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DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice

The views expressed are those of the author and are not necessarily those of Scientific American.


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Like many psychiatrists, I have been amazed by the debates surrounding the DSM-5, the first major revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in nearly twenty years, which was just released. Never before has a thick medical text of diagnostic nomenclature been the subject of so much attention.

Although I was heartened to see more and more people discussing the real-world issues and challenges—for patients, families, clinicians and caregivers–within mental health care, for which the book offers an up-to-the-minute diagnostic GPS, I was also alarmed at the harsh criticism of the field of psychiatry and the APA. Consequently, I believe that as you read and watch this increased coverage, it’s important to understand the difference between thoughtful, legitimate debate, and the inevitable outcry from a small group of critics –made louder by social media and support from dubious sources —who have relentlessly sought to undermine the credibility of psychiatric medicine and question the validity of mental illness..

DSM-5 has ignited a broad dialogue on mental illness and opened up a conversation about the state of psychiatry and mental healthcare in this country. Critiques have ranged in focus from the inclusion of specific disorders in DSM-5, to the concern over a lack of biological measures which define them. Some have even questioned the entire diagnostic system, urging us to look with an eye focused on the impact to patients. These are the kinds of debate that I hope will continue long after DSM-5’s shiny cover becomes warn and wrinkled. Such meaningful discourse only fuels our ability to produce a manual that best serves those touched by mental illness.

But there’s another type of critique that does not contribute to this goal. These are the groups who are actually proud to identify themselves as “anti-psychiatry.”

These are real people who don’t want to improve mental healthcare, unlike the dozens of psychiatrists, psychologists, social workers and patient advocates who have labored for years to revise the DSM, rigorously and responsibly. Instead, they are against the diagnosis and treatment of mental illnesses—which improves, and in some cases saves, millions of lives every year—and “against” the very idea of psychiatry, and its practices of psychotherapy and psychopharmacology. They are, to my mind, misguided and misleading ideologues and self-promoters who are spreading scientific anarchy.

Being “against” psychiatry strikes me as no different than being “against” cardiology or orthopedics or gynecology—which most people, I think, would find absurd. No other medical specialty is targeted by such an “anti” movement.

This relatively small “anti-psychiatry” movement fuels the much larger segment of the world that is prejudiced against people with disorders of the brain and mind and the professions that treat them. Like most prejudice, this one is largely based on ignorance or fear–no different than racism, or society’s initial reactions to illnesses from leprosy to AIDS. And many people made uncomfortable by mental illness and psychiatry, don’t recognize their feelings as prejudice. But that is what they are.

We have, as a nation, aggressively taken on racism, sexism, homophobia and other prejudices. Perhaps the occasion of this new DSM revision (and in the aftermath of the passage of the Mental Health and Addiction Parity Act) is the right time to grapple with the prejudice against mental illness and its caretakers—which every day makes it a little harder for people suffering from mental illnesses to live their lives, and makes it harder for those of us who treat mental illnesses to do our jobs.

I do understand how anti-psychiatry ideas first developed and why they have been so difficult to combat. There is historical fear of mental illness, stemming from when these diseases were viewed first as demonic possessions and later as character or moral defects, before we had any scientific understanding for the biological basis of, say, schizophrenia, bipolar disorder, autism or Alzheimer’s disease. The brain is a complex organ, slow to reveal its secrets, and the effort to understand its myriad functions goes to the core of each individual’s self-identity. Patients are challenged by the intimate aspects of their relationship with any doctor—a caregiver for whom you have to disrobe, and who pokes and pries. But in psychiatric treatment you “disrobe” in an even more profound way, revealing yourself psychologically.

And I do not overlook the checkered history of psychiatry itself. It’s a relatively new discipline which branched from neurology in the 19th century, whose early practitioners were alienists and analysts, superintendents of asylums and Freudian therapists. But, at the time, asylums were little more than humane warehouses, and Freudian theory turned out to be a brilliant fiction about personality and behavior. When psychiatry did make its first forays into medical treatment, it used crude instruments like strait jackets, cold packs, fever induction, insulin shock therapy and psycho-surgery. The underlying theories for the causes of these illnesses at the time were also wrong; it was largely about blaming the parents.

However, that was then and now is now. The scientific foundation of psychiatric medicine has grown by leaps and bounds in the last fifty years. The emergence of psychopharmacology, neuroimaging, molecular genetics and biology, and the disciplines of neuroscience and cognitive psychology have launched our field into the mainstream of medicine and on a course for future growth and success. Though not everyone, including ourselves, is satisfied with the rate of our field’s progress, no one can argue with one simple fact; if you or a loved one suffers from a mental illness, your ability to receive effective treatment, recover and lead a productive life is better now than ever in human history. Moreover, we have every reason to believe that there will continue to be unprecedented scientific progress, which will enhance our clinical capacity and benefit our patients.

For this reason, I am especially shocked when other clinicians—psychologists, social workers, even, in some cases, primary care docs who would rather just dispense psychiatric meds themselves—side with anti-psychiatry forces without realizing these people are “against” them, too. These strange anti-mental health bedfellows include a series of contemporary psychiatrists and psychologists who have fashioned platforms for self-promotion from their critical positions on psychiatry and DSM-5.

But, when it comes to medical illness, the “enemy of your enemy” is not always your friend.

For all the overt anti-psychiatry we see out there, I’m also concerned about the more subtle forms of prejudice among less radicalized segments of our society.

Only recently, I was at a meeting of medical school leadership at my university, where we discussed how to counsel medical students about choosing which specialty to pursue. One senior faculty member quipped “tell all students who get low scores on their board exams not to worry, they just need to change their career plans and go into psychiatry.”

A few months later, the same faculty member called me late one night, asking if I would see his wife, who was having a “psychiatric problem.”

The urgency of his request belied any awareness that the joke he made at psychiatry’s expense in that meeting undermined our ability to deliver the kind of quality care that his wife now needed. But it can, and it does.

Image: American Psychiatric Association

Jeffrey A. Lieberman About the Author: Jeffrey A. Lieberman, MD, is the Lawrence C. Kolb Professor and Chairman, Department of Psychiatry, Columbia University College of Physicians and Surgeons; Director, New York State Psychiatric Institute; and Psychiatrist-in-Chief, Columbia University Medical Center of the NewYork-Presbyterian Hospital. Dr. Lieberman’s work has advanced the understanding of the natural history and pathophysiology of schizophrenia and the pharmacology and clinical effectiveness of antipsychotic drugs. He is the recipient of many national and international honors and awards, including the Lieber Prize for Schizophrenia Research from the National Association for Research in Schizophrenia and Affective Disorders, the Adolph Meyer Award from the American Psychiatric Association, the Research Award from the National Alliance on Mental Illness, and the Neuroscience Award from the International College of Neuropsychopharmacology. He is a member of numerous scientific organizations, including the National Academy of Sciences Institute of Medicine. He has authored more than 500 papers and articles published in the scientific literature and written and/or edited ten books on mental illness, psychopharmacology and psychiatry. In May 2012, Dr. Lieberman was installed as President-elect of the American Psychiatric Association (APA); he will serve as APA President from May 2013 to May 2014. Follow on Twitter @drjlieberman.

The views expressed are those of the author and are not necessarily those of Scientific American.






Comments 47 Comments

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  1. 1. Rocza 11:20 am 05/20/2013

    Disappointing to see SciAm Mind posting this, after the very excellent and precise take-down, by Judy Stone, of psychiatry and the actions of the community that causes the mistrust of the field. It’s NOT about a fear of mental illness or against diagnosis – it IS a mistrust of the pharmaceutical industry and psychiatrists who are hand-in-hand complicit with studies like CATIE and CAFE, who are more interested in money and accolades than patient/human subjects research safety, or the investigation of failures within.

    Pushing medications that are barely better than, and after worse than, a placebo, is what harms psychiatry. Not the people who question the motivations of those prescribing practices.

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  2. 2. integral 12:53 pm 05/20/2013

    I have mixed feelings (& thoughts!)about this blog. On the one hand, it appears to be the first mature, informed Scientific American blog about the disputes surrounding the release of the DSM V, at last. I completely agree that the stigma surrounding mental health diagnosis and its providers is a social construct that the DSM V should not be blamed for. On the other hand, the blog appears to almost entirely celebrate biological treatment (and an indirect reference possibly to cognitive therapy). At the time of Freud, as detailed in the blog, the approaches to mental illness were also entirely biological, albeit much cruder that today’s medications and brain imaging. Freud introduced the idea of actually listening to the patients and using listening skills to help them focus and achieve clinical relief through expressing and achieving insights about their feelings.
    Despite the invalidation of some of Freud’s theoretical foundations, his basic clinical listening approach was taken up by Carl Rogers, et al and remains an essential adjunct to any mental or medical health treatment. The blog writer ignores the research on mind/body treatments, many using listening skills, that act as an effective “placebo” treatment for the relief of mental and medical suffering.

