“The reproducibility of published experiments is the foundation of science. No reproducibility – no science." - Moshe Pritsker, Ph.D., CEO of JoVE¹

By the turn of the 20th century medical science had fully embraced empiricism – the philosophy that knowledge is determined by rational experiments perceived by our senses. Proof rather than deduction or revelation was the new measuring stick. Experiments were designed, theories created, measurements taken, successes heralded, and experimenters often rewarded with fame and fortune. As important, empiricism brought with it the process by which all modern science is evaluated: the scientific method. The formality and rigor of this process was transformational in science. It’s worth a quick review.

The Scientific Method

The 5-step scientific method is simple to describe, and difficult to implement – and that is the point of this exacting process. The technique is designed to create empirical evidence – sometimes referred to as sense experience – utilizing the tools of observation and experiment. Results must be measurable in the physical world. When done as designed, the method provides quantifiable observations to the scientist - the facts of an experiment. In turn, the scientist provides an explanation of the facts – the theory of an experiment.

Step 1 of the scientific method requires the scientist to ask a question about nature, to make detailed observations and to gather information. In Step 2 the scientist forms a hypothesis (theory) about the observations and creates specific predictions. Next, in Step 3 the scientist tests the predictions with a detailed, observable, quantifiable experiment. Step 4 requires the scientist to analyze the data, to draw conclusions, and to accept, reject or modify the hypothesis. Finally, and most importantly, Step 5 compels the scientist to provide step-by-step directions to duplicate the experiment, and a new scientist must independently reproduce the experiment and find the same results before any knowledge can be proclaimed.

Turn-of-the-century medics must have been truly inspired. For the first time they could listen to – and see – telltale signs of health inside a living body. They could anesthetize their patients prior to surgery, and they used sterilized instruments in a disinfected operating room, blood transfusions available as needed. As important, given the overwhelming success of Pasteur’s germ theory, new hypotheses were being introduced at a fast pace, each theory looking for other likely “germs” that were the root cause of so much human suffering.

Thus, 20th century medical experimentalism launched with new tools, a new paradigm and a multitude of exciting projects. To kick off this new era, two medical devices were revamped during the last decade of the 19th century, setting the stage for the incredible 100 years to follow: the microscope and the culture dish.

Let There Be Light

August Köhler² was a student of zoology, botany, mineralogy, physics, and chemistry in late 19th century Germany. As a young, post-graduate staff member at Carl Zeiss AG (an optical systems manufacturer) he developed Köhler Illumination. Kohler’s invention produced even lighting across the field of view and greatly enhanced the contrast of the light microscope. During the next 45 years Kohler contributed to numerous other innovations including fluorescence microscopy and grid illumination, a method used in the treatment of tumors.

Around the same time, Julius Richard Petri was working for the Imperial Health Office in Berlin. Lab scientists were uniformly frustrated. In order to observe cultures through a microscope the cover had to be removed, exposing the bacteria to contaminants like dust, hair, and human breath. Petri had the simple idea of placing a slightly larger clear glass dish upside down over the culture dish to protect it from the external environment and, according to one science writer, “changed medical history.”³ Petri moved on to work in a lab in Germany for the rest of his career where he published nearly 150 papers about the spread of diseases.

“Magic Bullets”

Another German, Paul Erlich⁴, coined the term “chemotherapy” in 1900. Erlich theorized toxic compounds could be created to selectively target a variety of disease-causing organisms. He predicted future chemists would produce substances to seek out these disease-causing agents, dubbing the substances “magic bullets.” Erlich’s forecast was accurate. “Magic bullets” began to to materialize in science labs around the world. By 1901 blood types were discovered by Austrian Karl Landsteiner, in 1906 Frederick Hopkins discovered vitamins in England, and a Canadian, Sir Frederick Banting, discovered insulin in 1921.

It was a banner century for another “magic bullet”: the vaccine. The most celebrated was Jonas Salk’s polio vaccine. Once introduced in the United States (some may remember the March of Dimes immunization campaign in the early 1950’s) the annual number of polio cases fell from 35,000 in 1953 to 5,600 by 1957. By 1961 only 161 cases were recorded in the United States. Medical science also gave us vaccines for bacterial meningitis, chickenpox, haemophilus influenza, hepatitis A, hepatitis B, Japanese encephalitis, measles, mumps, papillomavirus, pneumococcus, rotavirus, rubella, tetanus, typhoid, tick encephalitis, whooping cough and yellow fever – saving and changing the lives of millions of people.

The Century’s Preeminent “Magic Bullet” – Penicillin

Before antibiotics (lit. against-life), 90% of children with bacterial meningitis died, strep throat was often fatal, and even minor infections would often lead to serious illness and death. Then in 1928, Sir Alexander Fleming⁵, a Scottish biologist and pharmacologist, made a fortuitous discovery from a discarded Petri dish. The mold that had contaminated an experiment turned out to contain a powerful antibiotic: penicillin. This one discovery, and the analogues to follow, has saved hundreds of millions of lives around the world. Fleming also predicted science would find many new “bacteria killers.” He was right too. Today there are thousands of antibiotics, more created every year.

More “Magic Bullets”

Here is a selection of “magic bullets” discovered and invented during the 20th century (there are many others):

• Arsphenamine for syphilis (1910)

• Nitrogen mustard – first cancer drug (1946)
• Acetaminophen (1948)

• Tetracycline (1955)
• Oral contraception – “the pill" (1960)

• Propranolol – first beta blocker (1962)

• Cyclosporine - immunosuppressant (1970)
• Lovastatin (Mevacor) - first statin (1987)

Procedures

There were amazing number of new procedures created by modern medicine over these 100 years too. Here’s a list of some of the “firsts”:

• Electrocardiogram (1903)

• Stereotactic surgery (1908)
• Laparoscopy (1910)

• Electroencephalogram (1929)
• Dialysis machine (1943)

• Heart-Lung Machine (1953)

• Ultrasound (1953)
• Kidney transplant (1954)
• Pacemaker (1958)

• "Test Tube Baby” (1959)
• Liver transplant (1963)
• Lung transplant (1963)

• Pancreas transplant (1966)
• Heart transplant (1967)
• MRI (1971)

• CAT Scan, (1971)

• Insulin pump (1972)

• Laser eye surgery (1973)

• Liposuction (1974)

• Heart-lung transplant (1981)
• Surgical Robot (1985)

Mankind has been the beneficiary of these creations and we gratefully acknowledge and salute medical science for their wondrous contributions, inclusive of all medical specialties – save one.

Again - What About Madness?

Medical scientists addressing madness contributed to this otherwise spectacular century with four “magic bullets” of their own during the first 50 years of the century, each an unmitigated disaster. The first three are collectively called Shock Therapies and include, Deep Sleep Therapy, Convulsive Therapy, and Insulin Shock Therapy. The fourth is Psychosurgery. Here’s a review.

Deep Sleep Therapy (DST)

Jakob Klaesi, a Swiss psychiatrist re-popularized DST in 1920 (after two failed attempts earlier in the century) using Sonmifen (a sedative) for his schizophrenia patients. For the next 20 years Klaesi and his colleagues dominated the mental health hospital circuit in Zurich using DST, despite high mortality rates and never ending doubts about efficacy. Undeterred, DST was promoted by many eminent psychiatrists of the time, including William Sargant of Great Britain:

"All sorts of treatment can be given while the patient is kept sleeping, including a variety of drugs. . . the patient does not know how long he has been asleep, or what treatment, even including ECT, he has been given. . . a new exciting beginning in psychiatry and the possibility of a treatment era such as followed the introduction of anesthesia in surgery."

The Australian Chelmsford scandal of 1983 finally put an end to this toxic procedure. Dr. Harry Bailey was in charge of Chelmsford Private Hospital in Australia and DST was the primary treatment for madness. Over sixteen years, 27 deaths were directly connected to DST with another 24 reports of suicide in the same year patients received treatment. Facing condemnation from families, the general public and the government, Bailey committed suicide in 1985.⁶ The scandal brought about new stringent laws and regulations regarding psychiatric care in Australia.⁷

Convulsive Therapy

Convulsive therapy took hold quickly. In 1934 Ladislas J. Meduna, a Hungarian neuropsychiatrist known as the “father of convulsive therapy,” used metrazol (a stimulant) to induce seizures in patients with schizophrenia and epilepsy. By 1937, the first international meeting on convulsive therapy was convened in Switzerland, and by 1940 metrazol-convulsive therapy was being used worldwide.

