On September 9, 2020, Jonathan Stea, PhD, Tyler Black, MD, and Joseph Pierre, MD, published a piece on MedPage Today.  The article is titled Why Anti-Psychiatry Now Fails and Harms.

Dr. Stea is a clinical psychologist and adjunct assistant professor at the University of Calgary.

Dr. Black is the psychiatric medical director of British Columbia Children’s Hospital.  He is also a clinical instructor in psychiatry at the University of British Columbia.

Dr. Pierre is a clinical professor in the Department of Psychiatry at UCLA.

The main theme of the article is contained in the title:  Why Anti-Psychiatry Now Fails and Harms.


Here’s the opening paragraph:

“The evolution of modern psychiatry has at times been fraught, but the discipline has adapted and survived through periods of controversy. As with any scientific endeavor, self-criticism and self-correction are intentional built-in features required for growth that move us closer to truth. Disciplines that lack rigorous mechanisms for such interrogation, such as the peer-review process, are at risk of crossing the fuzzy boundary from science into pseudoscience. Medical disciplines that do not confront their tarnished pasts — as all disciplines must — will never grow to be better versions of human healing. Scientific criticism of psychiatry is therefore both necessary and healthy to the benefit of people who experience mental health concerns.”

There’s a lot in this paragraph, so let’s open it up.

“The evolution of modern psychiatry has at times been fraught, but the discipline has adapted and survived through periods of controversy.”

This is true enough.  Psychiatry has survived; in fact it has enormously expanded its scope.

“As with any scientific endeavor, self-criticism and self-correction are intentional built-in features required for growth that move us closer to truth.”

This sentence is more problematic, because psychiatry is not, and never has been, a scientific endeavor.  From about 1750 to 1850, American asylums were, for the most part, small (about 200 residents) and provided what has come to be called “moral treatment”.  This was not so much a specific “treatment”, but rather something more akin to what, in the 1960’s, was called milieu therapy.  Every facet of daily life was seen and used as an opportunity to influence the residents in positive directions.  It was more like a teaching program than a medical one.  Residents were taught how to initiate and participate in conversations and how to develop pleasurable and purposeful activities.

Discharge rates were generally high.

After 1850, two developments occurred which undermined the success of the moral period.  Firstly, Dorothea Dix began her determined campaign to build, enlarge, and medicalize mental hospitals; and secondly, John Gray, MD, Superintendent of Utica State Hospital in New York, and editor of the American Journal of Insanity, precursor to the American Journal of Psychiatry, proclaimed, without evidence, that “insanity was always due to physical causes and that the mentally ill should be treated as physically ill.”  (Wikipedia) [Emphasis added]

“Gray…explained that mental illness can be affected by physical factors relating to an individual. He studied 3 such factors namely; diet, temperature and ventilation.” [Wikipedia]  His wiki page also notes that Dr. Gray was “…at the forefront of biological psychiatric theory during the 19th century.”

The critical point here is that Dr. Gray’s insistence that insanity always stems from physical causes was made without evidence, but has nevertheless, apart from the brief ascendency of Freudian theory, been the foundation of psychiatry to the present times.  And the evidence for this hypothesis is still not to hand.

Against this harsh and tragic reality, Stea et al’s characterization of psychiatry as a scientific endeavor needs to be greeted with extreme skepticism.  Psychiatry is not a scientific endeavor.  If it were, Gray’s hypothesis would have been rejected long ago.  In addition, Stea et al’s further assertion that “self-criticism and self-correction are intentional built-in features required for growth that move us closer to truth” becomes an absurdity.  It is only 5½ years ago that Jeffrey Lieberman, MD, former APA president, described Robert Whitaker as a “menace to society” for no other reason than the fact that he (Robert) dared to challenge psychiatry’s orthodoxy. (Here, starting at 0:50 of the provided audio link).  So much for self-criticism and self-correction.  There have been countless other attacks on critics of psychiatry, including the current Stea et al paper.

Psychiatry today bears much more resemblance to a dictatorial religious cult than to anything remotely scientific or self-correcting.  The general “rule” adopted by psychiatry in this regard is that one can criticize psychiatry all one likes, provided the criticism has absolutely no effect.

“Disciplines that lack rigorous mechanisms for such interrogation, such as the peer-review process, are at risk of crossing the fuzzy boundary from science into pseudoscience.”

“Medical disciplines that do not confront their tarnished pasts – as all disciplines must – will never grow to be better versions of human healing. Scientific criticism of psychiatry is therefore both necessary and healthy to the benefit of people who experience mental health concerns.”

Here again, these statements are true, but in the present context they are little more than meaningless exhortations to “do good” and “avoid evil”.  They are the moral equivalent of tautologies, and they ignore the fact that the most fundamental premise of psychiatry, the very cornerstone of the entire corrupt edifice – that psychiatry treats real illnesses – is nothing more than an unproven, self-aggrandizing assumption.


Let’s take a look at the origins of DSM-III (1980).  Here’s what Edward Shorter, PhD, wrote on this topic in 2015 (here).

“In 1980, DSM-III represented a massive ‘turning of the page’ in nosology, and it had the effect of steering psychoanalysis toward the exit in psychiatry and the beginning of a reconciliation of psychiatry with the rest of medicine.” [Italics in original]

Later in the same piece, Dr. Shorter wrote:

“Led by resident John Feighner, and then joined by the staff, in 1972, the St Louis group proposed specific criteria required for a diagnosis. For depression, the patient would need to have a ‘dysphoric’ mood plus five out of eight other criteria on a list. The diagnostic criteria soon became known as the ‘Feighner criteria’ and the article, helmed by a resident, qualifies as one of the most important contributions in modern psychiatry. The concept of diagnostic criteria became the backbone of DSM-III.”

