Reaching Out

Reaching Out

Reaching Out

Joe Tarantolo, M.D., Psychiatrist

Reaching out to the other fringe groups in conflict with conventional medicine. (Yes, ISEPP is at the margins, not with the conventional.)

Wise Traditions is the quarterly journal of the Weston A. Price Foundation, an organization that is dedicated to restoring “nutrient dense” food to our  20th-21st century high fructose corn syrup processed food addicted diets. High fat, unpasteurized milk, grass fed beef, wild salmon, fermented vegetables, anti fluoridation, anti vaccination---you get the picture.

Sally Fallon, an old friend whose cook book is my frequent guide in the kitchen , called me recently to ask me to present a talk this fall at their conference in Dallas. Their yearly conference attracts over a thousand folk (has ISEPP ever had a thousand attendees?). I hadn’t spoken to Sally in several years but she remembered a comment I had made about the dangers of antidepressants, viz., they induce “not caring.” She asked me to present  a talk. I accepted. The title of my talk: NOT BY BREAD ALONE DOTH MAN LIVE, EVEN IF IT’S SOURDOUGH: A CRITIQUE OF ANTIDEPRESSANTS AND THE MEDICAL MODEL IN PSYCHIATRY.”

My observations of those I see and read and with whom I interact in the alternative world, the herbalists, the naturopaths, the nutritionists is that they tend to make a mistake similar to the conventional model. But because they are not burdened by the prescription pad and the legal torments of forced treatments, they do less harm. But, they too make the mind/body split and tend to characterize “mental illness” as a “brain disease.” In fact “brain health” is a big seller in the alternative world. I am not dumping criticisms on brain herbs. I love them: Bacopa, Gingko, Rosemary, Kava, not to mention the plethora of herbs called adaptogens such as Reishi mushrooms  and Ashwaganda (one of my favorites, a potent Indian herb very useful in the prevention and treatment of cancer). But what I will tell the Wise Traditions crowd is that no amount of the best high Vitamin A and E cod liver oil will cure a bad marriage. High dose vitamin therapy will not cure schizophrenia. Actually, the high dose vitamin crowd doesn’t do too badly with schizophrenia. If you read the Canadian guru, Dr. Carl Pfeiffer, who claims an 80% cure rate of schizophrenia, what you see is he takes the schizophrenic off of neuroleptics and gets rid of those who don’t cooperate, i.e., they are not included in his statistics. Yes, taking people off of neuroleptics will improve their chances of getting better. I suspect it has little to do with the vitamins.

A healthy body does not determine psychological health. The person dying with a terminal illness can be psychologically and spiritually healthy: facing mortality with courage, leaving behind old complaints and petty slights. I was thinking about “The Longest Day”; yesterday was the 75th anniversary of D-Day. I’m told that General Eisehower could not sleep the whole week before the Normandy invasion. I am sure he did not go to a psychiatrist and complain about insomnia. Ike was psychologically healthy, preoccupied about the thousands of boys he was sending on an uncertain task to certain death. He was healthy. Hitler took a sedative, he was sick!

Mental health is not about being happy. Evil sadists are often happy and they are mentally sick. Mother Teresa who cared for the dying struggled with despair. She was mentally/spiritually healthy. Mental health includes the ability to hold conflict, i.e., to suffer. The psychotic, the manic, the obsessed, the somatically preoccupied, the sadist, the pathologic narcissist, all take flight from suffering. Drugging and ECT aid in this escape caper. They do not promote mental and spiritual health. That’s the second time I used the term “spiritual.” What’s up with spiritual? The terminology about health is fungible. The pre-enlightenment idea of health was being at peace with God/Yahweh/Allah. We post-enlightenment religious types are not satisfied with that too easy of a position. The capacity to doubt and question and struggle with meaninglessness must be part of the picture. There is no easy path.

Morality-Driven Illnesses

Morality-Driven Illnesses

Morality-Driven Illnesses

Chuck Ruby, Ph.D., Psychologist

Here we go again!

In response to political pressure, The World Health Organization's legislative body just ratified a June 2018 proposal to redesignate "gender incongruence" (called "gender dysphoria" in the DSM) so that it is no longer a mental illness.1 This change will be reflected in the 11th edition of the International Classification of Diseases (ICD). While I applaud any effort to depathologize natural human variation in interests and preferences, is this really how it works? Mental illnesses are voted in an out of existence because of political pressure and changes in ideas about morality? Well, yes, that is precisely how it works. 

The advocates of this change claim it "...was taken out from the mental health disorders because we had a better understanding that this wasn't actually a mental health condition and leaving it there was causing stigma."2 But we don’t identify real illnesses this way. Instead, we study the problem to determine what is causing the symptoms. It is only after we have a good theoretical hypothesis for, or actually find, the bodily defect responsible for the symptoms that we dub it an illness. We don’t merely claim that we have a “better understanding” of it without providing any scientific evidence or critical reasoning. It seems that "a better understanding" in this case means that they just thought it was a good idea to do it that way.

So how do we define mental illness? The ICD defines it as "a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions."3 (I wonder why just in "most cases"). The DSM's definition is far more convoluted than the ICD's, but it still seems to include just about anything that causes distress and interference in social functioning. Since it is clear that bucking the conventional ideas and behaviors about gender is going to attract righteous indignation and cause distress for the person, why wouldn't gender incongruence be considered a mental illness regardless of political pressure?

Further, keep in mind that gender incongruence was not completely removed from the ICD with the World Health Organization’s vote. Instead, it was only removed from the section dealing with mental illness but it was added to the section entitled "conditions related to sexual health." This was done in order to "...reduce the stigma while also ensuring access to necessary health interventions...."It is there along with the paraphilias, sexually transmitted diseases, and premature ejaculation. But how does removing gender incongruence from the mental illness section and placing it into the real illness section reduce the stigma? And why would we need a separate category identifying "necessary health interventions" that only transgender people suffer unless it is because of their transgender status? Doesn't this just worsen and perpetuate the stigma?

There have been other examples of this kind of shell game of eliminating mental illness by moral decree. For instance, during antebellum America, "dysaesthesia aethiopica" and "drapetomania" were discarded as mental illnesses.These had been used to diagnose slaves' laziness and their urges to escape their masters, respectively. They were considered serious mental illnesses at the time and slave owners must have been quite worried that they would contagiously spread throughout plantation life. But we now rail against the blatant racist morality upon which they were founded. 

This is also what happened in 1930s Germany when Dr. Hans Asperger came to the Nazi party's aid to designate the inappropriateness of socially reticent children as "autistic psychopathology."6 With this mental illness Dr. Asperger explained why those children didn't want to join the Hitler Youth and gave a reason for the Third Reich to euthanize some of them. We have heard echoes of this mental illness throughout the subsequent decades in the familiar name "Asperger's disorder," until it was removed from the DSM in 2013 and incorporated into the more serious designator "autism spectrum disorder" (by a vote).

Lest you think these examples were due to uninformed or prescientific minds of the times, there are more recent examples. For instance, the American Psychiatric Association (APA) asked its members in attendance at its 1973 annual convention to vote on whether homosexuality was a mental illness. The resulting tally was 3,810 in favor of its illness status and 5,854 votes against. Consequently, the "homosexuality" designator was removed from the DSM as a mental illness.7  However, even though "homosexuality" was no longer considered a mental illness, those same people who had earlier been diagnosed with homosexuality could still be diagnosed with "sexual orientation disturbance," "ego-dystonic homosexuality," or other diagnostic categories that reflect the difficulties inherent in living a gay lifestyle, especially openly. It is absurd to vote on whether homosexuality is a mental illness, it is even more absurd that 40% of those voting believed it was an illness. And this is science?

In the 1980s, "masochistic personality disorder" was considered for inclusion in the DSM. This disorder was thought to be the cause of (mostly women) allowing themselves to be abused by others (mostly men). Because of its glaring bias against women, the DSM committee proposed adding another disorder called "sadistic personality disorder" to balance out the situation with a mental illness that was equally biased against men. Fortunately, both were eventually dropped from consideration. The DSM task force that debated this issue included the wife of the task force chair. At one point she noted that one of the proposed symptoms for the disorder applied to her. In response, the chairman removed the symptom from the list.8 Even though masochistic personality disorder was dropped, there was a diagnosis remaining in the DSM section on conditions needing "further study." It was "self-defeating personality disorder," which mirrored the diagnostic criteria of masochistic personality disorder. Can it be more obvious?

All mental illness diagnoses suffer from this very same problem, including gender dysphoria. They aren't diagnoses of true illnesses. Instead, they are designators for experiences and behaviors that are considered by DSM or ICD committee voting members to be abnormal because they are in conflict with appropriate ways of living. This is reflected in the branch of psychology that deals with mental illness - abnormal psychology. But there is more to it than just being abnormal (it would require a whole chapter to explain the phantom concept of abnormality). There is also an element of contempt and disgust that is reflected in popular comments about those labeled with mental illnesses, such as, "He's not right in the head," and "Something is wrong with her." We don't see similar comments about right and wrong regarding true illnesses such as cancer and diabetes, unless the illness has to do with a moral failing such as with sexually transmitted diseases.

But just how do we distinguish between this kind of normal (right) and abnormal (wrong) mental functioning and behavior? If we dig down beneath the layers of medical disguise, we inevitably find the answer. The kind of abnormality associated with mental illness and the commonly held contempt about it is based on morality, not science. This includes the most recent example of how moral standards were the basis for identifying gender incongruence as a mental illness until this month, when a different set of moral standards were used to justify eliminating it as a mental illness. This move was not science and it does nothing to address the larger problem of allowing the medical and mental health industry to dictate appropriate morals.

1, paragraph 5.
World Health Organization. (1994). The ICD-10 Classification of Mental and Behavioural Disorders.p. 11. Retrieved from:
 4, paragraph 5.
 5 Cartwright, S. (1851). Diseases and Peculiarities of the Negro Race. DeBow's Review,11.
 6 Sheffer, E. (2018). Asperger’s Children: The Origins of Autism in Nazi Vienna. New York: W. W. Norton & Company.
 7 Burton, N. (2015, September). When homosexuality stopped being a mental disorder: Not until 1987 did homosexuality completely fall out of the DSM. Psychology Today. Retrieved from:
 8 Kutchins, H. & Kirk, S. (1997). Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders. New York: Free Press.

The Zombie Theory: Thorazine to the Rescue (Part 3)

The Zombie Theory: Thorazine to the Rescue (Part 3)

R. L. Cima, Ph.D.

As long as I live, I shall balk at having psychoanalysis swallowed by medicine. - Sigmund Freud


WHO’s Counting

Within the last 70 years, with the assistance of a trillion dollar worldwide pharmaceutical business and their partners in academia – and a willing populace – human beings are being drugged into “balance” to treat fictitious brain diseases in astronomical numbers.  In 2018, the World Health Organization (WHO) estimates 300 million people around the world have depression disorder, 60 million have bipolar disorder, and another 23 million have schizophrenia disorder and other psychoses- all of them in need of psychiatric medication.  According to WHO, it’s likely that accurate numbers are significantly higher as poorer countries have no way to record mental illness.  Leading the way – the United States. 