Around the same time Ugo Cerletti, an Italian neuropsychiatrist, was using electric shocks to produce seizures in his animal experiments. He noticed when pigs were given an electric shock before being butchered, they were in an “anesthetized state.” With his colleague Lucio Bini, they replaced metrazol and other chemicals with electricity. As a bonus, they surmised, ECT brought about retrograde amnesia so patients had no ill feelings about a treatment they could not remember. Cheaper and more convenient, ECT replaced chemical-induced convulsive therapy and by 1940 was being used in England, Germany, Austria, and the United States. (NOTE: Cerletti and Bini were nominated, though not selected, for a Nobel Prize.)

There was a marked decline in the use of ECT from 1950s to the 1970s because the public perceived the procedure as dangerous, inhumane and overused.⁸ However, because ECT was convenient and cost-effective, mental health providers balked. By 1985, the National Institute of Mental Health (NIMH) and the National Institutes of Health (NIH) convened a conference on ECT and concluded, while controversial, ECT was effective for a narrow range of psychiatric disorders. In 2001 the American Psychiatric Association expanded the role of ECT and, by 2017, ECT was covered by most insurance companies. This incredibly cruel and torturous “treatment procedure” is gaining popularity - again.⁹

Insulin Shock Therapy (or Insulin Coma Therapy)¹⁰

Dr. Manfred Sakel was a young doctor in Vienna in 1928 when he was given the task to reduce the unpleasant withdrawal symptoms of opiates. Experimenting with a newly discovered pancreatic hormone – insulin – he unexpectedly found a large dose would cause his patients to go into a stupor and, once recovered, were less argumentative, less hostile, and less aggressive. Thus, Insulin Shock Therapy (IST) was born. For the next 30 years IST was the go-to method for tens of thousands of mental health patients as IST doctors proudly proclaimed an “80 per cent cure rate for schizophrenia.” ¹¹

The actual procedure was intense. Insulin injections were administered six days a week for two months or more as the daily dose was gradually increased until hour-long comas were produced. Seizures before or during the coma were common as were hypoglycemic aftershocks. Often patients were subjected to ECT while comatized. Given the profuse cases of brain damage – and an estimated mortality risk rate ranging from 1-5%¹² – IST fell out of use in the United States, and nearly everywhere else, by the 1970s.¹³

Psychosurgery

In 1930 Antonio Egas Moniz, a Portuguese neurologist, used the term “leucotomy” (lobotomy) for the first time to describe a surgical operation that destroys brain tissue by extraction, burning, freezing, electrical current or radiation. The objective is to sever the connections between the frontal lobes and deeper structures in the brain. Approximately 40,000 lobotomies were performed in the United States alone from 1930 to 1970. By the way, the majority (nearly two thirds) were performed on women.¹⁴

Use declined rapidly due to increased concern about deaths and brain damage caused by the operation, and by the introduction of neuroleptic drugs. By the mid-1970s the use of psychosurgery had declined to about 100–150 operations a year and disappeared completely by the 1980’s. Remarkably, Moniz (and Walter Rudolf Hess) shared the Nobel Prize in 1949 for this discovery, though not without controversy that still exists in the scientific community.¹⁵

What A Century

For medical scientists focused on physical human ailments, it was a stupendous century. Life expectancy is approaching 80 years in the United States, up from 50 years at the beginning of the 20th century. We are routinely treated with medicines and procedures for debilitating diseases that diminished, disfigured and often killed our ancestors not long ago. As important, the consistency and precision provided by empiricism and the scientific method paid off for all medical specialties during those amazing 100 years – save one.

For medical scientists focused on madness it’s been one grotesque failure after another. These scientists put us to sleep for weeks at a time, induced comas for months at a time, used chemicals and electricity to convulse us, and surgically destroyed our brain tissue, all in an effort to fix our brain diseases. Along the way all of them ballyhooed their successes, using their special brand of science and patient testimonials to convince us of the medical necessity and efficacy of their “magic bullets.”

Then in 1950, as if a reprieve for past travesties, a fifth “magic bullet” appeared: neuroleptic (lit. nerve-effecting) drugs. This new state-of-the-art medicine was primed to replace the first four fiascos. Given the track record of Psychiatric Medical Model Theory (PMMT), it’s a wonder anyone took them serious.

Unfortunately, nearly everyone did.

NEXT TIME: Part 3: Thorazine to the Rescue

“Medicine men devised all manners of disabling methods—for three centuries—finally discovering drugs as an easy and efficient means of achieving disability."
- David West Keirsey, Disable Madmen, (https://professorkeirsey.wordpress.com/2011/08/17/disable-madman-part-i/)

Endnotes
¹The Journal of Visualized Experiments (JoVE) is a peer-reviewed scientific journal that publishes experimental methods in video format. https://www.jove.com/.

² https://en.wikipedia.org/wiki/August_K%C3%B6hler.


³ How Julius Richard Petri's Dishes Changed Medical History
https://www.medicaldaily.com/how-julius-richard-petris-dishes-changed-medical-history-246396.

⁴ Erlich shared the 1908 Nobel Prize in Physiology or Medicine with Élie Metchnikoff for their contributions to the field of immunology.

⁵ Fleming, Howard Florey and Ernst Boris Chain jointly shared the Nobel Prize in Medicine in 1945.


⁶ You can read more about this at https://chelmsfordblog.wordpress.com/aftermath-of-the-scandal/. 

⁷ In her book First Half, Toni Lamond described her experience at Chelmsford: "I was given a semi-private room. On the way to it I saw several beds along the corridors with sleeping patients. The patient in the other bed in my room was also asleep. I thought nothing of it at the time. Although it was mid-morning, the stillness was eerie for a hospital that looked to be full to overflowing. I was given a handful of pills to take and the next thing I remember was Dr Bailey standing by the bed asking how I felt. I told him I'd had a good night's sleep. He laughed and informed me it was ten days later and, what's more, he had taken some weight off me. I was checked out of the hospital and this time noticed the other patients were still asleep or being taken to the bathroom while out on their feet." https://en.wikipedia.org/wiki/Deep_sleep_therapy.

⁸ Later on, the public’s negative perception of ECT was further tarnished by the movie One Flew Over the Cuckoo's Nest.

⁹ Read about Pennsylvania’s Rotenberg Center at https://doctorcima.com/2012/06/. 

¹⁰ https://en.wikipedia.org/wiki/Insulin_shock_therapy#Decline. 

¹¹ https://en.wikipedia.org/wiki/Insulin_shock_therapy. 

¹² Ebaugh, FG. (1943). A review of the drastic shock therapies in the treatment of the psychoses. Annals of Internal Medicine. 18 (3): 279–296. doi:10.7326/0003-4819-18-3-279.

¹³ In 1953, British psychiatrist Harold Bourne published The Insulin Myth, arguing there was no sound basis for believing that insulin counteracted the schizophrenic process. He said treatment “worked” because patients were chosen for their good prognosis and were given special treatment. Bourne submitted the article to the Journal of Mental Science. After a 12-month delay, Bourne received a rejection, telling him to "get more experience." https://ipfs.io/ipfs/QmXoypizjW3WknFiJnKLwHCnL72vedxjQkDDP1mXWo6uco/wiki/Insulin_shock_therapy.html. 

¹⁴ https://en.wikipedia.org/wiki/Lobotomy. In addition, in Japan the majority of lobotomies were performed on children with behavior problems.

¹⁵ There have been calls in the early 21st century for the Nobel Foundation to rescind the prize it awarded to Moniz, characterizing the decision at the time as an astounding error in judgment. To date, the foundation has declined to take action and has continued to defend the results of the procedure.

Wayne Ramsay, J.D.

All diagnoses and treatment in psychiatry assumes the validity of the concept of mental illness or mental disorder.  Coverage for psychiatric and other mental health treatment in health insurance policies is based on the same assumption.  However, many mental health professionals have questioned the validity of the concepts of mental illness and mental disorder.

