by Chuck Ruby, Ph.D.

An interesting exchange has taken place between psychiatrist and Psychiatric Times author Awais Aftab, M.D. and journalist Robert Whitaker of Mad in America (MIA). The initial trigger was MIA’s March 27th review of a JAMA Psychiatry article that reported how psychiatry has failed to publicize data about treatment success rates over time.

A day after MIA's review, Aftab responded on his "Psychiatry at the Margins" blog, claiming that the MIA review was worded in a way that misrepresented the JAMA Psychiatry article. The title, and essence, of MIA's review was that psychiatry had "no evidence that psychiatric treatments produce 'successful outcomes,'" when the JAMA Psychiatry article actually said:

...success rate trends are rarely reported in psychiatric journals or in other mental health or behavioral medicine journals. This makes it difficult to determine whether psychiatric treatment outcomes are improving over time, stagnating, or perhaps even regressing.

The MIA review language, whether intended or not, does seem to imply that a lack of psychiatric treatment success rates over time is the same as there being no evidence of treatment success. This is contrary to the "absence of evidence is not evidence of absence" idea.

However, absence of evidence regarding this matter is astounding. In science, those who make a claim (such as the often-advertised assertion that psychiatric treatment is increasingly effective and safe over time) are obligated to provide the evidence to support that claim. As the JAMA Psychiatry article confirms, psychiatry has failed to do so. This doesn't mean the evidence isn't "out there" somewhere. But it is a flaw of reasoning, and a threat to consumers' rights and safety, to assume it is.

MIA was on spot in challenging why psychiatry hasn't established these success rates like other medical specialties have. Psychiatry is not exactly a new specialty, having existed for over two centuries, and since its foundation, it has steadily increased its impact and control over millions of lives with chemical, electrical, and surgical treatments for illnesses that it has a very hard time defining or even finding. 

In response to Aftab, Whitaker replied on April 6th, clarifying MIA’s original purpose and mission and further detailing the reasoning used in the MIA review and how important it was to address the problem that psychiatry has not provided trend data about treatment success. As part of his reply, Whitaker cited a litany of psychiatric research to date as a backdrop, which at the least, makes one seriously question the effectiveness and safety of psychiatric treatments, and why trend data is missing.

Aftab again replied to Whitaker on April 9th. But this time, his comments redirected away from the issue of psychiatry's lack of success rate trend data and, instead, he unfortunately seemed to go to lengths to belittle Whitaker and MIA.

He first described Whitaker's thoughtful and comprehensive reply of April 6th as “long-winded” and a “double down in the defense of” the original MIA review. He further suggested it would have been better if, instead of replying to Aftab’s March 28th blog, Whitaker just remained quiet, distanced MIA from the review, or reacted with contrition. This is a familiar reaction by mainstream psychiatry; they seem to only respect criticism that doesn’t seriously attack its foundations.

After this initial disparaging salvo, Aftab then launched into a false equivalency, claiming that both the institution of psychiatry and MIA are guilty of the sin of misleading the public. He pushed even further and resorted to the political red herring ploy of attacking the accuser, saying whatever the institution of psychiatry is guilty of, it doesn’t “absolve MIA of its sins and shortcomings.” This turning of the tables and pointing the finger back at Whitaker and MIA avoids the challenge of the March 27th review, which was about psychiatry’s empirical shortcomings of its widely claimed treatment successes over time. Challenge sidestepped.

Aftab further tries to marginalize Whitaker, condescendingly declaring that he “held some rather naïve ideas about psychiatry in the 1990s through no fault of his own.” Aftab is making the incredulous claim that Whitaker, an award-winning investigative journalist and part of a Pulitzer Prize finalist team, who has covered medicine and science for over 30 years, just doesn’t understand the complexities of psychiatric research. This is another ploy by mainstream psychiatry - when serious criticism comes, just discount it as naïveté. Aftab tops it all off by casting Whitaker and MIA aside with the charge of having “anti-epistemology” blinders.

Aftab spends considerable time (“long-winded”?) exploring questionable charges that Whitaker’s and MIA’s work (and presumably everyone else that challenges psychiatry’s orthodox standing) is contaminated with “trapped priors,” ideas of “progress narratives,” “epistemic echo chambers,” “intentionally selective” research coverage, and “ideological conflicts of interest.” It is ironic that these are the very things that have corrupted institutional psychiatry. Eventually, Aftab punctuates his mocking of Whitaker and MIA by insinuating they are conspiracy theorists.

Institutional psychiatry at its essence, not just its research and practice, is fundamentally flawed. It makes the assumption that emotional distress, suffering, difficult behaviors, and unusual thoughts are its proper target. Given that over 200 years of efforts have produced no evidence that these problems are the result of brain/body pathology that can be medically assessed and treated, it is not surprising that psychiatry cannot present medical success rate trend data. 

In quoting a previous blog of mine:

...research that conforms to proper design, methodology, and analysis to tease out confounding variables of effect and increase confidence in the results, has shown that traditional psychiatric treatment is either ineffective, only marginally effective, only temporarily effective, is "treatment that works," or is "efficacious in reducing symptoms." The latter two outcomes are examples of the ubiquitous medicalese commonly used by the mainstream to portray psychiatry's work as medical science. But in the case of prescribed drugs and ECT, the medicalese merely describes the psychoactive effects of chemicals and electricity and how they can act as tranquilizing (or energizing) agents, pushing someone to the point of not being as troubled by real life problems and, thus, not complaining about those problems, giving the false impression of some type of resolution.

Furthermore, those “successes” are presented in isolation, without the context of the longer term harm brought on by repeated treatment of that sort, just like what happens with long term illicit and recreational drug use. A quick snort of cocaine can rejuvenate an exhausted soul, a stiff drink can settle one's angst after a grueling week, and LSD can open up new possibilities. But daily lines of cocaine, stiff drinks, and acid trips can ruin lives, while they do little to address the important human challenges that we all face.

