Fact Checking Psychiatry

Psychiatry at a Crossroads?

Psychiatry at a Crossroads?

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.

A Novice in Neverland

A Novice in Neverland

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.


Randy Cima, Ph.D., is a psychologist by training. He was the Executive Director for several mental health agencies for children. He is avid opponent of psychotropic chemicals for children, and his efforts have successfully reduced and even eliminated chemicals in his work in helping them with a variety of problems. He also teaches, writes, and lectures on these matters.

A Valentine’s Day Reflection: The Heartbreak of Reductionism

A Valentine’s Day Reflection: The Heartbreak of Reductionism

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.

What’s an IQ – An Intelligence Question

What’s an IQ – An Intelligence Question

by Randy Cima, Ph.D.


IQ – Intelligence Quotient – is a problem in psychology. At best, IQ tests provide nothing more than the score you received on a test you took, on that day. At worst, IQ tests can be a humiliating, debilitating, and sometimes a lifelong imposed burden for some that negatively impacts employment, education and, most distressing, psychological assessments.

In general, just about everyone agrees with the following definition of intelligence, more or less, from Wikipedia (bold mine):

Intelligence has been defined in many ways: the capacity for abstraction, logic, understanding, self-awareness, learning, emotional knowledge, reasoning, planning, creativity, critical thinking, and problem-solving. More generally, it can be described as the ability to perceive or infer information, and to retain it as knowledge to be applied towards adaptive behaviors within an environment or context.

With a task of developing a universal tool to measure human intelligence, professionals from more than a century ago disagreed about one essential, fundamental question. Are we creating a test to measure someone’s intellectual ability (skill), or to measure someone’s intellectual capacity (volume)? These are two different things. This question was never resolved then – or now. It didn’t matter to them. Without knowing what, exactly, was being measured, the tests were created anyway.

Authors of WAIS, WISC, Stanford-Binet, Woodcock-Johnson, and others, cleverly alternate the terms ability and capacity when explaining their theories – as if the right answer to the question is “it’s both.” Incidentally, if you read the history of this science, eugenics (“biological determinism”) played a big roll. In 1908, Henry Goddard, an avowed eugenicist, created The Binet Test of Intellectual Capacity, seeking to expose and eliminate the “feeble-minded.” In the next six years his test was being used in public schools, courts of law, and for Ellis Island immigrants. This eventually led to 60,000 sterilizations nationwide of the “feeble-minded,” that also included the poor and a disproportionate number of minorities, California leading the way. (See Buck v. Bell 1927 that found sterilization constitutional, cited as one of the worst SCOTUS decisions ever.)

If IQ is an ability, then it seems some type of coaching would help, as it would with any ability. Or are we just born with limited abilities and coaching is a waste of time? Instead, if intelligence means capacity – more brain cells, more brain folds, more something biological – then is this itself its own natural limitation? Or are there ways to increase someone’s volume of intelligence? None of these explanations appealed to me, then or now, and the science of all of this, once your take the time to look at it, borders on superstition.

As a novice in the late 1970’s I couldn’t help but notice African American kids always scored 10-15 points less than white kids. How was that possible, I asked myself. I knew this black kid here was smarter than that white kid over there. Not according to the test. In addition to race, your gender matters, as does vocabulary, education, income, and a variety of other social variables that impacts the score you received on a test you took, on that day.

The IQ test itself - the actual categories and questions – are created by groups of like-minded scientists. These professionals are particularly detailed, fine-tuning among their specialties. As if searching for something, IQ tests include a number of logic questions, some math questions, questions about perception and spatial relationships, questions about pattern recognition and classification skills, and other obscure areas. The tests are made so that only a few could get the right answers for some of the questions. Then, they take those scores and compare them with other children with scores that deviate one way or another from an arbitrary “baseline” of one kind of another. That’s how we measure intelligence in human beings.

By the way, who does the best on IQ tests? Other like-minded scientists, who else? People like Einstein, most science teachers, all those IT guys and gals that keep our computers alive, and others who are born intrigued by puzzles and are stimulated by logic and similar thoughts. Elon Musk and Neil deGrasse Tyson come to mind. They, and others like them, have “high IQ’s.” Which means they did really good on the test they were given, on that day.

As an administrator for children living in mental health facilities, I ignored thousands of IQ tests. Completely. We were required to have them done, I always had a psychologist on my staff to perform this function, and we completed our obligation to our licensing body. We dismissed the results of IQ tests because they didn’t provide any useful information regarding treatment or prognosis. The problem is, most professionals think they do. It is especially prevalent when frustrated adults point to the problem child’s IQ as an “inherent limitation.”

As you can tell, I don’t like IQ tests, for what it’s worth. I suggest you ignore them too.


Randy Cima, Ph.D., is a psychologist by training. He was the Executive Director for several mental health agencies for children. He is avid opponent of psychotropic chemicals for children, and his efforts have successfully reduced and even eliminated chemicals in his work in helping them with a variety of problems. He also teaches, writes, and lectures on these matters.

Are You Kidding Me?

Are You Kidding Me?

by Phil Sinaikin, M.D., M.A.


In an August 5, 2022 edition of The Week (an excellent magazine by the way) there is a brief article entitled “Reassessing depression” that reports the results of a recent study by Joanna Moncrieff and her colleagues. The opening line: “Depression may not be caused by a chemical imbalance in the brain, a new analysis of research says--a finding that could upend our understanding of the science behind antidepressants.” (p.21, italics mine)

HUH?   HUH???

A new analysis? It’s been decades since we have officially debunked the chemical imbalance theory of depression and all other psychiatric “disorders.” How can this possibly be news now?

It is because it has nothing to do with science or research. What this is about is the social construction of “truth” independent of facts or science.

Those of us living in the current political environment of the past few years are acutely aware of this phenomenon: Pick a leader and trust them and what they claim. Don't trust your lying eyes. Don't be skeptical. Don't demand evidence. Don't think for yourself.

The institution of psychiatry is one of these leaders in our world, and it has unjustifiably attained that position of authority by sinking its tentacles into every aspect of life. It is fed by guild interests and financial gain, based on a lie, but has built itself to look like a shining city on the hill, when, in fact, that city is an alluring facade with no foundation. It is more like the seductive but inescapable hotel in the Eagles' song "Hotel California."

Psychiatry demands we trust it and its claims of personal disorder and illness. But it discourages us from asking the hard questions that would be demanded by science and logic. Chief among these is: Where is the evidence of brain disorder? So far, no such evidence has ever been found, despite decades upon decades of claims to the contrary. But psychiatry knows that one of the best marketing techniques is repetition - just ask Joseph Goebbels. It also knows that the best way to silence dissent is to attack the dissenters, like Dr. Moncrieff and her colleagues, who speak up about this charade.

And this is why the above "revelation" about depression seems to be news.

I am no longer practicing traditional psychiatry. My job now is prescribing medical marijuana exclusively. But as such I am kept acutely aware of the ongoing polydiagnosis, polypharmacy practices of psychiatrists. How often I see poor victims of this now seeking an alternative in medical marijuana? Very often. Usually after numerous medication trials rife with undesired side-effects (except of course for legal methamphetamine, Adderall, for recently diagnosed adult ADD).

So what do I want to say here? What can I say? I’ve already said it in my 375-page 2010 book Psychiatryland. From what I am seeing this book and numerous others critical of the medical model has done little to change psychiatric thinking or practices.

Perhaps the reason is best summarized by the final sentence in the above article in The Week: “The use of these medicines is based on clinical trial evidence,” says Allan Young, from Kings College London. “This review does not change that.” And I would add: nor his ability to make a good living practicing psychiatry.

By the way, notice the article doesn't say "Depression is not caused by a chemical imbalance in the brain." The power of psychiatry still has a hold on people's thinking, even in the face of incontrovertible evidence, enough to force "Depression may not be caused by a chemical imbalance in the brain."