The best known of these is psychiatry professor Thomas Szasz, M.D., whose book The Myth of Mental Illness was published in 1961.¹

However, even before this, in 1958, Philadelphia psychiatrist Philip Q. Roche, M.D., who was winner of the American Psychiatric Association's Isaac Ray Award for outstanding contributions to forensic psychiatry and the psychiatric aspects of jurisprudence, in his book The Criminal Mind, said:

[I]n the natural world there is no such thing as mental disease or defect, but rather certain patterns of behavior to which, in a given social context, we apply certain names which enable us to talk about and to effect certain changes in the social relationships of those who exhibit them and to effect changes in the individuals themselves. At best, we are left to the imposition of purely arbitrary criteria in selecting such persons.²

In his testimony before the Mental Health Committee of the New York State Assembly (state legislature) on May 18, 2001, neurologist John Friedberg, M.D., said, “I do not believe in mental illness....Psychiatric drugs and electroshock inflict real injury in the name of treating fictive maladies.”³

In 2012, neurologist Fred A. Baughman, M.D., said “there is no such thing whatsoever as a psychiatric or psychological disease.”⁴

In 2018, Chuck Ruby, Ph.D., a psychologist and Executive Director of the International Society for Ethical Psychology and Psychiatry (ISEPP), said “The conventional mental health industry goes to great lengths in an attempt to perpetuate the myth of mental illness ... ISEPP's goal is to dispel the myth of mental illness....The problems we've dubbed mental illnesses are about inter- and intra-personal, spiritual, existential, economic, and political matters, not real disease."5

In 2013, in their book Mad Science, Stuart A. Kirk, D.S.W., Tomi Gomory, Ph.D., and David Cohen, Ph.D., said:

…we have argued, the existence of a disease of mental illness has never been established...together we've amassed over seventy five years of teaching mental health courses in graduate schools of social work to thousands of students and practitioners...after more than ten decades of determined research and the expenditure of untold sums, no one can verify that madness is a medical disease....There is, of course, the unpredictable but remote possibility that the psychiatric system produces it's ‘Gorbachev,’ a widely acknowledged leader and spokesperson who says plainly and loudly that the emperor has no clothes, that while many people could use help for their distress or have their disturbance contained to preserve our peace of mind, there is no mental illness.⁶

In a lecture in 2015, psychologist Paula J. Caplan, Ph.D., said, “Nobody should be diagnosed with mental illness.”  After her lecture I asked Dr. Caplan if she really meant nobody.  She said yes and that is the reason the concept of mental illness itself is not valid.⁷

In 2015, in his book Deadly Psychiatry and Organized Denial, Dr. Peter C. Gøtzsche, a physician specializing in internal medicine, and professor of Clinical Research Design and Analysis at the University of Copenhagen, said:

Quite often, psychiatrists prefer to talk about a mental disorder, rather than a mental illness or disease, which is because psychiatric diagnoses are social constructs....psychiatrists have blown life into a social construct that is nothing but a variation of normal behavior and have given this construct a name, as if it existed in nature and could attack people.”⁸

The Merriam-Webster Dictionary defines “social construct” as “an idea that has been created and accepted by the people in a society”.⁹  Physical realities are not social constructs. For example, cancer is not a social construct.  Cancer is not a social construct because it exists whether we believe in it or not.  On the other hand, “crime” is a social construct: There is nothing in nature that defines hurting or killing a person or an animal as wrong.  Crime exists only because we define certain actions as crimes or our common agreement that certain things are crimes.

My argument here is that “mental illness” is only a social construct, not a real disease.  Mental illness exists only in the way crime exists and does not exist in the way cancer does.  There is no evidence for mental illness or disorder as a biological fact rather than as a social construct:

In 1974, in his book The Death of Psychiatry, psychiatrist E. Fuller Torrey, M.D., wrote, “None of the conditions that we now call mental ‘diseases’ have any known structural or functional changes in the brain which have been verified as causal.”¹⁰

In 1988, Seymour S. Kety, M.D., Professor Emeritus of Neuroscience in Psychiatry, and Steven Matthysse, Ph.D., Associate Professor of Psychobiology, both of Harvard Medical School, said “an impartial reading of the recent literature does not provide the hoped for clarification of the catecholamine hypotheses, nor does compelling evidence emerge for other biological differences that may characterize the brains of patients with mental disease.”¹¹

In 1992, a panel of experts assembled by the U.S. Congress Office of Technology Assessment concluded: “Many questions remain about the biology of mental disorders.  In fact, research has yet to identify specific biological causes for any of these disorders....Mental disorders are classified on the basis of symptoms because there are as yet no biological markers or laboratory tests for them.”¹²

In 1996, psychiatrist David Kaiser, M.D., said “modern psychiatry has yet to convincingly prove the genetic/biologic cause of any single mental illness.”¹³

In 1998 in his book Blaming the Brain: The Truth About Drugs and Mental Health, Elliot S. Valenstein, Ph.D., Professor Emeritus of Psychology and Neuroscience at the University of Michigan, said: “Contrary to what is often claimed, no biochemical, anatomical, or functional signs have been found that reliably distinguish the brains of mental patients.”¹⁴

According to neurologist Fred Baughman, M.D., in 1999, “there is no scientific data to confirm any mental illness.”¹⁵

In 1999, in their textbook Neurobiology of Mental Illness, three psychiatry professors at Yale University School of Medicine (Dennis S. Charney, M.D. et al.) said “We have so far failed to identify bona fide psychiatric disease genes or to delineate the precise etiological and pathophysiological basis of mental disorders.”¹⁶

In 2000, in his book Prozac Backlash, Joseph Glenmullen, M.D., clinical instructor in psychiatry at Harvard Medical School, said “In medicine, strict criteria exist for calling a condition a disease.  In addition to a predictable cluster of symptoms, the cause of the symptoms or some understanding of their physiology must be established....Psychiatry is unique among medical specialties in that...We do not yet have proof either of the cause or the physiology for any psychiatric diagnosis.”¹⁷

In 2001, in his book Commonsense Rebellion: Debunking Psychiatry, Confronting Society, psychologist Bruce E. Levine, Ph.D., said “no biochemical, neurological, or genetic markers have been found for attention deficit disorder, oppositional defiant disorder, depression, schizophrenia, anxiety, compulsive alcohol and drug abuse, overeating, gambling, or any other so called mental illness, disease, or disorder.”¹⁸

In 2009, Allen Frances, M.D., chairperson of the Task Force that created two editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, DSM IV (1994) and DSM IV TR (2000), criticizing the proposed Fifth Edition of this book published in May 2013, noted that “not even 1 biological test is ready for inclusion in the criteria sets for DSM V.”¹⁹  In 2013, in his book Saving Normal: An Insider's Revolt Against Out of Control Psychiatric Diagnosis, DSM 5, Big Pharma, and the Medicalization of Ordinary Life, Dr. Frances said “The powerful new tools of molecular biology, genetics, and imaging have not yet led to laboratory tests for dementia or depression or schizophrenia or bipolar or obsessive compulsive disorder or for any other mental disorders...We still do not have a single laboratory test in psychiatry....thousands of studies on hundreds of putative biological markers [for mental illness] have so far come up empty.”²⁰

In a lecture at the University of New England in 2013, British psychiatrist Joanna Moncrieff, Senior Lecturer in Mental Health Sciences at University College London, said “There is just absolutely no evidence that anyone with any mental disorder has a chemical imbalance of any sort...absolutely none.”²¹

In 1991, in his book Toxic Psychiatry, psychiatrist Peter Breggin, M.D., said “there is no evidence that any of the common psychological or psychiatric disorders have a genetic or biological component.”²² Twenty-four years later, on the Coast to Coast AM radio show on February 9, 2015, Dr. Breggin said “There is no known physical connection to any psychiatric disorder. There is no genetically determined cause. It's all drug company propaganda, because the pharmaceutical industry with its billions of [advertising] dollars, and the medical industry, thinks you're more likely to take drugs if you think you have a genetic or biological disease.”

In 2015, in his book Deadly Psychiatry and Organized Denial, Dr. Peter C. Gøtzsche, a physician specializing in internal medicine, and professor of Clinical Research Design and Analysis at the University of Copenhagen, said “it hasn't been possible to demonstrate that people suffering from common mental disorders have brains that are different from healthy people's brains.”²³

So, if mental illnesses, mental diseases, or mental disorders or syndromes must have a biological etiology or cause to qualify as illness, disease, disorder, or syndrome, none have been proved to exist.