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  3. 3. larkalt 3:14 pm 05/20/2013

    The anti-psychiatry people generally are patients or ex-patients who have had an unpleasant time in the mental health system, and they feel the treatments that were given them – or forced on them – didn’t help them, or actually hurt them (tardive dyskinesia, etc.)
    These people’s perspectives need to be listened to. They are giving valuable information on how the people most affected by psychiatry – the patients – feel about it.
    I had antipsychotic drugs forced on me at one time. Then almost 25 years later, I found out I (probably) have celiac disease, and when not eating gluten and various other foods that I’d developed allergies to, my psychological state was vastly improved. If I had been compliant to the psychiatrists at the time, likely I would have permanent neurological damage from tardive dyskinesia by now. And I would have spent years in a mentally squelched state from the antipsychotic drugs.
    Obviously psychiatry involves issues that other kinds of medicine don’t. It involves issues of personal freedom – can they force drugs on you if you are labeled crazy? Can they take your freedom away if you are labeled crazy?
    And, the brain is so little understood. Psychiatric medications are crude instruments. This was illustrated to me when I went through the long process of elimination diets and food challenges to find my delayed food allergies … and along the way, various symptoms like a hallucinatory aspect to my vision, intense anxiety, depression, compulsions went away – without the need for drugs.
    And I had never been told by any mental health professional that food could do this to you!
    Psychiatry needs to listen to its critics, they are criticizing for a REASON. Not because they’re in an unaccountably crabby mood … A lot of these people feel profoundly damaged by their experiences with psychiatry.

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  4. 4. tmonk 3:26 pm 05/20/2013

    As a psychiatrist (trained as a psychopharmacologist, and psychoanalyst) I was trained to listen very carefully to my patients narrative.
    Psychiatry ,as a field seems at times not to follow the same dictum.
    If one looks at the funding stream of research produced by the field,one can find ample support for promoting medications.Many of these are helpful-especially (and with little debate) in the major psychiatric illness of bipolar disease and schizophrenia.
    I find it sorely lacking in any area of grant monies -from the APA-into research in clinical neuroscience, or in the education of it (which I teach).
    Curiously, neuroscience grants can be found by the APA-as in psychology.Similarly I have found that neuroscience has been embraced to a much greater degree (as an educator) in the area of psychology, than in psychiatry.
    The lack of support by the field of psychiatry in giving grants to those educators who -teach neuroscience-might strike one as peculiar.The same might be thought to hold true in emphasizing the education of residents in psychiatric history, over taking a formal stance in teaching -and requiring a basic understanding in clinical neuroscience ie behavioral genetics, affective and cognitive neuroscience.

    The continued support of an a-theoretical DMS (other than a research vehicle) , and lack of policing of forensics seem to me to only add to the lack of credibility of the field.

    As of yet there has been no advance of the field psychiatry in developing a credible model of any of its disease state-anyone deserves to be heard who questions why this is so.And that the bulk of research in the field of psychiatric neuroscience seems to come from outside this country is also sad, and worth noting.

    The field should pay close attention to the complaints volleyed in its direction.Some might merit a close ear.By disavowing what one might argue as credible complaints: ie the drug reporting bias issue (of which psychiatry is not the only field cited)of drug response trials,the morass of forensics experts,as well as the potential negative effects of psychotherapy-seems to only add fuel to the fire-and minimize the incredible palliative effects “good” psychiatry bring to countless people who would otherwise suffer enormously.

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  5. 5. QuipsTravails 8:53 pm 05/20/2013

    I think you are missing an important point: psychopharmacology is often abused and many people are frustrated by that.

    I agree that there are many medications that are critically important, even lifesaving, but in my own experience, meds have been offered when other options should have been explored first (I know this because we refused the meds, and clearly made the right choice.) In addition, many people including myself are quite reasonably concerned that children are prescribed medications which have only been tested on adults.

    If your community wants to address the fringe element of consumers who take an extreme approach to psychiatric medications, you need to take ownership of those within your own ranks who are giving these medicines a bad name.

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  6. 6. holly1948 10:43 pm 05/20/2013

    Dr. Lieberman writes: … I do not overlook the checkered history of psychiatry itself. … However, that was then and now is now. The scientific foundation of psychiatric medicine has grown by leaps and bounds in the last fifty years.

    I submit that the present treatment of transgender people in the DSM-5 is virtually indistinguishable from the unethical treatment of homosexual people half a century ago. And in the same way and for the same reasons. The two are substantially parallel, with so-called “access to treatment” being used as the justification for unsupportable diagnoses.

    No sir, the dark days of psychiatry’s checkered history are very much ongoing. And yes, for psychiatry now really is now. But now is still not honorable. Perhaps things will improve in another 25 years when transsexuality is finally written out of the DSM. And psychiatry will finally emerge from its dark ages.

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  7. 7. softwarematters 3:13 am 05/21/2013

    Mr Lieberman,

    This is what Insel said,

    “The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”

    Now, prior to his April 29th blog, that was dismissed as “anti psychiatry”. Now it’s part of the official NIMH record. Your travesty/joint statement didn’t change that.

    It’s not prejudice that drives what you call “anti psychiatry”, but a desire for truth. Putting legitimate criticism to psychiatry on the same ground as AIDS denialism is an insult to intelligence. We have accurate biological tests to detect presence or absence of HIV infection. We know for a fact that except for a minority of so called “long term non-progressors”, every person infected with HIV ends up doing unless he/she is put on HAART. Psychiatry has nothing like that. Where is the biological test for schizophrenia? Nowhere. Diagnosis based on “behavior” is no different than labeling somebody a “heretic” based on the consensus of theologians. That is a fact.

    In a typical psychiatric trick, you are using semantics, ie a language that sounds scientific, to put forward fallacious arguments that do not stand any logical deduction. Psychiatry is a scam and DSM-5 has been the last straw. Apparently American shrinks got too greedy and though they could get away with labeling 50% of Americans as “mentally ill”. It has backfired and it was about time.

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  8. 8. andrewo@melbpc.org.au 6:40 am 05/21/2013

    What I’d like to know is why the medical authorities try to medicalise almost the entire population’s psychological traits …

    Imagine that Dr Sigmund Fraud were asked his opinion of the Westboro Baptist Church leadership … some really angry people I believe who have offended almost everyone with their disrespect at military funerals, not to mention other things …

    “Ah … I know … consults DSM 6.0 … ah-a, a rare case, very rare, almost certainly these pastors have Bats In The Belfry!”

    “What????”

    “Bats In The Belfry. Genetically a religious fundamentalist, full of irrational certainty, seem so phobic of cannibals that they develop I-thou total rage rejectionism of otherhood types, take no prisoners, give no quarter to anyone else, not gay, born that way.”

    “Eh???? Please don’t joke with me. You know that condition doesn’t exist …”

    “No, just very rare, incurable I’m afraid, it’s a genetic condition. Like pit bull terriers …”

    “Go on, Dr Fraud, you old fraud, tell me another one …”

    Given the increasing percentage of perfectly normal school students who are put on attention deficit drugs for no other reason but that the legislatures have banned the cane and the strap, and won’t let principals expel students even those convicted in the children’s court of felonious assaults on teaching staff, one begins to wonder which kind of violence is the lessor of two evils, the cane and the strap, applied rarely and judiciously, or drugging ten per cent of the students into senseless stupidity for breaches of school rules, ill-discipline of many and varied kinds …

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  9. 9. andrewo@melbpc.org.au 8:04 am 05/21/2013

    By the way, I believe that Bats In The Belfry was a sort-of standing philosophical joke in the anti-psychiatry movement of the 1920′s and 1930′s … refer Edgar Wallace’s “The Brigand” … pp109-110 … as first published 1928 …

    “Inside, written on stiff vellum and bearing no address but the simple words ‘The Inner Cabinet. Most Secret.’ was a letter:

    Dear Mr Longwirt,

    A crisis has arisen. We are meeting at Malby House, Blackpond, and require your immediate advice and presence. Do not ask for S– B– or anybody by name. Do not give you own name. Call yourself Nelson and ask to see the King of Greece. Be sure to do this, and under no cicrumstances mention names. THIS IS VITAL AND IMPORTANT. A– C– is coming by special train. Remember not a word! Malby House is the white house on the left of the road before you get to Blackpond.

    S.B. (P.M.)

    Mr Longwirt did not swoon. In his dreams such things had happened. He went down and ordered his car.

    ‘Draw the blinds.’ he said firmly. [...]

    [...]

    Nearing Blackpond (which he had once visited) he saw the white house and signaled to his chauffeur. They passed through heavy iron gates and drew up before the pillared portico. Instantly the door was opened and a man in a white jacket came out.