I'll leave on a somewhat positive note. In the article it is stated: “Instead the researchers found a strong link between depression and negative life events.” To that I say No s**t Sherlock.


Phil Sinaikin, M.D., M.A., is a psychiatrist who has been in clinical practice in numerous venues for over 35 years. He has been involved in the critical psychiatry movement for many years. He has published critical, humanistic and philosophical articles in peer reviewed journals and books. He is also the author of Psychiatryland, a comprehensive consumer friendly examination of what has gone so terribly wrong in psychiatry and what, if anything, can be done about it.

What is Mental Health and Mental Illness?

What is Mental Health and Mental Illness?

by Joe Tarantolo, M.D.


What is “mental health”?

What is “mental illness”?

No, I don’t like the terms either.

Let’s narrow it down some. How does one define health since the advent of "Humanism"? I’m defining humanism as simply the philosophical position that MAN IS THE MEASURE OF ALL THINGS. It is that position contrary to religious ideas that God defines what is right, and humans follow.

A few hundred years ago, health, in western culture, would most likely be, at least in part, a religious question. That’s for another time to consider since many patients do present with religious and biblical issues: "I am a messenger of God," "The Virgin Mary is a lover of mine," "God has chosen me," "My family has disowned me for marrying a----," etc.
 
The current psychiatric orthodoxy as reflected in the Diagnostic and Statistical Manual of Mental Disorders (DSM) gives us illnesses and diseases defined by committee.
Except for the dementias, there is no scientific way of making these diagnoses. For the most part, and at best, what the committee defines are arbitrary clusters of symptoms: anxiety, depression, panic attacks, bulimia, psychoses, personality features, etc.
 
So, the DSM does a good job of describing hundreds of SYMPTOMS, and these are symptoms of alleged mental illness because the committees say so. Okay. If they are the symptoms, then what is the illness? That is the challenge I propose to my colleagues.
 
I will give my very simple definition of mental health. It is THE CAPACITY TO SUFFER! And mental illness is the flight from suffering. The DSM simply lists the in- numerable ways to avoid suffering. Whether it is the psychotic flight , vomiting  food to keep oneself pretty, panic instead  of facing fear, dissociating, etc.
 
So, colleagues, what is your simple definition? What is mental health and mental illness?


Dr. Tarantolo is a graduate of Mt. Sinai Medical School and a board-certified psychiatrist. He has been in practice for more than three decades on Capitol Hill in Washington, D.C., where his practice is dedicated to psychotherapy and helping patients withdraw from psychiatric drugs. Dr. Tarantolo has helped hundreds of patients come off psychiatric drugs through individual and group psychotherapy, herbal remedies, meditation, nutrition, and spiritual counseling.

ISEPP Launches New Blog – “Fact Checking Psychiatry”

ISEPP Launches New Blog – “Fact Checking Psychiatry”

by Chuck Ruby, Ph.D.


ISEPP is launching a new blog entitled "Fact Checking Psychiatry." It is an attempt to change psychiatry and the allied mental health professions from within. Through the blog, ISEPP mental health practitioners and academics will share their criticism of the medical model of human distress and how that model can be misleading, a waste of time, and potentially dangerous. As much as is possible, we will focus essays on current events relative to ISEPP's mission.

The intent is to attract professionals from within the mental health industry and to encourage them to consider asking the hard questions about the foundation of their professions. We hope those professionals, as well as the many people who are at the receiving end of these dubious psychiatric services, follow this blog and submit comments in order to start an ongoing and serious discussion.

Perhaps the most important ISEPP criticism of the medical model is the very foundation of the construct of "mental illness" and "mental health." We see them as oxymoronic - if something is mental, it can't be about literal illness or health; if something is about literal illness or health, it must be physical.

The only way around this would be to invite the medical establishment - psychiatry and its allied professions - to rule over the experiences of emotions and thoughts and how we act in this world. This would, in effect, drastically alter the definition of "illness" to include any experience or behavior that is considered a problem. This would be a very dangerous idea since those mental health professionals have no expertise in determining the appropriate ways of living life.

Moral judgments are the only ways to identify those "illnesses," since there is no pathophysiological basis to detect. So, mental health professionals would be in the business of determining appropriate levels of emotional distress, problematic thoughts, and wayward conduct and of enforcing so-called proper ways. Who among us wants this?

This is exactly what happened centuries ago when the Church was given that role on a society-wide basis, and we all know how that turned out. We also know how that approach turned out in totalitarian governments during more recent times when the mental/moral/medical profession identified politically inconvenient people and targeted them for "treatment" to make them more easily handled by those in power. To the extent that the mental health industry has incorporated more and more human dilemmas and struggles into diagnostic categories, this very thing seems to be where we're now headed in the 21st century. ISEPP wants to change that.

The many, many problems that get lumped into the rubric of "mental illness" are serious and they can have devastating effects on people, both those directly suffering and those who suffer as witnesses. But, absent any evidence that the suffering is due to pathophysiology - something wrong in body functioning - those problems are hardly medical matters.

Instead, they are personal, spiritual, economic, political, interpersonal, and existential struggles. There are many methods to help people with those struggles outside a medical model, and those methods do not harm, they operate with full informed consent, and they respect the principles of self-determination.


Chuck Ruby, Ph.D., is a psychologist in private practice and the Executive Director of the International Society for Ethical Psychology and Psychiatry (ISEPP). He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness – An Insider’s Warning to Consumers. Dr. Ruby earned his doctorate at Florida State University in 1995. He is a 20-year U.S. Air Force veteran.

 

 

The Right to Mental Health?

The Right to Mental Health?

Chuck Ruby, Ph.D., Psychologist


Earlier this month, Dainius Pūras, M.D., was interviewed by Awais Aftab, M.D., of the Psychiatric Times. Dr. Pūras was asked about his experiences as a United Nations Special Rapporteur from 2014 to 2020. In that role, he was charged with assessing the human rights aspects of mental health1 systems across the globe and reporting his findings to the United Nations Human Rights Council.

A primary concern of Dr. Pūras' was his dissatisfaction with the traditional separation of physical health and mental health. He believes this separation causes stigma and discriminates against people who seek mental health services. He further thinks that combining them under the same rubric of health and medicine is the solution to achieving mental health parity, the end of stigma and discrimination, and the advancement of human rights for those seeking mental health services.

In addition to merging physical and mental health, he proposed that both systems deemphasize the biomedical approach, asserting that psychiatry and mental health professions are in a position to remind the rest of the medical world that medicine is fundamentally a social science. In other words, health and illness are largely affected by social determinants, such as poverty and other social inequities, and the field of medicine should be addressing these social determinants and not just the defective biology of patients.

I agree that the discrimination and stigmatization of those seeking mental health services are due to separating it from the rest of medicine, and I am glad to see Dr. Pūras objecting to the excessive biomedicalization of human living. However, I disagree that the solution to this problem is to merge mental and physical health.

Doing so would strengthen the medical industry's domination over individual lives, and solidify its role of morally judging the appropriateness of distress and behavior. Notwithstanding the importance of addressing social factors that impact health and illness, the study of medicine is primarily a chemical, mechanical, and biological endeavor. It is not suited for providing expertise in making judgements about how we should respond to the emotional challenges of living.

So, instead of combining physical and mental health, I suggest keeping them separate, but in a fundamentally different way. The solution to stigma and discrimination, and the subsequent threats to human rights for those seeking mental health assistance, is to realize that the essence of mental health care is not literally about health and illness. It definitely isn't about using chemical, mechanical, and biological knowledge and skills to correct dysfunctional physiology.

Instead, the term "mental health" is a figurative description of social challenges, personal meaning, emotional distress, and one's responses to these things. Therefore, it is in a domain completely separate from the study of medicine and the literal idea of health and illness, not a different type to merge with the physical type.