The Journal of the American Medical Association (JAMA) reported in 2017 more than 40 million adults were prescribed one or more psychiatric prescriptions in America (2013).Race, you should know, is a factor.  One in five white adults, one in ten black adults, one in twelve Hispanic adults, and one in 20 Asian adults are prescribed psychiatric medications.  By gender, the difference is as significant.  Nearly twice as many women (20.8%) are taking psychotropics than men (11.9%).  Age matters too.  About one in ten 18-39 year-olds are psychiatric patients, nearly one in five 40-59 year-olds, and, out in front by a wide margin, a solid one fourth of adults between the ages of 60-85 are prescribed psychiatric medications.  By the way, why is “mental illness” dependent on race, gender and age?  How does the psychiatric medical model (PMM) scientist explain this? 


There are 75 million children in the United States in 2019.3 Nearly 17 million are diagnosed with a brain disease.  The Center for Disease Control (CDC) reports 6.1 million children have been diagnosed with ADHD disorder, 4.5 million with a behavior disorder, another 4.4 million with anxiety disorder, and 1.9 million with depression disorder.4 And why are nearly one in five children being drugged?  The American Academy of Child & Adolescent Psychiatry (AACAP) declares there are eleven psychiatric symptoms and disorders for which psychiatric medication may be prescribed for children.  The list includes bedwetting, anxiety, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, depression disorder, eating disorder, bi-polar disorder, psychosis, autism spectrum disorders, severe aggression and sleep problems.5  

Toddler & Infants Too

From the New York Times, May 2014:

“About 15,000 American toddlers 2 or 3 years old, many on Medicaid, are being medicated for attention deficit hyperactivity disorder, according to data presented Friday by an official at the federal Centers for Disease Control and Prevention.”6

From Medical Daily, December 2015:  

“The report shows that psychotropic drug prescriptions among babies nearly doubled in one year, from 13,000 prescriptions in 2013 to 20,000 in 2014, despite the lack of evidence that shows they are effective and safe for young children . . .  psychiatrists often prescribe these drugs . . . for behavioral issues like unusual aggression, temper tantrums, or lethargy.”7

What Are We Taking – and Why Are We Taking Them?

From PsychCentral, here of the top 25 psychiatric drugs that were sold in America – and the reasons we take them – in 2016:8

Knot in the Mood

More than 338 million prescriptions were written just for anti-depressant medications in 2016, by far the winning diagnosis.  And depression isn’t as simple as you may think.  There are all kinds of depression including atypical depression, bipolar disorder I, bipolar disorder II, catatonic depression, cyclothymia, depressive personality disorder, double depression disorder, dysthymia, melancholic depression, minor depressive disorder, postpartum depression, premenstrual dysphoric disorder, psychotic major depression, recurrent brief depression, and last, but not least, seasonal affective disorder, affectionately known as SAD.  

Is there a common denominator for all of these chemicals?  Of course, and it’s easy to see.  All 25 chemicals address the same innate, unavoidable, uncomfortable, and sometimes-hard-to-shake-life-altering-human-experience:  mood.  And yes, that includes ADHD, including the effect ADHD has on the mood of others.  Ok, you may notice, schizophrenia is about consciousness, not mood.  Nonetheless, the PMM provides treatment for schizophrenia and other aspects of consciousness with the same mood medications:  tranquilizers.  Anything else these chemicals have in common?  Yes, of course, and it’s easy to see too.  Twenty-two of them are central nervous system depressants (CNSD), and three of them are central nervous system stimulants (CNSS).  What’s that about and why is it important?

Lost In the Shuffle

Rhône-Poulenc, a French pharmaceutical company, was developing antihistamines for nausea and allergies in the late 1940’s.  Scientists noticed some chemical compounds exhibited exceptional sedative effects.  Dr. Henri Laborit, a French surgeon, called this effect artificial hibernation, and described it as “sedation without narcosis.”  By 1951 Laborit was conducting clinical trials of the newest compound – chlorpromazine (CPZ) –  for use as an anesthetic booster for surgery patients.  He proclaimed CPZ the “best drug to date” in calming and reducing shock during surgery.  Known as "Laborit's drug" among colleagues9, by 1953 CPZ was released for use in the operating room.  

Laborit was also a persistent advocate for clinical trials for psychiatric patients using this new wonder chemical.  His persistence was rewarded.  On January 19, 1952, CPZ was administered to a manic patient named Jacque.  Jacque’s improvement was reported to be “dramatic.”  After three weeks – and 855 mg of CPZ – Jacque was released from the hospital.  Word spread quickly about this “breakthrough.”  Dr. Pierre Deniker10, another French surgeon, ordered CPZ for a clinical trial at the Sainte-Anne Hospital Center in Paris.  His findings were even more dramatic.  Often doubling Laborit’s doses, Deniker found CPZ had much more than sedative effects.  His patients showed “remarkable improvement in thinking and emotional behavior.”  By the end of 1952, Deniker abandoned old, ineffective, and harmful shock methods and began to treat mental illness with CPZ.  

Soon after, Kline & French Pharmaceuticals (today's GlaxoSmithKline) purchased the rights to CPZ from Rhône-Poulenc.  By 1954, Smith-Kline & French received FDA approval to market CPZ as Thorazine to treat schizophrenia.  The world’s first psychiatric medication was created – and marketed.  Advertisements and professionals soon were boasting how “Thorazine helps to keep more patients out of mental hospitals.”  Please remember, hospital beds were required because psychiatric patients needed time to recover from electrocution, the surgeon’s knife, or chemically induced, months'-long comas.  While a chorus of public outcries about the inhumane treatment of psychiatric patients had already begun to empty the beds of these tortuous asylums, psychiatric scientists and drug company marketers attributed this exodus to the “dramatic” success of Thorazine.

Then, in October 1955, Deniker’s Saint-Anne Hospital Center convened the first international Thorazine (CPZ) conference.  Attendees included scientists from Austria, Belgium, Brazil, Canada, Cuba, France, Germany, Great Britain, Holland, Luxembourg, Peru, Portugal, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States and Venezuela.  Soon to follow were thousands of papers from scientists around the world publicizing their own “dramatic” successes with Thorazine for an ever-widening variety of brain disorders, affecting millions of patients.  By 1957, Laborit, Deniker (and Heinz Lehmann) were awarded the prestigious Albert Lasker Award for their contributions to the clinical development and use of Thorazine - dubbed “the world’s first anti-psychotic medication.”11     

During the 1950’s and 1960’s, the pharmaceutical ads for Thorazine were ubiquitous.  Thorazine was prescribed for bursitis pain, cancer pain, emotional stress, anxiety, nausea and vomiting, “management of menopausal patients,” child behavior disorders, acute alcoholism, severe asthma, depression, hiccups, catatonic schizophrenia, schizoaffective conditions, epileptic clouded states, agitation in lobotomized patients, confusional states, senile psychoses, gastrointestinal disorders, psoriasis, and more.12 By 1964, fifty million people around the world had used Thorazine.13

In his book The Creation of Psychopharmacology (2002)14, David Healy, the renowned British psychiatrist, professor, scientist, author – and current director of an ECT clinic in Wales – proclaims the discovery of Thorazine as significant to medicine as the discovery of penicillin.  As important, he asserts, Thorazine was also the first profitable psychiatric medication for pharmaceutical companies.  He marks the convergence of these two events – a wonder treatment and profitability – as the genesis of what he termed “biological psychiatry,” and the 1980 publication of DSM-III as bonding psychiatry to the biological cause of mental illness, forever.  Healy also details the prodigious growth of pharmaceutical companies and their promotion strategies, including coordination with academia to find new mental illnesses, and to manufacture the medications to treat them.  

There were huge profits in the making for this burgeoning “take-a-pill-for-it” market, and Big Pharma began to flourish.  By the end of the 1960’s pharmaceutical companies had created dozens of “new and improved” medications for a growing number of new mental illnesses.  By then, Thorazine was regarded as just another, less effective medication, now criticized by its competitors for its notorious side effects.  And what were these “new and improved” medications from Big Pharma?  More tranquilizers.

Was the discovery of Thorazine really as significant as penicillin?  Yes, it was – if you are a proponent of the PMM.  Dr. Healy is, and he has company.  So is 94%15 of the general public and, presumably, 99+% of professionals.  However, if you are PMM antagonist, then Thorazine was – nothing more and nothing less – the world’s first tranquilizer, and a precursor to the hundreds of tranquilizers to follow.

A Lost Cause

Take a look at this chart of the top ten diagnosed brain disorders, and their causes:

There are a total of 713 medications manufactured by drug companies for the top ten brain disorders, for which there are no known causes.  How is that possible?  By the way, these are just the top ten diagnoses.  You can see the entire list of "Medications for Psychiatric Disorders" at Please be warned.  If you are looking for a cause for any of the brain disorders of the PMM, you will be disappointed.  There are none.  

So, do you wonder too?  What in the hell are they treating?  

Jacque to the Future

When Jacque took his first dose of CPZ in 1952, everything changed in psychology and psychiatry.  In just a few decades, psychological diagnoses became medical diagnoses, needing medical oversight, medical solutions, and medical doctors to do so.  Now, a psychiatric medical patient sees a medical doctor for psychiatric medication to address a brain disorder.  Behaviors once considered understandable responses to the challenges of life by psychology became “symptoms” to the doctors of the PMM, and the “symptoms” became evidence of the underlying medical deficiency, derangement, disease, disorder, disability, disturbance, or dysfunction (the 7 D’s of the PMM).

We are approaching 50 million men, women, children, toddlers and infants in the United States who are taking pills for brain disorders.  And business is booming.  Psychiatric medications – the majority tranquilizers, a handful of stimulants, and an occasional analgesic – now number in the thousands, more created every year.  Not a single cure, and not a single cause for any of the ever-growing brain disorders of the PMM.  

Did I mention business is booming?  

Welcome to Zombieland

Psychiatry entered the last half of the 20th Century on an upnote, despite a horrendous track record for the first 50 years.  The PMM scientists created a new, simple, humane, and easily administered treatment solution for mental illness, and by the 1960’s big pharma was making money hand over fist.  Only one thing was missing to unify this marriage.  Healy’s “biological psychiatry” needed a coherent, science-based, peer-reviewed theory to explain how all these miracle drugs worked.    

Well, they found one.  It’s about bad brain parts.  And a Zombie comes with it.