In order to correct this flaw, one of two things must happen. On one hand, psychiatry can abandon the role of the moral arbiter that anoints certain behaviors and experiences as abnormal, sick, inappropriate, but still medical matters, along with attempts to “treat” these transgressions. It can then stick with problems that are due to bodily pathology.

On the other hand, psychiatry can openly announce that it wants to be that moral arbiter, expanding medicine’s role to the extent that the Church did centuries ago in applying a religious model to human suffering. Until psychiatry makes this choice, it will continue to dance the psychiatry two-step, switching from one foot to the other, as it tries to obscure its failures that result from this fundamental flaw, yet continuing to claim professional standing without the evidence.

Again, to quote my previous blog entry, psychiatry is:

…a presumed medical specialty that has no reputable theory about the alleged internal dysfunction that causes mental illness, that has no biomarkers with which to diagnose those illnesses, that has no treatments that correct deficiencies of bodily systems responsible for those illnesses, yet that has a long history of coercing people to act, think, and feel in accordance with an ill-defined and ever-changing set of moral standards.

Chuck Ruby, Ph.D., is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.

Our ISEPP colleague Bruce Levine, Ph.D., gives an interview on the Corbett Report podcast, Finding Mental Health. It summarizes Bruce's ideas in his book A Profession Without Reason in particular, and in general his ideas about how psychiatry and the medicalization of human life has been a failure. At around the 29:10 time mark, he mentions ISEPP as one of the many organizations dedicated to exposing this failure. Keep up the great work Bruce!

by Chuck Ruby, Ph.D.

Ronald Pies, M.D., who is notorious for claiming more than a decade ago that psychiatry’s long-peddled chemical imbalance theory was "never a theory seriously propounded by well-informed psychiatrists," recently introduced his new book, Psychiatry at the Crossroads: Can Psychiatry Find the Path to a Truly Humanistic Science? He explains the main themes of the book in a March 25, 2023 guest post on Awais Aftab’s "Psychiatry at the Margins" substack.

Dr. Pies' longing for a humanistic psychiatry is laudable. However, the devil is in the details, as his notions about psychiatry at a very fundamental level ironically preclude the possibility that it actually becomes a humane science. Instead, when the rubber meets the road, his longing is for a psychiatry that broadens and solidifies its control over people's lives.

The primary problem with his ideas (presumably also contained in the book) is that he says "disease" should be defined as any form of human suffering. This is an even more expansive strategy than others who at least attempt to differentiate between illness (as any form of suffering) and disease (as dysfunction in the body).

I think in order to ensure a humane system of care, though, the definitions of illness and disease must be limited to dysfunctions or defects of bodily processes. Including "suffering" as disease expands the medical professions' reach to an absurd level where there are no limits to the medicalization of life, and where personal values, preferences, and meaning-making become the targets of medical treatment. In essence, he wants psychiatry to subject individual and personalized experiences to medical intervention.

Still, Dr. Pies assumes that any human suffering is psychiatric disease or illness and the legitimate target of medical forms of assessment and care. He says psychiatry‘s goal is the “relief of suffering and incapacity” of thought, behavior, and feelings (for now, let’s set aside the questionable notion of thought, behaviors, or emotions being literally incapacitating as is the case with blindness and paralysis). But if this has been psychiatry's goal, the profession certainly has done a poor job, owing primarily to their idea that the suffering is due to some phantom dysfunction in the individual to be corrected (perhaps the chemical imbalance that was never seriously propounded?).

If history is an accurate portrayal, I think we can say with near certainty that this has not actually been psychiatry‘s goal. Instead, its goal has been to control those who are deemed unusual, inconvenient, and bothersome, not necessarily to relieve their suffering, but to relieve the profession's and the public's suffering of witnessing their existence.

Moreover, in reviewing Dr. Pies’ comments, we find that he only respects criticisms of psychiatry that attempt to "remedy its shortcomings without disparaging its successes." But what exactly does this mean for a presumed medical specialty that has no reputable theory about the alleged internal dysfunction that causes mental illness, that has no biomarkers with which to diagnose those illnesses, that has no treatments that correct deficiencies of bodily systems responsible for those illnesses, yet that has a long history of coercing people to act, think, and feel in accordance with an ill-defined and ever-changing set of moral standards?

The term “shortcomings” doesn’t come close to describing these failures and the only way to remedy them is to abandon the medical model of human distress, as it is why psychiatry has failed over the years. Instead, Dr. Pies wants to broaden the medical model and, in what appears to be an attempt to protect the profession from real and substantial criticism, he only respects psychiatry's critics if they overlook these most serious challenges to the profession's foundational assumptions. Anyone not in compliance with this is often caste aside with the simple-minded and marginalizing charge of being a member of “antipsychiatry.”

Regarding psychiatry’s successes, where are they? Many have claimed the proof rests in professionals' and patients' anecdotal stories of lives being saved by prescribed drugs and ECT. I'm sure there are some people who have undergone such treatment and genuinely believe it was life-saving. However, research that conforms to proper design, methodology, and analysis to tease out confounding variables of effect and increase confidence in the results, has shown that traditional psychiatric treatment is either ineffective, only marginally effective, only temporarily effective, is "treatment that works," or is "efficacious in reducing symptoms." The latter two outcomes are examples of the ubiquitous medicalese commonly used by the mainstream to portray psychiatry's work as medical science. But in the case of prescribed drugs and ECT, the medicalese merely describes the psychoactive effects of chemicals and electricity and how they can act as tranquilizing (or energizing) agents, pushing someone to the point of not being as troubled by real life problems and, thus, not complaining about those problems, giving the false impression of some type of resolution.

Furthermore, those “successes” are presented in isolation, without the context of the longer term harm brought on by repeated treatment of that sort, just like what happens with long term illicit and recreational drug use. A quick snort of cocaine can rejuvenate an exhausted soul, a stiff drink can settle one's angst after a grueling week, and LSD can open up new possibilities. But daily lines of cocaine, stiff drinks, and acid trips can ruin lives, while they do little to address the important human challenges that we all face.