These quotes are in reference to the fact that in 1972, John Feighner, MD, a psychiatry resident at Washington University, St. Louis, co-authored a piece titled Diagnostic Criteria for Use in Psychiatric Research.   It was published in Archives of General Psychiatry, Vol 26, 1972.  Archives of General Psychiatry later became JAMA Psychiatry.  Here’s the abstract:

“Diagnostic criteria for 14 psychiatric illnesses (and for secondary depression) along with the validating evidence for these diagnostic categories comes from workers outside our group as well as from those within; it consists of studies of both outpatients and inpatients, of family studies, and of follow-up studies. These criteria are the most efficient currently available; however, it is expected that the criteria be tested and not be considered a final, closed system. It is expected that the criteria will change as various illnesses are studied by different groups. Such criteria provide a framework for comparison of data gathered in different centers, and serve to promote communication between investigators.”

Note firstly that the term “illnesses” occurs twice in the abstract, and it is clear both from the abstract, and from the later text, that the notion that psychiatric problems are illnesses is an a priori assumption, not something that has ever been proven.  In fact, in DSM-I, the various non-organic entries were referred to as reactions, rather than illnesses.

Feighner et al specify five phases for establishing diagnostic validity in “psychiatric illness”.  These are:

Clinical description
Lab studies, including chemical, physiological, radiological, and anatomical findings.
Delimitation From Other Disorders
Follow-up Study
Family Study

Feighner et al mention that lab studies “are generally more reliable, precise, and reproducible than are clinical descriptions”.  They also point out that:

“Unfortunately, consistent and reliable laboratory findings have not yet been demonstrated in the more common psychiatric disorders.”

and later:

While no psychiatric syndrome has yet been fully validated by a complete series of steps, a great deal of work has been published indicating that substantial validation is possible.” [Emphases added]

Feighner et al go on to provide tentative diagnostic criteria for thirteen psychiatric “illnesses”.  Earlier they had stated very clearly:

“These criteria are not intended as final for any illness.  The criteria represent a distillation of our clinical research experience and of the experiences of others cited in the references.  This communication is meant to provide common ground for different research groups so that diagnostic definitions can be emended constructively as further studies are completed.” [Emphasis added]

Here are the authors’ criteria for a “diagnosis of depression”:

Depression.– For a diagnosis of depression, A through C are required.

A.  Dysphoric mood characterized by symptoms such as the following: depressed, sad, blue, despondent, hopeless, ‘down in the dumps,’ irritable, fearful, worried, or discouraged.
B.  At least five of the following criteria are required for ‘definite’ depression; four are required for ‘probable’ depression. (1) Poor appetite or weight loss (positive if 2 lb a week or 10 lb or more a year when not dieting).  (2)  Sleep difficulty (include insomnia or hypersomnia).  (3)  Loss of energy, eg. fatigability, tiredness.  (4)  Agitation or retardation.  (5)  Loss of interest in usual activities, or decrease in sexual drive.  (6)  Feelings of self-reproach or guilt (either may be delusional).  (7)  Complains of or actually diminished ability to think or concentrate such as slow thinking or mixed-up thoughts.  (8)  Recurrent thoughts of death or suicide, including thoughts of wishing to be dead.
C.  A psychiatric illness lasting at least one month with no preexisting psychiatric conditions such as schizophrenia, anxiety neurosis, phobic neurosis, obsessive compulsive neurosis, hysteria, alcoholism, drug dependency, antisocial personality, homosexuality and other sexual deviations, mental retardation, or organic brain syndrome. (Patients with life-threatening or incapacitating medical illness preceding and paralleling the depression do not receive the diagnosis of primary depression.)”

It is noteworthy that these nine criteria (A and B, 1-8) are essentially the same as the nine criteria for major depressive disorder as listed in DSM-III through DSM-5.  In many cases the wording is almost identical.  The requirement of five “hits” out of the nine criteria is also a feature of the DSMs.

So, although Feighner et al stressed that their criteria were provisional, and would need amendment in the light of further studies, the exact same criteria are being used to this day, 38 years later.  So either Feighner et al were unbelievably lucky or, no progress has been made in the endeavor to create a scientifically validated nosology.  In addition, DSM-5 acknowledges that “…no lab test has yielded results of sufficient sensitivity to be used as a diagnostic tool for this disorder.”  (p 165).  DSM-III; DSM-III-R; DSM-IV, and DSM IV-TR have all made similar acknowledgements.

In other words, the notion that “major depressive disorder” is a bona fide illness is nothing more than an assumption adopted by Feighner et al and others in the late 60’s and early 70’s to make psychiatry seem like real medicine.  Psychiatry has made no progress in validating its criteria for this loose grouping of vaguely-defined thoughts, feelings, and behaviors.  The lab tests and other characteristic biological markers that psychiatrists at the time thought were “just around the corner” didn’t materialize – and still haven’t materialized.

The fundamental basis of psychiatry – that it treats real illnesses – is still just an unproven assumption despite a staggering expenditure of money, effort, and cognitive acrobatics to try to prove otherwise.  But the real illness fiction is crucial to psychiatry’s credibility.  Once this fiction is exposed, it becomes obvious that they are simply providing mind-altering fixes in the same manner as the street-corner vendors: “something to help you feel better”.