NEXT TIME:  Part 4:  The Dope About Dopamine – and Other Ridiculous Notions    

“When the doors to that dorm opened up a strange group of men would exit. They would seem to be in a hurry, but unable to coordinate their movements. Their heads would hang down and half expressions would ripple across their faces. They would run their hands over their heads over and over, and open and close their mouths while sticking their thick tongues out. Their gait was particularly peculiar, with stiff legs dragging their feet along, all the while seeming about to topple. We called this the ‘thorazine shuffle.’” - John Lash - Behind the Thorazine Shuffle, the Criminalization of Mental Illness (2012)17

Psychiatric Drugs For Babies? More Kids Aged 2 And Under Getting Prescribed Antipsychotics:

Some of his colleagues referrered to the effect as “non-permanent, pharmacological lobotomy."

10 Pierre Deniker Foundation – for research and prevention of mental illness.

12 For a thorough review of thorazine advertisements see:

14 See a review of The Creation of Psychopharmacology@

17Behind the Thorazine Shuffle, the Criminalization of Mental Illness.


A License To Kill

A License To Kill

Gail Tasch, M.D.

I was able to get a medical license in Florida, one of the more difficult states to get a license due to its history of medical fraud and abuse. In order to maintain a license in the state one has to take a “Medical Errors” continuing medical education course at licensure and every two years afterwards. I read the course and took the easy test and fulfilled the requirement. The course always begins with citing the 1999 study that stated that over 100,000 people die yearly from medical errors. I remember when this study came out and it made news headlines.

For the next license renewal 2 years later, I received the medical booklet for the course and the writer of the course said that now 200,000 people a year die from medical errors. Now this information isn’t coming from some "granola eating people" (that’s how the medical world refers to natural health practitioners) or some other offshoot group from Portland spreading “misinformation.” These courses are mainstream medical education. I was stunned by the doubling of the statistic and even wore the booklets out carrying them around and showing them to people. I brought the course booklets to dinner parties to show to other professionals and friends to see if they shared my outrage (none did).

So at the NEXT license renewal, lo and behold, the course in the booklet reported that “now it is closer to 400,000 people that die each year from medical errors.” Why is no one seriously looking at this statistic? My psychologist friend is fond of telling me “there are no doctor police!”  In medical school we are told that each doctor kills an average of 6 people during their practice. Looks like we are crushing it.

There has been some comparison of the healthcare system’s safety record to the airline industry. Hospitals made an effort to copy the airline industry’s stellar safety record with more team decision making and “time outs” in the operating room to ensure surgery took place on the correct side of the body, one of the most common surgical errors.

The number of fatalities in the aviation industry has fallen from approximately 450 to 250 per year.  This stands in comparison to the healthcare system where there is an estimated hundreds of thousands of preventable medical deaths each year.  This amounts to the equivalent of about three fatal airline crashes per day.  The renowned airline pilot, Chesley Sullenberger noted if such a level of fatalities was to happen in aviation, airlines would stop flying, airports would close, and there would be congressional hearings and a presidential commission.  No one would be allowed to fly until the problems have been solved.

 Sully has been passionate about safety for many years and serves on the editorial board of the Journal of Patient Safety and he is a member of the Greenlight Group, a team of experts supporting a number of global healthcare research and development initiatives.  He noted that in healthcare mistakes affect just one person at a time.  Mistakes are buried, failures are buried.  Sully has referred to an era in aviation where pilots acted like gods with a small "g" and Cowboys with a capital "C".  He said sadly some of this culture would still appear to remain in parts of healthcare.  He believes patient safely should be a priority at all levels in the healthcare system, from the emergency rooms to the board rooms.

Unfortunately, there is less and less transparency regarding medical errors. The USA TODAY newspaper reported that “The federal government this month quietly stopped publicly reporting when hospitals leave foreign objects in patients' bodies or make a host of other life-threatening mistakes.”

People are likely to die in other ways from our healthcare system. Dr. Gary Null published a very well researched white paper Death by Medicine.  In the paper, Dr Null reports that over 700,000 people die each year due to the healthcare system making healthcare treatment the number one cause of death in this country. It is very easy to me to think about friends and family members who died from the treatment they received. My wonderful sister-in-law died from the chemotherapy she received, not the lung cancer that plagued her.

Peter C. Gotzsche wrote an article for the British Medical Journal called “Does long-term use of psychiatric drugs cause more harm than good?”  Dr. Gotzsche concludes that psychiatric drugs are responsible for the deaths of more than a half a million people age 65 and older each year in the Western world.  He feels the benefits of psychiatric drugs are minimal.  He believes that psychiatric prescription drugs are the third leading cause of death after heart disease and cancer.  He believes that psychiatric drugs alone are the third major killer, mainly because antidepressants kill many elderly people through falls.

We are told as psychiatrists in our training that when prescribing atypical antipsychotic medications, we take 15-25 years off one’s life. These drugs cause weight gain, diabetes, chronic disease, and early deaths.

According to an article in the Journal of the World Psychiatric Association, antipsychotics, and to a lesser degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, hyponatremia; cardiovascular, respiratory tract, gastrointestinal, hematological, musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy, and treatment of vulnerable (e.g., old or young) individuals are associated with greater absolute (elderly) and relative (youth) risk for most of these physical problems.

The rationale is that they work so well that the tradeoff is justified. There is an attitude that because someone has mental health symptoms they don’t deserve the respect a “normal” person does. The psychiatric profession goes to great lengths to keep the current paradigm in place.

How would one best avoid these medical errors and adverse effects from medical treatment?  First of all, many of our illnesses are preventable. Eighty to ninety percent of visits to doctors and hospitals are for conditions that are preventable.  For instance, 50% of people over 50 years of age suffer from hypertension, a mainly lifestyle related problem. 

For the health care system in general, patient safety should be an integral part of medical training. Sully would say, “Safety should be a part and parcel of everything we do.  Every decision that is made, whether it is administrative, budgetary, or otherwise should take safety implications into account because there is such an important business case for doing so.” Unfortunately there is a great lack of accountability in our medical system.

I personally do not go to mainstream doctors, I went to midwives when I was having children, I don’t even have health insurance, but I do have an inexpensive catastrophic policy. I do not get mammograms or flu shots.

Our medical system provides the most expensive care, not what is in the patient’s best interest. When one does require care, one has to search out like minded practitioners. Unfortunately we do not have good mental health treatment but societies such as ISEPP and Mad in America are doing great work to reach people in need of help so that one can receive the very best care.

Wakefield, M. (2000). To err is human: An Institute of Medicine report. Professional Psychology: Research and Practice, 31(3), 243-244.

USA Today August 6, 2014.

Death by Medicine. March 2004. Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD.

Committee on Quality of Health Care in American. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.

Makary MA, Daniel M. Medical error: the third leading cause of death in the U.S. BMJ. 2016;353:i2139.

Does long term use of psychiatric drugs cause more harm than good? BMJ. 2015; 350. doi: (Published 12 May 2015).

JRSM Open. 2016 Jan; 7(1): 2054270415616548. Published online 2015 Dec 2. doi: 10.1177/2054270415616548 Aviation and healthcare: a comparative review with implications for patient safety Narinder Kapur,Anam Parand,Tayana Soukup, Tom Reader, and Nick Sevdalis.

World Psychiatry. 2015 Jun; 14(2): 119–136. Published online: doi: 10.1002/wps.20204. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. Christoph U Correll, Johan Detraux, Jan De Lepeleire, and Marc De Hert.

Schizophrenia: A Nonexistent Disease

Schizophrenia: A Nonexistent Disease

Wayne Ramsay, J.D.

The word “schizophrenia” has a scientific sound that seems to give it inherent credibility and a charisma that seems to dazzle people.  In his book Molecules of the Mind–The Brave New Science of Molecular Psychology, University of Maryland journalism professor Jon Franklin calls schizophrenia and depression “the two classic forms of mental illness.”According to the cover article in the July 6, 1992 Time magazine, schizophrenia is the “most devilish of mental illnesses.”This Time magazine article says “fully a quarter of the nation's hospital beds are occupied by schizophrenia patients.”Books and articles like these and the facts to which they refer (such as a quarter of hospital beds being occupied by so-called schizophrenics) delude most people into believing there really is a disease called schizophrenia. Schizophrenia is one of the great myths of our time.

In his book Schizophrenia–The Sacred Symbol of Psychiatry, psychiatry professor Thomas S. Szasz, M.D., says “There is, in short, no such thing as schizophrenia.”4In the Epilogue of their book Schizophrenia–Medical Diagnosis or Moral Verdict?, Theodore R. Sarbin, Ph.D., a psychology professor at the University of California at Santa Cruz who spent three years working in mental hospitals, and James C. Mancuso, Ph.D., a psychology professor at the State University of New York at Albany, say:

We have come to the end of our journey. Among other things, we have tried to establish that the schizophrenia model of unwanted conduct lacks credibility. The analysis directs us ineluctably to the conclusion that schizophrenia is a myth.5

In his book Against Therapy, published in 1988, Jeffrey Masson, Ph.D., a psychoanalyst, says “There is a heightened awareness of the dangers inherent in labeling somebody with a disease category like schizophrenia, and many people are beginning to realize that there is no such entity.”Jim van Os, professor and chair of the Department of Psychiatry at Maastricht University Medical Center in the Netherlands, states this conclusion in the February 2, 2016 British Medical Journal: “'Schizophrenia’ does not exist.”7

Rather than being a bona-fide disease, so-called schizophrenia is a nonspecific category which includes almost everything a human being can do, think, or feel that is greatly disliked by other people or by the so-called schizophrenics themselves. There are few so-called mental illnesses that have not at one time or another been called schizophrenia. Because schizophrenia is a term that covers just about everything a person can think or do which people greatly dislike, it is hard to define objectively. Typically, definitions of schizophrenia are vague or inconsistent with each other. For example, when I asked a physician who was the Assistant Superintendent of a state mental hospital to define the term schizophrenia for me, he with all seriousness replied “split personality–that’s the most popular definition.” In contrast, a pamphlet published by the National Alliance for the Mentally Ill titled “What Is Schizophrenia?” says “Schizophrenia is not a split personality.” In her book Schizophrenia: Straight Talk for Family and Friends, published in 1985, Maryellen Walsh says this:

Schizophrenia is one of the most misunderstood diseases on the planet. Most people think that it means having a split personality. Most people are wrong. Schizophrenia is not a splitting of the personality into multiple parts.8

In the Foreword to the second edition of the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders (DSM-II), Ernest M. Gruenberg, M.D., D.P.H., Chairman of the American Psychiatric Association's Committee on Nomenclature, said:

Consider, for example, the mental disorder labeled in the Manual as ‘schizophrenia,’... Even if it had tried, the Committee could not establish agreement about what this disorder is.”9

The third edition of the APA's Diagnostic and Statistical Manual of Mental Disorders, published in 1980, commonly called DSM-III, was also quite candid about the vagueness of the term. It said: “The limits of the concept of Schizophrenia are unclear”10 The revision published in 1987, DSM-III-R, contains a similar statement: “It should be noted that no single feature is invariably present or seen only in Schizophrenia.”11  DSM-III-Ralso says this about a related diagnosis, Schizoaffective Disorder:

The term Schizoaffective Disorder has been used in many different ways since it was first introduced as a subtype of Schizophrenia, and represents one of the most confusing and controversial concepts in psychiatric nosology.12

In Frances Farmer– Shadowland, a biography of a once well-known actress who became an involuntarily committed mental patient, William Arnold observes that “since the term schizophrenia was coined in 1911 it has had a thousand different meanings to a thousand different psychiatrists.”13

Particularly noteworthy in today's prevailing intellectual climate in which mental illness is considered to have biological or chemical causes is what the 1987 edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-III-R says about such physical causes of this catch-all concept of schizophrenia:  It says a diagnosis of schizophrenia “is made only when it cannot be established that an organic factor initiated and maintained the disturbance.”14 Underscoring this definition of “schizophrenia” as non-biological is the 1987 edition of The Merck Manual of Diagnosis and Therapy, which says a (so-called) diagnosis of schizophrenia is made only when the behavior in question is “not due to organic mental disorder.”15

Contrast this with a statement by psychiatrist E. Fuller Torrey, M.D., in his book Surviving Schizophrenia: A Family Manual, published in 1988. He says “Schizophrenia is a brain disease, now definitely known to be such.”16  If schizophrenia is a brain disease, it is organic. However, the official definition of schizophrenia maintained and published by the American Psychiatric Association in various editions of its Diagnostic and Statistical Manual of Mental Disorders specifically excludes organically caused conditions from the definition of schizophrenia. In Surviving Schizophrenia, Dr. Torrey acknowledges “the prevailing psychoanalytic and family interaction theories of schizophrenia which were prevalent in American psychiatry”17 that would seem to account for this.