Of course, as with all human activity, there is underlying biology at work. This fact, however, is not the same as claiming the biology involved is defective or malfunctioning. It doesn't even mean the biology causes those human actions any more than it could be said the actions cause the biology to occur.2 For example, when we walk or talk, there is biology that allows for walking and talking. Does biology cause walking and talking? Or, does walking and talking cause the biology to occur.

The same goes for when we think, feel emotions, and take action of any kind. There is biology always at work. Yet this fact doesn't mean that biology causes those things, and it clearly doesn't mean those things are disorders or illnesses caused by defective biology. Even when those human actions are very problematic, it is not logical to conclude they equal illness and lack of them equals health. If I walk in front of a bus and get injured, the decision to walk and the act of walking are not illnesses. Instead, the subsequent injury is the illness.

Having said this, the field of medicine does have an important, but limited, role at the intersection of physical health and mental health matters. Specifically, medical intervention can serve three purposes: 1) it can alleviate the negative physiological correlates of personal actions and distress (e.g., gastric damage, injuries); 2) it can identify and treat physiological defects, the results of which mimic mental health problems (e.g., poor nutrition, urinary tract infections); and 3) it can offer chemicals to those who choose, with full informed consent, to subdue their experiences of distress (e.g., Valium, Zoloft) just like it does for people who want to numb arthritis or headache pain.

This limited role is inherent in the fact that mental health problems are based on a definition that is void of any physiological ailment that medical specialists can diagnose and treat. More importantly, in situations where there is a physiological affliction, psychiatry (or the other mental health professions) would not handle it; the appropriate medical specialty would step in. Psychiatrists and psychologists don't treat gastric damage, broken bones, vitamin deficiencies, or urinary tract infections.

So, Dr. Pūras has good reason to be concerned about the separation of physical and mental health and the stigmatization and discrimination that come from it. However, it must be remembered that the mental health system created this problem in the first place in its definition of mental disorder. The DSM-5 defines it as a disturbance in thinking, feeling, or acting that is caused by impairment in mental functioning. Setting aside the circular nature of this definition, it makes mental disorder sound like a matter of dysfunction in a person, just like with physical illnesses.

But the main problem with this definition, and the reason it necessitate the separation of physical and mental health matters, is that such impairment in mental functioning cannot be identified without using moral judgments. It is not identified with an examination of chemical, mechanical, or biological dysfunction.

This is why DSM diagnoses and their criteria are developed out of the wrangling and consensus of committee members and not evidence of impairment. They are based on an aggregate moral judgment: what should we be distressed about, how much distress should we feel, how long should we feel distressed, and what should we do about the distress. In stark contrast to this, physical health matters are defined as actual bodily defects that threaten a person's physiological viability. No moral judgment is involved in identifying or theorizing about physical illness.

Therefore, it appears clear that the only way to eliminate the stigmatization and discrimination of those seeking mental health services is to eliminate this medical-moral model of mental health. Otherwise, those seeking services will continue to be seen as suffering from a mixture of medical and moral problems, which is why there is such popular fear and derision of those said to be mentally ill. It is also why they are stigmatized and discriminated against, and why their human rights are frequently violated.

By continuing to conflate physical health and mental distress, and anointing medical professionals as experts in the latter, the mental health system will always be prone to stigma and discrimination, opening the doors to involuntary and forced treatment. The resulting irony is that while we frequently see such coercion within the mental health system, we rarely see it with physical health. People who are diagnosed with physical health problems, such as diabetes, cancer, and heart disease are rarely treated involuntarily, against their will (unless, of course, they are judged mentally ill and, thus, not able to make "wise" choices).

In this way, the mental health professions have taken on a medical-moral role in identifying inappropriate (i.e., wrong, abnormal, bad, "sick") personal conduct and experiences, portraying them as the result of something impaired in the person, and seeking various ways to muzzle them. There is no way to medically correct the alleged impairment because there is no identifiable impairment to correct. All too often, the conventional methods of treatment are merely physical, chemical, and electrical restraint. Talk therapy, or psychotherapy, can also be a form of restraint in the form of scolding people for having these inappropriate experiences and persuading or coercing them to change their conduct. None of these are forms of medical treatment. They are forms of control.

Dr. Pūras' international efforts to ensure the right to mental health is a very worthy effort, but it means different things depending on the definition of “mental health” as explored above. If it is defined as in the DSM, then that right hardly applies to the person so affected. This is because, by definition, the affected person’s thoughts, emotions, and actions are the product of a dysfunction. Therefore, that person’s decisions and choices are not to be valued or honored because they are the tainted product of that dysfunction.

If, however, the right to mental health is defined as one’s right to decide how to resolve personal challenges, what to do about emotional distress, and what actions to take to resolve those challenges and distressing feelings, including which services of the conventional mental health system to take advantage of, then we’re really talking about respecting human rights.

In fact, Dr. Pūras was adamant that we should work toward eliminating all forms of coercive treatment and base our services on individuals' preferences and desires, even in cases where they are considered psychotic. But I don't see how this can possibly happen without abandoning the medical-moral model of human distress that defines mental health problems as something impaired in the person.

In his further emphasis on respecting individual choice, Dr. Pūras, pointed out the importance of democratic systems for the promotion of good mental health and adherence to human rights. But how can the right of mental health exist if the mental health system itself is not democratic, and instead mirrors the many totalitarian and authoritarian regimes that devalue the desires of its citizens? He lamented that mental health professionals and academics frequently block attempts to change the status quo, making the right to mental health impossible, since it prevents fully informed consent and it allows human rights to be routinely violated.

It appears clear to me that in order to arrive at a truly human rights based mental health system, we have to understand that the essence of mental health is not a matter of health and illness. Therefore, we need to find substitute terms for "mental illness" and "mental health" that accurately describe the very real problems that people endure and what can be done to help them. "Mental health" must not be seen as a different kind of hybrid health split off from physical health, and it must not be merged with physical health. It must be recognized as having to do with personal meaning, distress, and choice.


1I use the term "mental health" only as a metaphor. I do not intend to imply that it is a literal matter of health and illness.

2See Chapter 12, The Difference Between Brain and Mind in my book Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Welcome, MD: Clear Publishing for an elaboration of this conundrum.

Let’s Keep ISEPP Scientific and Focused

Let’s Keep ISEPP Scientific and Focused

Let's Keep ISEPP Scientific and Focused


Chuck Ruby, Ph.D., Psychologist


It is undeniable that officials within the CDC, FDA, and Big Pharma have engaged in corrupt practices and placed profit ahead of science. However, this doesn't mean everything they do is corrupt or unscientific. While skepticism is warranted - it is the hallmark of science - any claims of nefarious intent and action by them must be backed up by robust evidence. Leaping to conclusions based only on suspicion and cherrypicked evidence is conspiracy theory thinking.

Lately, the situation has become even more dangerous. Over the past few years, the political landscape has flipped. Left is right, yes is no, and true is false. The long-standing and generally condoned rhetorical tactics of politicians have been eroded away by insidious rumors, lies, and scapegoating that are so often used by totalitarian leaders to instigate widespread distrust of "elites" and long-respected institutions of information and knowledge. Public trust in critical thinking and science seems to be fading, while suspicion and accusations are overtaking reason as the criteria for truth. The resulting authoritarian effect of this phenomenon will remain with us like a stubborn stench that lingers long after the offending substance is gone.

These dangers are not new to ISEPP. For decades, we have been a passionate but marginal opponent in an uphill battle with an authoritarian emperor who lacks scientific substance for his medical model conspiracy theory of "mental illness" and instead peddles his own version of rumors, lies, and scapegoating. We have fought long and hard to expose this charade by doggedly presenting sound evidence that undermines the emperor. But, ironically, we are the ones who have often been viewed as conspiracy theorists, not the naked emperor and his conspiratorial followers. We are accused of being "mental illness deniers." How can we avoid this and not be lumped into the same category as the climate deniers, anti-vaxxers, and UFOlogists? How can we bolster our message and be taken seriously?