In the Introduction to DSM-III-R, this statement can be found:

“In several areas of the classification (Disruptive Behavior Disorders, Psychoactive Substance Use Disorders, and Personality Disorders), the diagnostic criteria have been revised to form an index of symptoms of which a certain number, but no single one, is required to make the diagnosis.  This polythetic format, in contrast to a monothetic format in which each of several criteria must be present for the diagnosis to be made, is likely to enhance diagnostic reliability.” (p xxiv)

In fact, the polythetic format (3 out of 5, 4 out of 7, etc.), far from enhancing diagnostic reliability, actually detracts from reliability.  There are, for instance, ten ways of selecting 3 items from a list of 5:  (123, 124, 125, 134, 135, 145, 234, 235, 245, and 345).  So a “diagnosis” that requires only 3 items from a list of 5 actually contains ten separate, and quite different, presentations.  This does not enhance reliability.  The polythetic format was actually adopted to keep the psychiatric net as wide as was feasible.  The notion that it enhanced reliability was just more psychiatric spin.

The corresponding statement in DSM-IV is a little different, but just as invalid:

“In recognition of the heterogeneity of clinical presentations, DSM-IV often includes polythetic criteria sets, in which the individual need only present with a subset of items from a longer list (e.g., the diagnosis of Borderline Personality Disorder requires only five out of nine items).” (p xxii)

But how do they know that “mental disorders” present themselves in such heterogeneous ways?  They don’t, because they have no validated yardstick to determine what the various “mental disorders” consist of.  Psychiatrists are like golfers who play only in dense fog.  They can congratulate themselves and one another on the excellence of their swings, their impeccable follow-through, their firm grips, their open stances, etc., but they have no way of telling if the ball goes into the hole.  They have no way of telling whether any given “mental illness” is a real illness, or whether it is heterogeneous or homogeneous, curable or incurable, etc.  Nevertheless, they continue to insist that their “illnesses” are real illnesses, laboring apparently under the modern political fantasy that falsehoods become true if they are repeated often enough.


The Introduction to DSM-IV (1994) contains the following assertion:

“More than any other nomenclature of mental disorders, DSM-IV is grounded in empirical evidence.” (p xvi)

This was very comforting, of course, but only 19 years later (2013), the Introduction to DSM-5 contained the following statement:

“While DSM has been the cornerstone of substantial progress in reliability, it has been well recognized by both the American Psychiatric Association (APA) and the broad scientific community working on mental disorders that past science was not mature enough to yield fully validated diagnoses—that is, to provide consistent, strong, and objective scientific validators of individual DSM disorders.” (p 5)

So, according to the APA’s 1994 statement, DSM-IV was grounded in empirical evidence, but nineteen years later they admit that they and “the broad scientific community” well recognize that “past science” (presumably the science underlying DSM-IV) was not sufficiently mature “to yield fully validated diagnoses”.

In other words, everything that has gone before, from DSM-I to DSM-IV-TR, has been junk science.  No “consistent, strong and objective scientific validators of individual DSM disorders” have been discovered.  Not a single mental “illness” has been proven to be a real illness.

But, despair not, my dauntless readers, because:

“…the last two decades since DSM-IV was released have seen real and durable progress in such areas as cognitive neuroscience, brain imaging, epidemiology, and genetics.” (p 5)

but – tragically – no fully validated diagnoses.  No lab tests or other clear biological markers, characteristic of the illness in question.

All that psychiatry can show for decades of work and millions, or perhaps, billions, of dollars spent is – nothing!  Apart from those DSM diagnoses that are clearly attributable to a medical condition, no progress has been made in the pursuit of diagnostic validity.  We’re still using Feighner et al’s guesses and conjectures and those of their various successors.

. . . . . . . . . . . . . . . . .


Back to Drs. Stea, Black, and Pierre:

“But beyond scientific critique, psychiatry has long been a target of criticism that has been moralistic and ideological as well.”

So, we anti-psychiatry writers have been challenging, not only the fact that psychiatry is based on pseudo-science and unproven assumptions, but have also criticized psychiatry on “moralistic” and “ideological” ground.  This is interesting, in that the two words “moralistic” and “ideological” have obvious negative connotations.  “Moralistic” means “characterized by, or expressive of, a narrow moral attitude” (Random House).  “Ideological” means “visionary theorizing” with implications of interpreting events in the light of preconceived ideas.

And yes, there is a measure of truth in these assertions.  We anti-psychiatry writers do, for the most part, subscribe to a “narrow moral attitude”.  For instance, we expect practicing psychiatrists to keep the corrupting influence of pharma at arms length, which they don’t.  We expect psychiatric research to be untainted by pharma influence, which it isn’t.  And, of course, on ideology, we expect psychiatry to place client welfare above considerations of remuneration and self-aggrandizement.  We also expect psychiatrists to provide full information to clients concerning the adverse effects of the “treatments” provided.  Such a narrow-minded moralistic approach!  Clearly we should be ashamed of ourselves.

. . . . . . . . . . . . . . . .

But watch where our dauntless trio go next:

“Dating back to at least the 1960s, the so-called “anti-psychiatry” movement began as an understandable reaction to various missteps of psychiatry, such as the over-medicalization of mental health, the inhumane management of asylum care, and the inappropriate pathologizing of minority groups.”