In 1988, in Nature, genetic researcher Eric S. Lander of Harvard University and M.I.T. summarized the situation this way:

The late US Supreme Court Justice Potter Stewart declared in a celebrated obscenity case that, although he could not rigorously define pornography, ‘I know it when I see it.’ Psychiatrists are in much the same position concerning the diagnosis of schizophrenia.  Some 80 years after the term was coined to describe a devastating condition involving a mental split among the functions of thought, emotion and behaviour, there remains no universally accepted definition of schizophrenia.18

In Surviving Schizophrenia, Dr. Torrey quite candidly concedes the impossibility of defining what “schizophrenia” is.  He says:

The definitions of most diseases of mankind has been accomplished.... In almost all diseases there is something which can be seen or measured, and this can be used to define the disease and separate it from nondisease states. Not so with schizophrenia! To date we have no single thing which can be measured and from which we can then say: Yes, that is schizophrenia. Because of this, the definition of the disease is a source of great confusion and debate.19

What puzzles me is how to reconcile this statement of Dr. Torrey’s with another he makes in the same book, which I quoted above and which appears more fully as follows:

Schizophrenia is a brain disease, now definitely known to be such. It is a real scientific and biological entity, as clearly as diabetes, multiple sclerosis, and cancer are scientific and biological entities.”20

How can it be known that schizophrenia is a brain disease when we do not know what schizophrenia is?

The truth is that the word schizophrenia, like the words “pornography” and “mental illness”, indicate disapproval of that to which the word is applied and nothing more. Like “mental illness” or “pornography”, “schizophrenia” does not exist in the sense that cancer and heart disease exist but exists only in the sense that good and bad exist. As with all other so-called mental illnesses, a diagnosis of “schizophrenia” is a reflection of the speaker’s or “diagnostician’s” values or ideas about how a person “should” be, often coupled with the false (or at least unproven) assumption that the disapproved thinking, emotions, or behavior results from a biological abnormality. Considering the many ways it has been used, it’s clear “schizophrenia” has no particular meaning other than “I dislike it.” Because of this, I lose respect for mental health professionals when I hear them use the word schizophrenia in a way that indicates they think it is a real disease. I do this for the same reason I would lose respect for a person’s perceptiveness or intellectual integrity after hearing him or her admire the emperor’s new clothes. While the layman definition of schizophrenia, internally inconsistent, may make sense in some situations, using the term “schizophrenia” in a way that indicates the speaker thinks it is a real disease is tantamount to admitting he doesn’t know what he is talking about.

Many mental health “professionals” and other “scientific” researchers do however persist in believing “schizophrenia” is a real disease. They are like the crowds of people observing the emperor’s new clothes in Hans Christian Andersen’s short story. They are unable or unwilling to see the truth because so many others before them have said it is real. A glance through the articles listed under “Schizophrenia” in Index Medicus, an index of medical periodicals, or an Internet search, reveals how widespread the schizophrenia myth has become. Because these “scientists” believe “schizophrenia” is a real disease, they try to find physical causes for it. As psychiatrist William Glasser, M.D., said in 1976: “Schizophrenia sounds so much like a disease that prominent scientists delude themselves into searching for its cure.”21 This is a silly endeavor, because these supposedly prominent scientists can’t define “schizophrenia” and accordingly don't know what they are looking for.

According to three Stanford University psychiatry professors, “two hypotheses have dominated the search for a biological substrate of schizophrenia.” They say these two theories are the transmethylation hypothesis of schizophreniaand the dopamine hypothesis of schizophrenia.22 The transmethylation hypothesis was based on the idea that “schizophrenia” might be caused by “aberrant formation of methylated amines” similar to the hallucinogenic pleasure drug mescaline in the metabolism of so-called schizophrenics. After reviewing various attempts to verify this theory, they conclude: “More than two decades after the introduction of the transmethylation hypothesis, no conclusions can be drawn about its relevance to or involvement in schizophrenia.”23

Columbia University psychiatry professor Jerrold S. Maxmen, M.D., describes the second major biological theory of so-called schizophrenia, the dopamine hypothesis,in his book The New Psychiatry, published in 1985: “...many psychiatrists believe that schizophrenia involves excessive activity in the dopamine-receptor system...the schizophrenic's symptoms result partially from receptors being overwhelmed by dopamine.”24 But in the article by three Stanford University psychiatry professors I referred to above they say “direct confirmation that dopamine is involved in schizophrenia continues to elude investigators”25 In 1987 in his book Molecules of the MindProfessor Jon Franklin said “The dopamine hypothesis, in short, was wrong.”26

In that same book, Professor Franklin aptly describes efforts to find other biological causes of so-called schizophrenia:

As always, schizophrenia was the index disease. During the 1940s and 1950s, hundreds of scientists occupied themselves at one time and another with testing samples of schizophrenics’ bodily reactions and fluids. They tested skin conductivity, cultured skin cells, analyzed blood, saliva, and sweat, and stared reflectively into test tubes of schizophrenic urine. The result of all this was a continuing series of announcements that this or that difference had been found. One early researcher, for instance, claimed to have isolated a substance from the urine of schizophrenics that made spiders weave cockeyed webs. Another group thought that the blood of schizophrenics contained a faulty metabolite of adrenaline that caused hallucinations.  Still another proposed that the disease was caused by a vitamin deficiency. Such developments made great newspaper stories, which generally hinted, or predicted outright, that the enigma of schizophrenia had finally been solved. Unfortunately, in light of close scrutiny none of the discoveries held water.27

Other efforts to prove a biological basis for so-called schizophrenia have involved brain-scans of pairs of identical twins when only one is a supposed schizophrenic. They do indeed show the so-called schizophrenic has brain damage his identical twin lacks. The flaw in these studies is the so-called schizophrenic has inevitably been given brain-damaging drugs called neuroleptics as a so-called treatment for his so-called schizophrenia. It is these brain-damaging drugs, not so-called schizophrenia, that have caused the brain damage. Anyone “treated” with these drugs will have such brain damage. Damaging the brains of people eccentric, obnoxious, imaginative, or mentally disabled enough to be called schizophrenic with drugs (erroneously) believed to have antischizophrenic properties is one of the saddest and most indefensible consequences of today’s widespread belief in the myth of schizophrenia.

Belief in biological causes of so-called mental illness, including schizophrenia, comes not from science but from wishful thinking or from desire to avoid coming to terms with the experiential and environmental causes of people’s misbehavior or distress. The American Psychiatric Association’s definition of “schizophrenia” as non-organic, and the repeated failure of efforts to find biological causes of so-called schizophrenia suggest “schizophrenia” belongs only in the category of socially or culturally unacceptable thinking or behavior rather than in the category of biology or “disease” where many people place it.

1John Franklin, Molecules of the Mind – The Brave New Science of Molecular Psychology (Dell Publishing Co., 1987, p. 119

2July 6, 1992 Timemagazine, p. 53

3Id., p. 55

4Thomas S. Szasz, M.D., Schizophrenia–The Sacred Symbol of Psychiatry  (Syracuse University Press, 1988), p. 191

5Theodore R. Sarbin, Ph.D., and James C. Mancuso, Ph.D., Schizophrenia–Medical Diagnosis or Moral Verdict?(Pergamon Press, 1980), p. 221

6Jeffrey Masson, Ph.D.,Against Therapy(Atheneum 1988), p. 2

7Jim van Os, British Medical Journal, February 2, 2016, “`Schizophrenia’ does not exist” 352/bmj.i375

8Maryellen Walsh, Schiz-o-phre-nia: Straight Talk for Family and Friends(Warner Books 1985), p. 41

9Ernest M. Gruenberg, M.D., D.P.H., Diagnostic and Statistical Manual of Mental Disorders (DSM-II) American Psychiatric Association 1968), p. ix

10American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-III, 1980), p. 181.

11American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), p. 188

12Id., p. 208

13William Arnold, Frances Farmer– Shadowland(Berkley Books 1982), p. 125

14DSM-III-R, p. 187

15Merck Manual of Diagnosis and Therapy, 1987, p. 1532

16E. Fuller Torrey, M.D.,Schizophrenia: A Family Manual(Harper & Row 1988), p. 5

17Id., p. 149

18Eric S. Lander, Nature, November 10, 1988, p. 105

19E. Fuller Torrey, M.D., Surviving Schizophrenia – A Family Manual (Harper & Row 1988), p. 73

20Id., p. 5

21William Glasser, M.D., Positive Addiction(Harper & Row 1976) p. 18.

22Jack D. Barchas, M.D., et al., “Biogenic Amine Hypothesis of Schizophrenia”, appearing inPsychopharmacology: From Theory to Practice, Oxford University Press, 1977, p. 100

23Id., p. 107

24Jerrold S. Maxmen, M.D., The New Psychiatry(Mentor 1985), pp. 142 & 154

25Barchas, et al. (note 22), p. 112

26Franklin (note 1), p. 114

27Id., p. 172

THE AUTHOR, Wayne Ramsay, is a lawyer whose practice has included representing psychiatric “patients”.

Mental Health Screening: Public Service or Dangerous Marketing?

Mental Health Screening: Public Service or Dangerous Marketing?