Nevertheless, Dr. Pies justifies psychiatric treatment by saying it is “at least as effective as treatments in general medicine.” This is nothing to write home about, as it reveals problems with the drug industry in general and their shenanigans in presenting their cures as a panacea. This is especially problematic if we keep in mind that psychiatric treatment does not target specific dysfunctions in the individual’s chemical/mechanical make up. Remember, he suggests that disease be defined as suffering. Therefore, by definition, treatment of the disease of suffering can only be on the surface and palliative; there's nothing below the surface to correct.

Dr. Pies repeats an exhortation we've heard many times before. He suggests that psychiatry take the road of "holistic and comprehensive care" that is guided by the biopsychosocial model. That model has been historically ignored by psychiatry, and translated into a bio-bio-bio model. The token nature of that model makes sense if one considers that psychiatry has always viewed the psychological and social factors in a person's life as secondary to the biological factors. This is reflected in the DSM definition of mental disorder as a “dysfunction in the individual,” as well as how psychiatry has always considered the psychologically and socially oriented non-medical mental health professionals of psychology, social work, and counseling as second class. Why hasn’t the bio part in the biopsychosocial model ever been second or third in line? Can you imagine the implications of the social-psycho-bio model and psychiatry's resistance to adopting it?

Mainstream psychiatry is not at a crossroads, it is at a dead end, as long as it follows the same rules of the road that it has been using for over two centuries - constantly searching for but never finding an internal dysfunction, yet assuming one exists, and ignoring the fact that so-called mental disorder is really about moral proscriptions and prescriptions.

Still, I do think psychiatry can have a role and can be redeemed if it stays within the boundaries of medical science, using that science to identify physiological dysfunctions that have emotional, behavioral, and cognitive symptoms, handing off the treatment to those real medical specialties that target those physiological dysfunctions. Psychiatrists can also have an important role in the short term and limited use of chemicals in acute situations and in helping people wean off of prescribed psychiatric drug cocktails.

Once psychiatrists leave medical science and enter into the arena of “talk therapy,” they are no longer medical specialists, but hopefully they become compassionate assistants for people struggling with life, ever respecting the other’s worldview, instead of paternalistically cajoling people into the "proper" ways of being. But I'm not holding my breath.

Dr. Pies concludes his comments in the substack by suggesting the grandiose idea that the medical specialty of psychiatry could have a role in addressing the “breakdown of civility“ in the world as well as the serious problem of gun violence and “the spiritual needs of our patients.” But he simultaneously fears the risk that “psychiatry will overreach [I agree] and imagine that a mere medical specialty has the means to reform and repair our terribly troubled world.”

But this is what happens when you define your medical target of treatment as all of human suffering.

Chuck Ruby, Ph.D., is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.

by Randy Cima, Ph.D.

The Beginning

My first contact with the psychiatric profession was in 1974. Armed with a new bachelor’s degree in Sociology, I found work as a counselor at an 85-bed boy’s home in Corona, California.

I went back to college at 25 to get a bachelor’s degree so I could become a teacher and coach athletics. I was a good coach. I earned respect from the kids, I treated them with respect, I was in their face just like my best coaches were with me when I needed it, and I tried to help them improve their talents and skills. I liked coaching almost more than playing. Coaching was my style at the boy’s home too, and it was effective.

Dr. Duncan was our M.D. He was a wonderful man. He donated his time, services, and money to the care of these teenage boys. Dr. Duncan was not a psychiatrist. Though there were psychiatric medications available to adults at the time, they were not in common use for children. However, Dr. Duncan found some new psychiatric training available to MD’s regarding some miracle chemicals now available to help children. So, once he was trained, we began to give children chemicals.

Not all of them, mind you. It was the most difficult to manage kids who were given chemicals, the ones the adults complained about the most. The explanation used by the experts at the time was these particular children were hard to manage “because . . .,” and then these same experts would say something vague about brain chemicals and brain parts that didn’t make sense. That’s when this whole idea of magical chemicals began to get fuzzy for me.

How to Stimulate the Already-Too-Stimulated

“What is this Ritalin stuff?,” I asked Dr. Duncan. After all, I was giving these pills to kids, and I wanted to know what they were.

By the mid-seventies, Ritalin was the treatment of choice for hyperactivity, or what was then called hyperkinesis, or minimal brain dysfunction, or minimal brain damage. In the eighties, the term Attention Deficit/Hyperactivity Disorder (ADHD) was coined. In 1987, ADHD was voted-in as a disease in the newest version of the Diagnostic and Statistical Manual (DSMIII-R), psychiatry’s book of diseases.

As a direct care counselor, I used to keep the pill packets in my shirt pocket while managing my group of kids. I handed them out as prescribed, usually after dinner or before bed. The only thing noticeable was that the kids had a tough time going to sleep and were often groggy in the morning. That was explained to me as a “side effect.” I quickly came to hate the term. There was nothing “side” about it. These were full-blown effects.

“It’s a stimulant,” Dr. Duncan replied.

I thought his answer was odd. A few of the boys I was giving it to were arrested and placed on probation because they were using stimulants, usually Benzedrine (“bennies”).

“Why do we give it to kids already too stimulated?” I asked in turn.

This is where it begins to get tricky.

“We don’t know,” Dr. Duncan would say. “It’s what they call a ‘paradoxical effect.’”

This made me nervous. You see, I’m a bit of a skeptic. Skeptics make good scientists and terrible blind proponents. My ears perk up when I wait to hear someone answer a why question, about anything.

To begin with, I wanted to know who “we” and “they” were, and I wanted to know how “we” and “they” know what they say they know. Besides, saying something like “paradoxical effect” doesn’t explain anything. It’s just another way of saying “we” and “they” don’t have a clue.