Marvel, my dear and patient readers, at the exquisite side shuffle.  Psychiatry has made “various missteps” in the past.  Oh how easy it is to discuss and dissect the errors made by those who went before us and are now long dead.  Stea et al provide three examples:  the “over-medicalization” of mental health; the inhumane management of asylum care; and the inappropriate pathologizing of minority groups.  This list is truly bizarre.  Over-medicalization is still rampant in psychiatry, and if anything, is on the increase.  The asylums (now euphemistically known as mental “hospitals“) still practice forced drugging, which many survivors experience as a form of rape; informed consent is routinely dispensed with when deemed “necessary”, and covert or surreptitious drugging still occurs.  The inappropriate pathologizing of minority groups is presumably a reference to the inclusion of homosexuality, and its eventual exclusion, from the DSM catalog.  But, of course, psychiatry continues to pathologize all groups: minorities, majorities, black, white, brown, etc.  Anybody, we are routinely told, can become “mentally ill”.  It’s a disease – just like diabetes.  Nobody is immune!

Back to Drs. Stea et al:

“In the early days of the movement, it might be said that “anti-psychiatry” helped psychiatry to self-correct in a way that moved the discipline towards a more scientific endeavor reliant on empiric evidence, while maintaining a sharp focus on the interaction between biological, psychological, and social contributions to mental health and illness.”

Ah, the good old days when psychiatrists and anti-psychiatrists worked together to improve psychiatry.  And now, with the improvements made,  all that bad stuff is behind us:  the over-medicalization; the inhumane “treatment”; the pathologizing of minority groups.  We’re much more scientific now.  We rely on empirical evidence!  And of course we keep a “sharp focus” on psychological and social “contributions” to mental health and illness.

The reality, however, is that there is nothing scientific about psychiatry.  It was junk science in the 1850’s when John Gray, MD, proclaimed, without the slightest evidence, that “insanity” is always due to physical causes.  And it is still junk science today.  No progress has been made in validating their “diagnoses”.


“More recently, however, the anti-psychiatry movement has lost its way. It has transformed from a predominantly academic and political movement to one of consumer groups, akin to the anti-vaccine saga. In its current form, anti-psychiatry exists as a disorganized entity outside of mainstream medicine, largely propagated on social media and in non-peer-reviewed sources like newspaper opinion articles, books, and blogs that evade scientific dialogue and critique.”

We’ve lost our way.  Oh, the sadness of it all.  There we were, chugging along nicely offering polite suggestions to psychiatrists, which they, of course, immediately and enthusiastically adopted, but now…we have cast off our academic and political anchors and have become a movement of “consumer groups, akin to the anti-vaccine saga.”  We are “a disorganized entity, outside of mainstream medicine.”

But why and how have we lost our way?  Apparently by forsaking our respectable academic and political roots, and allowing consumer groups (ugh!), akin to the anti-vaccine saga (ugh! ugh!) into our midst.  (I’m not sure how a consumer group can be likened to a saga, but we can let that go.  Within the hallowed chambers of psychiatry, anything can happen)

So increasingly large numbers of people who have been damaged (sometimes permanently) by psychiatrists come together to form a support/educational/protest group, and these three learned doctors disrespect them in this way.  This kind of disrespect is common in psychiatry.  Remember the learned and illustrious Dr. Pies challenging the credibility of psychiatric clients unless their assertions could be confirmed by their psychiatrists, who are, as everyone knows, the great exemplars of truth, integrity, and honesty.

I know of nothing that suggests that anti-psychiatry is opposed to or outside of mainstream medicine.  It is psychiatry that we oppose, and one of our primary criticisms is that it is not a legitimate branch of medicine because most of the problems it purports to “treat” are not bona-fide illnesses.

Stea et al continue by pointing out that we are largely propagated on social media and in other non-peer-reviewed sources “that evade scientific dialogue and critique.”

Again, my dear and patient readers, note the subtle implication that we use the Internet, in all its facets, for the purposes of evading scientific dialogue and critique.  In reality, we use the Internet because it is the quickest, most convenient, and incidentally, successful form to spread our message.  And as for evading criticism, I personally receive a great deal of criticism from various pro-psychiatry individuals and groups, to which I routinely respond.  I welcome dialogue, and have never blocked any critic from my site or from my Twitter stream, which is more than can be said of a great many psychiatrists.

“Modern anti-psychiatry is not a monolith, yet there are common themes that could be harmful to patients. Different from helpful scientific criticism, it often takes the dangerous form of disinformation that aims to tear down the discipline and deter treatment-seeking.”

Which causes me to ask:  what disinformation?  I’m sure that some anti-psychiatry writers, including myself, make errors, the correct term for which is “misinformation”.  Disinformation implies that the erroneous information was promoted deliberately.  I have not come across this to any significant degree.  But what Stea et al need to do if they are aware of anything of this sort is to confront it openly and fair and square.  To level criticisms of this sort at unnamed perpetrators is simply cowardly, and serves no purpose other than smearing a large group of people whose only “crime” is having the audacity to challenge psychiatric dogma.

Drs. Stea et al continue:

“Those who espouse anti-psychiatry ideology…”

Here we go again – we’re just a bunch of ideological scalawags!

“…often lay charges against the very existence of psychiatric disorders and the wholescale efficacy of psychiatric medication.”

The position espoused by most anti-psychiatry writers in my experience is that the “mental illnesses” listed in the DSM (other than those that are clearly identified as caused by a general medical condition) are not bona fide illnesses in any ordinary sense of the term.  However, the problems on which psychiatry bases its “diagnoses” of these so-called illnesses are frequently real and can, sometimes, feel devastating.  This is a long-winded statement, and I can believe that some anti-psychiatry writers abbreviate it to “mental illnesses don’t exist”.  But if Drs. Stea et al had the slightest interest in dialogue, they would have long-ago discerned the significance of these kinds of assertions.