Chuck Ruby, Ph.D., Psychologist

In 2016, the Centers for Disease Control and Prevention (CDC) urged that children be screened for autism as early as three years old.1 In 2018, the American Academy of Pediatrics (AAP) recommended that all teenagers be screened for depression.2  The National Alliance on Mental Illness (NAMI) also supports widespread mental health screening:

Mental health screenings are a key part of youth mental health. Approximately 50% of chronic mental health conditions begin by age 14 and 75% begin by age 24. At the same time, the average delay between when symptoms first appear and intervention is 8-10 years. Mental health screenings allow for early identification and intervention and help bridge the gap.3

To the ill-informed, these pronouncements appear to be of great public service. Who could argue the virtues of identifying mental health problems in our children as early as possible so that we could offer them assistance in avoiding a life of suffering?

However, to those willing to question the conventional wisdom, and think critically about the matter, quite a different picture emerges. Screening tools are dangerous to our children, but they are helpful to the mental health industry by increasing the potential market of consumers.

Whereas it is true that mental health screening is a cost-effective substitute for full psychological testing, it nonetheless presents a significant danger. This is the danger of false positives. A false positive is when a screening tool wrongly identifies a child as having a problem (e.g, the DSM definitions of depression, autism, anxiety, etc.) when, in fact, the child doesn't have that problem.

Keep in mind that childhood problems do exist, even if they aren't illnesses. So, for instance, a child experiencing traumatic circumstances might withdraw from the world and that self-imposed isolation can have devastating effects. But this is not an illness called "depression." It is an understandable problem and an expectable reaction to trauma.

The false positive problem occurs even with the most accurate of screening instruments. An instrument's accuracy is stated as sensitivity and specificity. Sensitivity is the rate at which the tool correctly identifies a person with the problem. Specificity is when the tool correctly identifies a person who doesn't have the problem. Sensitivity and specificity rates of .80 are considered "levels that are reasonably good for a screening instrument."4

But regardless of this "reasonably good" accuracy, when we screen for any low base-rate event, such as the problems that are subsumed under the label "mental illness," we will necessarily have a large number of false positives. This results in many, many children being identified as the target of psychiatric intervention when there is no real problem.

To see just how dangerous this is, let's look at the statistical nuts and bolts in the table below. Take a hypothetical population of 1,000 kids and screen them for depression with an instrument that has a .80 accuracy rate. According to the CDC, 3.2% of children between 3 and 17 years old have been diagnosed with depression.5 This is a 3.2% base-rate. With this data, we would get the numbers below.

                       Actually Depressed?
Screening Results: Yes No Total
     Depressed 26 194* 220
     Not Depressed    6 774 780
     Total 32 968 1,000

* false positives

So out of 1,000 children and a 3.2% base rate of depression, there will be 32 children who actually are suffering from the problems labeled "depression" and 968 who aren't. A screening instrument with sensitivity and specificity of .80 will correctly identify 26 of the depressed kids. It will also correctly identify 774 of the non-depressed kids. However, it will wrongly identify 194 of the non-depressed kids as depressed. This is a 88% false positive rate (194 ÷ 220 = .88).

The significance of this cannot be overstated. When using a screening instrument like this, nearly 9 out of every 10 children who are identified as depressed wouldn't really be suffering from that problem. Nevertheless, they would still be subjected to the attention and potential treatment of the mental health system, with all of the accompanying stigma and other harmful effects, such as the prescription of unnecessary psychiatric chemicals.

And what do you think would happen when the children or their parents disagree with the professional's screening conclusion and become resistant to subjecting the child to treatment? Of course, it would very likely be seen as either a sign of anosognosia (lack of insight into one's illness) or as parental neglect in refusing to get treatment for their children.

This is frightening.

There are about 74 million children and adolescents living in the United States.When using screening instruments like this, imagine the untold number of kids who are not suffering from the problem but who would nonetheless be a target of the mental health industry. If all of them were screened with this tool, millions would be falsely targeted! And, if you are skeptical about whether our children would be subjected to these harmful screenings, just remember that the American Academy of Pediatrics recommended that all teenagers be screened for depression.

With the screening of real medical problems, such as cancer, there is a potential solution to this false positive problem. It is to conduct a more detailed examination of the patient with laboratory tests such as X-rays, CAT scans, and blood tests to determine if the disease is actually present.

But with the problems labeled "mental illness," there is no follow up to the screening instrument because there is no internal dysfunction that can be detected with a more detailed examination. Even more in-depth psychological testing wouldn't suffice since psychological tests are also screening instruments, they're just more complicated. But, they do not assess internal malfunctioning.

Mental illness diagnoses refer to problems only, not bodily disease processes that cause the problems. In fact, the formal diagnostic guidelines in the DSM are screening instruments themselves! They are merely checklists of "symptoms." In this sense, the DSM has the same false positive danger as does any other screening instrument. Using it to diagnose "mental illness" results in an overabundance of people wrongly branded with mental illness diagnoses. Yet, those people become a fertile market for the mental health industry.







The Myth of Biological Depression

The Myth of Biological Depression

Wayne Ramsay, J.D.

In the Introduction to his book Rethinking Depression (New World Library 2012, p. 3, italics his) California-licensed family therapist Eric Maisel, Ph.D., says this:

One of the goals of this book is to help you remove the word depression from your vocabulary and, as a result, from your life. If depression were an actual disease, illness, or disorder you wouldn't be able to rid yourself of it just by removing it from your vocabulary. But since it isn't a disease, illness, or disorder, you can dispense with it right this second. What I would love for you to say is "I can't be depressed because there is no disease of depression!

Similarly, in her book A Straight Talking Introduction to Psychiatric Drugs (PCCS Books, Ross-on-Wye 2009, p. 65), Joanna Moncrieff, M.B.B.S., M.Sc., MFRCPsych, M.D., Senior Lecturer in Mental Health Sciences at the University College, London, says this: is important to say here that the term "depression" as currently used is misleading. ... there is no scientific evidence to support the idea that there are particular features of the brain that give rise to the particular feeling of depression.

Unhappiness or "depression" alleged to be the result of biological abnormality is called "biological" or "endogenous" or "clinical" depression. In her book The Broken Brain: The Biological Revolution in Psychiatry, University of Iowa psychiatry professor Nancy Andreasen, M.D., Ph.D., says: "The older term endogenous implies that the depression 'grows from within' or is biologically caused, with the implication that unfortunate and painful events such as losing a job or lover cannot be considered contributing causes." (Harper & Row 1984, p. 203).

Similarly, in 1984 in the Chicago Tribune newspaper columnist Joan Beck alleged: "...depressive disorders are basically biochemical and not caused by events or environmental circumstances or personal relationships" (July 30, 1984, Sec. 1, p. 16). A July 2013 Readers Digest article (pp. 132-133) says "For the past 50 years, the conventional wisdom among many psychiatrists was that depression was caused by a brain-chemical imbalance such as low levels of the feel-good hormone serotonin."

The concept of biological or endogenous depression is important to psychiatry for two reasons. First, it is the most common supposed mental illness. As Victor I. Reus, M.D., wrote in 1988: "The history of the diagnosis and treatment of melancholia could serve as a history of psychiatry itself" (appearing in: H. H. Goldman, editor, Review of General Psychiatry, 2nd Edition, Appleton & Lange 1988, p. 332). Second, all of psychiatry's biological "treatments" for depression—whether it is drugs, electroshock, or psychosurgery—are based on the idea that the unhappiness we call depression can be caused by a biological malfunction in the brain rather than life experience. The erroneous belief in biological causation justifies the otherwise unjustifiable use of biological therapies, primarily "antidepressant" drugs and electroconvulsive "therapy" (see Psychiatry's Electroconvulsive Shock Treatment—A Crime Against Humanity). The biological therapies for this nonexistent "disease" of depression and other so-called mental illnesses also in theory justify the existence of psychiatry as a medical specialty distinguishable from psychology, social work, and counseling.

Many professional and lay people today think depression can be caused by a"chemical imbalance" in the brain even though no chemical imbalance theories of depression have been verified. As psychiatry professor Thomas S. Szasz, M.D., said in 2006, "There is no evidence for a chemical imbalance causing mental illness, but that does not impair the doctrine's scientific standing or popularity" ("Mental Illness as a Brain Disease: A Brief History Lesson"). Psychiatry professor Nancy Andreasen discusses some of the chemical imbalance theories of depression in her book The Broken Brain.

One of the theories she describes is the belief that "depression" (what I think should be called simply unhappiness or severe unhappiness) is the result of neuroendocrine abnormalities indicated by excessive cortisol in the blood. The test for this is called the dexamethasone suppression test or DST. The theory behind this test and the claims of its usefulness were found to be mistaken, however, because, in Dr. Andreasen's words, "so many patients with well defined depressive illness have normal DSTs" (pp. 180 182). An article in the July 1984 Harvard Medical School Health Letter reached a similar conclusion. The article, titled "Diagnosing Depression: How Good is the 'DST'?", reported that "For every three office patients with an abnormal DST, only one is likely to have true depression. ... [And] a large fraction of people who are depressed by other criteria will still have normal results on the DST" (p. 5). Similarly, in an article in the November 1983 Archives of Internal Medicine three physicians concluded that "Data from studies currently available do not support the use of the dexamethasone ST [Suppression Test]" (Martin F. Shapiro, M.D., et al., "Biases in the Laboratory Diagnosis of Depression in Medical Practice", Vol. 143, p. 2085). In her 1993 book If It Runs In Your Family: Depression, Connie S. Chan, Ph.D., acknowledges that "There is still no valid biological test for depression" (Bantam Books, p. 106). Despite its having been discredited, some biologically oriented psychiatrists are (apparently) so eager for biological explanations for people's unhappiness or "depression" that they continue to use the DST anyway. For example, in his book The Good News About Depression, published in 1986, psychiatrist Mark S. Gold, M.D., says he continues to use the DST. In that book Dr. Gold claims the DST is "highly touted as the diagnostic test for biologic depression" (Bantam, p. 155, emphasis in original).

In The Broken Brain, Dr. Andreasen also describes what she calls "the most widely accepted theory about the cause of depression...the 'catecholamine hypothesis.'" She emphasizes that "the catecholamine hypothesis is theory rather than fact" (p. 231). She says "This hypothesis suggests that patients suffering from depression have a deficit of norepinephrine in the brain" (p. 183), norepinephrine being one of the "major catecholamine systems" in the brain (pp. 231 232). One way the catecholamine hypothesis is evaluated is by studying one of the breakdown products of norepinephrine, called MHPG, in urine. People with so called depressive illness "tended to have lower MHPG" (p. 234). The problem with this theory, according to Dr. Andreasen, is that "not all patients with depression have low MHPG" (Id). She accordingly concludes that this catecholamine hypothesis "has not yet explained the mechanism causing depression" (p. 184).