    ‘I am Nelson,’ he said in a low vibrant voice, ‘and I wish to see the King of Greece.’

    The man nodded.

    ‘Certainly, Admiral,’ he said ‘Will you step in?’

    [...]

    ‘I am Nelson and I wish to see the King of Greece.’

    Dr Clayfield glared benevolently at the visitor.

    ‘And you shall see him, Admiral and Napolean and the Rajah of Bhong!’

    He rang a bell, and this time two men in white appeared.

    ‘No. 8 Observation,’ said the doctor briskly, and Mr Longwirt went joyously forth.

    A few minutes before noon, the returning officer waited for the arrival of Mr Josias Longwirt. [...]

    [...]

    It took three solicitors four hours to secure the release of Mr Josias Longwirt from the Claverly mental Hospital.

    [...]

    ‘I’ll sue you!’ screamed Joaias. ‘Ill have questions asked in the House of Commons.’

    Mr Anthony Newton, MP for the Borough of Bursted (unopposed) advised him against such a course of action.”

    Given the conservative nature of the 1920′s and 1930′s, I simply do not credit the theory that psychiatrists then used this non-existent medical condition to persecute religious fundamentalists and frame them up in order to exclude them from standing for parliament.

    Also, given the allegation in detective story circles that Edgar Wallace was, in fact, ethnically German, though back then a respected racing journalist and author etc etc one might consider this adds doubt to such theories …

    I believe anyone wanting this book in New York would be well advised to visit one of the best new and second hand detective fiction bookshops, not only in New York, but worldwide … “Murder Ink” …

    Not to mention that Edgar Wallace bothered to have his best works translated into German, such as Edgar Wallace, “Treffbube ist Trumpf”, Kriminalroman, Ullstein Bucher.

    Not that I blame book reciprocity workers setting up protocol sentences for orchestrating, architecting, inciting, planning, and setting up with malice aforethought world war two to further their political aims; the unspeakable unstoppable nationalist scum in Germany did that.

    The whole point is that wicked crime contradicted the values of most English and American detective story writers … divine retribution, natural justice, natural rights, property rights, the freedoms of the individual, etc etc …

    Take Agatha Chistie, for example, a feminist detective story and spy story writer in the 1920′s and 1930′s, whose politics got so burned out during the war, that she went all conservative and reactionary afterwards …

    If only there were sufficient barbers to give haircuts to every last one of the unspeakable unstoppable political scum in Berlin!

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  10. 10. matthewncohen 9:02 am 05/21/2013

    The shocking thing about Mr. Lieberman apology for his profession is the fact that he ignores the pressing concerns for human rights and empowerment that come directly from survivors of lies, coercion, and other offenses in the psychiatric system. This talk of “self-promoters” and people who are “anti-mental-health-care” are strawmen that apply to perhaps 1% of those who would describe themselves as anti-psychiatry (I wouldn’t accept that label on myself, but I advocate for many people who would).

    I can only hope that Mr. Lieberman and his colleagues will take time away from profusely defending their ideology to read and listen to the many first-hand accounts of those who experienced their lives being taken away from them by psychiatry’s labels, authoritarian power structure, and so-called “medical” treatments. Last I checked very few individuals experience patterns of psychological and physical duress, dehumanization, and stark disempowerment at the hands of cardiologists or gynecologists. One obvious reason being that high-handed enforcement of normative behavior with drugs is not the purview of these respectable disciplines.

    These personal stories, offered by struggling survivors, can be found all over, including on our website: http://madinamerica.com and now in the form of hopeful video testimonials at http://openparadigmproject.com

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  11. 11. Robert D. Stolorow, PhD 10:15 am 05/21/2013

    Deconstructing psychiatry’s DSM: http://www.psychologytoday.com/blog/feeling-relating-existing/201204/deconstructing-psychiatrys-ever-expanding-bible

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  12. 12. portland17 2:29 pm 05/21/2013

    Wow. Where do I begin to approach this amazingly shallow collection of ad hominem attacks and unscientific rhetoric? The author does not once even mention an actual scientific study or identify and counter a coherent argument put forward by those who oppose the new DSM and its arbitrary system of identifying any form of distress as a “brain disorder.”

    For starters, I don’t know of anyone who identifies their own group as “antipsychiatry.” This is a term that is mostly used by psychiatrists such as the author to try and undermine the credibility of their critics. Notice that the author doesn’t identify one single group that so identifies – he just broad-brush paints that “there are these people out there who oppose mental health treatment and they are bad.” A classic ad hominem attack.

    The author compares prejudice against psychiatry to racisim, sexism and homophobia, and talks about prejudice against “mental illness and its caretakers.” This is a highly offensive comparison for a couple of reasons. First off, psychiatry was part and parcel of the prejudice against gay and lesbian people – homosexuality was designated a mental illness until the 1970s by the very DSM this guy is defending! But more importantly, racism and sexism and homophobia are efforts by those in positions of POWER to undermine groups who did not have the power to defend themselves. It is especially ironic to talk about prejudice against psychiatry in this context, as psychiatrists are, in fact, the ones with the power to detain people against their will and force “treatment” on them based on the spurious diagnoses invented and voted on at the DSM conferences. And more ironically, it has been shown that the medical view of mental illness as brain disease INCREASES the negative stigma associated with mental and emotional distress. In fact, many of those opposed to the DSM and the current treatment practices of psychiatry are patients who feel victimized by the psychiatrists who treated them. To lump psychiatrists in with patients in terms of prejudice is an extremely shallow and self-serving viewpoint.

    The author also states that: “… no one can argue with one simple fact; if you or a loved one suffers from a mental illness, your ability to receive effective treatment, recover and lead a productive life is better now than ever in human history.” Actually, that is EXACTLY what the argument is about! There is plenty of evidence, starting with the WHO studies in the ’90s and continuing right on through the work of Harlow that was recently published, that psychiatric drugs are NOT associated (in the aggregate) with a more productive life – rather, people maintained on psychiatric drugs appear to be MORE likely to remain disabled and have multiple hospitalizations than those who avoid drugs or have a short-term course of medical treatment. See Robert Whitaker’s “Anatomy of an Epidemic” for more details.

    One doesn’t have to be opposed to psychiatry in principle to be concerned about the enormous rise in the use of psychiatric drugs, especially when the long-term outcome studies across the board suggest that unmedicated sufferers tend to do as well or better than their medicated counterparts over time. This is not to say that no one can or does benefit from psychicatric drugs. It is more to say that the current paradigm of care does not appear to meet the needs of many of those suffering mental/emotional distress. To label such concerns as “antipsychiatry” smacks of someone trying to avoid seeing the flaws in their own argument by attacking those who have the courage to point out those flaws.

    There are a lot of fairly mainstream psychiatrists and mental health professionals who have had concerns for years about the DSM, and who have even more concerns about the oddities and excesses of the newest version (such as labeling a person who is depressed at the loss of a loved one as mentally ill if they haven’t recovered two WEEKS after the fact!) It’s clear the author is committed to his philosophical view, but if he really wants to convince anyone, he’d do better to address the scientific facts that are aligned against the “brain disease” theory, rather than attacking those who have read the research and have legitimate concerns about the DSM and the current treatment paradigm in psychiatry. You don’t have to believe that mental illness isn’t real to believe that the DSM is of questionable validity. Ask Thomas Insel, head of the NIMH. Is he “antipsychiatry,” too?

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  13. 13. nkachuck 2:38 pm 05/21/2013

    Dr. Lieberman’s bias towards pharmacopsychiatry may have left him with a blind spot in which much is hidden from him. As a neurologist trying to heal the suffering, I am continually aware of the emergent qualities of mind and psyche which play such a large role in human nature. These qualities are indeed psychological, and are formed, modulated and often distorted not just by the neural/astrocyte networks which subserve them, but by all of the dynamic forces which impact on that self, through development, maturation, and aging, health and disease. Orthomolecular biology is real, but there are just as potent and critical effects on human nature, and its epigenomic expression in the phenotype of the human life, of parenting, attachments and relations with others, individuation,and the ways culture impact on the person. Their being overlooked by folks in the thrall of the neurochemical is why neurologists with patients who need real psychological help, have an impossible time finding a psychiatrist who can listen, comfort, confront, and counsel, in addition to providing psychotropic brain re-booting. Dr. Lieberman might be advised to tend to these aspects of the healing arts in his practice, as he no doubt does in his personal life.