“But that doesn’t make any sense,” I deplored of Dr. Duncan. “How can a stimulant calm a kid down?”

Seems like a reasonable question, doesn’t it? Why would medical doctors prescribe stimulants to help “perk up” people experiencing excessive daytime sleepiness, and also prescribe them to kids who need to “perk the hell down?” How does a chemical act as a stimulant for adults, and as a sedative for children? How does a chemical know how old someone is?

The reply to these questions, and many, many others? Well, it was the same from all medics and other experts I knew at the time, as I persistently and annoyingly continued to ask. At some point the conversation usually ended with, more or less:

“Shut up and give him the pills!”

I had a degree in sociology. So, I gave them the pills. But I didn’t shut up.

A Very Private Practice

One day a boy had to be taken to the psychiatrist. The doctor’s office called and said there was a last-minute cancellation, and my supervisor picked me to take him to the doctor’s office. I was a little apprehensive. I had pestered this doctor with my questions, apparently to the breaking point. I was nearly 30 by then, I had two daughters of my own, and I wanted clear answers. I don’t do well with platitudes. I guess it showed. At some point he decided he didn’t want to answer any more of my questions, especially when he found out I had a bachelor’s degree in sociology. So, this time I walked in with one of the boys and I quietly found a seat. The boy was soon escorted to a room in the back where he would wait to see the doctor.

It was late in the day and the office was empty. I took a seat just below and to the right of the sliding glass window where the receptionist was. I was extra quiet. After a few minutes, I was out of sight and, as I soon found out, out of mind.

About 10 minutes later, I heard the doctor approach the receptionist area. The receptionist, I would learn, also did the doctor’s billing. Her name was Evelyn. I remember her name because, unbeknownst to the doctor, this is what I heard him say to her, in no uncertain terms:

“Goddammit Evelyn, how many times do I have to tell you?! I don’t get paid for this diagnosis!!”

Hmmm. As I was to learn in the next few years, the love of money really is the root of all evil.

Jimmy

A few years later my wife and I were running an 8-bed facility for teenage boys. We were independent, live-in home parents. We were the child’s counselor, social worker, and therapist all in one. With one of our best friends at the time working on the weekends, the three of us were very successful. We had a work ethic, and the kids were busy around the house. We made sure they got a lot of recreation, we fed them well, we included their parents in the program from the beginning, and, for the first time at this facility, at the end of a year all eight were attending public school. One 12-year-old boy, Rodney, was playing little league, and another 16-year-old, Jimmy, was taking piano lessons. Jimmy was the reason I stopped medicating children.

Jimmy arrived drugged. He was the perfect medication icon. He had been in and out of a number of mental health facilities from the time he was eight, never completing a program and, according to his parents, had just gotten “worse and worse.” He was verbally aggressive, sometimes physically aggressive, but mostly he was defiant. Tell him to go left, and he went right. You get the picture.

One day, after three months at our home, during a common confrontation, I told him to do something or not do something, I don’t know which. It doesn’t make any difference. It’s what adults do with teenagers. He explained his non-compliance to me rather matter-of-factly:

“I can’t help it. I’m hyperactive.”

This bothered me. Though I’d heard it before, this time it was done with what I thought was way too much self-assurance on Jimmy’s part. I think he kind of smiled when he said it. I was caught in the same dilemma as everyone is who adheres to psychiatry’s indefensible and harmful disease model. If it’s really a disease and out of a person’s control, why does anyone expect them to control themselves when you ask them to?

In any event, I replied to his nearly proud declaration, just as matter-of-factly:

“Not anymore.”

With his parents’ blessings and encouragement, we stopped giving him his daily chemical. Over time, with trust, persistence, old-fashioned parenting, educated guidance, family support and Jimmy’s gutsy fight, he improved. So did his confidence. He was cured of a disease he never had in the first place. Despite the cautious and pessimistic handwringing by all the medics who had known him, he was relieved and so were his parents. Now, when he acted like a jerk, he was just a jerk. He wasn’t sick, nor was he “out of control.” He went home to his family nine months later.

I think it went to my head, just a little.

First Date: Meeting a Live Psychiatrist

About a year later, I received a call from the Department Director of the psychiatric hospital at UCLA Medical Center. Pretty big stuff. The doctor said he had a boy, Mark, who has been at UCLA for about four months. Since he heard we had an opening, he asked if I would be available to meet with them to see if Mark would be appropriate for our home. “Sure,” I said, “bring him out.”

Mark was 15 and overweight. He had gained 40 pounds while at UCLA. This was — and is — common in psychiatric settings. There were still some “psyche” hospitals for kids back in the ’70’s and early 80’s in California and I was familiar with several. They all looked the same. Locked doors everywhere, little if any outside recreation areas or equipment — nor the inclination to provide any. There were locked rooms where crafts and groups occurred, always populated by unhappy children and unhappy professionals, all those new medications leading the way. They weren’t treated as kids in these places. God help them, they were treated as medical patients with diseases. They still are.

Mark and his doctor showed up for an interview the next day. The doctor told us about Mark’s history again, and he let us know Mark was clinically depressed. Sounded serious. He told us about what his hospital did, he told us about the professionals there and the papers they’ve written and will write, and in general, overwhelmed us with credentials, experience, and vocabulary. He then told us this:

“Before I forget, Mark is taking 1500 milligrams of Lithium a day because of his depression. I’ll make sure you get his medication and a new prescription until you can get him to your psychiatrist.”

Do 1500 milligrams seem like a lot to you? It did to me. OK, maybe I wasn’t sure what a milligram was back then, however 1500 seemed like a big number. Also, from my point of view, given what I learned about Mark’s family history, it would have been strange had he not been depressed.

And what the hell is lithium?