The central issue here is that the concept of illness necessarily entails the presence of biological pathology.  This is how the word is used in ordinary speech, and this is how clients understand it, and tragically believe it, when psychiatrists tell them that their sadness, or their lack of attention, or their temper tantrums are illnesses. 

I am very familiar with the common psychiatric response to this contention (distress plus impairment), but the inescapable fact is that that is not the common use of the term illness, and frankly, the contention is untenable.  For decades psychiatry promoted (and in some contexts still promotes) the notion that depression, say, which crosses certain vague and arbitrarily identified thresholds of severity, duration, and impact is an illness, just like diabetes.  They have searched high and low, but have consistently failed to identify a characteristic biological pathology that would provide proof of this assertion.  And now, with the Holy Grail nowhere to hand, they are saying, in effect:  “Oh, we don’t mean illness in the generally accepted sense of “caused by a biological pathology”, we just meant “anything that entails distress plus impairment”.  Yeah, right!

And note, the individual entries in successive DSM revisions specify distress or impairment, a much more relaxed requirement.

Even Jeffrey Lieberman, MD,  past president of the APA and staunch advocate of all things psychiatric, admitted in a recent Medscape article The Past, Present, and Future of the DSM (December 15, 2020):

“It’s easy to criticize the DSM,” said Jeffrey A. Lieberman, MD, professor and chair of psychiatry at Columbia University College of Physicians and Surgeons in New York City. “But at this point, it represents a system that is as good as we can have, given our current state of knowledge.” [Emphasis added]

Dr Jeffrey Lieberman

“Is it ideal?” asked Lieberman, who served as APA president from May 2013 to May 2014. “By no means. But there’s no better alternative. Hopefully, research will soon enable modifications that will lead to pathologic diagnostic assessments, like every other field of medicine has.” [Emphasis added]

“… like every other field of medicine has.”  What could be clearer?  All other branches of medicine recognize and accept the obvious reality that the defining feature of a disease is its characteristic biological pathology.  Only psychiatry claims otherwise, and this is because they haven’t been able to identify biological pathologies, though they constantly claim, as Dr. Lieberman does in the above quote, that the great discoveries in this area will “soon” be available.  I have been hearing this since the 1960’s, when psychiatry, desperate for medical respectability and increased income, was in the process of extricating itself from psychoanalytic theory.

Back to Stea et al.

“…and the wholescale efficacy of psychiatric medication.”

It seems here that Stea et al are claiming that “psychiatric medications” have “wholescale efficacy” and that anti-psychiatry writers are challenging this.  Shouldn’t we challenge this?  Shouldn’t we point out that psychiatric clients are seldom fully informed of risks? Shouldn’t we write about these risks?  Shouldn’t we draw attention to the risk of suicide with SSRI’s?  Shouldn’t we try to educate consumers about akathisia?  Tardive dyskinesia?  Neuroleptic malignant syndrome?  Tardive dysphoria?  Since psychiatrists routinely neglect these aspects of informed consent, shouldn’t somebody be picking up the slack?  Shouldn’t somebody expose, or at least attempt to expose, psychiatry’s misleading and self-serving safe-and-effective-treatments hoax?  Shouldn’t somebody publicize the dangers of administering high-voltage electric shocks to the brain?

“A tragedy of anti-psychiatry is that its merit is lost in its extremism. Topics that warrant amplification — such as the importance of risk-benefit in full informed consent of medications and patient autonomy — are drowned out by sentiments that position psychiatry as the enemy where only harm stories count and taking a pill is viewed as a morally weak and reckless act that destroys lives.”

Oh my goodness, what a gem of literary legerdemain.  Watch how they do this – don’t blink.

  1. There are topics that “warrant amplification”, i.e. that need to be stressed and repeated.
  2. These include “the importance of risk-benefit in full informed consent of medications”
  3. and “patient autonomy”.

The critical question here is why do these topics warrant amplification?  And the answer is: because psychiatrists have deliberately and self-servingly neglected these matters for almost their entire history.

And far from being “drowned out”, these topics are front and center on almost every anti-psychiatry website with which I’m familiar.

And in drawing attention to these matters and other areas of psychiatric malpractice, some of us, myself included, do indeed identify psychiatry as the enemy – the enemy of truth; the enemy of patient autonomy; the enemy of interpersonal respect; the enemy of informed consent; and the enemy of science.

“…taking a pill is viewed as a morally weak and reckless act that destroys lives.”

I’m not aware of any anti-psychiatry site that condemns pill-taking on the grounds of morality or recklessness.  But it is a fact that for many people, the pills and the shocks have indeed destroyed their lives.  This is psychiatry’s dirty little secret, and it is tempting to attribute the virulent condescending tone of this piece to Drs. Stea et al’s concern that their profession’s concealment of these matters is being outed on all sides.  “Patients” who complain concerning their “treatment” have to be marginalized lest their protests spread and become even more widely recognized and accepted.

Let me divert briefly with a personal story.  In 2001, I lost my kidneys to an out-of-the-blue autoimmune disease called Wegener’s granulomatosis.  By the time I got to see a nephrologist, there was little left of the kidneys, but he suggested that it might be worth trying to save something.  He explained that high doses of cyclophosphamide and prednisone might help with this.  But he added that these drugs have serious adverse effects.  I asked what these were.  He replied that he would leave some literature for me to read, but that the short version was:  “every adverse effect you’ve ever heard of, including death.”

Now that’s informed consent.  And despite the fact that large numbers of people die each day from the effects of psychiatric drugs and shocks, I have never encountered a client in all my career who seemed even remotely aware of these dangers.  Nor have I ever come across a psychiatrist who seemed to feel the slightest need to share this information with all his/her clients.  It is only within the parameters of the anti-psychiatry movement that one encounters those honest and forthright assessments of psychiatric “treatment”.