Mental illness being a social construct and not a real illness, disease, syndrome, or disorder is illustrated by the fact that homosexuality was once considered mental illness or disorder but is not now in 2019.  Homosexuality was officially defined as a mental disease or disorder on page 44 of the American Psychiatric Association's standard reference book, DSM II: Diagnostic and Statistical Manual of Mental Disorders (the 2nd Edition), published in 1968.  In 1973, the American Psychiatric Association voted to remove homosexuality from its official diagnostic categories of mental illness.²⁴  So when the third edition of this book was published in 1980 it said “homosexuality itself is not considered a mental disorder.”²⁵  The 1987 edition of The Merck Manual of Diagnosis and Therapy states: “The American Psychiatric Association no longer considers homosexuality a psychiatric disease.”²⁶  If mental illness were really an illness in the same sense that physical illnesses are, the idea of deleting homosexuality or anything else from the concept of illness by having a vote would be as absurd as a group of physicians voting to delete cancer or measles from the concept of disease.  But mental illness isn't “an illness like any other illness.”  Unlike physical disease where there are physical facts to deal with, mental “illness” is entirely a question of values, of right and wrong, of appropriate versus inappropriate.  After homosexuals successfully demanded acceptance of their sexual orientation, it no longer seemed appropriate to call homosexuality a “disorder.”

If anyone should be able to define what is and is not a mental disorder, it is Allen Frances, M.D., chairperson of the Task Force that created the 1994 and 2000 editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).  According to Dr. Frances, “there is no definition of a mental disorder.  It's bullshit.  I mean, you just can't define it.”²⁷

Actually, you can: The defining characteristic of a mental illness or disorder is simply disapproval: Anything in a person's mentality that most people greatly disapprove of qualifies. This is true whether it is homosexuality or unusual political or religious beliefs, or anything else.  For example, when the “New Hampshire Hospital was established, in 1842...in the first year, more than a quarter of admitted patients suffered from an ‘overindulgence in religious thoughts,’ with several claiming to be prophets”.²⁸  Political dissidents have been committed to mental hospitals in the Soviet Union and China²⁹ — and the USA: When I observed commitment hearings in Washington, D.C., many were “White House cases,” people who went to the White House to protest something and were involuntarily “hospitalized.”

Today's almost universal belief in mental illness can be compared with another, at one time, almost universal belief that was also only a social construct: witchcraft.  Belief in witchcraft resulted in the infamous Salem witchcraft trials and the conviction and execution of supposed witches.  A witch was defined as a person who was in league with the Devil and had supernatural powers.  There actually were no such persons.  Just as it was impossible to be a witch, it is impossible to be “mentally ill” in a genuinely biological, medical, or scientific sense. Scientific determination that a person is mentally ill is as impossible as scientific determination that someone is a jerk.  Calling someone mentally ill or disordered reveals an attitude rather than stating a fact.

What if we did find a biological cause of a supposed mental illness or disorder?  Were that to happen, psychiatry professor Thomas Szasz once said, the finding of a physical cause would make the problem a physical illness, and whatever mental changes occurred as a result would be symptoms of bodily disease.³⁰  For example, brain cancer, stroke, and bacterial or viral infection of the brain are not usually considered causes of mental illness even when they cause abnormalities in thinking or behavior.  Since nothing can be an “illness” (or disease or syndrome or disorder) without a biological abnormality, and the finding of a biological abnormality makes the problem a physical illness rather than a mental illness, “mental illness” is actually an oxymoron or nonsensical term.

People can and do experience debilitating depression, anxiety, obsessions, compulsions, phobias, panic attacks, hallucinations, and delusions, and they may be violent or suicidal, but there is no evidence the reason is usually or typically biological abnormalities or, in other words, illnesses.

Because “mental illness” is an invalid concept, all laws predicated on “mental illness” should be repealed or invalidated by courts.  Nothing should ever happen because of diagnosis of fictitious disease.

References

(1) Thomas S. Szasz, The Myth of Mental Illness (Harper & Row 1961). 

(2)  Philip Q. Roche, The Criminal Mind (Farrar, Straus and Cudahy 1958), p. 253. 

(3) John M. Friedberg, M.D., “Neurologist John M. Friedberg on ECT”, May 18, 2001, http://ectjustice.com/neurologist-john-m-friedberg-on-ect/, accessed January 5, 2019.

(4) Fred A. Baughman, M.D., in his lecture at the Empathic Therapy Conference 2012, “The ADHD Stimulant Epidemic”, at 33 minute, 2 seconds point, available on DVD at EmpathicTherapy.org. 

(5)  Chuck Ruby, Ph.D., April 2018 Bulletin of the International Society for Ethical Psychology & Psychiatry, https://psychintegrity.org/wp-content/uploads/2018/11/Apr-2018.pdf, accessed January 5, 2019

(6)  Stuart A. Kirk, D.S.W., Tomi Gomory, Ph.D., & David Cohen, Ph.D., Mad Science (Transaction Publishers 2013), pp. 195, 301, 302, 328, italics in original, underline added. 

(7)  Paula J. Caplan, Ph.D., “Diagnosisgate”, conference of National Association for Rights Protection and Advocacy (narpa.org), Washington, D.C., August 23, 2015. 

(8) Dr. Peter C. Gøtzsche, Deadly Psychiatry and Organized Denial (People's Press 2015), pp. 26 & 145. 

(9) “Social construct”, Merriam-Webster Dictionary, https://www.merriam-webster.com/dictionary/social%20construct?utm_campaign=sd&utm_medium=serp&utm_source=jsonld, accessed January 5, 2019.

(10)  E. Fuller Torrey, M.D., The Death of Psychiatry (Penguin Books 1974), pp. 38-39. 

(11)  Seymour S. Kety, M.D. & Steven Matthysse, Ph.D. in Armand M. Nicholi, Jr. (ed.), The New Harvard Guide to Psychiatry (Harvard University Press 1988), p. 148.

(12)  The Biology of Mental Disorders (U.S. Gov't Printing Office 1992), pp. 13, 14, 46, 47. 

(13)  David Kaiser, M.D., “Commentary: Against Biologic Psychiatry”, Psychiatric Times, December 1996, http://www.psychiatrictimes.com/bipolar-disorder/commentary-against-biologic-psychiatry, accessed January 5, 2019.

(14)  Elliot S. Valenstein, Ph.D., Blaming the Brain: The Truth About Drugs and Mental Health (Free Press 1998), p. 125.

(15)  Fred Baughman, Insight magazine, June 28, 1999, p. 13.

(16) Dennis S. Charney, M.D. et al., Neurobiology of Mental Illness (Oxford Univ. Press 1999), p. vii.  

(17)  Joseph Glenmullen, M.D.,, Prozac Backlash (Simon & Schuster 2000), pp. 192, 193. 

(18) Bruce Levine, Ph.D., Commonsense Rebellion (Continuum 2001), p. 277.  

(19) Allen Frances, M.D., “A Warning Sign on the Road to DSM V”, Psychiatric Times, June 26, 2009, http://www.psychiatrictimes.com/diagnostic-and-statistical-manual-mental-disorders/warning-sign-road-dsm-v-beware-its-unintended-consequences, accessed January 5, 2019.

(20)  Allen Frances, M.D., Saving Normal (Harper¬Collins 2013), pp. 10, 11, 244.  

(21)  “Joanna Moncrieff—The Myth of the Chemical Cure; The Politics of Psychiatric Drug Treatment”, https://www.youtube.com/watch?v=IV1S5zw096U, at 53 minutes, 52 seconds point, accessed January 5, 2019.

(22)  Peter Breggin, M.D., Toxic Psychiatry (St. Martin's Press 1991), p. 291.

(23)  Dr. Peter Gøtzsche, Deadly Psychiatry and Organized Denial (People's Press 2015), p. 26. 

(24)  “An Instant Cure”, Time magazine, April 1, 1974, p. 45. 

(25)   American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III - 1980), p. 282. 

(26)  Merck Manual of Diagnosis and Therapy, 15th edition, 1987, p. 1495.

(27)  Allen Frances, M.D., quoted  by Gary Greenberg, “Inside the Battle to Define Mental Illness”, Wired Magazine, December 27, 2010, https://www.wired.com/2010/12/ff_dsmv/ , accessed January 5, 2019.

(28)  Rachel  Aviv, “God Knows Where I Am”, in M. Kaku (ed.), Best American Science Writing 2012 (HarperCollins 2012), p. 246-247. 

(29)  Richard J. Bonnie, LL.B.,“Political Abuse of Psychiatry in the Soviet Union and in China”,  J.Am.Acad.Psych.Law 30:136-44 (2002), http://jaapl.org/content/jaapl/30/1/136.full.pdf, accessed January 5, 2019

(30)  Thomas S. Szasz, Lexicon of Lunacy (Routledge 1993), p. 33.