The answer lies in making sure our reason is not blinded by our passion. As a scientifically-minded research and public education organization, ISEPP must stand back from the current political maelstrom and not get drawn into its alluring but fatal depths. If we are to garner and maintain the respect of the public, and be seen as a serious challenge to the orthodoxy, it is essential that we do two things. First, we must prioritize the evidentiary foundations of our critique. Second, and perhaps more importantly, we must keep our focus on the ball and not get distracted by topics that are at best tangential to our mission. We cannot dilute our efforts and tarnish our reputation by joining the many ongoing bandwagons of alarming and hastily constructed theories that are divisive and that have little to do with the ethics of psychology and psychiatry.

Conspiracy theories abound during any crisis, and the current COVID-19 scare is no exception. News about  the development of vaccines and therapeutics for the virus, as well as efforts to determine its origin, have raised the specter of profit-driven corruption and conflicts of interest within government and the pharmaceutical industry. Unfortunately, this has drawn the attention of many in ISEPP who go beyond skepticism and entertain the idea that the crisis is being used by a cabal of powerful people as a "false flag" operation in order to increase and maintain control of the population. Multiple and rapid-fire bits of dubious "evidence" and innuendo have been offered in an attempt to shore up this theory. However, in addition to demanding that any such theory be firmly grounded in science, it is even more important to remember that the reality, origin, and contagion of COVID-19 is not ISEPP's target. We are not an organization that broadly investigates government and industry corruption in matters of healthcare. Instead, we are an organization that exclusively critiques the threadbare medical model of "mental illness" and the corruption that maintains it.

The importance of ISEPP remaining focused and firmly rooted in science was highlighted recently. In the past few weeks, ISEPP social media posts have been identified by Facebook as "abusive." This is very likely due to our challenge to the medical model of human distress and how some people rely on that baseless model for comfort. We are appealing this ruling, but in the meantime, we have to remember that we are making a very unorthodox claim and we will have formidable and well-funded opposition that enjoys conventional trust. So, as we increase our public platform and reach, we are at risk of being belittled as just another among a plethora of dangerous conspiracy theorists, other well-known but denigrated public figures, and organizations whose reputations are damaged beyond repair because of their sensational but unfounded claims.

ISEPP's mission is to educate the public about the orthodoxy's lack of evidence that "mental illness" is a medical matter that is best treated within a medical model, and the many harms that come from that model. It is also to suggest more humane ways that we can help our fellow human travelers as they face the natural but painful parts of living this life. In this campaign, we demand the long asserted, but yet-to-be revealed, evidence that the orthodoxy continues to claim as the foundation upon which the conventional system has been built. In our efforts at chipping away at that system, we hope to remove the trust that has historically been placed with the orthodoxy. This will allow a more humane model to rise up and replace the old. Many have fought long and hard in our struggle, at times to their deaths. Let's honor them by keeping ISEPP on firm scientific footing with a crystal clear focus!

Why the Myth of Mental Illness Lives On (Part 2) – The Inadequacy of Rule of Law

Why the Myth of Mental Illness Lives On (Part 2) – The Inadequacy of Rule of Law

Wayne Ramsay, J.D.


In Part 1 of this essay (8/6/2019)1, I described several reasons the myth of mental illness persists: (1) the effects of repetition of the myth by many people over time, particularly by opinion leaders, (2) disapproval from others for anyone who questions widespread myths, including the myth of mental illness, (3) support for the myth stated by those perceived as experts — in this case psychiatrists, psychologists, and social workers, (4) the desire of some people to avoid personal responsibility for their actions and their lives, (5) there being more comfort in believing a myth than in acknowledging ignorance, and (6) drug companies using huge advertising budgets to perpetuate the myth of mental illness and biological theories of mental illness for the purpose of increasing psychoactive drug sales and maximizing drug industry revenues and profits.

Here in Part 2. I will focus on another of the most important reasons the myth of mental illness persists: the inadequacy of rule of law.

“Rule of law” is a sacred concept in American jurisprudence.  On the day she was sworn-in as a U.S. Supreme Court justice, Sonia Sotomayor spoke eloquently about how deeply and sincerely she believes in rule of law. With the exception of civil commitment and involuntary guardianship laws, American courts invalidate laws that fail to put people on notice of what is required or prohibited on the ground they are void for vagueness. An example is Papachristou v. City of Jacksonville wherein a unanimous U.S. Supreme Court overturned the decision of lower courts and declared a Jacksonville, Florida vagrancy ordinance unconstitutionally vague.  The Supreme Court said this:

This ordinance is void for vagueness, both in the sense that it “fails to give a person of ordinary intelligence fair notice that his contemplated conduct is forbidden by the statute,” and because it encourages arbitrary and erratic arrests and convictions.  Living under rule of law entails various suppositions, one of which is that “[all persons] are entitled to be informed as to what the State commands or forbids.”2

Judged by this standard, all laws authorizing civil commitment for mental illness, or involuntary guardianship (of adults), or other loss of rights because of supposed mental illness, are void for vagueness and unconstitutional because they do not allow people of ordinary intelligence to know in advance what behavior or expression of ideas or outward display of emotions may result in losing their liberty or civil rights because of a “diagnosis” of “mental illness” or mental incapacity.

One might argue the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) delineates what is and is not a mental disorder, and hence what speech and behavior is and is not allowed, and that therefore the DSM provides the constitutionally required notice of what the state commands or forbids. However, the “Cautionary Statement” at the beginning of DSM-IV-TR explicitly disclaims the manual provides guidance for legal purposes:

It is to be understood that inclusion here, for clinical and research purposes, of a diagnostic category such as Pathological Gambling or Pedophilia does not imply that the condition meets legal or other non-medical criteria for what constitutes mental disease, mental disorder, or mental disability.  The clinical and scientific considerations involved in categorization of these conditions as mental disorders may not be wholly relevant to legal judgments, for example, that take into account such issues as individual responsibility, disability determination, and competency.3

An introductory chapter in DSM-5, published in 2013, includes a similar disclaimer titled “Cautionary Statement for Forensic Use of DSM-5”:

...it is important to note that the definition of mental disorder included in DSM-5 was developed to meet the needs of clinicians, public health professionals, and research investigators rather than all of the technical needs of the courts and legal professionals.  ...  When DSM-5 categories, criteria, and textual descriptions are employed for forensic purposes, there is a risk that diagnostic information will be misused or misunderstood.  These dangers arise because of the imperfect fit between the questions of ultimate concern to the law and the information contained in a clinical diagnosis.  In most situations, the clinical diagnosis of a DSM-5 mental disorder such as intellectual disability (intellectual developmental disorder), schizophrenia, major neurocognitive disorder, gambling disorder, or pedophilic disorder does not imply that an individual with such a condition meets legal criteria for the presence of a mental disorder or a specified legal standard (e.g., for competence, criminal responsibility, or disability).  For the latter, additional information is usually required beyond that contained in the DSM-5 diagnosis ...  assignment of a particular diagnosis does not imply a specific level of impairment or disability.  ...  Nonclinical decision makers should also be cautioned that a diagnosis does not carry any necessary implications regarding the etiology or causes of the individual’s mental disorder or the individual’s degree of control over behaviors that may be associated with the disorder.4

Even if the DSM is nevertheless accepted as a valid standard for legal judgments, it fails to provide the constitutionally required notice of what the state commands and forbids, failure to comply with which may result in forced treatment or loss of liberty, because the DSM does not state which supposed disorders justify involuntary commitment, or loss of civil rights, and which do not.