Another theory is that severe unhappiness ("depression") is caused by lowered levels or abnormal use of another brain chemical, serotonin. A panel of experts assembled by the U.S. Congress Office of Technology Assessment reported the following in 1992 (The Biology of Mental Disorders, U.S. Gov't Printing Office, pp. 82 & 84):

Prominent hypotheses concerning depression have focused on altered function of the group of neurotransmitters called monoamines (i.e., norepinephrine, epinephrine, serotonin, dopamine), particularly norepinephrine (NE) and serotonin. ... studies of the NE [norepinephrine] autoreceptor in depression have found no specific evidence of an abnormality to date. Currently, no clear evidence links abnormal serotonin receptor activity in the brain to depression. ... the data currently available do not provide consistent evidence either for altered neurotransmitter levels or for disruption of normal receptor activity.

Even if it was shown there is some biological change or abnormality "associated" with depression, the question would remain whether this is a cause or an effect of the "depression". A brain-scan study (using positron emission tomography or PET scans) found that simply asking normal people to imagine or recall a situation that would make them feel very sad resulted in significant changes in blood flow in the brain (José V. Pardo, M.D., Ph.D., et al., "Neural Correlates of Self-Induced Dysphoria", American Journal of Psychiatry, May 1993, p. 713). Other research will probably confirm it is emotions that cause biological changes in the brain rather than biological changes in the brain causing emotions.


One of the more popular theories of biologically caused depression has been hypoglycemia, which is low blood sugar. In his book Fighting Depression, published in 1976, Harvey M. Ross, M.D., says "In my experience as an orthomolecular psychiatrist, I find that many patients who complain of depression have hypoglycemia (low blood sugar). ...Because depression is so common in those with hypoglycemia, any person who is depressed without a clear cut obvious cause for that depression should be suspected of having low blood sugar" (Larchmont Books, p. 76 & 93). But in their book Do You Have A Depressive Illness?, published in 1988, psychiatrists Donald Klein, M.D., and Paul Wender, M.D., list hypoglycemia in a section titled "Illnesses That Don't Cause Depression" (Plume, p. 61). The idea of hypoglycemia as a cause of depression was also rejected in the front page article of the November 1979 Harvard Medical School Health Letter, titled "Hypoglycemia—Fact or Fiction?"

Another theory of a physical disease causing psychological unhappiness or "depression" is hypothyroidism. In her book Can Psychotherapists Hurt You?, psychologist Judi Striano, Ph.D., includes a chapter titled "Is It Depression—Or An Underactive Thyroid?" (Professional Press 1988). Similarly, three psychiatry professors in 1988 asserted "Frank hypothyroidism has long been known to cause depression" (Alan I. Green, M.D., et al., The New Harvard Guide to Psychiatry, Harvard Univ. Press 1988, p. 135). The theory here is that the thyroid gland, which is located in the neck, normally secretes hormones which reach the brain through the bloodstream necessary for a feeling of psychological well being and that if the thyroid produces too little of these hormones, the affected person can start feeling unhappy even if no problems result from the endocrine (gland) problem other than the unhappiness. The American Medical Association Encyclopedia of Medicine lists many symptoms of hypothyroidism: "muscle weakness, cramps, a slow heart rate, dry and flaky skin, hair loss ... there may be weight gain" (Random House 1989, p. 563). The Encyclopedia does not list unhappiness or "depression" as one of the consequences of hypothyroidism. But suppose you began to experience "muscle weakness, cramps...dry and flaky skin, hair loss ... weight gain"? How would this make you feel emotionally?—depressed, probably. Just as hypothyroidism (hypo = low) is a thyroid gland that produces too little, hyperthyroidism is a thyroid glad that produces too much. Therefore, if hypothyroidism causes depression, then it seems logical to assume hyperthyroidism has the opposite effect, that is, that it makes a person happy. But this is not what happens. As psychiatrist Mark S. Gold, M.D., points out in his book The Good News About Depres-sion: "Depression occurs in hyperthyroidism, too" (p. 150). What are the consequences of hyperthyroidism?: Dr. Gold lists abundant sweating, fatigue, soft moist skin, heart palpitations, frequent bowel movements, muscular weakness, and protruding eyeballs. So both hypo- and hyper- thyroidism cause physical problems in the body. And both cause "depression". This is only logical. It is hard to feel anything but bad emotionally when your body doesn't feel well or work properly. It has never been proved hypothyroidism affects mood other than through its effect on the victim's experience of feeling physically unhealthy.

Some people think chemical imbalance related to hormonal changes must be a possible cause of "depression" because of the supposed biological causes of women's moods at different times of their menstrual cycles. I don't find that argument convincing because I've known so many women whose mood and state of mind was consistently unaffected by her menstrual cycle. Psychology professor David G. Myers, Ph.D., labels premenstrual syndrome (PMS) a myth in his book The Pursuit of Happiness (William Morrow & Co. 1992, pp. 84-85). Of course, some women experience physical discomfort due to menstruation. Feeling lousy physically is enough to put anybody in a bad mood.

Some people believe women experience undesirable mood changes for biological reasons because of menopause. However, a study by psychologists at University of Pittsburgh reported in 1990 that "Menopause usually doesn't trigger stress or depression in healthy women, and it even improves mental health for some". According to Rena Wing, one of the psychologists who did the study, "Everyone expects menopause to be a stressful event, but we didn't find any support for this myth" ("Menopausal stress may be a myth", USA Today, July 16, 1990, p. 1D).

It is also widely believed that women go through a period of depression for biological reasons after giving birth to a child. It's called postpartum depression. In his book The Making of a Psychiatrist, Dr. David Viscott quotes Dr. George Maslow, a physician doing an obstetrical residency, making the following remark: "Come on, Viscott, do you really believe in postpartum depression? I've seen maybe two in the last three years. I think it's a lot of shit you guys [you psychiatrists] imagined to drum up business" (Pocket Books, 1972, p. 88). A woman who had given birth to eight (8) children, which in my opinion qualifies her as an expert on the subject of postpartum depression, told me what she called "postpartum blues" are real, but she attributed postpartum blues to psychological rather than physiological causes. "I don't know about the physiological causes", she said, but "so much of it is psychological." She said "You feel awful about your looks", because in our society a woman is "supposed" to be thin, and for at least a short time after giving birth a woman usually isn't. She also said after childbirth a woman feels considerable "physical exhaustion". Childbirth also is the beginning of new or increased parental obligations, which if we are honest we must admit are quite burdensome. The arrival of new or additional parental obligations and the realization of the negative ways new or additional parenthood obligations will affect a woman's (or man's) life is an obvious non-biological explanation for postpartum depression. It may not be until the actual birth of the child that parents realize how parenthood changes their lives for the worse, but a letter from a female friend of mine who at the time was only three months pregnant with her first child illustrates that depression associated with childbirth may come long before the postpartum period: She said she was frequently breaking down in tears because she thought with a child her life would never the same and that she would be a "prisoner" and wouldn't have time to do what she wanted in life. A reason these psychological causes are often not candidly acknowledged and postpartum (or pre-partum) blues instead attributed to unproven biological causes is our reluctance to admit the downside of parenthood.

Another theory of biologically caused depression is based on stroke damage in the left front region of the brain. What makes it seem possible this might be neurologically caused rather than being a reaction to the situation a person finds himself in because of having had a stroke is stroke damage in the right front of the brain allegedly causing "undue cheerfulness." However, a careful reading of books and articles about neurology for the most part doesn't support the allegation of undue cheerfulness from right front brain damage. Instead, what most neurological literature indicates sometimes results from right front stroke-related brain damage is anosognosia, usually described as lack of concern or inability to know their own problems, not happiness or cheerfulness (e.g., neurology professor Oliver Sacks in The Man Who Mistook His Wife for a Hat and Other Clinical Tales, Harper & Row 1985, p. 5).

Perhaps the most often heard argument is that antidepressant drugs wouldn't work if the cause of depression was not biological. But antidepressant drugs don't work. As psychiatrist Peter Breggin, M.D., says in his book Talking Back to Prozac (St. Martin's Press 1994, p. 200), "there's no evidence that antidepressants are especially effective". Or as British psychiatrist Joanna Moncrieff writes in her book The Myth of the Chemical Cure—A Critique of Psychiatric Drug Treatment (Revised Edition, Palgrave Macmillan 2009, pp. 144 & 152):

...contrary to current opinion, antidepressants are not superior to placebo even in the most severe forms of depression. ... The idea that antidepressants have a specific action on a biological process is still cited as the main justification for the idea that depression is caused by a biochemical abnormality. ... However, the evidence reviewed above suggests that antidepressant drugs do not exert a specific effect in depression.

Psychologist Irving Kirsch, Ph.D., wrote an entire book bebunking the assertion that so-called antidepressants have antidepressant effects: The Emperor's New Drugs—Exploding the Antidepressant Myth (Basic Books 2010). In The Antidepressant Fact Book (Perseus 2001, p. 14) psychiatrist Peter Breggin, M.D., says "The term 'antidepressant' should always be thought of with quotation marks around it because there is little or no reason to believe that these drugs target depression or depressed feelings." There is even evidence that so-called antidepressants make people feel more depressed: According to Dr. Moncrieff, "Evidence suggests that for people without mental health problems, antidepressant drugs are unpleasant to take and make them feel worse. The evidence reviewed in the previous chapter suggests that we have no reason to believe that they elevate mood in patients either" (The Myth of the Chemical Cure, p. 171). Antidepressants are, in other words, a health care scam. Their only possible beneficial effect is placebo effect. This has not prevented drug companies from making billions of dollars selling supposedly antidepressant "medications," however. As California-licensed family therapist Eric Maisel, Ph.D., asks in his book Rethinking Depression (p. 240), "Has the 'mental disorder of depression' been fabricated by the mental health industry to turn human unhappiness and the consequences of human unhappiness into a cash cow? ... You will have to decide if all this mental health labeling is a marvel of medical progress or a variation on the age-old penchant for selling snake oil." Even if so-called antidepressants did help (aside from placebo effect), that wouldn't prove a biological cause of "depression" any more than would feeling better from using marijuana or cocaine or drinking liquor.


A careful reading of the books and articles by psychiatrists and psychologists alleging biological causes of the severe unhappiness we call depression usually reveals purely psychological causes that explain it adequately, even when the author believes he has given a good example of biologically caused depression. For example, in Holiday of Darkness: A Psychologist's Personal Journey Out of His Depression (John Wiley & Sons 1982), an autobiographical book by York University psychology professor Norman S. Endler, Ph.D., he alleges his unhappiness or so-called depression "was biochemically induced" (p. xiv). He says "my affective disorder was primarily biochemical and physiological" (p. 162). But from his own words it's obvious his depression was due primarily to unreturned love when a woman he got emotionally involved with, Ann, decided to "wind down" her relationship with him (pp. 2-5) and when he suffered a career setback (loss of a research grant) at about the same time (p. 23). Despite his claims of biochemical causation, nowhere does he cite any medical or biological tests showing he had any kind of biological, bio¬chemical, or neurological abnormalities. He can't, because no valid biological test exists that tests for the presence of any so-called mental illness, including allegedly biologically caused unhappiness (or "depression").