Recommended Video

“There is no such thing as mental illness”, Stefan Molyneux, YouTube.com (2011)

THE AUTHOR, Wayne Ramsay, is a lawyer with the Law Project for Psychiatric Rights (PsychRights.org).

Joe Tarantolo, M.D., Psychiatrist

“… the tyranny of randomized controlled experiments…” (David Brooks, New York Times, October 8, 2018)

“… Science Without Humanity…” is 1 of the 7 deadly sins of Mahatma Gandhi

“Most clinical research is not useful.” (John Ioannides, MD - https://www.youtube.com/watch?v=Uok-7NPFn4k)

“… it is essential that psychoanalysis be situated as an existing practice within the art of science… a controlled randomized comparison study has not been conducted…” (Dr. Aida Alayarian, J.A.S.P.E.R. International, 2018 Vol 2, Issue 1)

When in confusion about good and evil, it is often helpful to turn to Nazi atrocities for clarification. Although the Third Reich did not/has not cornered the market on “bad,” they were expert and like many clever evil doers they sucked in those with an insecure hold on their own morals. They did many heinous “experiments” but the most famous was the Dachau hypothermia experiments. Robert L. Berger, MD examined these experiments (see “Nazi Science – the Dachau Hypothermia Experiments, NEJM, 1990, Vol 322:1435-1440.) The experiments were directed by Sigmund Rascher, a deadbeat Nazi with no experience in scientific research who wanted to impress Himmler. The debate has been: given the unethical malice of the experiments – at least 80 of the 300 “volunteers” died – should the data be used anyway in the hope that they, the data, at least might contribute to scientific knowledge? Allegedly Dr. Rascher wanted to find the best way to re-warm soldiers and pilots who were subjected to cold water i.e. sinking ships, crashed airplanes. In sum (I’d rather not give details of the sickening experiments) Dr. Berger demonstrates the scientific uselessness of these experiments: “…critical shortcomings in scientific content and credibility… without an orderly experimental protocol… with inadequate methods and an erratic execution… riddled with inconsistencies… data falsification and… fabrication… [unsupportable] conclusions… a consistent pattern of dishonesty and deception… all the ingredients of a scientific fraud…”

But, there is a problem here for me. There is the implication that if Rascher had not been a medical nincompoop, had been a serious intellectual, had adhered to coherent scientific protocol, maybe then the data would pass muster, putting aside the obvious ethical lapses – clearly these were not “volunteers” fully informed about risk! My contention is that science without humanity is not only a “sin” but it is useless. As David Cohen and David Jacobs point out, Randomized Controlled Trials (RCT) of antidepressants are “clinically and scientifically irrelevant” (see Cohen & Jacobs (2010). Randomized Controlled Trials of Antidepressants: Clinically and Scientifically Irrelevant, The Institute of Mind and Behavior, Inc., 31:1,2, pp. 1-22; & Jacobs & Cohen (2010). The Make-Believe World of Antidepressant Randomized Controlled Trials — An Afterword to Cohen and Jacobs. The Institute of Mind and Behavior, Inc., 31:1,2, pp. 23-36).

I believe this goes for all RCTs.

-----------------------------------------------------

PLACEBO IS A BASTARDIZATION OF SELF HEALING

-----------------------------------------------------

Cohen and Jacob's critique, however, focuses on the design of the studies, the capriciousness of the medical diagnostic category model, and the toxicities of drugs. They also make clear that the RCT model tries to “stamp out high placebo rates rather than reveal their clinical implication.” (p 1) Let me say more about this because here is where my bias is most pronounced. The premise of the RCT method is if you completely fool/trick the subjects (e.g., in the antidepressant drug experiments), then the experiment is worthwhile, i.e., the subject does not know if they got the real drug or the sugar pill. Of course there is a relatively easy way to do that. Simply use an active placebo rather than sugar pill. Big Pharma will not do this because efficacy of the drug disappears when using an active placebo. Fooling and tricking the subjects, in my estimation, is not ethical, even if you tell the subjects in advance that they will not be told whether they are getting the real thing. There is some evidence, by the way, that placebos often work even when the subject is told that they are receiving a placebo (personal communication, Irving Kirsch, ISEPP Conference, Toronto, 2018). Evidently some people find the ritual of taking a pill beneficial.

So what exactly does a placebo activate? I would say self-healing or better yet, inter-self healing. My position then is that using placebo with its implication of trickery is unethical. Placebo is a bastardization, I believe, of the biological mystery of self-healing. I have often opined that my patients get better in the waiting room. The decision to take on their suffering in and of itself has healing power: the will to live, a hope that past traumas can be tamed, that honest dialogue with an expert all promote healing, self-acceptance and self-care, social integration, building self resiliency. I recently attended a Harvard course on Psychiatry and Neuroscience with more that a dozen psychiatrist and neurologists wedded to the medical model. It was not my cup of tea. They did not attempt to define either consciousness or will, for example, and repeatedly made associations of brain connection with behavior and mood. Cogently one presenter said, “In the brain everything is connected to everything,” indeed! But one truth that we all shared was that a principle “side effect” of antidepressants was “apathy.” So if you maintain an existential philosophy, as I do, this is the killing power of drug treatment. Without the will we don’t heal. The higher power is not the drug or the analyst or a god but rather the biological miracle of self-healing promoted by inter-self dialogue. Some call it psychoanalysis.

Al Galves, Ph.D.

What are the forces that have driven the dramatic increase in the use of psychotropic drugs by the American public?  The most common candidates are the drive of the pharmaceutical companies to make money and mainstream psychiatrists to finally become “real medical practitioners.”

This article suggests that there are larger historical and cultural forces that are behind this phenomenon, among them the following:

• The age of reason.
• The rise of scientism.
• The cult of professionalism.
• The industrial and technical revolutions.
• The myth of the heroic American.
• The myth of equal opportunity.
• The myth of progress.

The forces are briefly described and an argument made for addressing them.

The power and speed with which Americans have embraced psychotropic drugs as the response to troubling emotions and thoughts is dramatic and arguably without precedent.  The combined sales of antidepressant and antipsychotic drugs jumped from $500 million in 1986 to nearly $20 billion in 2004, a 40-fold increase.¹

The frequency of antipsychotic prescriptions for children increased from 8.6 per 1000 children in 1995-96 to 39.4 per 1000 children in 2001-2.²

The use of methylphenidate, a stimulant similar to cocaine, was more than 7 doses per 1000 persons in 2004.  This compares with less than 1 dose per 1000 persons in the United Kingdom, Germany and Australia.³

This fact is all the more amazing in view of the evidence that the drugs are very harmful to human beings, causing impairment of the ability to walk and control muscles, heart disease, diabetes, mania, psychotic symptoms, impaired immune function and early death⁴; and that they disable the fine-tuned emotional faculty that has been evolving over millions of years to enable humans to know what is important, what is threatening, what is precious and what needs to be protected.

What are the forces that have driven this phenomenon?  Can it be attributed wholly to the drive of pharmaceutical companies to make money and of mainstream psychiatrists to finally become “real medical practitioners?”   Or are there other forces at work here?   

This article is an attempt to name and describe some of the historical and cultural forces behind the zeal and credulousness with which consumers are using mind-altering drugs and which might explain how a newspaper editor would fashion the following headline for a story about a randomized, double-blind clinical trial which found a placebo to be more effective in treating depression than either Zoloft or St. John’s wort: “Antidepressant Outdoes St. John’s Wort in Treating Depression.”

First, there is the Age of Reason, which has been ascendant with minor eclipses for the past 800 years.  This movement that celebrates and honors the rational faculty has dishonored and discounted the emotional and intentional faculties that are just as crucial to healthy human functioning.  If you want proof of this, spend some time in a typical American public school.  You will find almost total focus on developing the rational faculty.  Some lip service is paid to emotional development but it consists mainly of browbeating children into believing that certain emotions – love, happiness and kindness – are good and should be favored and others – anger, jealousy and sadness – are bad and should be extinguished.   And you’ll find virtually no attention paid to the development of the intentional faculty, the wills of children.  In fact, you would think that human beings didn’t have wills, at least not ones worthy of attention or development.