In The Manufacture of Madness in 1970, psychiatry professor Thomas S. Szasz, M.D., said, “psychiatry shows an unmistakable tendency to interpret all kinds of deviant or unusual behavior as mental illness.”5  When Dr. Szasz wrote those words, homosexuality was an example.  Would it have been appropriate to subject all homosexuals to involuntary treatment prior to the American Psychiatric Association’s vote in 1973 to de-designate homosexuality as a mental disorder? The DSM-II, published in 1968, said homosexuality was a mental disorder,6 but it did not say all homosexuals should be treated involuntarily if they refused treatment for their homosexuality.  However, it probably happened to homosexual adolescents whose parents were upset by their homosexuality. Some of those adolescents may even have been lobotomized (yes: lobotomized) as treatment for their homosexuality: In Psychosurgery—Damaging the Brain to Save the Mind in 1992, Joann Ellison Rodgers of The John Hopkins Medical Institutions says in the middle of the 20th Century:

Rapists, pedophiles, homosexuals, exhibitionists, and transvestites were all candidates for lobotomies. ...  Many lobotomies, for example, were performed on the institutionalized mentally ill to stop or limit ‘bizarre’ sexual behavior, which at that time meant masturbation, homosexuality, and for women, almost any overt desire for sexual release.

Similarly, in 2005 Emad N. Eskandar, M.D., G. Rees Cosgrove, M.D., and Scott L. Rauch, M.D., of Massachusetts General Hospital and Harvard Medical School said:

Psychiatric neurosurgery was first introduced as a treatment for severe mental illness by Egas Moniz in 1936.  ...  despite a lack of objective therapeutic benefit, psychiatric neurosurgery was enthusiastically adopted by practitioners of the day.  At the height of enthusiasm, psychiatric neurosurgery was recommended for curing or ameliorating schizophrenia, depression, homosexuality, childhood behavior disorders, criminal behavior and uncontrolled violence.7

Lobotomizing people as treatment for masturbation, homosexuality, or normal heterosexual desire is an example of harm caused by psychiatric “diagnosis” that is based on deviance from cultural norms or values rather than demonstrated biological abnormality.  It is also an example of why I call psychiatry evil.

I have uncovered no 21st Century reports of involuntary psychosurgery, but brain-damaging “medication” and electroshock are given to people over their objection every day in the U.S.A., either of which is capable of inflicting brain damage as severe as occurs with psychosurgery.


LOBOTOMY AS TREATMENT FOR HOMOSEXUALITY?


People are committed involuntary to mental hospitals every day in the U.S.A. because they have “suicidal ideation” despite the fact that neither the DSM nor civil commitment laws put people on notice they are allowed to think about some things but not other things.  Where is it written, even in the DSM, that Americans are not permitted to even think about ending their own lives—and that, if they do, loss of liberty may be the consequence?

This leaves aside the equally important question of whether the there is a right to freedom of thought under U.S.A.’s First Amendment (made applicable to the states by the Fourteenth Amendment), similar state constitutional provisions (e.g., Article 1, Section 8 of the Texas Constitution), or constitutional provisions in other countries, that should take precedence over psychiatry’s supposedly diagnostic (but actually only descriptive) classification system and the State’s statutory involuntary commitment criteria.

It should be obvious that one of the purposes of the DSM is to allow mental health professionals to bill health care insurance companies and government programs such as Medicare and Medicaid for virtually anything (which is one reason health care insurance premiums are exorbitant, and one reason health care and health care insurance are bankrupting the U.S. government and bankrupts many Americans).  Much normal human thinking and behavior at least arguably falls within a category of mental disorder in the DSM.  The supposedly diagnostic (but actually only descriptive) criteria in the DSM are so broad that many commentators and critics have correctly said there probably is no human being alive who falls within none of the DSM’s various categories of mental disorder, and most people meet the criteria for several psychiatric diagnoses simultaneously.  For example, “In court testimony, under oath, Jay Katz, a professor of psychiatry at Yale, admitted that ‘If you look at DSM-III you can classify all of us under one rubric or another of mental disorder’”.8 In his book The Hyperactivity Hoax, board-certified neurologist and psychiatrist Sydney Walker III, M.D., said:

The other major flaw of DSM, related to the first, is that it labels virtually everything as some type of disorder.  Thus, a child who sees a DSM-oriented doctor is almost assured of a psychiatric label and a prescription, even if the child is perfectly fine.9

According to Marcia Angell, M.D., Senior Lecturer in Social Medicine at Harvard Medical School and former editor-in-chief of The New England Journal of Medicine, in her endorsement on the dust cover of Dr. Allen Frances’ book, Saving Normal, Dr. Frances “was once the most influential psychiatrist in the country, as head of the task force that compiled the last [fourth] edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)”.  Yet even this highly esteemed psychiatrist, Dr. Frances, says he “met many other friends working on DSM-5 who were similarly excited by their pet innovations and soon discovered that I personally qualified for many of the new disorders that were being suggested by them for inclusion for DSM-5.”10 Dr. Frances cites “a study that found 83 percent of kids qualify for mental disorder diagnosis by the time they are twenty-one.”11 In 2013 in their book Mad Science: Psychiatric Coercion, Diagnosis, and Drugs, three American professors of social work and social welfare said:

According to the latest American Psychiatric Association methods of diagnosing mental illness, nearly one hundred million people, 25 to 30 percent of the US population, have a mental illness during any one year, and half of the population will have a mental illness during their lifetime.12

Similarly, in 2011 Dr. Vernon Coleman, a British physician, wrote that “diagnostic symptomotology is so vague and far reaching that I could, without much difficulty, find some definable mental illness in every person in the UK.”13

In 1997 in Whores of the Court: The Fraud of Psychiatric Testimony and the Rape of American Justice, Boston University psychology professor Margaret A. Hagen, Ph.D., said:

The newest (1994) Diagnostic and Statistical Manual of Mental Disorders provides the civil litigant with literally hundreds of possible disorders, each neatly laid out with the necessary symptoms.  It is hard to imagine that anyone could live in today’s society and not be diagnosed with at least one of these many disorders.14


THE DSM LABELS VIRTUALLY EVERYTHING AS SOME TYPE OF DISORDER


DSM-5 broadens the categories of mental disorder even more than DSM-III, DSM-IV or DSM-IV-TR.  According to Dusan Kecmanovic, professor of psychiatry and political psychology at Sarajevo University, “it will be difficult to be normal after the publication of DSM-5.”15  (Americans should keep this in mind when considering laws to keep guns out of the hands of “the mentally ill”: Since nearly everyone qualifies as mentally ill under current criteria, such laws could in application be a de facto repeal of the Second Amendment.)  In her book, The Trouble With Drug Companies, Dr. Marcia Angell says, “few psychiatric disorders have objective criteria for diagnosis”.16  Actually, none do.  The vague, unreliable, unpredictable, and invalid nature psychiatric diagnosis enables and encourages arbitrary “diagnosis” and arbitrary involuntary treatment.  That violates the constitutional standard stated by the Supreme Court in Papachristou.

The constitutional law requirement that government must tell you what is and is not allowed before it may do anything to you as a consequence of your failure to act as expected is only fair. That’s why the U.S. Supreme Court has declared it to be constitutionally required.

There is, however, a problem with this constitutional requirement, or said another way, there is a problem with rule of law: We can’t always anticipate and articulate, in advance, everything a human being might possibly say or do that other human beings, upon being made aware of it, will consider unacceptable.

This epiphany came to me in 1992 when I was sitting at a table in a restaurant in Manhattan with the woman I was dating at the time.  Our table was located next to a window on the other side of which was a sidewalk.  A man who looked like he was homeless put his face very close to the window as he stared at us, pointed at us, made funny faces, and did an odd sort of dance. His behavior was distracting and inappropriate, but how would one write a law prohibiting what he was doing?: Don’t look into or get too close to restaurant windows?  Don’t point at people?  Don’t make funny faces?  Don’t dance on the sidewalk?