Lithium is one of the fundamental elements from the Periodic Table. It’s number three, right after hydrogen and helium. In its pure form lithium is the least dense metal, and it’s widely distributed on earth. It’s light enough to float in water. It’s also flammable in certain conditions. Lithium and its compounds are used in heat-resistant glass and ceramics, and its alloys are used in aircraft and batteries. Psychiatric medicine found a use for lithium too, in the form of a salt. More of that at a different place and time. For now, let’s get back to the head psychiatrist from UCLA, Mark, and me.

After hearing his best medical advice, I said to the psychiatrist in a firm yet polite manner:

“We’re going to take him off this medication when he gets here.”

His response was equally polite, as though I hadn’t heard everything he said. So, he repeated himself, explaining again how serious Mark’s disease was, and that he had to be on this medication — probably for life — or there would be serious and dire consequences to his health and well-being. To this I said:

“We’re going to take him off this medication when he gets here.”

This time he was angry and accusatory. He made it clear he did not approve and that it was evident I didn’t understand. I fully expected him to get up, grab Mark, and leave, huffing and puffing his way out the door. He didn’t. He placed Mark with us instead.

So much for his conviction, I said to myself, this medical doctor who was the director of the psychiatric department at UCLA. He placed him with us because Mark was a management problem and he wanted to get him out of his hospital. If he was true to his science, he would have driven him back to Westwood, cursing me as he did. He either didn’t believe what he was saying, or it didn’t matter to him. Either way, we were glad to have Mark in our home.

We took him off his chemicals, with parents’ approval, a few days later. Within four months, he had taken off most of his weight and he fit in with the rest of the kids. There were, of course, the same problems along the way that we had with Jimmy. That’s the nature of the business. We eventually sent him back home to his family a year later.

For the next few years, I was promoted to ever increasing responsibilities. By then, I had little regard for the psychiatric profession and this practice. There were times when I would be training others, and I would steer the conversation to this subject, just so I could say:

“If we gave this many chemicals to animals, the ASPCA would be screaming.”

Chemicalizing children was a growing truth among professionals, and I was out of sync. Nonetheless, I thought the practice was despicable. Most important, I never saw any improvement, in any of the kids, at any time.

To me, this was, and still is, child abuse.

A Keirsey Moment

About this time, colleagues convinced me I should go back to school to get my master’s degree if I wanted to be taken seriously, so I did. By 1979, I started at Cal State University in Fullerton (CSUF). I was going to get my master’s degree in Counseling Psychology and, along with learning new skills, I hoped I was going get to the bottom of the medication thing.

I knew I was enrolling as a small fish from a small pond. It’s one thing to be a little cocky based on self-proclaimed successes. It’s quite another to go into a field where chemicals were being touted as the second coming. I didn’t think I’d fit in, and I knew I wouldn’t be able to keep my big mouth shut. I was a little trepidatious, but fearless.

My first class in my first semester was Counseling 735. It was also the last class for Dr. David Keirsey before he retired from a long career. He had already written Please Understand Me with Marilyn Bates. Since then, he had written several other books, including his seminal work, Please Understand Me II. If you want to understand human behavior, and yourself, read this book. Millions of others have, around the planet.

As the Department Head for the Counseling/Psychology Department at CSUF, Keirsey developed a unique program based on the practice of doing therapy rather than learning the various theories of therapy. He was also a walking bibliography when it came to the history and evolution of human psychology. That made it easy for me. Why go through all the pain of reading this stuff if he already had, I reasoned to myself. Better to see if he had anything worth saying.

Turns out he did. A number of things. A few that changed my entire view of psychology, including an orientation to holistic psychology I will reserve for another time. It was at one of his initial lectures my ear perked for the first time. There were only fifteen of us in the class, so it was comfortable.

He somehow got onto the subject of medicating children. Before academia, he had a career as a child psychologist, working with troubled and troublesome kids in schools and other settings. He had an opinion. He expressed it, and when someone pressed him as to what, exactly, did he mean, he turned, looked at his student, and declared:

“I said I think it (the practice of medicating children), should be criminalized.”

Did I just hear him right? Did he just say giving these chemicals to children should be against the law? Yes he did. I sat up in my chair. He didn’t sound at all like the doctor from UCLA. If I was hearing him right, he would have had him locked up. This was affirming. Though he was unknown to me, this was Dr. David Keirsey, Clinical Psychologist, and the head of the Counseling/Psychology Department at Cal State Fullerton.

But it wasn’t just that. I’m not so easily impressed by credentials or experience. Fools often have the right credentials and experiences. I had met a lot of them already. No, it was that there were voices out there in the professional world who had long ago came to the same conclusion as I. This was just the first time I heard it. This meant my views had professional merit.

By 1983, I was immersed in my Master’s program. I took work as admissions director and child-care trainer at a 120-bed agency in Southern California. I did many workshops about strategies and techniques in child management, and I always folded this subject in, indicating the practice was (1) unproven, (2) ineffective, (3) detrimental to children, and I would list the evidence for each. I was not persuasive, and I still had that damn degree in sociology.

It didn’t matter. No one was paying attention anyway. The chemical wave had started.

The APA

Around this time, I was sitting in a barbershop on a Saturday morning, waiting my turn. I was thumbing through a psychology magazine. I ran across an article written by someone from the American Psychiatric Association. The APA is a member-based lobby group for psychiatrists.

Back then psychiatrists were still doing therapy while their client was on a couch, staring at the ceiling, and disclosing his or her most private thoughts and feelings. Troubled adults went to their psychiatrist to talk about their troubles, and the relationship they had with their doctor was very important. These chemicals were intended to be an addendum to the real therapy that took place in a quiet office for an hour. After all, a psychiatrist is first an MD, and if there are chemicals available to ease physical discomforts and complaints, they could be used with certain clients so the therapy in the office could continue with better results.