I propose that this overvaluing of the rational faculty and discounting of the emotional and intentional faculties makes it easier for people to use drugs that impair their emotional processing.  Since they don’t value the intricate, fine-tuned emotional processing mechanism that has been evolving over millions of years, there is little resistance to disabling it with drugs.  One wonders if consumers would be as ready to take drugs which impaired their rational functioning.

Second, there is the Rise of Scientism.  “Scientism” is defined by Webster’s New Collegiate Dictionary as “an exaggerated trust in the efficacy of the methods of natural science to explain social or psychological phenomena, to solve pressing human problems, or to provide a comprehensive unified picture of the meaning of the cosmos.”  Scientism has convinced us to discount anything that can’t be quantified, measured, touched, seen or physically manipulated.  No wonder then that we put so much faith in a pill and are so skeptical of the value of learning to manage our emotions, integrate the parts of ourselves we don’t like, become more objective in our thinking, use the stress response to address things that are threatening us and develop our assertiveness skills.

Along with the Rise of Scientism has come the Cult of Professionalism, the idea that people with degrees and credentials are smarter and more effective than we are, that they have a mysterious hold on a fount of knowledge and skill to which we are not privy.  This has caused people to lose faith in their bodies and their minds.  It has taken away their sense of agency, of being able to figure things out for themselves.  It has caused them to become overly dependent on experts.

In his book The Coming of Post-Industrial Society, Daniel Bell predicted that the major conflict of the 21st century would be between professionals and non-professionals.⁵   That it appears there will be no such contest is testimony to the power of credentialism and the higher education industry and the inability of non-professionals to organize in any meaningful way.

And there’s the Industrial Revolution, which turned people from craftsmen who took responsibility for an entire piece of work from start to finish to assembly line workers who are small cogs in a big machine.  Again, a force that takes away the sense of agency and dependence on oneself.

And the Technological Revolution which reinforced the belief that the important things are the things outside of ourselves – machines and computers.

The combination of these forces has caused people to lose faith in their bodies and minds.  Since they can’t see their immune system and understand how it functions, they would rather depend on an antibiotic, which they can see and understand.  Instead of understanding that fever and vomiting and mucous build-up are evidence of healing mechanisms, they use substances to counteract them.  Instead of appreciating the value of shutting down for a while and using an internal focus to take a look at their lives, do a mid-course appraisal and, perhaps, adopt a creative change of course, they take an antidepressant.  Instead of trusting themselves and their organisms, they trust the expert.

Here is Theodore Roszak’s description of the forces at hand:

“The same revolutionary movement that made the universe safe for democracy made it no fit home for such archaic superstitions as “sanctity” of any kind, because sanctity is no empirical finding, no verifiable hypothesis.  Rather, it is an intuition of the sacramental.  We are dealing here in political mysteries that trace back to the charisma of kings, the taboo of tribal priests…. Whenever humanistic spirits rush forward to defend our personal dignity from invasion or insult, though they may not know it, they invoke an authority which we inherit from priest and prophet.  They are asserting the personality as a locus of magical powers.  But the idea has been cut off at its historical and psychological roots, because the severely logical eye, obedient to the best scientific standards, finds no place for magic in the universe; it simply cannot admit the legitimacy of sacramental experience…. In this, then, we find the darkest irony of the revolutionary tradition.  The justified anticlericalism of the Age of Reason has become a sweeping rejection of all sacramental experience.”⁶

One of the pieces of “magic” that is being ignored and discounted is the self-healing power of the human organism.

There are also some uniquely American forces at work.  One is the Myth of the Heroic American.  We have received a barrage of messages telling us that we are a favored people, the greatest country on earth, anointed by God as the only remaining superpower on the planet, the shining city on the hill.  This puts pressure on us – pressure to be successful, happy, rich and prosperous.  It’s really not OK to be sad, down, depressed, unhappy and upset.  What’s wrong with us?  We live in the greatest country on earth.  What more do we want?   So, if we’re not rich, exalted, famous or outstanding we attribute it to our shortcomings.  I guess I’m just not good enough.  I couldn’t make it. We get down on ourselves, become anxious and depressed and grab for the quickest and easiest remedy - psychotropic drugs.

There’s another force which reinforces that pressure: The Myth of Equal Opportunity.  We are constantly told that Americans are equal before the law, that, unlike other, more traditional societies, we all have an opportunity to be rich, famous, good-looking, happy and successful.  If we aren’t, it’s our own fault.  We just aren’t good enough.  There’s something wrong with us.  We’re deficient.  

In other societies, there are explanations which are less pejorative.  If I am not doing well in India, it is because of the caste I was born into.  If I am dissatisfied with my status in Great Britain, I can attribute it to the class, neighborhood, family into which I was born.  What do you expect from me?  I don’t even speak with the right accent.

This is the message of Michael Moore’s film Bowling for Columbine.  Moore asks why there is so much violence in the United States.  He dismisses the pat answer – more guns – by disclosing that there are more guns per capita in Canada and the murder rate in Canada is one-twentieth of the murder rate in the United States.  After considering other explanations, he comes down to the insight that this is not a very compassionate country.  And the compassion that is lacking is not so much for other people as it is for ourselves.  People who lack compassion for themselves are prone to violence.

Because of these two myths, Americans are allergic to “blaming” themselves for their “shortcomings.”  They are especially reluctant to take responsibility for whatever deficiencies or doubts they might have about themselves.  So if they are feeling sad, agitated, upset, angry, anxious, down, discouraged it’s much easier to blame it on chemical imbalances that result from genetic inheritance than it is to blame it on anything they have control over.  Instead of taking a good look at myself, doing some self-reflection and some repair work, I’ll just take this pill that will correct my chemical imbalance.

Finally, there is the Myth of Progress.  These psychotropic drugs fit nicely into that myth.  Isn’t scientific medicine wonderful?  Look, we cured malaria and polio.  We do heart transplants and artificial hips.  Now there are medicines that cure mental illnesses.  Amazing.  What will they come up with next?

This is my short list of historical and cultural forces:

• The Age of Reason
• The Scientific Revolution
• The Cult of Professionalism
• The Industrial and Technological Revolutions
• The Myth of the Heroic American
• The Myth of Equal Opportunity
• The Myth of Progress

There may be other, more important forces at work.  Something is going on that is bigger than the power of the pharmaceutical companies and mainstream psychiatry.  I encourage readers to wonder and search.

But suppose it is true that these forces are driving the movement to embrace psychotropic drugs as the answer to these painful states which, being devoid of clear physiological etiology, are called “mental illness.”  What can we do about the forces?  They are large and inchoate.  

How do we counter them?  I think we chip away at them little by little in the same way that dissidents chipped away at the former Soviet Union.  When the Soviet Union collapsed in 1989, it seemed to happen rapidly, almost overnight.  But the seeds of that demise were being planted and fertilized over the previous 60 years by ordinary Russians telling jokes about the system, talking to each other behind closed doors and, in some courageous cases, protesting in public.   I think that is how the biopsychiatric juggernaut will eventually be brought down – through a constant, even if often dim, shining of light on the harm done by psychotropic drugs and their lack of effectiveness and through the slow, steady development of more safe, humane and effective ways of helping people who want help in their effort to overcome suffering.

Morris Berman describes the characteristics of American culture that mark it as a culture in the process of dying, dying because we have lost track of what is important, we have allowed unconscionable inequalities to exist, we are squandering our resources on killing people, we are losing our common sense, our wisdom and our spiritual awareness.  And he asks: what recourse is available to those who see what is happening and who want to protect and nurture what is being lost?

His answer is that they should do what the monks did in their monasteries during the Dark Ages.  During that period between the Greek and Roman empires and the Renaissance, the monks scribed the works of the great Greek and Roman philosophers, clerics and scientists so they would be available to future generations.  Berman suggests that those who are aware of what is happening and who want to protect what is being lost do so by living their lives according to what they know to be true and by continuing to speak that truth in all the ways they can.⁷

Organizations like the International Society for Ethical Psychology and Psychiatry, the International Society for Psychological and Social Approaches to Psychosis, and MindFreedom International are important and valuable mediators and repositories of that truth.

The other thing people can do is reform our public schools so they become places in which young persons can learn to use their wills, emotions and critical faculties to make up their own minds, find their own answers and pursue their own truth free from the oppressive mantle of the educational establishment, an establishment which is the paradigmatic reflection of,  and a major propagator of the Age of Reason, the Rise of Scientism, and the Cult of Professionalism.