Similarly, I once saw a man sleeping on the floor in a hotel corridor with his face against a dirty carpet.  At first I thought he might be dead, but after several seconds of observation I could see he was breathing. I advised the hotel front desk clerk who roused the man and told him he couldn’t sleep there and told him to go sleep in his hotel room.

The next day in a Subway Sandwich Shop a patron who looked like he was homeless began singing loudly and vastly off-pitch along with the music playing on speakers in the ceiling of the shop, disturbing everyone in the shop.

Examples abound in the evidence introduced at involuntary commitment and involuntary guardianship hearings.  After I think I’ve heard and seen everything, the behavior or ideas of a proposed patient in an involuntary commitment for supposed mental illness or of the proposed adult ward in an involuntary guardianship trial confronts me with yet another example of unacceptable thinking or behavior I wouldn’t have thought of had I been given the job of writing a state’s criminal code and other laws.  It is largely because of this difficulty that we have the concept of mental illness.

Sociologist Thomas Scheff has defined mental illness as “residual rule-​breaking”: “After crime,” wrote two of his critics, “perversion, drunkenness, bad manners, there are always those diverse grab-bag violations for which the culture has no explicit label—the ‘residual rules’ broken by those deemed mentally ill.”17 The concept of mental illness allows us, as a society, to impose sanctions, that is, punishment (called “therapy”) on law-abiding people who fail to live in accordance with our expectations about what conduct people should and should not engage in, and what beliefs or thoughts people should or should not express.  As psychiatry professor Thomas Szasz said in 1994, “when I grew up in Hungary—1920s, 1930s—it was very, very clear that psychiatry was essentially a jail function.  There were blue coated policemen and white coated policemen.”18 In "Mental Illness as Brain Disease: A Brief History Lesson," Dr. Szasz says “The contention that mental illness is brain disease is as old as psychiatry itself: it is an integral part of the grand lie that psychiatry is a branch of medicine and healing, when in fact it is a branch of the law and social control.”19

Similarly, in 2011 three authors including psychology professor Mark Rapley and psychiatrist Joanna Moncrieff call psychiatry “the enterprise of policing human conduct”.20

British psychiatrist Suman Fernando says “psychiatry...from the very beginning...has been concerned with social control.”21

In Madness—A Brief History, Roy Porter, Professor of the Social History of Medicine at the University College, London says “To many the psychiatrist seemed to have been reduced to acting as society’s policeman or gatekeeper, protecting it from the insane.”22 

The role of psychiatrists as police is also underscored by the subtitle of Louise Armstrong’s book And They Call It Help—The Psychiatric Policing of America’s Children.23

Blue-coated police enforce written laws.  White coated police—psychiatrists and those who work with them—enforce unwritten laws prohibiting thinking and behavior we either didn’t think to write a law against or choose not to (for reasons discussed below) or for which we just can’t find the right words (like my above examples).  Psychiatry’s roles as (1) part of the medical profession and (2) de facto police who enforce society’s unwritten laws are obfuscated and confused, resulting in violators of society’s unwritten laws not having the benefit of the protections that exist in criminal law.  Violating society’s unwritten laws is called mental illness or mental disorder.  The punishment is imprisonment called involuntary hospitalization and psychological and physical misery and brain damage caused by “involuntary medication” or involuntary electroconvulsive “therapy”.

Oddly, violators of our unwritten laws tend to be punished more harshly than those who violate our written laws: Would anyone advocate drug or electroshock induced brain damage as punishment for bank robbery or even murder?

New York (or whatever state’s) Penal Code
Punishment for a Class A misdemeanor shall be involuntary administration of a neurotoxic medication until brain damage and permanent neurological disease or disability including uncontrollable muscle movement (dyskinesia) is achieved.

Such a law would probably be declared a violation of the U.S. Constitution’s Eighth Amendment prohibition of cruel or unusual punishment. However, inflicting exactly this on a person becomes acceptable when administered as “therapy” for “mental illness,” and it is commonplace, even though mental “illness,” like crime, is nothing more than violating society’s (other people’s) rules.

Our current approach of calling prohibited thinking or behavior “mental illness” circumvents the difficult task of defining, in advance, what is and is not permitted, and it permits us to impose especially severe punishments.  It is easier to call people mentally ill and incarcerate and punish them with supposed treatment for their supposed mental illness than it is to anticipate everything people might do that is unacceptable and enact laws prohibiting the behavior.


PSYCHIATRISTS AND THEIR CO-WORKERS ARE
WHITE-COATED POLICE WHO ENFORCE SOCIETY’S UNWRITTEN LAWS


Sometimes belief in mental illness, or a pretense there is such a thing as mental illness, is the only way we can impose sanctions for disliked speech or behavior because, if we were to write laws clearly describing what is prohibited, it would be obvious we are violating the constitutional rights of the accused with such laws. For example, people are often forced into psychiatric “treatment”, including involuntary hospitalization, because of what they say rather than because of what they do.  Does this violate the First Amendment guarantee of freedom of speech?  Does the First Amendment protect only speech other people consider sane or rational?

Refusing to speak when other people think you should is another example. In 2011, I was an observer at an involuntary commitment hearing of a man whose “Selective Mutism” (rarely saying a word to anyone, DSM-IV-TR diagnosis 313.23)24 was his main supposed symptom of supposed mental illness, and at that hearing (after expiration of the time he could be held on a criminal charge) he was involuntarily committed to Kerrville State Hospital. In 1977, in Wooley v. Maynard, the U.S. Supreme Court said, “the right of freedom of thought protected by the First Amendment against state action includes both the right to speak freely and the right to refrain from speaking at all.”25  Texas Jurisprudence, a legal encyclopedia, says, “Liberty of silence is included by the guarantee of liberty of speech.”26  Because it would be unconstitutional, nobody is going to write a law saying you must speak with people. Nevertheless, engaging in normal conversation with those around you is an expectation nearly everyone has.  Therefore, mutism or selective mutism can become “mental illness” motivating involuntary “treatment” and did in this case despite the constitutional right to, in the U.S. Supreme Court’s words, “refrain from speaking at all.”  It is possible to incarcerate a person because he exercises a constitutional right such as refusing to talk if the ostensible or supposed reason is “mental illness” rather than the constitutionally protected action or inaction.

We could enact criminal laws against mutism, or unconventional religious or philosophical beliefs, or converting to a religion your family abhors, or loudly expressing nonreligious beliefs most people disagree with, or being grandiose or obnoxious, or revealing oneself to be excessively unhappy (“depressed”), or talking aloud to oneself with others present, or admitting to thinking about suicide, or attempting suicide.  We don’t, because writing such laws wouldn’t seem right.  In many cases such laws would be an admission of how narrow-minded, intolerant, authoritarian, and even despotic we sometimes are, including in nations like the United States of America where freedom is frequently touted as the reason for American patriotism. Frequently, such laws would be impossible to reconcile with America’s First Amendment guarantee of freedom in thought and expression or similar guarantees in other democracies and Article 19 of the United Nations Universal Declaration of Human Rights adopted by the United Nations General Assembly in Paris on December 10, 1948:

Everyone has the right to freedom of opinion and expression;  this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media...