Similarly, in The Broken Brain, psychiatry professor Nancy Andreasen gives the example of Bill, a pediatrician, whose recurrent depression she thinks illustrates that "People who suffer from mental illness suffer from a sick or broken brain [emphasis Andreasen's], not from weak will, laziness, bad character, or bad upbringing" (p. 8). But she seems to overlook the fact that Bill's allegedly biologically caused recurrent depressions occurred when his father died, when he was not permitted to graduate from medical school on schedule, when his first wife was diagnosed with cancer and died, when his second wife was unfaithful to him, when he was arrested for public intoxication during an argument with her and this was reported in the local newspaper, and when his license to practice medicine was suspended because of stigma from psychiatric "treatment" he received (pp. 2-7).

One of the reasons for theorizing about biological causes of severe unhappiness or "depression" is sometimes people are unhappy for reasons that aren't apparent, even to them. The reason this happens is what psychoanalysts call the unconscious:

Freud's investigations shocked the Western world ... Comparing the mind to an iceberg, largely submerged and invisible, he told us that the greater part of the mind is irrational and unconscious, with only the tip of the preconscious and conscious showing above the surface. He main¬tained that the larger, unconscious part—much of it sexual—is more important in guiding our lives than the rational part, even though we deceive ourselves into believing it is the other way around. [Ladas, et al., The G Spot And Other Recent Discoveries About Human Sexuality, Holt, Rinehart & Winston 1982, pp. 6 7]

In An Elementary Textbook of Psychoanalysis, Charles Brenner, M.D., says "the majority of mental functioning goes on without consciousness... We believe today that...mental operations which are decisive in determining the behavior of the individual...even complex and decisive ones—may be quite unconscious" (Int'l Univ. Press 1955, p. 24). A news magazine article in 1990 reported that "Scientists studying normal rather than impaired subjects are also finding evidence that the mind is composed of specialized processors that operate below the conscious level. ...Freud appears to have been correct about the existence of a vast unconscious realm" (U.S. News & World Report, Octo¬ber 22, 1990, pp. 60-63). An article in the June 2011 Psychology Today magazine tells us "Neuroscience has also confirmed another fundamental tenet of psychoanalytic theory—the idea that our motivations are largely unconscious ... 'Neuroscience tells us unambiguously that consciousness really is just the tip of the iceberg'" (Molly Knight Raskin, "The Idea That Wouldn't Die", p. 75 at 83). People's unhappiness or so-called depression being caused by life experience is not always obvious, because the relevant mental processes and memories are often hidden in the unconscious parts of their minds.


This critical aspect of human psychology was missed or overlooked in an otherwise excellent book, The Loss of Sadness—How Psychiatry Transformed Normal Sorrow Into Depressive Disorder (Oxford University Press 2007) by Allan V. Horwitz, Ph.D., Professor of Sociology and Dean of Social and Behavioral Sciences at Rutgers University, and Jerome C. Wakefield, Ph.D., D.S.W., Professor of Social Work at New York University. Drs. Horwitz and Wakefield effectively debunk the American Psychiatric Association's concept of depression as a disorder except when there is no obvious cause in terms of life experience. They erroneously assume experiences in life and the thinking that cause sadness will always be obvious and easy to identify and that when no such cause can be readily identified, deeply felt or prolonged sorrow may indeed be a true biological or psychological "disorder" even though they, like all who support the idea of endogenous or biological depression, are unable to identify the supposed non-experiential, biological causes and simply assume such causes must exist.

I believe unhappiness or so-called depression is always the result of life experience. There is no convincing evidence unhappiness or "depression" is ever biologically caused. The brain is part of our biology, but there is no evidence severe unhappiness or "depression" is sometimes biologically caused any more than bad TV programs are sometimes electronically caused. "[T]he question is not how to get cured, but how to live" (Joseph Conrad, quoted by Thomas Szasz, The Myth of Psychotherapy, Syracuse Univ. Press 1988, title page). "When mental health professionals point to spurious genetic and biochemical causes," of depression and recommend drugs rather than learning better ways of living, "they encourage psychological helplessness and discourage personal and social growth" of the sort needed to really avoid unhappiness or "depression" and live a meaningful and happy life (Peter Breggin, M.D., "Talking Back to Prozac" Psychology Today magazine, July/Aug 1994, p. 72).

Saving Psychotherapy

Saving Psychotherapy

Eric Maisel, Ph.D.

Psychotherapy is not quite a dying profession. But it is certainly a limping profession. Statistics indicate that over the past two decades fewer and fewer clients have gone in for "the talking cure." What's going on?

The typical reasons given for this decline are the following four. First, the pill-popping mental disorder paradigm has made meds more attractive than talk. Second, life coaching has grabbed a significant bit of psychotherapists’ clientele. Third, psychotherapists have done a poor job of branding themselves (compounded by legal restrictions against certain kinds of promising). And fourth, there is some basic passé quality to the whole enterprise, with its long-ago early-nineteenth century flavor.

On top of these, there are other reasons, too, reasons that were always there. For one, it was never really clear what a psychotherapist was supposed to be an expert “at.” Interpreting a dream? Diagnosing a mental disorder? Being a paid listener? Picking a single thing (like a client’s cognitions) as the most important thing or even the only thing to look at? Making wise suggestions? Never making any suggestions? What exactly was this sort of talk supposed to accomplish or even be “about”?

Further, psychotherapy was only attractive to a certain sort of person: basically, to an educated, psychologically-minded person who was willing to talk and willing to reveal. The client had to buy into the basic idea, that sitting, chatting with someone, and telling him or her about what was bothersome was something that made sense to do and was worth doing once a week for fifty minutes (for three hours, really, if you included the commute and the waiting time). So, right from the beginning, there was always a limited pool of prospective clients.

What's more, the staggering range of psychotherapist types, personalities, styles, and basic competences made landing on a therapist who might really serve you quite a crapshoot. Here was a person you were supposed to trust and open up to: and you might get someone wet behind the ears, or trapped on a single note (“And how did that make you feel?”), or not very wise, or icy cold, or downright cruel.  

This same variety and eclecticism that made every psychotherapist his or her own gunslinger, one using unsubstantiated Freudian language, another still poring over dreams, a third looking only at cognitions, a fourth rebranding psychological conflicts as spiritual crises, and so on, meant that it was rather hard to believe that there was actually any there there. Didn’t it rather seem like each psychotherapist was just making it up?

Of course, psychotherapy always had one thing going for it: talking to another person can help. That person need not have been a psychotherapist—it could be your brother, aunt, pastor, or best friend—but by and large psychotherapists were good at listening, empathizing, reflecting back, and so on, qualities in short supply among people not paid to exhibit them. That was always what psychotherapy had going for it. But it also had all the negatives I just described; and so, the chickens were really bound to come home to roost.

So, what might now save psychotherapy? Shifting its feet. Rather than promoting itself as expert talk of one sort—expert at “diagnosing and treating mental disorders” or expert at “reducing mental and emotional distress” or expert at “solving problems of living,” it could—and really ought to—promote itself as the best investigative tool around, one that uses the scientific method (by floating hypotheses and checking them out) rather than pretending to be a pseudo-medical enterprise or a medical sub-specialty (which it is not).

If psychotherapy shifted in the direction of promoting itself as the premier investigative tool for understanding emotional health and problems in living, and lived up to that promotion, that would change its footing, putting it on much more solid ground. It would also help therapists better know what they were actually doing in session, in addition to listening: they would be investigating. A great body of knowledge around what constituted smart investigating could grow, all therapists could be trained in something really useful and actionable (ways of investigating), and, insofar as human nature is amenable to being investigated, finally some smart investigating could commence.

I’m calling this reframed, redefined and rebranded version of psychotherapy multi-lens therapy, to put the emphasis on where it ought to have been put all along: not on diagnosing, not on problem-solving, not even on relating (which is a good and lovely thing), but on investigating. A multi-lens therapist would be trained to look at human affairs through twenty-five specific lenses (among them the lenses of original personality, formed personality, trauma, development, family, circumstance, social connection, and life purpose and meaning) rather than reducing the enterprise to the reductionist tactic of “treating the symptoms of mental disorders.” A multi-lens therapist would be trained to accept the largeness of human reality and, as a result, would work more deeply, more powerfully—and more truthfully—with clients.

The enterprise of helping another person through talking is worth saving. It always has been worthwhile and it will always continue to be worthwhile for one person to unburden himself or herself to another person, for one person to seek advice from another person, for one person to use another person as a sensible sounding board. For psychotherapy to distinguish itself from all that, for it to represent a real body of knowledge, and for it to be useful in its own right, it needs to grow and change. It needs to become the home of smart investigating and the place where you come when something human needs figuring out. It is not that yet—but it could become that.

Why I’ve (Almost) Given Up

Why I’ve (Almost) Given Up

Phillip M. Sinaikin, M.D., M.A. (retired), Board Certified in Psychiatry

Earlier this year I participated in an online symposium sponsored by the East Side Institute in New York City. Among the participants was Robert Whitaker, author of Mad in America1 and other excellent books and articles critical of medical model psychiatry. He has probably drawn more attention to this topic than anyone and has lectured all over the world. And yet during this symposium Robert clearly expressed a sense of demoralization because, as he put it, despite his and so many others’ detailed, rational and inarguable critiques of medical model DSM psychiatry “the needle hasn’t moved even a little bit.”

I too have been an active member and participant in the critical psychiatry movement while practicing clinical psychiatry for over 30 years. I have lectured, written and published in mainstream and radical literature as well as putting all my thoughts together in a 375-page book published in 2010: Psychiatryland 2. I too have not seen the needle move at all or, if it has, even further in the wrong direction toward speculative functional neurobiology justifying even more diagnoses and crazy combination psychotropic medication treatment plans.

I will be honest, it was with a great sense of relief that I retired about a year ago from active practice and really haven’t looked back. But that doesn’t mean things don’t still bug the hell out of me and occasionally prompt me to spring into action. Case in point, the political and public reaction to the Parkland school shootings. Once again, I witnessed an outcry for more mental health evaluations of children and teens to make early diagnoses of mental disorders and impose treatment that will prevent future mass shootings. In addition, while there was (briefly) a discussion about background checks for gun ownership being denied for the “mentally ill” I decided I needed to speak up. But how? Oh, I know, write an op-ed piece for a major newspaper. That should do the trick and get an important discussion going. Or so I thought….

Without going into too much detail you need to know that it seems a whole lot of people feel the need to publish op-ed opinions in major newspapers. So many in fact that the papers have all kinds of rules governing submission including the maximum number of words, topics, and whether they will even acknowledge receiving the article and that they won’t get back to you.  “If you don’t hear from us in three weeks you should assume we have elected not to publish it.”

Undaunted, I decided to go ahead, shaving down the word number when required and waiting the requisite three weeks between submissions. Here is a list of the papers I never heard back from: The New York Times, The Washington Post, The Wall Street Journal, USA Today, The Miami Herald, The Los Angeles Times, The Chicago Tribune and The Pittsburgh Press. Because I live here and could call and bug them on the phone, I did get some feedback from The Tampa Bay Times. They “passed” on the article because they saw the issue I was presenting as an internal debate in psychiatry, not an issue of urgent national concern.

