous serotonin hypothesis paper reveals these entities engaged in ‘medical fraud.’” Earlier, in his July 2022 tweets, Aftab admonished, “Anyone not attuned to the emerging intersection of psychiatric critique & far-right politics is not paying attention. We’ve already seen previews of this relationship when it comes to gender critical ideology & anti-vaccine sentiment; it’s going to become more explicit with time”; and then offered this warning: “Those engaged in a Faustian bargain will realize too late, if they realize at all, what ugly forces they have unleashed.”
Phelps, Pies, and Aftab are open to criticism of psychiatry as long as it stops short of acknowledging the increasingly well-documented reality that psychiatry lacks any scientific merit, which logically results in the questioning of the legitimacy of psychiatry.
To be a critical freethinker, one need not conclude that psychiatry should be abolished. One need only be open to questioning psychiatry’s legitimacy, as a critical freethinker would be open to questioning the legitimacy of any institution.
A critical freethinker may even conclude that while there is no scientific merit to psychiatry, given the nature of modern society and psychiatry’s role in it, psychiatry’s abolition might result in an even more problematic institution taking psychiatry’s societal role of controlling inconvenient people and providing fictional explanations for unhappiness.
While being a critical freethinker does not necessarily mean coming to the conclusion that it would be a good idea for psychiatry to be abolished, it does mean being open to any and all facts, and being open to any and all logical conclusions from such facts. In their lack of openness, Phelps, Pies, and Aftab make clear that they are not critical freethinkers.
Webster’s Dictionary offers both a formal and informal definition of hysterical. The formal definition of hysterical is “feeling or showing extreme and unrestrained emotion.” The informal definition is “very funny.”
Maybe it’s just me, but with respect to both the formal and informal definition of hysterical, I find Hellerstein’s equating Moncrieff’s recent review to “the discrediting of the black bile theory,” Phelps’s “don’t throw out the baby with the psychiatric bathwater” defense, Pies’s good-and-evil categorization of psychiatry critics, and Aftab’s apocalyptic fear mongering of what will be unleashed by freethinking critics of psychiatry all to be . . . hysterical.