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  14. 14. HumbleSci 3:09 pm 05/21/2013

    This is idea of 50,000 strong British Psychological Society regarding DSM-5, extracted from Wikipedia. They are not “Anti-psychiatry”

    [We recommend] a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with ‘normal’ experience, and that psychosocial factors such as poverty, unemployment and trauma are the most strongly-evidenced causal factors. Rather than applying preordained diagnostic categories to clinical populations, we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or ‘symptoms’ or ‘complaints’…… We would like to see the base unit of measurement as specific problems (e.g. hearing voices, feelings of anxiety etc)? These would be more helpful too in terms of epidemiology. While some people find a name or a diagnostic label helpful, our contention is that this helpfulness results from a knowledge that their problems are recognised (in both senses of the word) understood, validated, explained (and explicable) and have some relief. Clients often, unfortunately, find that diagnosis offers only a spurious promise of such benefits. Since – for example – two people with a diagnosis of ‘schizophrenia’ or ‘personality disorder’ may possess no two symptoms in common, it is difficult to see what communicative benefit is served by using these diagnoses. We believe that a description of a person’s real problems would suffice. Moncrieff and others have shown that diagnostic labels are less useful than a description of a person’s problems for predicting treatment response, so again diagnoses seem positively unhelpful compared to the alternatives.

    —British Psychological Society June 2011 response

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  15. 15. marcellas 10:41 pm 05/21/2013

    I urge any adherent of scientific method to examine more closely Dr. Lieberman’s assertions in his article of May 20, 2013.
    Despite his exuberance for the new DSM 5, there remains no blood test or brain scan for any diagnosis of mood, thought, or personality disorder. There is no objective measure for severity of illness. There is no way to prove a person does not have a mental illness.
    We continue to have no “meaningful scientific understanding” of diagnosis, cause, or treatment. None of this has changed in DSM 5.. Psychiatry remains faith based medicine.
    Remember that even today, there is no general agreement on “recovery” (i.e. does recovery mean staying on the meds or learning to not need the meds anymore?) There is no definition of “Normal”.
    I find Dr. Lieberman’s dismissive and misleading remarks of DSM 5 critics alarming. How does he respond to Robert Whitakers Anatomy of an Epidemic? Has he read and fact checked the book? How does industry thinking explain the rise in disability rates for people who are in treatment?
    Thomas Insel, the Director of The National Institute of Mental Health, released a statement last month calling the DSM 5 “invalid”, and that people with mental illness “deserve better”. A week later, he and Dr. Lieberman issued a joint statement, calling DSM 5 the “Gold Standard” in modern Psychiatry.
    Possibly all of Insel’s statements are true: The Gold standard in psychiatry is invalid, and people deserve better.
    Where does Dr. Lieberman draw the line between psychiatry’s “checkered past” and this new age of enlightenment? Where is his evidence that the medications are actually safe and effective? That diagnosis (old or new) is reliable and valid, and that treatment leads to better outcomes?
    From my experience, (25 years leading group psychotherapy inside and outside the medical model) Better outcomes in mental health result from encouraging people to have faith in their strengths rather than their (entirely hypothetical) limitations. Even very sick people can recover, or become less chronically ill, when they are connected in some way to other people, (a social group) and engage in some form of structured occupation (work, school, volunteerism). These things help people find purpose and meaning in life. Any of these things can be done on or off the meds. (Although the side effects are problematic).
    Dr. Lieberman doesn’t seem to realize that the antipsychiatry movement is largely populated by former patients and their family members. In other words; people who are intimately familiar with mental illness. Their experience of “stigma” is no academic abstraction, at some point they accepted their illness and took the meds.
    The true stigma of mental illness is low expectations for recovery.

    Link to this
  16. 16. Discover and Recover 1:28 am 05/22/2013

    Unfortunately, psychiatry has been allowed to exercise a monopoly on “treatment” for “severe mental illness” – involving methods that have shown to be failures, for decades.

    Rather than continue to be taken on this path, many folks are blazing their own trail – searching for and finding many ways to deeply heal, to recover, to thrive.

    Psychiatry does not need to be repaired. It needs to be replaced – with holistic options that offer hope.

    And it is being replaced, as we speak.

    Duane Sherry, M.S., CRC-R
    Retired Counselor
    discoverandrecover.wordpress.com

    Link to this
  17. 17. Discover and Recover 1:45 am 05/22/2013

    Dr. Lieberman,

    Insofar as there is no science to back up its diagnoses; no legitimate civil law to back up its use of force; an ever-increasing body of evidence to show that long-term outcomes are worse for those who remain compliant, it seems obvious that psychiatry (as practiced today) is dead.

    Duane Sherry, M.S., CRC-R
    Retired Counselor
    discoverandrecover.wordpress.com

    Link to this
  18. 18. Rocza 9:52 am 05/22/2013

    Oh hold on, Lieberman was PI on the CAFÉ study? The one that is currently under serious scrutiny by ethicists, bloggers (including those at SciAm), community activists, and science writers, because of the numerous violations in human subjects research participation around the study and in particular Dan Markingson?

    I am disappointed in you, Scientific American. I thought you would be better than this.

    Link to this
  19. 19. Discover and Recover 10:36 am 05/22/2013

    Dr. Lieberman,

    There is no validity in the diagnoses of your profession; no real legal justification for the use of force; no proof that the “treatments” are either safe or effective.

    In fact, just the opposite:

    The labels are meaningless medically, but dehumanizing nonetheless; forced incarcerations, drugs and ECT are unconstitutional; and “treatment”, including the long-term use of drugs, especially neuroleptics causes more harm than good for the vast majority.

    So where does that leave psychiatry?

    It seems as though people are finding their own ways to deeply heal, recover and thrive without your profession. This includes those folks who have been labeled as “severely mentally ill”.

    They are choosing safer, more effective options and doing quite well without conventional psychiatrists – professionals such as yourself.

    In short, it seems as though psychiatry (as practiced in the past and today) is being replaced. And that’s a good thing.

    Duane Sherry, M.S.
    Retired Counselor

    Link to this
  20. 20. duffmcduffee 1:57 pm 05/22/2013

    “However, that was then and now is now. The scientific foundation of psychiatric medicine has grown by leaps and bounds in the last fifty years.”

    Hmm, has the National Institute for Mental Health been informed of these scientific foundations? Because they recently reported that the DSM categories should be called into question when doing research into the biological basis of mental distress.

    To quote NIMH director Thomas Insel:

    “The strength of each of the editions of DSM has been ‘reliability’ – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”

    The one thing I can give credit to Lieberman for is at least he didn’t call his opponents “crazy,” as many patients still are today for questioning their diagnosis, or complaining about symptoms from the drugs they are prescribed.

    Lieberman compares some people’s anti-psychiatry stance as akin to racism or sexism. But the psychiatrists have always been the ones in power. So it is more like he is saying that individuals who critique psychiatry in ways that he doesn’t like are critiquing the system of power that labels people, that quite often controls their fate. This is the opposite of racism or sexism.

    Link to this
  21. 21. Cledwyn Enemy of the Pus-heads 4:15 pm 05/22/2013

    Millions of lives saved or improved every year? Saved from what exactly? Mental cancer? A mentally transmitted disease? If anyone died of “mental illness”, it is because of the influence of the idea of “mental illness”, an idea that resonates in the minds of the enemies of liberty and those who would drop dead if they weren’t able to mold, manipulate and control people in the service of the enlargement of their egos, and to make themselves feel important.

    All this talk about “have saved millions”, over and above its purpose to give the appearance of substance to ad-speak (the kind of talk that should be inimical to a man of science like you, who supposedly operates under the guidance of reason), is just an elating cliche, an apotropaic verbal ritual designed to ward off psychological and emotional evil, chanted in times of rigorous scrutiny of beliefs held by the psychiatric faithful, beliefs arrived at through the activity of the bowels and not the brain, beliefs reinforced in seeming perpetuity within your community, which depend for their subsistence upon human sacrifices.

    All people who oppress others, and fertilize the soil out of which their existence grows with human blood, who use other people’s bones as a supporting framework for the construction of their worldly success, have their own repertoire of elating cliches at their disposal for the circumvention of complex psychological and moral crises that they chant unthinkingly whenever they have occasion to do so.

    As for all this “then and now” talk, whilst it really does break my heart (honestly) to put a dampener on your spirits and introduce a bit of reality into your self-congratulatory, triumphalist ardor, there has been no real rupture between the past and present, the points of continuity being many and of discontinuity few. Anyway, the discontinuities don’t necessarily cover contemporary psychiatry in glory, such as the fact that in our age psychiatry has expanded the scope of its tyranny to accommodate within its territory more and more vulnerable powerless, voiceless people whom it can betray and abuse and whom it will continue to betray and abuse until it is willing to have an honest reckoning with its own history, which might help illuminate the areas where psychiatry is going wrong today.

    To say the least, I’m not holding my breath, and I feel quite confident we’ll be no better off in a hundred years time, but worry not, most of the so-called radical critics exhibit a disturbing intellectual affinity with the Mental Health brigade anyway and identify with most of its interests, but merely want to “humanize treatment”, delivering the iron fist of psychiatric “treatment”, with all that that truly entails (such as coercion, incarceration and torture), in a velvet glove, and to abuse fewer people.