However, the article’s author, also a psychiatrist, was concerned a growing number of his colleagues were relying way too much on these new chemicals. He warned too many psychiatrists were abandoning more traditional forms of therapy, succumbing to the appeal of prescribing chemicals to treat psychiatric disorders. In doing so, they were minimizing, and sometimes eliminating, traditional talk therapy sessions. As important, said the writer, the financial incentive was undeniable. Many psychiatrists were doubling their income, with much less work. The profession, the author feared, was turning away from psychology and towards medicine when it came to helping their clients with persistent life problems. The tone of the article was cautious and meant to discourage their members from getting too far from the couch.

Unfortunately, it didn’t take.

A Little While Later . . .

Now, quickly, roll the clock forward 15 years. By 1999, I was the Executive Director for a new wraparound program working with children still living at home with their families. We had a contract with a county Mental Health Department in Southern California. Though we were an independent, private, nonprofit agency, the contract required all agencies to defer all medical decisions to the county psychiatrist. The treatment plan for any adult or child in the mental health system in California is required to be reviewed and approved by a psychiatrist. Funding depends on it. No psychiatric overview, no funding.

I attended a weekly treatment meeting that included my staff, several other non-profit agencies and their staff, and the staff from the Mental Health Department (no clients). The psychiatrist sat at the head of the table while therapists from each program reviewed the progress for their most troublesome clients. Based on this information the psychiatrist would increase or decrease the amount of a current chemical, leave it the same, or change the chemical to something more effective.

One day, a therapist from another program was exasperated. Her client was not improving, and in fact was getting worse. With the best of intentions, and a little desperate, she was looking for support and assistance, so she asked the psychiatrist:

“Would you mind talking to my client yourself, just to see what you think?”

My ear perked, again, like it always does when something interests me. I wanted to hear his answer. I thought it put him on the spot and I didn’t mind him squirming a bit. Regrettably, once again in my career — you’d think I’d learn — I underestimated the implied supremacy that accompanies all psychiatrists, and their proponents. In an angry, frustrated, and accusatory tone, he replied to this young, uninformed therapist, and everyone else in the room to boot, slamming the palm of his hand on the table for emphasis as he did so (and beginning the short rant with the same expletive as the first psychiatrist!):

“Goddammit!! When is everyone going to finally understand?! Psychiatrists prescribe meds!! That’s it!!”

Game Over

And that was it.

He made it official. There was neither need nor inclination for anyone to pretend psychiatrists did anything else. In just 15 years from the time I read that cautious APA article, the author’s concern had been addressed and firmly answered in the profession. Nationwide, psychiatrists had hauled their couches to the curb, got a lifelong supply of prescription pads, and became engaged in their work by prescribing chemicals for every human shortcoming known, fully prepared for next year’s crop of new diseases — making a fortune while doing so.

Talk therapy was demoted to others without prescriptive powers. Without anyone’s notice, talking directly to the client for an hour about his or her problem was no longer necessary and, by some, frowned upon in the revised Scope of Practice of modern-day psychiatrists. The relationship between patient and psychiatrist was no longer relevant.

I knew by then there was a small but growing number of professionals who saw this for what it is: a vast marketplace worth a hundreds of billions of dollars a year worldwide, and a remarkable era on earth when well-meaning adults give harmful chemicals to children for diseases they don’t have, blessed by the vast majority of citizens in the United States. That means most of you.

I’m not a novice anymore. Along the way, I’ve learned all about Neverland, and the pseudoscience of psychiatry, and I know their results.

So will you.

The Ethics International Press Critical Psychiatry and Critical Psychology Series was created by creativity coach and lead editor Eric Maisel, Ph.D. He is assisted in this project by his co-editor, psychologist Chuck Ruby, Ph.D. The books in this series are for everyone who would like to understand what’s wrong with the current “mental disorder” system, especially how chemicals are employed to deal with life’s problems.

The first two volumes in the series,

Critiquing the Psychiatric Model and Humane Alternatives to the Psychiatric Model, have just come out in a lower-cost paperback (the hardback, for institutions, was pricey) and the publisher is offering an additional 20% off the paperback price. Just employ the code MORALS20 at checkout. These books will provide you with a picture—maybe even a life-changing picture—that you will not get in the mainstream media, which is dominated by the power of Big Pharma.

Come take a look. You will be very happy that you did!

We are saddened to hear about the death of a legend in the critical psychiatry and psychology fight. Fred Baughman, M.D., died last October, peacefully at his home in El Cajon, California. Fred was a giant in the field and accomplished an incredible amount in his profession and well as creating a wonderful family environment at home. One of his many accomplishments was the publication of his 2006 book, The ADHD Fraud: How Psychiatry Makes Patients Out of Normal Children. The world will not be the same without him.

You can read in detail about his life here.

By Todd DuBose, Ph.D.

I wish everyone a very happy Valentine’s Day, but the reality is that Valentine’s Day is usually mixed with a fluidity of conflicting emotions, memories and hopes. I know it is for me. That said, and felt, for better or for worse, the grip of medically-modeled ideology (e.g., existence is a physically deficient problem that needs to be corrected with medical intervention) has made its way even into romance and heartbreak.

Many people these days have heard of Takotsubo Syndrome, or “broken heart syndrome,” where acute stress from a loss can impact and stress the heart in such a way that looks physiologically like other cardiac illnesses and damage. I appreciate this kind of research and care as long as biology and meaning are in dialogue, not in a subjugated, causal relationship of the former causing the latter.

To this point, in a recent TED Talk, educator Shannon Odell, in a talk on “The Science of Falling in Love,” 
https://www.ted.com/talks/shannon_odell_the_science_of_falling_in_love/transcript?user_email_address=c224cc2cc4774297bf1d314d7bc0fd3f , echoes the central agenda of contemporary health care professions, as well as one of the current National Institute of Mental Health’s strategic goals of “defining the brain mechanisms underlying complex behavior,” https://www.nimh.nih.gov/about/strategic-planning-reports. Granted I am referencing just a TED talk, and I wish Shannon a very happy V-day as well, but our culture’s sharing of information in everyday discourse and encounters is by way of TED talks, TikTok, Twitter, and other kinds of sound bite existence. So, I wanted to respond.