¹Whitaker, R. (2003). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Cambridge, MA: Perseus Publishing Group.

R. L. Cima, Ph.D.

- Hippocrates, On the Nature of Man, circa 5^th century BC

Part 1 - A Balancing Act

21^st Century schools of medicine teach their graduates human behavior – what I do in my own body in the next moment of my life – is understood by microscopically studying invented and invisible anatomical brain centers, each center equipped with miraculous behavioral functions.  Students of psychiatry are instructed that undesirable behavior (psychiatry’s “symptoms”) is caused by a chemical imbalance effecting the brain centers.  Treatment, then, is to prescribe laboratory chemicals to balance natural body chemicals that are, somehow, out of balance.  Worth noting, the Psychiatric Medical Model Theory (PMMT) offers no definition, or explanation, of “balance.”

Practitioners of the PMMT believe you and I are victims of our excessive or insufficient chemicals – usually serotonin or dopamine – as well as our faulty “connectors” that negatively impact the brain centers where all behavior is neatly stored. Thus, psychiatric patients learn undesirable and life altering behaviors are caused by a deficiency, or derangement, or disease, or disorder, or disability, or disturbance, or dysfunction (the 7 D’s of the PMMT).  Patients inadvertently suffer the consequences of these brain flaws. “It’s not you,” the doctor confidently instructs the patient, “it’s your disorder that’s causing you to experience the undesirable behavior.”  Hence the title:  The Zombie Theory.  

Humankind has witnessed miraculous progress in medical science during the past 100 years.  Thanks to new discoveries, medicines and procedures, we have benefitted greatly when it comes to our physical well-being.  Especially true in modern countries, we live longer, our quality of life is better, our physical maladies better treated.  Our flesh, blood and bones have never been in better hands.  However, when it comes to human conduct, medicine has failed miserably throughout human history, up to and including today, without exception.

Medicine as Art¹

Twenty-five hundred years ago, the Hippocratic School of Medicine began to understand medicine as an art form, and healers as practicing artists. Disease was no longer divine wrath, nor was healing a gift from God.  Over time, heavenly punishments and gifts were replaced with cause and effect, providing the underpinnings for the burgeoning artform to become a rational science in the physical world.  Along the way, medical ethics and standards of care were crafted, both keystones of the ancient Greeks that continue to guide modern day medicine.  Most important, three primary conditions were identified and interconnected:  the disease, the patient and the healer. 

Healers were trained in the Seven Natural Factors in this holistic system of medicine: The Four Elements, The Four Humors, The Four Temperaments, The Four Faculties,The Vital Principles, The Organs and Parts and The Forces.  The underlying theory was simple.  When there is balance and harmony within the Seven Natural Factors, there is health. When they are not in balance, there is dysfunction and disease.  When any one of the Seven Natural Factors ceases to function, there is death.  Balance then, as it is now, was the pursuit.

For the first time detailed experiments were conceived and conducted, data was collected, results were assessed and treatments were formalized.  Six healing pathways emerged, from mild to severely invasive.  The first treatment of choice?  Diet, considered the most gentle and safest path to restore balance.  Second in this formal progression of treatment paths focused on altering the patient’s lifestyle and hygiene habits that were causing the imbalance of body humors (fluids).  Only when the first two treatments were found to be ineffective did the healer select the third treatment path:  medicine.  Chemical concoctions with inherent healing powers were dispensed in the form of supplements, potions, tonics and herbs.  These first three paths were self-administered, under the guidance of a healer.  

Paths four, five and six were administered by the healer.  The first of these, physiotherapy, included heat treatments to induce sweating, massages with medicated oils, and a variety of muscle, bone and other body manipulations designed to release trapped toxins.  Physiotherapy was often a preparative stage for detoxification, the fifth path of treatment.  Common purification methods included emetics (to induce vomiting), enemas, diuretics and, frequently, bloodletting.  Only when the first five paths fail does the healer turn to surgery, the last treatment path.  Surgery was seen as the most invasive and, except for immediate trauma and other emergencies, the last resort for the trained healer.

Also historic, diseases were systematically classified according to similarities and differences as the disciplines of etiology and pathology began to emerge.  The goal was to ensure the healers diagnosis and choice of treatment was based on fact-based information.  As momentous, individualized treatment was a core value.  “It's more important,” professed Hippocrates in one of his famous aphorisms,“to know what kind of person has a disease than what kind of disease a person has.”  Healers were trained to understand individual patients as living in a dynamic relationship with their environment.  This new art form treated the patient, not just the disease.

What About Madness?

For epochs before this new medicine ancient civilizations viewed madness as punishment from an angry God for divine trespasses.  The healers of 10,000 years ago treated their patients with music, prayer, charms, spells and other incantations.  This new school of medicine professed madness to be the result of natural occurrences in the brain, centered around the four essential humors.  To treat madness, patients would routinely be bled from the forehead, or from a large vein in the arm or leg or rectum to draw corrupted humors away from the brain in order to bring the body back to balance. 

Thus, Greek medicine began with two interrelated principles.  The first is to provide the body its natural beneficial cravings:  a wholesome diet, healthy habits, adequate exercise, and sufficient rest and sleep.  The second is to cleanse the body of wastes and pathogenic matter inside and out, creating a healthy body balance.  Though form and fashion may be different, modern medicine embraces these same principles. Unfortunately, as you will see, so does modern psychiatry.

Primum Non Nocere – “First, do no harm"²

The Hippocratic Oath is the first expression of medical ethics in human history and it remains a rite of passage for medical graduates around the globe.  This oath reminds the healer to be aware of the possible harm that can occur from any kind of intervention.  “Practice two things in your dealings with disease,” reiterated Thomas Inman, a 19^thcentury Liverpool surgeon, “either help or do not harm the patient.”  Nonetheless, history has many examples of this oath being violated, and much harm done. 

Here’s the longest lasting. 

Bloodletting

For more than two millennia the treatment of choice for healers around the world was bloodletting, mainly because of its versatility.  In addition to madness, this medical technique was prescribed for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis and a hundred more – including heartsickness, and heartbreak.   

The Talmud was cited by healers to proclaim the most beneficial days and times of the month to use this procedure.  Christian healers gave guidance to their followers by declaring the specific Saints' Days favorable for this medical technique.  Islamic healers too heralded bloodletting, particularly for fevers.  During medieval times bleeding charts were common, designating specific bleeding sites on the body.  The vein in the right hand, for example, was bled for liver problems, the vein in the left hand for spleen problems.  “Do-it-yourself" instructions were created and distributed worldwide. 

Bloodletting was in its heyday during the Middle Ages, prescribed by healers as both a curative and preventative medical procedure.  The actual procedure was often done by a trained barber-surgeon, the red and white barber pole symbols of blood and bandages.  There were a variety of techniques too.  A phlebotomy occurred when blood was drawn from the larger external veins, an arteriotomy from arteries usually from the temple.  Some healers used a scarificator, a specially crafted tool cast in a brass case that enclosed a spring-loaded mechanism with blades of steel.  Leeches were commonly used too.

Bloodletting theory – the science of how it “works” – was based on two ideas; (1) blood did not circulate and would "stagnate" in the extremities; (2) removal was done to attain humoral balance to fight off illness and to restore health.  The more severe the disease, the more blood that needed to be drained, fevers requiring the largest amount of drainage.  Importantly, six hundred years later Galen, a philosopher-physician from the Roman Empire, revitalized, reinvented and “rebooted” Hippocratic humoralism as a meticulously detailed, rational, technique-focused medical theory that retained its popularity in cultures around the world for another seventeen centuries.

The End of Bloodletting    

The 19^thcentury was revolutionary for medical science.  During the first half a British chemist discovered the anesthetic properties of nitrous oxide, a French doctor invented the stethoscope, and a British obstetrician performed the first successful blood transfusion.  In the fourth decade an American surgeon used ether for the first time, and a Hungarian doctor discovered disinfecting the hands of medics, midwives and nurses drastically reduced the incidence of death from childbed fever that was killing nearly a third of infected mothers.

The second half of the century was equally impressive.  A British surgeon introduced phenol to clean wounds and to sterilize surgical instruments.  Louis Pasteur published the Germ Theory of Disease in 1970 and within 12 years his labs produced vaccines for chicken cholera, anthrax and rabies.  The first Nobel Prize in Medicine was awarded to Emil von Behring, a German physiologist, for creating vaccines for diphtheria and tetanus.  X-rays were discovered by German physicist Wilhelm Conrad earning him the Nobel Prize in Physics.  Finally, in 1897, a German pharmaceutical company, Bayer AG, created a new wonder-drug:  aspirin.  Within two years aspirin was a global phenomenon.