    Then again, it is not so much that psychiatry is going wrong, and more to do with the fact that it just is wrong. It is a receptacle for the medically, scientifically and therapeutically disguised preservation of all the things that we like to think we are above in modern societies that at least outwardly aspire to tolerance and liberty (and inwardly conspire to reduce the scope of individual freedom, be it freedom of expression, speech, emotion or thought). These include torture, intolerance of human differences, slavery, and many more, basically all the things that can only survive through a process of systematic mislabelling that seemingly reconciles these institutions and phenomena to the principles we at least claim to respect.

    You talk about a “small group of critics”. In democratic societies, such talk is usually a thinly-veiled attempt to influence others by appeal to culturally conditioned sentiments. They are only a minority, and in democratic societies the minority are always wrong, and demotic opinion, and consensus opinion on a given issue, is right.

    “These are real people…”

    Well of course they are real people…

    You say that the nation has aggressively taken on racism and homophobia. As a nation, perhaps, with varying degrees of success (most of these prejudices have just been driven underground, both socially and psychologically). As a profession, you have done nothing to tackle these prejudices, and much more to foster their growth and perpetuate them.

    No, most people who would identify themselves as anti-psychiatric and those disparate identities and perspectives you would all lump together as anti-psychiatric, are opposed to institutional psychiatry in the former, and some aspect of psychiatric orthodoxy in the latter. This is a transparent attempt to drag your accusers down to your own level, down into the moral gutter with you.

    It would strike you as being no different than being anti-oncology or cardiology, because you are the president of the APA, and would never have become the president of the APA if you didn’t tell yourself otherwise. The analogy is a false one. Whereas coercion, torture and general human rights violations are embedded in the very administrative fabric of psychiatry, this is not the case with the two examples you invoked in a failed attempt to show the absurdity of being opposed to your beloved profession, which has obviously treated you so well.

    As for the accusation of bigotry, if there is any truth in that, then it is equally applicable to you. You hate me, I hate you. What’s the difference? At least acknowledge the mutual exchange of hatred here.

    Difference is with me, I don’t filter my hatred so that in uttering it I am observing the proprieties of bourgeois society, where inauthenticity has a certain glamour.

    Typical psychiatrist, its all right for him to hate those who is he in conflict with, but not the other way round. It’s always the same; one rule for the psychiatrist, another for the patient. It’s alright for psychiatrists to be violent and delusional, to make millions of people victims of their fantasies!

    As for all this talk about the brain being a complex organ, I’m not going to listen to the head of an organization which represents a profession with the worst record in human history of damaging the human brain when it comes down to this delicate, sensitive organ. Your profession has millions and millions of damaged and diseased human brains on its conscience, and mine’s one of them. I want my brain back!

    Link to this
  22. 22. Cledwyn Enemy of the Pus-heads 4:21 pm 05/22/2013

    That should be “this is all a transparent attempt to drag..”, a general comment about his article.

    Link to this
  23. 23. MatthewL 9:46 pm 05/22/2013

    “This relatively small “anti-psychiatry” movement fuels the much larger segment of the world that is prejudiced against people with disorders of the brain and mind and the professions that treat them. Like most prejudice, this one is largely based on ignorance or fear–no different than racism, or society’s initial reactions to illnesses from leprosy to AIDS.”

    That’s completely untrue. You confuse “anti-psychiatry” with “pro human rights.” But, this article is intentionally meant to persuade and deceive.

    Psychiatry has always had unscientific, quack treatments like lobotomies, blood-letting, and electro-shock therapy. Now, you’ve evolved into chemical lobotomies with dangerous and unproven psychotropic drugs.

    Shame on you. The profession labels normal life happenings as disorders so they can medicate, rather than educate.

    Still no scientific test to prove a chemical imbalance, is there? That’s what I figured.

    Anyone who actually does research on the history of psychiatry clearly sees how barbaric and unscientific it is.

    The non-profit organization, Citizens Commission on Human Rights (CCHR), has done a great job exposing these frauds.

    How many millions more lives have to be ruined, people killed, and families torn apart by this junk science?

    Link to this
  24. 24. Olga Runciman 6:23 am 05/23/2013

    As chair of the Danish Hearing Voices Network, I presume I am probably one of them placed under the banner of anti-psychiatry by Jeffrey A. Lieberman. Personally, I prefer to define myself, and the Hearing Voices Network, as post-psychiatry.

    Lieberman appears to find that being against psychiatry is no different to being against cardiology, orthopaedics or gynaecology I beg to differ. A fundamental difference between these medical specialities and psychiatry is that there is solid physical evidence such as heart disease, broken bones and pregnancy to support them. Psychiatry has no such evidence but it is only now that this lack of evidence is seeing the light of day on a large scale, a fact that psychiatry including Lieberman himself is being forced to acknowledge. Another profound difference is that psychiatry has been given the socially condoned authority to force people into treatment despite having no evidence that what they are treating actually exists. This equates to human rights abuse something The UN Special Rapporteur on Torture, Juan E Méndez (2013) agrees with, stating:

    “It is important that States review the anti-torture framework in relation to persons with disabilities in line with the CRPD. States should impose an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs, for both long- and short- term application”.

    Lieberman refers quite rightly to psychiatry’s checkered history however, he fails to mention the even darker history, that of psychiatry’s role in the eugenics era with forced sterilizations and in Germany actually killing those defined as a burden to society. Today psychiatry uses psychotropic drugs and I suspect that just like we look back now to the times when people were put in straitjackets and exposed to insulin shock therapy and lobotomy with horror, we too will be looking back on this period of time, the chemical era, with shame. For Lieberman fails to acknowledge the lived evidence that the people whom I represent, myself included, epitomize. The fact is those who are labelled schizophrenic and placed on powerful antipsychotics can expect to live on average 25 years shorter than those in the normal population. Tragically, those labeled schizophrenic are not alone in these statistics. A recent article published by a prominent Danish Professor of psychiatry showed, that for every one young woman in the age group 18 to 30 who died in the normal population 14.4 young women of the same age were dying in Danish psychiatric group homes while the number in treatment psychiatry was 13.9. Nowhere else do we see a medical specialty that actually shortens people’s lives such as we see in psychiatry.

    Knowledge is power, however the knowledge that psychiatry has based its medical model upon is being exposed as fraudulent and is I believe being clearly expressed here when the President-elect feels compelled to resort to name-calling rather than simply producing the evidence for the ‘scientific evidence’ upon which they base their profession and ultimately damage so many people.

    Link to this
  25. 25. fnd hope 12:18 pm 05/23/2013

    There will always be extremes which is what the DSM should be defining-not variants of normal.

    I am perplexed that you would see those who have voiced concern for patient care in regards to problems associated with a few of the changes in the DSM-5 as being against or siding with anti-psychiatry.

    I wonder if this misunderstanding comes from the disillusionment that can creep into psychiatry, and I don’t mean through the patients. There seems to be a tendency if there is a discrepancy between the view of the clinician and the patient’s self identity it is regarded as the patient’s inability to handle the truth. There is an arrogance harbored by some clinicians who believe their subjective opinion is factual and should not be challenged. I can’t imagine they would presume to be infallible.

    “That was then and this is now” is a naive perspective. We have evolved from the time when we murdered those who were once diagnosed as hysteric women because of thoughts of witch craft association. We then advanced into some inexcusable sexual abuse treatment therapies. I hope you excuse me when I don’t share your view of how far we have come. Before we pat ourselves on the back too much, we are reminded this great transformation led to straitjackets and tied downs. That was then and of course all those physical treatments are inhumane.

    However, now some doctors use the acceptable mental tie downs of belittlement, self-doubt and denial of medical care as the preferred route of treatment.

    I would argue shackling patients by their own mind which they can not escape is by far the worst offense of them all.

    Yes, many diagnostic labels and treatments have transformed. In fact a large sum have advanced right out of the DSM and are no longer considered mental illnesses, but some have not changed as much as we would like to pretend.

    I agree Mental health labels may be the last prejudice still accepted. To bury one’s head in the sand and fantasize that the mental health field do not contribute to this, is dangerously irrational.

    Doctors that recognize the imperfections and speak rather than cover for their profession are noble, not critical, and certainly not anti-psychiatry.

    Link to this
  26. 26. Discover and Recover 5:51 pm 05/23/2013

    Psychiatry appears to be based upon less than valid diagnoses; less than scientific drug studies; less than beneficial treatments – for the vast majority.

    A strong argument can be made that the profession has caused more harm than good.

    What is it Dr. Lieberman feels the need to protect?