State and federal laws authorizing civil commitment for mental illness in the United States of America and other nations routinely violate this right to freedom of opinion and expression.  Freedom of thought, opinion, and expression is respected in the U.S.A. if a person thinks Jesus is the Son of God but not if he thinks he is the Son of God, or if he thinks others are persecuting him (and others disagree), or if he thinks his life is not worth living (and others disagree), or if he has other thoughts other people consider crazy or bothersome.  As psychiatry professor Thomas Szasz wrote in 1973: “If you talk to God, you are praying; If God talks to you, you have schizophrenia.”27 We on the Western side of what was once (prior to the breakup of the USSR) called the Iron Curtain like to think of ourselves as freedom-loving people who uphold human rights.  The concept of mental illness permits us to violate our professed values about freedom and disregard the principal of rule of law without admitting to ourselves this is what we are doing.  It permits us to violate what the American Declaration of Independence of July 4, 1776 says are the God-given and unalienable rights of all men (and women): “...that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness.”  The myth of mental illness permits us to deprive law-abiding people of their supposedly unalienable right to liberty and pursuit of happiness, and because of fatal effects of psychiatric “treatment” such as sudden death caused by neuroleptic “medications” effect on the heart, or neuroleptic malignant syndrome, or electroshock, or physical restraint (causing asphyxiation), sometimes even their right to life, by pretending we are “treating them for their mental illness.”  Ron Leifer, M.D., a psychiatrist, said it well in 2000:

The problem is that society demands a greater degree of social control than law allows.  The public wants to be protected from unconventional, threatening, and dangerous behavior.  There is, thus, a public mandate for a covert form of social control which supplements rule of law.  Medical-coercive psychiatry, in alliance with the state, performs this function disguised as medical diagnosis and treatment.  ...  involuntary, coercive psychiatry serves society by providing a supplemental form of social control which, because it is covert or disguised, preserves our national pride by giving us the appearance of being a nation of free individuals under law.  On the other hand, when the covert is exposed it can be seen to violate the honored values on which this nation was founded.28

An example that was prominently featured in news reports in New York City in 1987 was the use of the concept of mental illness to get homeless people off the streets and out of the public parks of the City.  A New York Times article called it “a Koch administration program to involuntarily hospitalize severely mentally ill homeless people living on city streets.”29 Rather than admit the real motive was getting rid of these people whose presence was irritating to other people, New York City Mayor Ed Koch asserted the purpose was to get them “hospitalized” (involuntarily, of course) for allegedly needed “mental health” treatment.  It was a classic case of oppression disguised as benefaction.  New York lawmakers could have created a law making it illegal to be homeless or to sleep on park benches, sidewalks, or in subway stations and swept homeless people into detention facilities of some kind.  But they couldn’t or didn’t want to accept the moral implications of such a choice and therefore preferred to use mental illness as an excuse to justify incarcerating homeless people.  This was intellectually dishonest, because the real reason was disapproval of or annoyance with homeless people, and because imprisonment does not become benign merely because it is called hospitalization.

Even if it were possible to anticipate everything people might do that we as a society want to prohibit, and even if we didn’t care if writing such laws clearly and explicitly reveals we are violating human and constitutional rights with such laws, in many cases it would be impossible to write a statute that would prohibit the behavior we want to prohibit without encompassing other behavior we do not want to prohibit.  An example is crying in public.  A person who cries in public too often, or for reasons with which few others sympathize, or for reasons others don’t understand, bothers other people.  Few would advocate making it illegal to cry in public, because there are circumstances in which most people think crying in public is understandable and acceptable and shouldn’t be prohibited.  People are expected to intuitively know when it is okay to cry in public and when it isn’t.  A person who cries in public for reasons with which others are unsympathetic or at times others dislike, or more often and more loudly than other people think is appropriate, is breaking a residual rule of behavior, that is, a rule that isn’t written anywhere but which people are nevertheless expected to know about and abide by.  Violating this unwritten expectation may result in punishment called involuntary psychiatric treatment, including involuntary “hospitalization” for major depressive disorder or some other supposed diagnosis.  How and when and how loudly to express one’s anger, even verbally and without threatening others with physical harm, is also the subject of residual rules of conduct the violation of which might result in involuntary psychiatric “treatment”, including involuntary “hospitalization” or an involuntary outpatient commitment court order compelling a person living in his own house or apartment to appear at a clinic for bi-weekly or monthly injections of a long-acting drug intended to treat a supposed mental illness such as inappropriately expressed anger.


THE CONCEPT OF MENTAL ILLNESS PERMITS US TO VIOLATE OUR PROFESSED VALUES ABOUT FREEDOM AND RULE OF LAW WITHOUT ADMITTING TO OURSELVES THIS IS WHAT WE ARE DOING


In a letter dated October 14, 2009, I proposed the above ideas to retired psychiatry professor Thomas S. Szasz, who I had shortly before visited in his home town of Manlius, New York:

I believe the reason the myth of mental illness continues is not only or even mainly because people do not understand its scientific invalidity, although that is of course a factor.  I believe one of the most important reasons the concept of mental illness continues to be accepted legally and otherwise is it is impossible to write into criminal codes and other laws all commonly held expectations of behavior—and people’s desire to enforce these unwritten expectations. Mental illness is the rationalization used to punish people who violate unwritten rules—with punishment called involuntary hospitalization, and with torture inflicted as punishment but called treatment for the supposed but actually nonexistent “mental illness”.  ...  I think overcoming this problem is an important challenge facing people like you and me who want America and other nations to be governed by rule of law rather than arbitrary after-the-fact determinations of what behavior was right or wrong.

With my above letter I gave Dr. Szasz a tape recording I had made of the speeches including his own at the Thomas S. Szasz Tribute Dinner I had attended in Manhattan in 1990.  Dr. Szasz’s reply in an e-mail on October 19, 2009 was “Dear Mr. Ramsay, Many thanks for the tape - and your letter, with which I agree completely.  Marginal rule violation and its punishment is the name of the game.  Best wishes, Thomas Szasz”


MARGINAL RULE VIOLATION AND ITS PUNISHMENT IS THE NAME OF THE GAME


We as a society and as citizens of democracies would be more honest if we discard the myth of mental illness, repeal our civil commitment laws, and in their place enact a criminal law that openly acknowledges legislators are unable to anticipate and write a law against every act that should be prohibited.  Such a law might be titled “Criminal Conduct NOS."  It seems the majority of psychiatric diagnoses in involuntary civil commitment for mental illness I have seen end with the letters NOS, e.g., Personality Disorder NOS or Psychotic Disorder NOS.  In his book Hippocrates Cried: The Decline of American Psychiatry in 2013 psychiatrist Michael Alan Taylor, M.D., says “upward of a third of psychiatric patients end up being given the label NOS (Not Otherwise Specified).”30  Even with the ever-increasing number of supposedly diagnostic categories with each new edition of the American Psychiatric Association’s DSM, resulting in each edition being a bigger book with more diagnoses (or descriptions) than the last, psychiatrists continue to find it necessary to use “NOS” diagnoses. If we are going to incarcerate people on the basis of a supposed diagnosis ending with the letters NOS, why not have a criminal law with a name ending in NOS that does the same thing?  Criminal Conduct NOS might be defined as “an act not mentioned in this Penal Code but which the defendant knew or if he was a reasonable person of ordinary intelligence would have known he should not have performed.”  Replacing civil commitment law with a criminal or penal code provision such as Criminal Conduct NOS would represent a constriction of the power of families and government to incarcerate and punish people for (otherwise) lawful but bothersome behavior, or what Dr. Szasz called marginal rule violation, compared with today’s laws authorizing civil commitment for supposed mental illness, for these reasons: To obtain a conviction for Criminal Conduct NOS, the prosecution would be required to prove the defendant was guilty of specific past act rather than allowing imprisonment (called involuntary “hospitalization”) and corporal punishment and psychological torture (called involuntary “medication” or involuntary electroshock) for an alleged, arbitrarily and often vaguely defined state of mind such as depression or schizophrenia or bipolar or personality disorder, or predicted future conduct—“dangerousness.”  The “clear and convincing” standard of proof permitted by the U.S. Supreme Court in civil commitment for supposed mental illness in Addington v. Texas31 and employed in many states of the U.S.A., would be replaced with the more stringent standard of proof “beyond a reasonable doubt” that applies in criminal cases. Most Americans have a right to trial by jury in civil commitment for mental illness, but many do not.  If civil commitment laws are repealed and Criminal Conduct NOS is added to each state’s criminal code, the defendant’s right to trial by jury would be respected to the same extent it is in other criminal cases, because legislators and judges would no longer be playing word games or employing deceptive semantics to avoid respecting defendants’ constitutional rights, including the right to trial by jury, by calling the proceedings “civil” or “special” rather than criminal.  The judge or jury would be required to find the defendant not only did the act alleged but also at the time knew what he did was wrong or that a reasonable person of ordinary intelligence would have known what he did was wrong.  To avoid convicting a person who lacked the mental capacity of a reasonable person of ordinary intelligence of a “criminal” offense, the judge or jury would need to be empowered to find the defendant did the act alleged, that a reasonable person of ordinary intelligence would have known the act was wrong, but that the defendant lacked the mental capacity of a reasonable person of ordinary intelligence, withhold adjudication of a “criminal” offense, and sentence the defendant to a type of incarceration or program deemed educational or therapeutic.

