In the current issue of the journal Ethical Human Psychology and Psychiatry, Australian dissident psychiatrist Niall McLaren titles his article, “Psychiatry as Bullshit” and makes a case for just that.
The great controversies in psychiatry are no longer about its chemical-imbalance theory of mental illness or its DSM diagnostic system, both of which have now been declared invalid even by the pillars of the psychiatry establishment.
In 2011, Ronald Pies, editor-in-chief emeritus of the Psychiatric Times, stated, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” And in 2013, Thomas Insel, then director of the National Institute of Mental Health, offered a harsh rebuke of the DSM, announcing that because the DSM diagnostic system lacks validity, the “NIMH will be re-orienting its research away from DSM categories.”
So, the great controversy today has now become just how psychiatry can be most fairly characterized given its record of being proven wrong about virtually all of its assertions, most notably its classifications of behaviors, theories of “mental illness” and treatment effectiveness/adverse effects.
Among critics, one of the gentlest characterizations of psychiatry is a “false narrative,” the phrase used by investigative reporter Robert Whitaker (who won the 2010 Investigative Reporters and Editors Book Award for Anatomy of an Epidemic) to describe the story told by the psychiatrists’ guild American Psychiatric Association.
In “Psychiatry as Bullshit,” McLaren begins by considering several different categories of “nonscience with scientific pretensions,” such as “pseudoscience” and “scientific fraud.”
“Pseudoscience” is commonly defined as a collection of beliefs and practices promulgated as scientific but in reality mistakenly regarded as being based on scientific method. The NIMH director ultimately rejected the DSM because of its lack of validity, which is crucial to the scientific method. In the DSM, psychiatric illnesses are created by an APA committee, 69 percent of whom have financial ties to Big Pharma. The criteria for DSM illness are not objective biological ones but non-scientific subjective ones (which is why homosexuality was a DSM mental illness until the early 1970s). Besides lack of scientific validity, the DSM lacks scientific reliability, as clinicians routinely disagree on diagnoses because patients act differently in different circumstances and because of the subjective nature of the criteria.
“Fraud” is a misrepresentation, a deception intended for personal gain, and implies an intention to deceive others of the truth—or “lying.” Drug companies, including those that manufacture psychiatric drugs, have been convicted of fraud, as have high-profile psychiatrists (as well as other doctors). Human rights activist and attorney Jim Gottstein offers an argument as to why the APA is a “fraudulent enterprise”; however, the APA has not been legally convicted of fraud.
To best characterize psychiatry, McLaren considers the category of “bullshit,” invoking philosopher Harry Frankfurt’s 1986 journal article “On Bullshit” (which became a New York Times bestselling book in 2005).
What is the essence of bullshit? For Frankfurt, “This lack of connection to a concern with truth—this indifference to how things really are—that I regard as of the essence of bullshit.”
Frankfurt devotes a good deal of On Bullshit to differentiating between a liar and a bullshitter. Both the liar and the bullshitter misrepresent themselves, representing themselves as attempting to be honest and truthful. But there is a difference between the liar and the bullshitter.
The liar knows the truth, and the liar’s goal is to conceal it.
The goal of bullshitters is not necessarily to lie about the truth but to persuade their audience of a specific impression so as to advance their agenda. So, bullshitters are committed to neither truths nor untruths, uncommitted to neither facts nor fiction. It’s actually not in bullshitters’ interest to know what is true and what is false, as that knowledge can hinder their capacity to bullshit.
Frankfurt tells us that the liar hides that he or she is “attempting to lead us away from a correct apprehension of reality.” In contrast, the bullshitter hides that “the truth-values of his statements are of no central interest to him.”
Are Psychiatrists Bullshitters?
Recall establishment psychiatrist Pies’ assertion: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” What Pies omits is the reality that the vast majority of psychiatrists have been promulgating this theory. Were they liars or simply not well-informed? And if not well-informed, were they purposely not well-informed?
If one wants to bullshit oneself and the general public that psychiatry is a genuinely scientific medical specialty, there’s a great incentive to be unconcerned with the truth or falseness of the chemical imbalance theory of depression. Bullshitters immediately recognize how powerful this chemical imbalance notion is in gaining prestige for their profession and themselves as well as making their job both more lucrative and easier, increasing patient volume by turning virtually all patient visits into quick prescribing ones.
Prior to the chemical imbalance bullshit campaign, most Americans were reluctant to take antidepressants—or to give them to their children. But the idea that depression is caused by a chemical imbalance that can be corrected with Prozac, Paxil, Zoloft and selective serotonin reuptake inhibitor antidepressants sounded like taking insulin for diabetes. Correcting a chemical imbalance seemed like a reasonable thing to do, and so the use of SSRI antidepressants skyrocketed.
In 2012, National Public Radio correspondent Alix Spiegel began her piece about the disproven chemical imbalance theory with the following personal story about being prescribed Prozac when she was a depressed teenager:
My parents took me to a psychiatrist at Johns Hopkins Hospital. She did an evaluation and then told me this story: “The problem with you,” she explained, “is that you have a chemical imbalance. It’s biological, just like diabetes, but it’s in your brain. This chemical in your brain called serotonin is too, too low. There’s not enough of it, and that’s what’s causing the chemical imbalance. We need to give you medication to correct that.” Then she handed my mother a prescription for Prozac.
When Spiegel discovered that the chemical imbalance theory was untrue, she sought to discover why this truth had been covered up, and so she interviewed researchers who knew the truth. Alan Frazer, professor of pharmacology and psychiatry and chairman of the pharmacology department at the University of Texas Health Sciences Center, told Spiegel that by framing depression as a deficiency—something that needed to be returned to normal—patients felt more comfortable taking antidepressants. Frazer stated, “If there was this biological reason for them being depressed, some deficiency that the drug was correcting, then taking a drug was OK.” For Frazer, the story that depressed people have a chemical imbalance enabled many people to come out of the closet about being depressed.
Frazer’s rationale reminds us of Edward Herman and Noam Chomsky’s book Manufacturing Consent, the title deriving from presidential adviser and journalist Walter Lippmann’s phrase “the manufacture of consent”—a necessity for Lippmann, who believed that the general public is incompetent in discerning what’s truly best for them, and so their opinion must be molded by a benevolent elite who does know what’s best for them.
There are some psychiatrists who view the chemical imbalance theory as a well-meaning lie by a benevolent elite to ensure resistant patients do what is best for them, but my experience is that there are actually extremely few such “well-meaning liars.” Most simply don’t know the truth because they have put little effort in discerning it.
I believe McLaren is correct in concluding that the vast majority of psychiatrists are bullshitters, uncommitted to either facts or fiction. Most psychiatrists would certainly have been happy if the chemical-imbalance theory was true but obviously have not needed it to be true in order to promulgate it. For truth seekers, the falseness of the chemical imbalance theory has been easily available, but most psychiatrists have not been truth seekers. It is not in the bullshitters’ interest to know what is true and what is false, as that knowledge of what is a fact and what is fiction hinders the capacity to use any and all powerful persuasion. Simply put, a commitment to the truth hinders the capacity to bullshit.
Bruce E. Levine is a practicing clinical psychologist. His latest book is Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite.
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