    Duane

    Link to this
  27. 27. ronpies 1:37 am 05/24/2013

    I very much appreciate Dr. Lieberman’s reasoned defense of psychiatry. Equally, I am disappointed to read the anonymous slurs and distortions contained in many of the comments that follow this piece. Yet as a psychiatrist, I take seriously the degree of suspicion and mistrust that these responses convey. I realize that we, as medical professionals, must do much better in reaching out to the general public and explaining what we do and why we do it.

    Of course, there are legitimate scientific controversies about categorical diagnostic systems, such as the DSM-5, as there are about the nature and treatment of what we call “mental illness”. But as a psychiatrist who has seen, firsthand, the destruction and suffering brought on by conditions like schizophrenia and major depressive disorder; and who has also seen, in hundreds of cases, the tremendous benefits of good psychiatric care and treatment, I am saddened that these cynical comments are so removed from the everyday suffering of millions of people with psychiatric illness–people whose lives were made better through psychotherapy, medication, or both.

    Several of the comments also reflect a serious misunderstanding regarding the meaning of “validity” in science. It is much more than whether there is a biological or “lab” test for a condition. Critics of the DSMs often forget that biomarkers are merely one
    type of “validation”. There is also discriminant validity (our ability to tell one condition from another) and predictive validity (how well
    does the set of signs and symptoms predict course of illness, morbidity/mortality, familial/inheritance patterns, response to treatment, etc.) We have very good evidence that for conditions like schizophrenia
    and bipolar I disorder, our diagnostic criteria show
    quite good predictive validity.(1,2).

    We also know that our treatments-while far from ideal–can greatly reduce the suffering and impairment so common in these conditions. Over the past 30 years in the profession, I have seen hundreds of shattered lives turned around by psychiatric care and treatment.

    To be sure, most DSM categories can benefit from more research on their discriminant and predictive validity, even as we investigate these criteria sets for biological validity. But to criticize the
    DSM-5 for lacking biomarkers or “lab tests”–and to insist that this renders the framework “invalid”–is to misunderstand the broad concept of scientific validity.

    As researcher Dr. Bernard Carroll recently observed in
    an email message, “Laboratory measures are the servants of clinical science, not the other way around.”

    In the mean time, we must do our best with what we have, in order to address the here-and-now suffering and incapacity of our patients.

    Ronald Pies MD

    [The writer reports no financial or other conflicts of interest, and is now retired from clinical practice]

    1. Geller B, Tillman R, Bolhofner K et al: Child Bipolar I Disorder :P rospective
    Continuity With Adult Bipolar I Disorder; Characteristics of Second and Third Episodes; Predictors of 8-Year Outcome
    Arch Gen Psychiatry. 2008;65(10):1125-1133.
    2. Mason P, Harrison G, Croudace T, Glazebrook C, Medley I. The predictive validity of a diagnosis of schizophrenia. A report from the International Study of Schizophrenia (ISoS) coordinated by the World Health
    Organization and the Department of Psychiatry, University of Nottingham. Br J Psychiatry. 1997 Apr;170:321-7

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  28. 28. tmonk 10:02 am 05/24/2013

    I wrote the first response-maybe the last as well.
    The author wrote a blog-yet I see no response by the author. I suppose for some practitioners,this his how the field works-it is as I say it is, because I say it.

    Only Bob Dylan gets that respect ,in my opinion.

    DSM perhaps will dye a slow death as younger people begin to take over the field.Hopefully I will be a part of that.

    Link to this
  29. 29. abbabubba 11:26 am 05/24/2013

    It’s about time the APA responded to the narcissistically injured and professionally lagging voice of the stubbornly entitled ‘anti-psych’ ‘activists.’ I used to to think it good that they simply be ignored, but at this point any efforts to get these people to stop distracting themselves from the real problems our society faces seems worth an attempt.

    Link to this
  30. 30. portland17 5:18 pm 05/24/2013

    To Dr. Pies: I am glad you take the degree of suspicion and distrust expressed in these comments seriously. However, I don’t think more “explanations of what we do and why we do it” would be even slightly helpful. We KNOW what you do and why you say you do it. The problem is that your perception of how incredibly helpful what you do is varies dramatically from the perception of those who have experienced your “helpful” interventions.

    Rather than continuing to “explain” things from a safe intellectual distance, perhaps it is time for you to LISTEN while those who have been on the receiving end of psychiatric intervention explain TO YOU how they feel about what happened to them.

    As to your perception of the “millions of people made better” by psychiatry, I would suggest you read or re-read Robert Whitaker’s excellent summary of the long-term outcome research over the last 50+ years, in his book, “Anatomy of an Epidemic.” You’ll have to do some work to explain how US psychiatric care has helped millions when the schizophrenia outcomes, just to choose one example, are far better in Brazil and India than they are in the US or other countries that rely heavily on psychiatric drugs for their mental health treatment.Surely, you are familiar with the two WHO studies in the ’90s that showed this clear and dramatic result. How has Psychiatry dealt with this meaningful data? Ignored it completely.

    Or to mention another point, how about the millions of kids put on antipsychotic drugs since the late 90s based on the work of Joseph Biederman, who was later discredited both by the poor predictive value of his criteria for “juvenile bipolar” and his obvious pro-pharmaceutical company bias? How many new cases of diabetes were created by this little “mistake?”

    Or what about the fact that those with serious mental illnesses are dying 20-25 years earlier than the general population? Is that just because they’re smoking more? Think taking drugs that induce diabetes, heart disease, and physiological brain damage might contribute to the situation?

    I agree, we must do the best with what we have, but psychiatry is not providing or pursuing that, and in fact ignores research that could be incredibly enhancing. I would use as an example the works of Bruce Perry based on 10 years of “Decade of the Brain” studies, showing that brains can be damaged and repaired by creating the wrong or right environment and relationships and exercises. Why is this not promoted by psychiatry? Why is it always drugs?

    Anyone with any level of sanity and honesty will admit that there are two major contributors to a person’s mental health: environment and physiology. Psychiatry ignores the former, even though it’s the easiest one to change. It also carves out 90% of the latter, including exercise, diet, meditation, sleep, etc., and lays it all on genetics, which is the one and only thing in the list I mentioned above that no one can actually do anything about! That’s what I call an irrational approach.

    No, we’re not doing the best with what we have, at least from the patients’ point of view. Maybe it’s time to stop talking and start listening. The reason people don’t trust you may not be because you haven’t explained yourself. It may be entirely because you haven’t earned their trust.

    — Steve

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  31. 31. Nijinsky 10:39 pm 05/24/2013

    When someone starts touting what HE calls a disease; and touts this as a medical condition, when it has never been proven to have a biological basis; all in order to try to dismiss a whole wonderful society of intelligent compassionate people he calls “anti-psychiatry…” people he says promote stigma and prevent treatment. If one would actually look at those he’s mislabeling, this movement HE calls anti-psychiatry has methods such as Healing Homes of Finland, Open Dialogue, The Soteria Project along with many therapists who actually can relate to people as emotional, vulnerable, human and sensitive beings rather than those who have a biological defect because of a behavior that’s not understood. Methods which have superior results, cost less, don’t take away basic human rights. And the “treatments” Lieberman touts ALL involve interfering with natural neurological processes of the mind, they all cause chemical imbalance rather than healing it. With “schizophrenics” (who have a high rate of complete recovery non existent in main-stream psychiatry) with the treatments Lieberman is promoting there is consistently a 20 to 25 year loss of life span, there’s more disability, there are truly serious addictions that occur that DO cause a biological disease which wasn’t there before treatments and there’s more cost.
    I might add that the drug companies have actually stopped research into new drugs because this chemical imbalance they have been talking about for more than a few decades hasn’t turned up in ANY scientific tests. THAT’S the science of it. Instead Liebermann makes the following statement: “Moreover, we have every reason to believe that there will continue to be unprecedented scientific progress, which will enhance our clinical capacity and benefit our patients.” And the treatments that he’s promoting ALL correlate with brain damage, more disability, an increase in mental illness that’s truly shocking and no ability to truly back up their claims that there’s a biological disease in existence that they’re treating.
    And so, the people Liebermann calls “anti-psychiatry” people produce results superior to what his system has, they don’t take away basic human rights, they don’t give people extreme addiction and chemical imbalance or other forms of brain damage or trauma to the body with what are labeled as treatments, they enlighten people to understand the human condition and emotions rather than to create fear of natural response to stress (which excuses those causing the stress), they don’t tell you stories of chemical imbalances that haven’t been proven to exist, they are more cost effective; and they don’t make people dependent on the drug companies.
    So yes, when it interferes with drug company profits, and ALL of the conflicts of interest LIEBERMANN HAS with the drug companies, than this is called “antipsychiatry.” In reality he’s talking about people that actually do heal the human psyche rather than promote profits and promote unproven ideology by the drug companies. You only have to read his article and look into the true facts as to whether there is at all this “chemical imbalance,” this “biological disease” that’s promoted to see how extremely defensive he is. And how he falls into name calling and contortion of simple facts.