Some will object to this approach because it does not allow intervention to prevent future acts.  My response is we can’t predict a person’s future conduct reliably enough to justify incarceration as a preventive measure.  In the words of a clergyman whose Sunday sermon I saw on C-Span on January 1, 2012, “The only evidence of what a person will do in the future is their record of what they have done in the past.”32 A person’s future conduct cannot be proved by any burden of proof, not even “preponderance of the evidence”, unless perhaps he says he is going to do something, or he has a long history of similar acts in the past.33

Substituting a criminal law titled Criminal Conduct NOS for current civil commitment law is only a partial solution, because sometimes people’s behavior is bothersome but does not justify criminal prosecution, including Criminal Conduct NOS.  Enforcement of private property rights that give property owners authority regarding what can be done on their property may be the best solution in some situations.

Because there is no credible evidence of any so-called mental illness being caused by biological abnormality, so-called mental illness is definable only as thinking or behavior that is considered unacceptable.  Without a biological abnormality proved to be the cause of the behavior or supposed symptoms, a supposed mental illness does not qualify as true illness or as true disease.  The word “mental” implies non-physical: A person can no more have “mental illness” than he can have mental cancer.  It is possible to have brain cancer but not mental cancer.  For similar reasons, it is possible to have a brain disease but not a mental disease.  Likewise, it is no more possible to have a “mental” illness than it is possible to have a “religious illness” or a “political illness.” Mental illness exists only as a concept in the minds of people who believe in mental illness. Involuntary psychiatric “therapy” is punishment for thinking or behavior people dislike, not health care as people like to think and as legislators and judges assume.  If the so-called professionals in what we call mental health allowed themselves to use only the term brain disease (not “mental illness”) and refused to believe a brain disease is present unless true physical, biological (not merely mental, emotional, or behavioral) evidence is found, most if not all psychiatric and psychological “diagnosis” (confusing values with health) would cease.  But then, as psychiatrist Ronald Leifer pointed out (above), we as a society would be stuck with rule of law, and “the public will be deprived of an extra-legal means of maintaining domestic tranquility."34

Belief in mental illness continues for all of the above reasons, none of which are valid from a logical or scientific or legal and constitutional standpoint.


1Wayne Ramsay, J.D., “Why the Myth of Mental Illness Lives On (Pt. 1), ISEPP Bulletin July 2019, https://psychintegrity.org/why-the-myth-of-mental-illness-lives-on-part-1
2Papachristou v. City of Jacksonville, 405 U.S. 156 at 162 (1972), citations omitted
3Diagnostic and Stastical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR, American Psychiatric Association 2000), p. xxxvii
4Diagnostic and Stastical Manual of Mental Disorders, 5th edition (DSM-5, American Psychiatric Association 2013), p. 25
5Thomas S. Szasz, M.D., The Manufacture of Madness (Harper & Row 1970), p. 68)
6Diagnostic & Statistical Manual of Mental Disorders — Second Edition (American Psychiatric Association 1968), p. 44
7Emad N. Eskandar, M.D., G. Rees Cosgrove, M.D., and Scott L. Rauch, M.D., “Psychiatric Neurosurgery”, neurosurgery.mgh.harvard.edu, accessed February 5, 2014, underline added
8Prof. Jay Katz, quoted in Thomas Szasz, Insanity—The Idea and It’s Consequences (Syracuse University Press 1997), p. 57
9Sydney Walker III, M.D., The Hyperactivity Hoax (St. Martin’s Press 1998), p. 23. Italics are Dr. Walker’s.
10Allen Frances, M.D., Saving Normal—An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (HarperCollins 2013), p. xvii
11Id., p. 177: Journal of American Academy of Child and Adolescent Psychiatry: “Cumulative Prevalence of Psychiatric Disorders by Young Adulthood: A Prospective Cohort Analysis from the Great Smoky Mountains Study”, Vol. 50, No. 3, (2011) pp. 252-261, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049293/
12Stuart A. Kirk, et al., Mad Science: Psychiatric Coercion, Diagnosis, and Drugs (Transaction Publishers 2013, p. vii
13Vernon Coleman, MBChB, D.Sc.(hon), Do Doctors and Nurses Kill More People Than Cancer?, (European Medical Journal 2011), p. 32
14Margaret A. Hagen, Ph.D, Whores of the Court: The Fraud of Psychiatric Testimony and the Rape of American Justice (ReganBooks 1997), p. 250
15Dusan Kecmanovic ,“DSM-5: The More It Changes The More It Is the Same”, Psychiatria Danubina, 2013; Vol. 25, No. 2, pp. 94-96
16Marcia Angell, M.D., The Truth About Drug Companies—How They Deceive Us and What To Do About It (Random House 2005), p. 88
17Rael Jean Isaac & Virginia C. Armat, Madness in the Streets (Free Press/Macmillan 1990), p. 49
18“Thomas Szasz on Socialism in Health Care”, https://www.youtube.com/watch?v=FC9r3Gs8XuU, at 1:24:42
19Thomas Szasz, M.D., “Mental Illness as Brain Disease: A Brief History Lesson”, http://www.szasz.com/freeman13.html, accessed September 16, 2020
20Mark Rapley, et al., Medicalizing Misery, Palgrave Macmillan 2011, p. 4
21Id., p. 50
22Roy Porter, Madness—A Brief History, (Oxford University Press 2002), p. 186
23Louise Armstrong, And They Call It Help—The Psychiatric Policing of America’s Children (Addison-Wesley Pub. Co. 1993).
24DSM-IV-TR diagnosis code 313.23 appears on p. 125
25Wooley v. Maynard, 430 U.S. 705 at 714 (1977)
269 Tex.Jur. Constitutional Law §91, p. 525
27Thomas Szasz, M.D., The Second Sin (Anchor/Doubleday 1973), p. 113
28Ron Leifer, M.D., “A Critique of Psychiatry and an Invitation to Dialogue”, Ethical Human Science and Services, December 27, 2000, available at www.critpsynet.freeuk.com/critique.htm
29Josh Barbanel, “New York Ordered to Find Care for Homeless Woman”, The New York Times, November 25, 1987, p. B3
30Michael Alan Taylor, M.D., Hippocrates Cried: The Decline of American Psychiatry (Oxford University Press 2013), p. 39
31Addington v. Texas, 441 U.S. 418 (1979)
32Rev. Bill Tvedt, Jubilee Family Church, Oskaloosa, Iowa
33See Is Involuntary Commitment for “Mental Illness” or “Dangerousness” a Violation of Substantive Due Process?, www.wayneramsay.com/due-process.htm
34Ron Leifer, M.D., “A Critique of Psychiatry and an Invitation to Dialogue”, Ethical Human Science and Services, December 27, 2000, www.critpsynet.freeuk.com/critique.htm, accessed March 9, 2013.