Odell notes:

The VTA (Ventral Tegmental Area) is the reward-processing and motivation hub of the brain, firing when you do things like eat a sweet treat, quench your thirst….Activation releases the “feel good” neurotransmitter dopamine, teaching your brain to repeat behaviors in anticipation of receiving the same initial reward. This increased VTA activity is the reason love's not only euphoric, but also draws you towards your new partner…. No matter the reason a relationship ends, we can blame the pain that accompanies heartbreak on the brain. The distress of a breakup activates the insular cortex, a region that processes pain— both physical, like spraining your ankle, as well as social, like the feelings of rejection. As days pass, you may find yourself once again daydreaming about or craving contact with your lost partner. The drive to reach out may feel overwhelming, like an extreme hunger or thirst. When looking at photos of a former partner, heartbroken individuals again show increased activity in the VTA, the motivation and reward center that drove feelings of longing during the initial stages of the relationship. This emotional whirlwind also likely activates your body’s alarm system, the stress axis, leaving you feeling shaken and restless.

Who would ever know pining for a loved one could be worded in such sexy ways! I have boldened points for consideration in this transcript. This is a perfect example, if not sine qua non example, of tangible-izing the intangible, in this case, love. We just can’t seem to let go of control, concretes and needing life to run in engineered algorithms, which continue to miss the invisibility of love and its meaning—including the unacknowledged love of control, concretes, and engineered algorithms! 

Notice the sleight-of-hand throughout the opining, trading at will different categories and experiences as if interchangeable: heartbreak and rejection and sprained ankles, missing a lover and hunger/thirst, and so forth. Unwittingly, the inescapability and irreducibility of the intangibles shows up in the discourse anyway:  If the brain “causes” we can’t “teach it”; causation does not “draw us towards” and isn’t a process of “longing.”  What if one ends an abusive relationship? Celebration may very well replace longing.

The difference is not neurology but meaning.  What if feeling shaken and restless is due to existential fears of being alone, unloved, or unlovable? What if someone would rather die trying to love than satisfying pleasure centers? Sacrifice, rather than satiation? Yes, VTA lights up when we love and hurt, but the mattering of how and why it does is intangible in itself, and just as influential on neurology as we are told is the other way around.

One would think with plasticity studies over the past several decades now that we would be done with seeing the brain as the Unmoved Mover. The brain is malleable and in dialogue with us, not causing us, but the tenacity of the Unmoved Mover ideology runs deep. Folks like myself and others thinking like me, are seen as too superstitious to let go of intangible dreams, grow up, and accept the neuro/material reduction, while I, and others with me, challenge the arrogance and myopia of the reductionist’s fundamentalism regarding the singular definitions of evidence, empiricism, that is transfused with fears of unknowing, uncertainty, uncontrollability, and the intangibles.

This is where our dialogue stalls and signals how much work is still ahead of us in guarding the intangibles, particularly love. So, today I wish others a kiss (and more I hope) that is not just the pressing together of epiderma, and the gift of dopamine and oxytocin as consequential gifts rather than causes of this human, all too human guest at the door, love.

Todd DuBose, Ph.D., is an award winning Distinguished Full Professor at The Chicago School of Professional Psychology, as well as a licensed psychologist with over twenty years of teaching, supervising, and consulting experience, and over thirty years of clinical experience, including nine years as a former chaplain at the famed Bellevue Hospital in New York City. He holds degrees in contemporary continental and comparative philosophy of religion (B.A., Georgia State University; M.Div., Union Theological Seminary, NYC) and in human science clinical psychology (Ph.D., Duquesne University).  He integrates these traditions in an existential-hermeneutical-phenomenological way of caring for others, specializing in extreme, limit or boundary events and their accompanying crises of meaning (e.g., violence, loss, trauma, psychosis, nihilism).  He teaches regularly in international venues and has done so in twelve countries. His research and scholarship also focus on critiques of implicit biases in foundational ideologies of standardized practices of care, particularly the medical/disease model of engineering existence, that can intentionally or unwittingly harm others in the name of care.  He is committed to the engaged practitioner, public scholar practice of community engagement and advocacy.

by Barry Duncan, Psy.D.

Dr. Jacqueline A. Sparks, social justice advocate, critical thinker extraordinaire, beloved university professor, ISEPP journal Editor-in-Chief, gifted therapist, and my best friend, died November 3rd after a lengthy illness. The world is not quite as good without her. Behind her voluminous publications, impeccable scholarship, and amazing writing abilities, Dr. Sparks championed two ideals in her work throughout her career. First and foremost, she was driven to transform systems of care to privilege the service user, especially their goals for service and how those goals are approached—to include consumers in all decisions that affect their care. Deeply embedded in her unyielding drive for client privilege was a call for cultural responsiveness and the promotion of social justice. Jacqueline operationalized this ideal in the Partners for Change Outcome Management System or PCOMS, a method that levels the hierarchy in therapy and honors service user views of benefit and relationship. Ten randomized clinical trials and four editions of the PCOMS manual later, this ideal has become manifest. Dr. Sparks was not only a great thinker, she also got things done.

The second ideal was an unwavering commitment to challenge the status quo, to question presumed mental health authority and ask the hard questions. But this was not just rebellious talk to her, it emerged from a deep dive into research and exposing the science, or rather the science fiction masquerading as science, regarding psychiatric diagnoses and psychotropic medication. Our 2000 article in the Psychotherapy Networker, “The Myth of the Magic Pill,” called attention to the flawed science and the financial web of deceit of the pharmaceutical industry. This article was recognized by Project Censored as one of the “Top Ten Under-Reported Stories of 2000.” It also received the “The Networker 20thAnniversary All Time Top Ten Award” as one of the most influential features in magazine history. Since then, Dr. Sparks continued to question the “taken for granted,” exposing the bankrupt science and corruption that permeates psychiatric diagnosis and medication in multiple articles in top tier journals, uncovering the methodological tricks of drug company research and building the case for psychotherapy as a first line intervention for both every day and catastrophic problems that humans face. For this enormous body of work, Jacqueline received the Lifetime Achievement Award from the International Society of Ethical Psychology and Psychiatry.