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  32. 32. softwarematters 1:37 am 05/25/2013

    To Ron Pies,

    You were invited to engage in a respectful debate at Mad In America on this issue, but you refused. You are repeating the same canards that Lieberman with a little bit more “make up”, but they are still the same canards.

    Both of you -as do many psychiatrists and the overwhelming majority of DSM-5 committee members- have a vested interest in prolonging the life of this scam. When you read “criticism to psychiatry” (even exquisite criticism such as this one http://blogs.scientificamerican.com/molecules-to-medicine/2013/05/24/anti-psychiatry-prejudice-a-response-to-dr-lieberman/ ) what you are actually reading is “criticism to your income”, which is why both of you have reacted with such nonsensical and incoherent messages. DSM-5 is to psychiatry what 9/11 was to terrorism. An event so outrageous that gave visibility to the most incomprehensible human rights abuses that had been going on for decades. What I am still at odds to understand is who in his/her right mind at the APA thought that they could get away with labeling 50% of the American people as “mentally ill” with DSM bogus problems. Your greed turned out to be your undoing.

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  33. 33. larkalt 8:14 am 05/25/2013

    “Disappointing to see SciAm Mind posting this”
    It’s also disheartening that the head of the APA has no more insightful response to criticism of psychiatry than to accuse it as coming from prejudice against mental illness.
    Psychiatrists are supposed to be trained to listen to people.
    Dr. Liebermann’s post seems utterly partisan, motivated strictly by the wish to defend professional interests.
    His response to the low opinion that other doctors often have of psychiatry, also doesn’t have much content. Similarly to anti-psychiatry activists, the doctors also have a real point.
    Psychiatry has been given power FAR out of proportion to the crudeness of its methods. It is startling and rather horrible that people can sometimes have psychiatric medications forced on them – when these medications are such a crude tool used on people’s very complex brains! Psychiatric surgery and electroshock has also been forced on people.
    Psychiatry has been extensively used as a weapon, for example men labeling their wives crazy to get rid of them. And I doubt very much that this is all in the past!
    People – anyone, not just psychiatrists – may find their critics USEFUL. Not that the critics are 100% correct, of course they aren’t. But they can awaken people to the element of truth in the criticism.

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  34. 34. larkalt 8:46 am 05/25/2013

    “I realize that we, as medical professionals, must do much better in reaching out to the general public and explaining what we do and why we do it.”
    Um, there is a LOT more than that, that is needed!!!
    Sure, psychiatrists do help some people.
    However, there are other people who find the psychiatrists’ approach horribly lacking. As I explained in comment #3, I’m one of them.
    The “drug them” approach to psychological problems falls right in line with denial of family issues and societal issues. That’s why it’s very suspicious. People everywhere, don’t want to deal with those difficult issues. If they become aware of those issues, they might have difficulty getting along with their parents, for example. Commonly they would much rather be drugged than explore such potentially disruptive or even explosive issues.
    I don’t believe that people never benefit from psychiatric drugs or from seeing a psychiatrist. Sometimes those drugs might even save someone’s life by preventing suicide. Or pull someone out of a psychotic state.
    There is truth both in what you’re saying and in what the critics are saying. Those truths do not contradict each other.

    Link to this
  35. 35. ssenerch 7:26 am 05/27/2013

    Ronald Pies, for goodness sake, people like you are absolutely maddening. To think that people like you have the power to lock up, control, and forcibly inject others is quite sickening. And abbabubba, you are a sad, small person. Your attitude is akin to slaveholders disparaging their slaves’ silly desires for freedom or men disparaging women who wanted the vote. In time your attitude will come to be just as socially acceptable as these racist, sexist, abusive attitudes. “Narcissistically injured, stubbornly entitled ‘anti-psych’ ‘activists’”? I’m assuming you’re unaware that most people who go through the psych system have histories of trauma and/or abuse, and many find the system to be additionally traumatizing and/or abusive, and that often it’s the luckiest and strongest that are able to even make it to the point of being post-psychiatric system anti-psych activists? Who’s the entitled narcissist now? Is it so “entitled” to protest your human rights being trampled by controlling quacks who have no evidence base to back up their so-called science? I suppose it was narcissistic and entitled of slaves to want their freedom or women to not want to be dominated by men. Really? Is anything that someone else wants or needs, that you can’t personally identify with, entitled and narcissistic? As for professionally lagging, why don’t you tell that to the British Psychological Society, the Critical Psychiatry Network, and any number of other groups and individuals of the highest credentials and professionalism who speak out on this matter, and much more credibly than Jeffrey Lieberman or Ron Pies has done here.

    Link to this
  36. 36. ronpies 7:49 pm 06/2/2013

    Here are a few excerpted remarks from Natasha Tracy’s essay from some months ago, titled, “Hatred of Psychiatry Doesn’t Create Change”, which
    I believe are relevant to many of the comments posted above:

    “ . . . OK I get it, you don’t like psychiatrists. Personally, I would find a more intelligent way to express an argument, but your point is clear nonetheless. You’re ranting. I get that. I rant. We all do. It’s a healthy expression of the frustration seen when dealing with so many things outside of our own control.
    But at some point you have to stop hating…and committing moral condemnation and actually do something useful . . . When we say we “hate” something what we really mean is our emotions have overwhelmed us to the point where we no longer think rationally. Something you “hate” can’t be redeemed, can’t be made better and contains no shades of grey . . . .Hatred is a mucky darkness that lets you scream and yell all day but doesn’t let you move on to affect the thing you “hate.

    . . . I have to engage with psychiatry in order to be a functioning human being. I understand [that] for all its faults, and yes, there are many, psychiatry saves lives every day. I understand [that] psychiatry
    gave me, and so many others, a life. And I understand blind hatred doesn’t help me get any better . . . people need to engage the psychiatric system
    to treat their mental illness . . . I believe in: educating people, empowering people . . . encouraging patients to take their doctors to task . . . making people more active in their own health care [and]
    reducing prejudice.”

    from: http://www.healthyplace.com

    [Submitted by Ronald Pies MD]

    Link to this
  37. 37. Josephmar 11:58 pm 06/2/2013

    The DSM needed to be revised. The fact that there are so many professionals making decisions on what the latest content is, could very well be a step back in treating the mentally ill. There are too many cooks in the kitchen. Maybe a division of some sort needs to occur.

    Link to this
  38. 38. portland17 10:28 pm 06/4/2013

    Seriously, Ron? Re-read my post (#30) and tell me where I express “hatred of psychiatry?” I raise a list of legitimate, rational, scientific points, from better schizophrenia outcomes in developing countries to the inappropriate use of antipsychotics on millions of young people incorrectly labeled with “bipolar disorder” to the early deaths of many treated with antipsychotic drugs to the failure of psychiatry to utilize the results of 10 years of useful and practical discoveries about the flexibility and growth potential of the human brain. You answer not one of these rational, legitimate points and again return to the idea that somehow we are all “hating psychiatry.”

    I don’t hate psychiatry or psychiatrists – I hate poor results and pretentiousness of those in power and the harming of patients for no good reason! We KNOW better than to continue down the path of label-and-drug – it has bad outcomes, and there are other, more successful and less damaging options. That’s what SCIENCE is telling us. Do you care about science at all? If so, I ask that you respond to the points I and others have so articulately raised. Otherwise, I am forced to assume that you’ve abandoned science in favor of dogma that make you feel comfortable, regardless of the impact on your unfortunate clients whose reactions don’t match your expectations.

    If you take people’s negative reactions to psychiatry as seriously as you claim, should you not listen to the substance of these critiques, and either address them, or acknowledge the justice in their remarks?

    Perhaps it is you who are approaching your critics with hatred in your heart…

    —- Steve

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  39. 39. chrisdubey 8:11 pm 06/8/2013

    “However, that was then and now is now.”

    No, Jeffrey, psychiatric abuse and other major psychiatric iatrogenesis continues rampantly. I am a survivor of forced electroshock from 2005-2006. I have written about the harm caused by modern electroshock. It’s not just the barbaric use in the past. It’s not just a fictional movie.

    http://www.examiner.com/article/letter-to-three-connecticut-politicians-about-involuntary-electroshock

    http://www.examiner.com/article/a-summary-of-references-against-electroshock-treatment

    http://www.examiner.com/article/proposed-bill-5298-and-a-second-summary-of-references-against-ect

    http://www.examiner.com/article/bill-to-abolish-involuntary-shock-therapy-flutters-through-first-public-hearing

    http://www.examiner.com/article/bill-5298-the-written-testimony-part-1

    http://www.examiner.com/article/bill-5298-the-written-testimony-part-2

    http://www.examiner.com/article/bill-5298-the-written-testimony-part-3

    “But there’s another type of critique that does not contribute to this goal. These are the groups who are actually proud to identify themselves as “anti-psychiatry.”