And that, Drs. Stea, Black, and Pierre, is one of the reasons that you may find yourselves portrayed as the enemy.  There are many other reasons, and if you care to browse my website, or other anti-psychiatry sites, you’ll find them clearly and unambiguously set out.  Of course not all psychiatry’s failings can be laid on all psychiatrists, but it is rare indeed to find psychiatrists who are willing to address even the most blatant transgressions.  A code of silence pervades the practice of psychiatry concerning the damage being done and the efforts made to keep it hidden.

Backtracking a little:

“…are drowned out by sentiments that position psychiatry as the enemy where only harm stories count and taking a pill is viewed as a morally weak and reckless act that destroys lives.”

The reason that we focus on “harm stories” is quite simply that psychiatrists suppress them.  They parrot the standard dogma that psychotropic drugs are “safe and effective”, but won’t take on board the reality that people coming off SSRI’s can experience severe and protracted withdrawals.  Nor will they acknowledge the obvious correlation between taking psychiatric drugs and perpetrating mass murders and suicides.  Nor will they undertake a definitive research study to explore whether or not this correlation is causal.

In 2016, the late Senator John McCain, and House Representative David Jolly brought forward bills in their respective chambers to require a post mortem search for drugs (including prescription drugs) in all military service members who had taken their own lives.  The bill received no support from psychiatry, and died in both houses.  Why didn’t psychiatry support this long-overdue initiative?  Could it be that psychiatry, even at this advanced stage of destructiveness, is still more concerned with protecting their guild interests than protecting their clients?

But over and above this, there are more than 3,000 psychiatrists working for the US Veterans’ Administration.  Surely, somewhere in that group, the expertise and the time could be found to conduct this particular piece of research.  Why is this not being done?  In fact, why isn’t it being done every year, with the results being publicized nationally for the benefit of all?

Of course, suppression of embarrassing information is nothing new in psychiatry.  For years, they denied that benzos were addictive even as benzo addicts were being admitted to addiction units all over the nation (and probably in other countries too.)  According to this 2013 abstract from Consultant Pharmacist journal:

“In the mid-to-late 1970s, benzodiazepines topped all ‘most frequently prescribed’ lists. It took 15 years for researchers to associate benzodiazepines and their effect on gamma-aminobutyric acid as a mechanism of action. By the 1980s, clinicians’ earlier enthusiasm and propensity to prescribe created a new concern: the specter of abuse and dependence. As information about benzodiazepines, both raising and damning, accumulated, medical leaders and legislators began to take action. The result: individual benzodiazepines and the entire class began to appear on guidelines and in legislation giving guidance on their use. Concurrently, clinicians began to raise concerns about benzodiazepine use by elderly patients, indicating that elders’ lesser therapeutic response and heightened sensitivity to side effects demanded prescriber caution. The benzodiazepine story continues to evolve and includes modern-day issues and concerns beyond those ever anticipated.”

. . . . . . . . . . . . . . . .

“A person who identifies with a nuanced explanation of mental disorders – like borderline personality disorder or even schizophrenia – are told that these disorders do not exist.”

This sentence is ambiguous, but the authors seem to be saying that people who “have” “borderline personality disorder” or “schizophrenia” and have had these particular “illnesses” explained to them in some nuanced fashion, are told that these disorders do not exist.  This is the same matter that I discussed earlier.  The issue is that none of psychiatry’s functional (to use the old term) “diagnoses” are entities that are found in nature (as real disease are).  Rather, they are loose collections of vaguely-defined thoughts, feelings, and behaviors which psychiatrists have arbitrarily aggregated for the purpose of promoting the fiction that they are real doctors treating real illnesses.  The truth is that although they have medical qualifications, their activities are not medical in nature, and their treatments are essentially drug-pushing, differing only from the street-corner variety in that the latter makes no pretentions to being a helping profession.

“There are common tropes of anti-psychiatry that, in the age of social media, continue to sprout up each day as if they are new, unrefuted issues (see the eight points below). Though debunking these tropes is easy enough, the recurrence of these claims and the personal manner in which they are defended often degenerates into an all-too-familiar pattern of social media name-calling. As one psychiatrist colleague wrote during a discussion about informed consent, ‘I want to step in and say something, but I don’t want to be attacked and harassed online like you all are.’”

Obviously there is a conflict between psychiatry and anti-psychiatry.  For decades the anti-psychiatry advocates tip-toed politely around the issues, offering suggestions here and there and commenting gently on the value of inter-disciplinary input.  Almost all psychiatrists ignored these suggestions unless they took the form of encouraging customers to “take their meds as ordered” and keep their appointments.  Suggestions that entailed genuine psychosocial perspectives or interventions, were deflected with the injunction:  First we must treat the depression or the anxiety, etc., meaning first we get the individual on the drugs, and hound him or her to take them despite the frequently unconscionable adverse effects, and the lack of informed consent.  Those of us who identify with the anti-psychiatry movement sat on our hands for too long.  We have learned the hard way that polite discussions had no effect, and we’re not going back there.  You can block us from your Twitter feeds, but you can’t silence the truths that we speak.


At this point in the article the authors enumerate their eight “common tropes of anti-psychiatry” writers.  Here’s their first trope:

Trope # 1:

‘”Psychiatry still promotes the ‘chemical imbalance’ hypothesis…”‘

And here’s their refutation:

“Not really. The ‘chemical imbalance’ explanation was an early and incorrect way to make sense of the effectiveness of medications that alter neurotransmitters like dopamine or serotonin in the brain, whereas in reality the biochemical mechanisms of mental illness and how treatments work are still being researched.”