The successes of this maturing art of medicine spelled the end to the ancient and barbarous practice of bloodletting.  Centuries old theories as well as healer and patient testimonials could not stand up to the new and emerging regimen found in science.  By the end of the 19^thcentury Bloodletting was nearly extinguished worldwide (though not completely!). 

In its place a new awakening was unfolding:  modern medical science. 

NEXT TIME:  Part 2:  The Era of Medical “Experimentalism”

~~~~~~~~~~~~~~~~~~~

Life is short; and the art long.

 - Hippocrates

David Katz, the Jacksonville shooter, is the latest in a long line of scapegoats for an apparent epidemic of violence. Just this past Sunday he opened fire at a e-sports tournament, wounding 10 and killing three, including himself. Katz' motives are still under investigation, but people are already implicating the bogeyman of mental illness. See CNN's reporting today - Jacksonville shooter had a history of mental illness and police visits to family home.

According to the report, Katz was prescribed "a number of psychiatric medications," including antidepressants and antipsychotics. He also was said to have seen "a succession of psychiatrists." These statements imply that Katz' a mysterious alien entity residing with him, called "mental illness," was the culprit. There is even current quibbling over what the "correct" diagnosis was.

A more reasonable explanation would be that Katz had been struggling with several real personal dilemmas, he wasn't infected with a nonsensical illness of the mind. Just one example is that he had to witness his parents' vicious divorce and custody battle over him. Instead of following the suggestion of his father for peer-based support group assistance during middle school, there was the default turn toward psychiatric treatment, as if there was something in him to truly treat via medical means.

If the treatment went as it typically does, this would have meant increasing focus on him as the problem, rather than his circumstances. Being subjected to a "succession of psychiatrists" means that one superficial attempt after another didn't work, so he was shuffled to the next psychiatrist in line. He likely felt the increasing sense of being misunderstood and persecute by those medical attempts to sedate him.

This is just the last in a long and continuing line of horrific episodes. It will continue. It will continue because the authorities are not looking at the causes of these events. They are trying to find a scapegoat. Three hundred years ago that scapegoat would have been witchcraft or demons. Now, it is the internal infection of "mental illness."

To make matters worse, the alleged treatment for that infection is typically to coerce the person into compliance. In other words, it is to get them to stop complaining about the problems (euphemistically called "symptoms reduction"). And the icing on the cake is that psychiatric drugging into a state of agitation clearly increases the chances of impulsive outbursts of violence. See ISEPP's White Paper on the link between psychiatric drugs and violence.

Chuck Ruby, Ph.D.

"I Want To Die” - Take 2

In my previous commentary concerning suicide (see July 21, 2017) I made the point that even though suicidal thinking is quite common, actual suicidal death is not; it’s only 1.5% of all deaths in the U.S. (2015 statistics). One “expert” (I’ve forgotten who it was) claimed it was 250 thinkers of suicide to 1 doer. It’s even greater than that when one realizes that suicidal thoughts are often camouflaged. “I’m sick and tired…,” “I hate my life,” “Life sucks!” But WOW does suicide make headlines, particularly when the rich and famous do it: of late, Anthony Bourdain, the world-traveling chef/social commentator, and Kate Spade, the billionaire handbag entrepreneur. Both hung themselves. Why so much interest? Well, perhaps it’s as in the old Broadway song from Camelot “What do the simple folk do?” Well, “They sit around and wonder what Royal folk would do!”

No, there is more to it.

We are shocked, I think, because: (1) we project on those who seem to have everything (fame, fortune, beauty, brilliance) great happiness, and (2) we (the public) tend to see suicide as a consequence of mental illness. Thus, “We didn’t know that _____ was mentally ill!” There is a dearth of existential thinking in our culture. Our fascination with suicide has really more to do, I think, with our perplexity about life. WHO AM I? WHAT AM I DOING HERE? Facing meaninglessness and/or chronic pain is or can be tortuous.

99.9% of the time suicide is a very private affair. The suicide takes place alone in a hotel room, behind the shed, the privacy of one’s own room, or home when everyone has gone out. The other 0.1% is a grand performance usually to make some profound statement. I recall with horror watching on TV the Buddhist monks in Vietnam self-immolate to protest the goddamned WAR! More recently, a gentle person, environmentalist, David Buckel, on April 14, 2017, imitated the Buddhist monks this time in Prospect Park Brooklyn: “My early death by fossil fuel reflects what we are doing to ourselves,” he wrote in his final email. Perhaps as therapists we must always be looking for the underlying message, whether it be a socially redeeming commentary or a “Fuck YOU to all who hurt me!!”

Steve Pinker in his new book Enlightenment Now: The Case for Reason, Science, Humanism and Progress ( 2018, Viking Press) takes on the issue of happiness (see chapter 18) and examines the suicide rates of three countries for which there is the best historical data (US, Switzerland, England). There are various peaks and troughs these last 150 years with all three countries showing the highest rates during the Great Depression (Switzerland ~25.6/100,000; US ~17/100,000; England ~20/100,000). He has no explanation for the current bump in the US suicide rate from about 10 in 1960 to about 11 in 2000 to about 13 currently. Nor does he find evidence of an increase in depression. We really can’t use the disability numbers because there are economic incentives to declare oneself depressed. The current psychiatric profession helps this along by being quick to diagnose this “brain disease.” Nor is there evidence of any increase in serious mental illness or for that matter of loneliness. And although he feels Americans“should” (page 284) be happier given how “amazing our world has become” he also acknowledges that the increase in anxiety is not pathological. In fact, “anxiety has always been a perquisite of adulthood.”

So, my worried friends, family, colleagues: welcome to maturity.

My Country 'Tis of Hate

Coincidence. I read with horror the NY Times exposé by Ron Nixon and Michael D. Shear, “Over 700 Children Taken from Parents at Border” (April 20, 2018) within a few hours of starting to read D. H. Dilbeck ‘s biography “Frederick Douglas, America’s Prophet” (2018 Chapel Hill Press). “The mere whim of a master could separate forever a child from his family,” (p. 13) Douglas is quoted from his autobiography “My Bondage My Freedom.” Six-year-old Frederick was the beloved of his grandmother guardian, also a slave. She was ordered by her master, however, to give him up, and simply disappear from his life. "…granmammy gone! granmammy gone!" “Frederick franticly searched the kitchen. When he realized his grandmother had left, he collapsed in a fit of inconsolable tears. He sobbed himself to sleep that night.” This was the first of many “traumatic terror(s)” inflicted by slavery on Frederick.

We ISEPP members call ourselves a society concerned about “ethical practices” in the mental health field. We are expert in our understanding of the vicissitudes of Attachment and Separation. So, as experts, even putting aside moral and ethical principles, we understand the damage that America’s terrible immigration policies can inflict.

ISEPP members, should we not speak out?

It seems the administration fears that some immigrants commit fraud by using minors, not their own, to bolster their case for admission when seeking asylum from political violence. Alright. I understand desperate people will lie to survive. But our system of justice is based on due process, and as Ben Franklin once said, ”Better that a hundred guilty Persons should escape than one innocent Person should suffer.” This issue, I think, is related to those who criticize psychiatry’s power to commit a person deemed dangerous even if he has committed no crime. I am making a connection here. I am positing that what many members of ISEPP hate about psychiatry is not a psychiatry problem but rather an insidious social/cultural stain directly in contradiction of our avowed ideal that “all men are created equal.” The Eugenics movement of the late 19th century was essentially a continuation of a slave economy justified by the notion that Africans are inferior creatures. An illustration: In 1851 a physician, Samuel A. Cartwright of Louisiana in his book “Diseases and Peculiarities of the Negro Race,” proposed a disease entity, drapetomania, a running away mania, a particular disease entity of Negroes who ran away from their servitude.” The cure was “whipping the devil out of them.” (see Wikipedia, Drapetomania) Of course God is the source, according to Cartwright, of the righteousness of slavery, the white race domination of the black. Please note when our President demeans migrants fleeing for their lives, referring to them as murderers and rapists, he puts us all back into the scientism of the mid-19th century thus justifying their mistreatment.

ISEPP members. Should we not speak out against this madness?