    Yes, I am proud to be part of the antipsychiatry movement and that is completely rational and justified. It is a coalition of forces with similar insight about the corruption in psychiatry, although our opinions differ on the finer points.

    My reviews of the DSM books:

    http://www.examiner.com/review/the-book-of-woe-about-the-dsm-is-a-revelation

    http://www.examiner.com/review/allen-frances-is-not-normal-but-he-has-solutions-to-the-dsm

    Link to this
  40. 40. Ringersoll 4:40 pm 06/10/2013

    As a psychologist who has written on psychopharmacology and psychopathology, the ongoing issue of psychiatry’s alliance with drug companies must be aggressively addressed if psychiatry is to be trusted. Psychiatrists are the ones who perpetrated the “chemical balance” hoax and while I know many good psychiatrists who try their best, it seems that the profession as a whole is still not comfortable with the truth that we have yet to understand what the etiology is for any mental disorder. I’ve tried to address this is a recent ted talk (if I am not allowed to post you can find it at TEDxCLE). I teach all my students “when in doubt,tell the truth.”

    Link to this
  41. 41. shelaghstephen 10:23 pm 07/8/2013

    It’s not prejudice when it’s coming from victims of psychiatry. It’s judgement after, not before.

    Link to this
  42. 42. Mersenne 10:03 pm 08/10/2013

    What a disappointing article, for so many reasons. That the so-called “anti-psychiatry” movement is a minority doesn’t either legitimize or invalidate the concerns this movement has. It isn’t scientific to take a vote when deciding what’s a valid argument. Reality isn’t what the majority agrees on. And where is this science in psychiatry Lieberman writes of in such sweeping terms? In fact, there is no blood test or brain scan that proves so-called mental illness. That emotional distress and altered mental states exist is something we can all agree on. Whether or not it’s useful to label these conditions as illnesses that are mysteriously both unprovable and chronic is another debate–one that Lieberman dodges. Robert Whitaker, an investigative journalist (“Mad in America” and “Anatomy of an Epidemic”) draws a convincing portrait of what ails psychiatry: a foundation in the eugenics movement that demeans the experiences of patients; a wish on the part of psychiatrists to be seen as mainstream doctors; corruption in the drug industry. According to both Whitaker and Dr. Marcia Angell, another critic of psychiatry, the huge increase of psycho-active drugs has put many more Americans on long-term disability–about tenfold the number of those on psychiatric disability in the pre-drug era. Surely this cost takes away from what could be spent on treatment methods that have been proven to work more effectively: rest, respect, compassion, cognitive behavioral therapy, and so on.

    Link to this
  43. 43. Annoyed Citizen 11:57 am 08/13/2013

    Per the prompting of a colleague, I found this post and have to say, wow, this is what the leadership of the APA has to rebut the “antipsychiatry” movement? And for Dr Lieberman to dismiss Freud so completely? Absolutely astounding what someone would do to promote an agenda, not a health care cause.

    Yes, it is painfully obvious to me, as a fellow psychiatrist, the APA is lost, that greed, lust for power and control, and sheer arrogance is what the organization has devolved into. This biochemical model that most in positions of power and influence claim is the paradigm for the field is rather disgusting to endure being in the profession. But, when you are forced into roles as hydraulic lift operators, just raising and lowering medication dosages like a fork lift operator in a warehouse, it dumbs you down.

    Pathetic what allegedly represents psychiatry in this millenium, eh? Just my opinion!

    Link to this
  44. 44. kris10J 9:58 am 12/7/2014

    The author states:
    “The scientific foundation of psychiatric medicine has grown by leaps and bounds in the last fifty years. The emergence of psychopharmacology, neuroimaging, molecular genetics and biology, and the disciplines of neuroscience and cognitive psychology have launched our field into the mainstream of medicine.”
    I argue that these examples of emerging and growing fields cannot give psychiatry the scientific foundation that it never had from its beginning. These certainly gives the appearance of operating within the medical field with the impressive technological toys and brain images, but they cannot provide the missing link required for true validity. Psychiatry’s classifications are determined by agreement as stated by another commenter.
    As I stated in my master’s thesis last year:
    “Currently, biological and genetic explanations for these problems are privileged and most commonly adhered to in the dominating paradigm, but these explanations do not engender a lot of hope for either the person diagnosed or the helping professional. It has been shown that professionals holding biogenetic etiological beliefs tend to believe in a poor prognosis for schizophrenia and have perceptions of lower effectiveness of treatment (Lincoln, Arens, Berger, & Rief, 2008; Phelan, Yang, & Cruz-Rojas, 2006). Additionally, reductionist understandings are disconnected from individuals’ histories and have a silencing effect on alternative contextual, non-Western, and non-pathological understandings as these are considered less scientific or less “real” (Robbins, 2011). The environment created by these complex intersections of discourse and assumed knowledge very often result in disempowering experiences for the service user in ongoing treatment, and is at direct odds with a person’s recovery.”
    Supporters of anti-psychiatry are NOT, as the author states, “prejudiced against people with disorders of the brain and mind and the professions that treat them.” It is the notion that people’s problems stem exclusively from a “disorder of the brain” ITSELF, that is the root of the argument.
    Check out Mary Boyle’s (2003) “Schizophrenia: A Scientific Delusion?”

    Link to this
  45. 45. Lerkkweed 5:25 pm 12/7/2014

    This article conflates legitimate disciplines like psychology and psychotherapy with psychiatry.

    To borrow a computer analogy: I regard the fundamental error of psychiatry as that of confusing a software problem for a hardware problem. The “software” in this case being the human soul, by which I mean the totality of mind, memory and emotion sans supernatural connotations. The goal of psychiatry is pacification and social control, not healing.

    Though there are psychiatrists who can be effective as psychologists and psychotherapists – guiding the patient to the roots of their travail and helping them release, feel and integrate it – every psychiatric treatment qua psychiatry e.g. psychotropic drugs, ECT and lobotomy (now phased out in favor of ECT, which, as Peter Breggin points out, produces similar effects) “works” by causing brain damage. It tends to view intense feelings, natural responses to extreme situations – above all, trauma – as pathologies, thereby pathologizing the human soul.

    In the hands of a good psychotherapist an expression of intense emotion such as rage, pain, grief can be an orange flag indicating precisely where the patient needs to go, and the therapist will actually take him or her into those feelings, allowing the eruption to occur fully, understanding that there is no other way to truly resolve them.

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  46. 46. 4TimesAYear 11:03 pm 12/7/2014

    The problem I have with psychiatry is that they use a diagnostic term instead of considering whether someone’s experience is real. It’s not psychoses when you have all the evidence on tape. Psychiatrists can be delusional, too. No one can get inside someone else’s mind and know what is really happening in their heads, and when psychiatrists think they know what a patient’s reality is, they think they are God. They won’t go back and amend the record, and it cannot be expunged. Even after an experience is validated, a psychiatrist maintains the delusion that your “psychoses” were real and “just because you experienced them once, doesn’t mean you will again” – never mind you didn’t experience psychoses once – only the psychiatrist did.

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  47. 47. mhadvocate 12:57 pm 12/8/2014

    An overhaul of the mental health system is needed, but the silo mentality of many of those in mental health prevent real reform from happening. The DSM-V adds no real value, but simply increases the fear many have developed regarding psychiatry. Studies show between 5% to 75% are erroneously diagnosed, often for treatable conditions. The Koran algorithm (Hospital & Community Psychiatry Dec. 1989, vol. 40 #12) and differential diagnosis need to be more widely used in order to cut down the number of individuals mistakenly given a mental health diagnosis. Check magnesium levels – Magnesium deficiency causes serotonin-deficiency with possible resultant aberrant behaviors, including depression, suicide or irrational violence. (Transdermal Magnesium Therapy by Mark Sircus, Ac., O.M.D. pg. 172) Screen for trauma before labeling individuals. “Trauma exposure has been linked to later substance abuse, mental illness, increased risk of suicide, obesity, heart disease, and early death.”(Leading Change: A Plan for SAMHSA’s Roles and Actions 2011–2014 – pg. 8). Somatic Experiencing (www.healingtrauma.com) & other non drug programs are available, but rarely used. “Respect for authority needs to be earned… know the difference between obedience and willing cooperation. Obedience is maintained when people submit because we have the power to reward or punish. Willing cooperation can only be received when people feel free from this kind of coercion and they trust that their needs as human beings are valued.” (Excerpt from Non Violent Communications by Marshall Rosenberg.) More in my newly released book Liberty & Mental Health – You Can’t Have One Without the Other. http://bookstore.trafford.com/Products/SKU-000906908/Liberty–Mental-Health.aspx

    Link to this

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