So, there you have it. Another non-movement of the needle. Chuck Ruby has asked for submissions to the ISEPP Bulletin so the following is the text of my op-ed article that never saw the light of day.

1 Whitaker, R. (2003). Mad In America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. New York, NY: Basic Books.

2Sinaikin, P. (2010). Psychiatryland: How to Protect Yourself from Pill-Pushing Psychiatrists and Develop a Personal Plan for Optimal Mental Health. IUniverse.

Who decides who is too “mentally ill” to buy a gun?

As an M.D. psychiatrist who recently retired after 33 years of work in diverse clinical settings, I am deeply concerned about the role being assigned to mental health professionals in the various proposals to end mass shootings in our schools and other public places. It seems as if the American public and policy makers continue to believe that psychiatry is a medical specialty comparable to other medical specialties such as internal medicine or oncology. It is mistakenly believed that when a patient is given a psychiatric diagnosis of, for example, bipolar disorder or ADD it represents a scientific certainty, no different from a diagnosis of diabetes, heart disease, cancer or an infection made in other medical specialties. But this is simply not the case.

Diagnoses in mental health are derived from the Diagnostic and Statistical Manual of Mental Disorders, currently in its fifth revision, the DSM 5. Deciding whether someone is or is not mentally ill, (or, technically, has a “mental disorder”), and what precisely that mental disorder is relies solely on referring to the diagnostic criteria listed in the DSM. These criteria are lists of signs (observable symptoms such as motor restlessness), and  subjectively reported symptoms such as feeling depressed or anxious or confused. Some of the most serious symptoms in psychiatry such as delusions, hallucinations or suicidal ideation are of the subjective variety and therefore prone to individual interpretation, variation and distortion.

When these symptoms and signs occur in specified clusters and are of sufficient duration and intensity, they “qualify” the patient for a particular mental disorder diagnosis. How this differs from all the other medical specialties is that in internal medicine, oncology, orthopedics and the rest, the initial diagnostic assessment of signs and symptoms is merely step one. What comes next is a battery of objective tests such as X-Rays, blood tests or biopsies to confirm the initial diagnostic impression or prove it wrong. In psychiatry, this second round of testing does not occur (other than to rule out a physical cause such as a tumor or infection causing the mental symptoms). That is because in psychiatry THERE ARE NO OBJECTIVE LAB, X-RAY OR ANY OTHER DIAGNOSTIC TESTS TO PROVE OR DISPROVE A PSYCHIATRIC DIAGNOSIS.

In psychiatry, diagnoses are made by the clinician based solely on the clinical exam and DSM criteria alone. What that means is that there is a lot of room for varying “expert” opinions in mental illness diagnosis because there are no objective and inarguable biologic tests to prove (or disprove) a DSM derived psychiatric opinion about the correct diagnosis. A misbehaving difficult child could potentially be diagnosed as suffering from bipolar disorder or from ADD or from oppositional defiant disorder or from “depression” or even from a brand new mental disorder just added in DSM 5: DMDD, Disruptive Mood Dysregulation Disorder. Am I saying that the same child with the same “symptoms” could in fact be diagnosed with any of these widely divergent mental “disorders” depending solely on the clinical opinion of the examining psychiatrist and his or her interpretation of the presenting symptoms and the DSM criteria? Yes, that is exactly what I am saying because I have seen it time and time again in my 33 years of practice.

Although most people have been led to believe that an imbalance in brain chemicals or faulty brain circuit wiring is the underlying cause of mental illness this has never been irrefutably demonstrated in any human being to be the case, despite decades of intense research. There are no definitive biologic tests of any sort to reliably diagnose the exact nature of or cause of a mental illness from the mildest to most severe conditions. So how can we trust psychiatry to play a pivotal role in determining who is mentally ill, what precisely is wrong, what treatment is indicated and what is the prognosis? We can’t! So how should medical model psychiatry be asked to determine who can safely be allowed to own a gun?

From what I’ve read, the Parkland shooter had accumulated three widely divergent mental illness diagnoses: ADD, autism and generically described “depression.” Each of these “disorders” has its own course, treatment recommendations and prognosis. How to deal with all three at once? The Sandy Hook shooter had reportedly also received mental health evaluations and treatment with diagnoses of Asperger’s syndrome (in DSM 5 now autism spectrum), depression, anxiety and obsessive-compulsive disorder. Again, what to treat? How to treat? And, does this make someone dangerous? Should anyone with these diagnoses be kept from purchasing a gun?

In my experience, the ever-evolving, fluid and yes, still highly controversial, medical model in psychiatry is resulting in more than one mental illness diagnosis at a time becoming the norm, not the exception. And since psychiatry utilizes only about 5 classes of medications in treating the over 300 identified mental disorders in DSM 5, patients are frequently subjected to numerous medication trials and complex medication combinations, often with ambiguous results.

Medical model psychiatry is not, as yet, anything like the other branches of medicine. It is far from an exact science, in fact one could reasonably argue that it is not a science at all. I am not saying psychiatry never does anybody any good. Far from it. Psychiatrists deal with some very difficult and disturbed human beings and tries to do its best to relieve emotional pain and suffering. In addition there are numerous other disciplines such as social work, psychology and counseling to help people with emotional and behavioral problems. But most often it is the M.D. psychiatrist who has the final authority in assessing diagnosis and potential for danger to self or others. But psychiatry cannot and should not be relied upon to somehow objectively and scientifically weed out the “mentally ill” who represent a threat of mass violence and therefore would be disqualified from owning a gun. Many mental illness diagnoses refer to mild often transient emotional and behavioral disturbances, many of which might not even merit a mental disorder diagnosis, but due to insurance regulations and the requirement for a “reimbursable DSM diagnosis” to pay for mental health care, a diagnosis is nevertheless assigned. But even in the more severe conditions, violence is rare. Society needs to stop trying to fall back on the current mental illness model to predict who will become a mass shooter. We need to look elsewhere (social conditions, gun ownership laws) because current DSM medical model psychiatry won’t be of any real help.

PTSD, The Grand Scapegoat

PTSD, The Grand Scapegoat

PTSD, The Grand Scapegoat

Joe Tarantolo, M.D., Psychiatrist

The diagnosis of PTSD was created in response to pressure from Vietnam veterans who wanted to be sure of their right to receive medical and financial benefits as befitting any man (the military was minimally integrated at that time) who fought in an unpopular and hateful war. We must be clear about this to be able to take PTSD out of the sphere of medical diagnoses and place it where it belongs: a social, political, and moral position in a country ambivalent about its warriors.

If PTSD is not an illness, a medical condition, if we are clear about that, we can then be able to ask pertinent questions about the function and purpose of this pseudo-illness. What purpose does this diagnosis serve? Whereas initially, post-Vietnam, the diagnosis allowed an outlet for the country’s guilt for over 50,000 American deaths and a million Vietnamese deaths for an ill-begotten war which ultimately detracted from our world status and security, we are once again faced with harrowing questions about our national character:

(1) Are we a peace-loving or warmongering nation?

(2) Are we freedom-loving? Do we love freedom more than security?

(3) Are we committed to a noble view of the “warrior class” or is our deeper value more darkly cynical?

In answering these questions certain truths should be addressed:

(1) A large chunk of our volunteer military, perhaps a majority, seek out the military for a secure job, not out of patriotic love of country or the honor and courage associated with military service. This is particularly true in difficult economic times. We now have a type of military socialism – not quite what Eisenhower warned about a “military-industrial complex” but close – where very large numbers of the populace directly rely on the war machine to earn a living.

(2) Our freedom has been lessened, not enhanced, by the misnomer “war on terror:” restrictions on movement, unauthorized government intervention wiretaps, restrictions on habeas corpus and more. This is important given that the rationale for the war machine is to “protect our freedom,” literally die for our freedom. To understand pseudo-diagnoses one has to address Orwellian misspeak.

(3) With the perfecting of drone attacks, killing increasingly comes from afar. Killing from afar runs contrary to every cultural notion of a noble warrior class. This idea got significant play under the Clinton administration with the sending of bombers but no foot soldiers to make war on Serbia. There were actually some national/international voices calling us cowards. “Why don’t you fight like a man?!”

My thesis is that the function of the PTSD pseudo-diagnosis is that it gives voice as scapegoat to disowned parts of our national laments. We might think of PTSD as scapegoat – those with the diagnosis hold the revulsion that we can’t express more directly because of political and cultural constraint.

The PTSDer gets an enormous amount of pseudo-sympathy directed at him. The complexity is that he is also held in contempt, drugged as if he is unable to bear his memories, pathetic, requiring medical attention in lieu of compassionate understanding.

He, the PTSDer, must hold both our shame and our guilt, our guilt in that we have become the primary international killers and our shame in that we kill out of fear rather than noble cause.

A true “treatment” of PTSD needs a national voice that will not be spoken. We are not allowed to “apologize for American values” nor criticize our rationale for war. Recall, a decorated veteran (J. Kerry) of the Vietnam War, running for President, was called a liar and coward because he headed a band of vets who condemned the war. On the other side of that coin we were not allowed to criticize another nominee (J. McCain) for his bombing of innocent Viet Nam civilians.

We are now faced with an overwhelming number of veterans demanding disability benefits. I suspect much of this “disability” is the inability to speak out against the “war on terror.” Rage has become pathos, spousal abuse, suicide, homicide, drunkenness, and wounded brains. As Stan White (father of 2 vets lost because of the war on terror and who has championed better treatment of veterans) says, “Anger doesn’t accomplish anything.” Indeed.

Treatment Principles: ( The term “treatment “ is problematic but for now we are stuck with it.)

(1) Best in a group where multiple points of view are aired.

(2) Group leader quickly establishes that he does not think they have a disease.

(3) Minimal emphasis on symptoms such as insomnia, anxiety, depression, etc.

(4) The object of the intervention is clarity of thought, not in “ feeling better”.

(5) Therapist must be able to hold a whole spectrum of points of view, “ God bless America” “ God damn America”.

(6) The position of the therapist/facilitator is we are dealing with a moral, political, spiritual, existential problem, not a brain disease.

(7) Encouragement to “Speak-Up” about what you think about country, war, the “enemy”, government, leaders, particularly the negative views. In the negative views one will find the anger and ultimately the deeper sadness about themselves as “failed” warriors and failed peacemakers.

(8) The object, ultimately is to transform the military scapegoat (alias PTSD) into a role model for honest debate about who & what we are as a nation & a people.

(9) The group, as they reflect & debate will discover they are a microcosm of their country/culture debate, a debate poorly articulated. As they experience the conflict within the group, they will begin to see the conflict within each individual.

(10) Bad dreams & flashbacks are respected as the mechanism whereby we dare not forget. We must all hold the various horrors together.