However, there are a great many psychiatrists who continue to promote this falsehood.  For instance, Nicholle Peralta, MD, a psychiatrist working in Colorado, has this on her website:

In a recent newspaper article, Greeley Tribune, December 26, 2020, Dr Peralta elaborated:

“What we are trying to do, whether it is with medications or TMS therapy, we try to balance out those neurotransmitters.” [Emphasis added]

Not much ambiguity there.

. . . . . . . . . . . . . . . .

This screenshot was taken from Johns Hopkins Medicine website on December 29, 2020.

Note “It’s caused by a chemical imbalance…”

Again, pretty clear.

. . . . . . . . . . . . . . . .

From the University of Rochester’s Medical Center website:

“What causes depression?

Researchers are studying the causes of depression. Several factors seem to play a role. It may be caused by chemical changes in the brain. It also tends to run in families. Depression can be triggered by life events or certain illnesses. It can also develop without a clear trigger.” [Emphasis added]

. . . . . . . . . . . . . . . . .

Same U of R website:

“What causes mood disorders in a teen?

What causes mood disorders in teens is not well known. Certain chemicals in the brain are responsible for positive moods. Other chemicals in the brain (neurotransmitters) control the brain chemicals that affect mood. Mood disorders may be caused by a chemical imbalance in the brain. This can happen on its own. Or it can happen along with environmental factors, such as unexpected life events or long-lasting stress.” [Emphasis added]

. . . . . . . . . . . . . . . .

From the Mayo Clinic website:

“Depression (major depressive disorder)…


It’s not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

    • Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
    • Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
    • Changes in the body’s balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
    • Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.” [Emphasis added]

. . . . . . . . . . . . . . . .

Colorado TMS Services:

“TMS therapy uses targeted magnetic pulses to stimulate key areas of the brain that are underactive in people experiencing depression. This is not electroconvulsive  therapy (ECT).

The leading scientific theory behind the cause of depression is that it is due to an imbalance in the brain’s neurotransmitters. Neurotransmitters are the chemical messengers that send signals to brain cells. During a TMS treatment session, a magnet is used to stimulate nerve cells in areas of the brain believed to control mood.” [Emphasis added]

. . . . . . . . . . . . . . . .

University of North Carolina, Chapel Hill, School of Medicine, Department of Psychiatry:

“These electrical currents activate cells within the brain which are thought to release neurotransmitters like serotonin, norepinephrine, and dopamine. Since depression is thought to be the result of an imbalance of these chemicals in the brain, TMS can restore that balance and, thus, relieve depression. Though one session may be enough to change the brain’s level of excitability, symptom relief isn’t usually noticeable until at least the third week of treatment.” [Emphasis added]

. . . . . . . . . . . . . . . .

Psych Associates of Maryland:

“The reason TMS Therapy is so effective can be explained through the root causes of depression. Depression can be defined as a chemical imbalance in the brain caused by underactivation of the frontal cortex: the forward-facing portion of the brain responsible for controlling mood and personality. When this part of the brain is underactive, it is not able to properly utilize chemicals—typically serotonin and dopamine—to give you feelings of happiness, motivation, and excitement.” [Emphasis added]

. . . . . . . . . . . . . . . .

Pacific Psych Centers:

“Researchers have found that TMS treatment and antidepressants can be combined for those patients who can tolerate the medication. One therapy augments the other, potentially optimizing results for the best possible outcome.

When successful, the combined treatments can reduce or even eliminate symptoms by correcting the chemical imbalance in the patient’s brain. Further, using antidepressants with TMS treatment can extend the effects of the latter.” [Emphasis added]

. . . . . . . . . . . . . . . .

LifeCare, Chapel Hill NC:


The brain is an organ where specialized treatment and medications may be needed to help restore physiological balance and correct functioning. Our psychiatric and therapy team work together to address the whole person to bring healing to the body, mind, and soul. Medication management allows the client to maintain optimal health and well-being.” [Emphasis added]

. . . . . . . . . . . . . . . .

It took less than half an hour’s Internet search to find the above examples.  There seems to be no end to these invalid explanations, despite the attempts of various psychiatric leaders to disavow them.  The reality is that at grassroots level (as opposed to ivory towers), the chemical imbalance theory (guess/conjecture/deception) is alive and thriving.

. . . . . . . . . . . . . . . .

Trope # 2:

“‘It is not ethical to use a medication if one doesn’t know the mechanism of action’.”

Refutation from Dr. Stea et al:

“This has never been a principle of medicine. Efficacy and safety are routinely established long before full mechanisms are understood and they guide future understanding of pathophysiology.”

However, the average efficacy of antidepressants is about 2 points on the Hamilton Depression Scale – a difference that would be barely detectable in real life.  Is it ethical to expose a client to the risks of the known adverse effects for such a meager return?  Wouldn’t it be ethical to say something along the lines of:  we don’t know how helpful this will be for you, but the average efficacy is barely detectable, and there are some significant adverse effects that we should consider?  We need to try to weigh the possibility of a meager benefit (and possibly no benefit) against the known adverse effects and their probabilities.

Now that would be truly informed consent.  I leave my readers to estimate how often this kind of conversation occurs in psychiatrists’ offices.  From my searching of psychiatrists’ websites, I would guess close to zero.  The essential message I find on these sites is one of ridiculously over-optimistic prospects if “treated”, and dire predictions if “treatment” is deferred or declined.

Trope # 3:

“‘Psychiatric medications are harmful.’”