Pictured below is Jackie smiling broadly holding the Psychotherapy Networker issue containing our award-winning article.

On a personal note, Jackie was also my closest friend, my ally through thick and thin. I counted on her keen analyses and insightful perceptions of any situation, personal or professional, and I knew I could always expect her unyielding support. Knowing this made me stronger and knowing her made me a better person.

Jackie was diagnosed last summer, and she courageously faced and endured everything that might prolong her life. Simultaneously she squeezed every ounce of enjoyment out of each day, playing her violin (she was a brilliant musician), decorating her new house, and traveling with her partner, Martin, and her sister and brother-in-law (Trish and John). Just a couple of weeks before she died, although not able to eat, she travelled to New York and profusely enjoyed a concert (Tedeschi Trucks Band) at the Beacon Theater and a Broadway musical (Six). She excitedly gave me a detailed description of the trip in our last conversation before she was hospitalized.

But treatment did not stop the aggressive spread of the cancer. Suddenly, months left became weeks left, and then days left—the end came unexpectedly rapidly. Our plan for her and Martin to escape the cold and stay with Barbara and I in January was not going to happen. With her death imminent, I flew to Rhode Island to give my last goodbye to my best friend. It was devastating, yet beautiful and inspirational. When Jackie awakened and saw me, she cried and we shared 25 years of love expressed in joyful tears. Unbelievably, in her weakened state, she asked the nurse to help sit her up, with her legs over the side of the bed so she could face me. Her body barely there and her voice but a whisper, we talked until she couldn’t anymore. We discussed our work, our history, our relationship—we laughed and cried, and said everything that needed to be said.

After an emotionally soothing dinner with her fantastic partner, Martin, also a lifelong social justice advocate, I laid awake that night in my hotel feeling the brunt of my grief. Because I couldn’t accept that I wouldn’t see her or talk to her again, I planned to stop at the hospital and see her one last time on the way to the airport. I summoned  a car on a familiar service and waited…and waited until I got the message that no cars were available. I had never experienced this before, but this was a small town, not like the cities I usually frequented. I was frantic. I called other local services but only got recordings. When I was about at my wits end, the front desk person, Stacy, said she would get back to me. I told her I would gladly pay $20 (the cost of the service) for the ride if anyone there could do it. The manager okayed it, and Lucas, a young man of no more than 19 took me to South County Hospital where my friend lay in a Hospice bed.  Lucas, who I noticed was not wearing trendy clothes or expensive sneakers or anything even remotely new, asked me about my friend and told me of his grandma’s battle with cancer. We enjoyed a quiet, empathic, and melancholic ride, our shared experience making an unspoken connection in minutes, if not seconds. There was a wonderful, comforting kindness to this young man that provided some solace to my grief. When we arrived after our brief trip, I pulled out my wallet to give him the twenty, and he told me he couldn’t accept any money from me. I asked if he was sure as it was clear he could use it, but he declined and wished me the best.

I was disappointed because Jackie did not regain consciousness for my final visit. In fact, she didn’t regain consciousness after I left her the night before. I felt fortunate and gratified that I had said everything I wanted to say the day before. But I still said everything I wanted to say, again. Jackie died later that day. But as I experienced my grief about the loss of this stunningly compassionate, brilliant human being, I realized that Lucas somehow personified Jackie’s kindness and integrity. In this world of vitriol and hatred, there are those who care about the plight of others, and act to ease their burden in small but meaningful ways. Thank you, Lucas, for showing the spirit of Jackie, and continuing my faith in the human species.

And thank you, Jackie, for being in my life, enriching me personally and professionally, and being the friend who everyone should be fortunate to have. I love you. I miss you—along with many others whose lives you touched.
 
 

ISEPP has chosen two of the most qualified people of the critical psychology and psychiatry movement to join the editorial staff of Ethical Human Psychology and Psychiatry: An International Journal of Critical Inquiry (EHPP).

EHPP's new Editor-in-Chief is Don Marks, Psy.D., Associate Professor and Director of Clinical Training at Kean University, NJ. He is a clinical health psychologist specializing in strategies for living with chronic pain and advanced illness. His work on psychological interventions for chronic pain has led to research regarding sport injury and athlete psychological well-being. He is also a marriage and family psychologist, working primarily with couples and families facing medical illness. Dr. Marks completed both the professional practicum and internship in mindfulness-based stress reduction (MBSR) at the Jefferson-Myrna Brind Center of Integrative Medicine of Thomas Jefferson University Hospitals. He completed his postdoctoral fellowship and served as a clinical instructor in psycho-oncology and palliative medicine at The Ohio State University Medical Center. He has been a member of the Association for Contextual Behavioral Science (ACBS) since 2005, and he has served as president of the organization's Greater New York chapter. Dr. Marks is the past Editor-in-Chief of the Journal of Clinical Sport Psychology.

We are also excited to announce that Niall (Jock) McLaren, MBBS, FRANZCP, was selected as an Associate Editor of EHPP. He joins our current Associate Editor, Jim Tucker, Ph.D., in assisting Dr. Marks in continuing to make EHPP an important voice in the critical psychology and critical psychiatry field. Dr. McLaren is an Australian psychiatrist who recently retired after 50 years of practice. He is an Honorary Research Fellow in the Department of Philosophy at University of Queensland. He has published a number of monographs on the application of the philosophy of science to mental disorder, most recently with a fierce critique of the so-called "bio-psycho-social" model, showing how it is without substance. He lives in the rural outskirts of Brisbane with his family and keeps busy growing trees.