And their refutation:

“All medical interventions can cause harm, including surgery, medications, psychotherapy, and recommendations to exercise. In medicine, interventions must be understood and explained to patients in terms of ‘risk-benefit’ relative to prognosis without treatment. This is the foundation of informed consent.”

It is indeed, but tragically it is almost entirely absent in psychiatric interventions.  In my experience, it is rare to encounter a psychiatrist who routinely informed clients that neuroleptics and antidepressants can induce unbearable akathisia that has driven many a hapless “patient” to suicide.

Trope # 4:

“‘Psychiatric medications don’t work’.


“There are a range of different psychiatric medications used to treat different conditions, each with varying levels of efficacy compared to placebo.”

I haven’t come across this particular “trope”, though it’s indeed possible that the authors are more familiar with the anti-psychiatry movement than I am.  What I have come across frequently, however, is the assertion that no psychiatric drugs fix anything in the brain (or elsewhere), but rather exert their influence by disrupting normal brain functions.  And this assertion, to the best of my knowledge, is accurate.  Nevertheless, it is routine in psychiatric circles to promote the fiction that psychiatric drugs restore balance in the brain.  (See earlier paragraphs on chemical imbalance).  It is also the case that many psychiatric websites present an exaggerated account of the efficacy of psychiatric drugs.

Trope #5:

“‘Psychiatric diagnoses are made by checklist.’”


“Sound diagnosis requires thorough investigation, interview, collateral history, objective examination, and sometimes ‘ruling out’ medical disorders and other psychiatric issues. Bonus side trope debunking: the DSM (Diagnostic and Statistical Manual of Mental Disorders) is not the “Bible” of psychiatry — it is more of an imperfect ‘rough guide’ that continues to be revised.”

Very nice in theory, but the actual diagnosing is done by checklist.  Why, for instance, do psychiatrists conduct investigations (thorough or otherwise)?  To see if the person meets the diagnostic criteria.  Similarly, why conduct an interview, gather collateral history, gather “objective information“, rule out medical disorders or other psychiatric issues?  All of these facets of the assessment are carried out to confirm the presence or absence of one or more items from the checklist.

DSM-III and DSM-IV even had decision trees for differential disorders!  Here’s a quote from the introduction to the decision trees in DSM-IV-TR:

“Each decision tree starts with a set of clinical features. When one of these features is a prominent part of the presenting clinical picture, the clinician can follow the series of questions to rule in or rule out various disorders.” (p 745)

This sounds about as challenging as the children’s game Connect the Dots, though considerably less useful.  Similar “instructions” are provided in DSM-III, DSM-III-R, and DSM-IV.  The decision trees were dropped with no explanation in DSM-5.  Perhaps because psychiatrists finally realized the somewhat brainless aspect of the matter.

In addition to all of this, the APA has published “pocket” editions of each DSM from DSM-III to DSM-5.  These pocket-sized books contain only the diagnostic criteria, and are used extensively by psychiatrists in cases where they can’t recall the items on the pertinent checklist.  The books are referred to as Mini-D’s (I kid you not), and although they encourage readers to refer to the main text for additional information, it is pretty obvious to anyone who has seen psychiatrists “in action” that this seldom happens.

In the Introduction to DSM-III, the reader will find this:

“In making a DSM-III diagnosis the clinician may find it more convenient to consult the Quick Reference to the Diagnostic Criteria from DSM-III, (Mini-D), a pocket-sized booklet sold separately, that contains only the classification, the diagnostic criteria, a listing of the most important conditions to be considered in a differential diagnosis of each category, and an index.” (p 11)

So, psychiatric “diagnosis” is made by ticking off items on a checklist.  What’s surprising, however, is that psychiatrists are so obviously embarrassed by this.  All physicians diagnose by checklist.  The difference is that in real medicine, the checked items seldom exceed two or three in number and have a direct bearing on physiological pathology.  They are also based on an understanding of the specific biological pathology and how this affects various organs.  In psychiatry, apart from those diagnoses that are due to a general medical condition, this is never the case.  Not one of psychiatry’s functional “diagnoses” has the slightest validity.  They are nothing more than psychiatric inventions designed to increase their income and perceived respectability.

And incidentally, here’s a quote from the APA’s website concerning the pocket edition of DSM-5:

“It includes the fully revised diagnostic classification, as well as all of the diagnostic criteria from DSM-5® in an easy-to-use paperback format. This handy reference provides quick access to the information essential to making a diagnosis.” [Emphasis added]

The Mini-D checklist is all you need: “quick access to the information essential to making a diagnosis”.  What could be clearer?  It’s pure Mickey Mouse, only not as challenging.  Tick off five of the nine items and voila!  You’ve got a billable “diagnosis”.  You don’t have any understanding of the so-called illness, but, never mind, the insurance company will pay up.

. . . . . . . . . . . . . . . .

Trope # 6:

“‘Psychiatrists practice ‘biological psychiatry.’”


“Modern psychiatry is a medicine subspecialty that seeks to understand mental illness based on the integration of biological, psychological, and social aspects of one’s life. In this respect, psychiatry was ahead of most medical fields in understanding the impact of psychology and social factors on health.”

I think this entire line of “reasoning” has been covered earlier. What’s noteworthy here, however, is that Dr. Stea et al are trying to have their cake and eat it too.  For decades, psychiatry promised that the physiological discoveries that would establish psychiatry as a bone fide medical field were just around the corner.  Now, many corners later, and still empty-handed, a small minority of them are tentatively probing the notion that there just may be some significant psychological and social factors  involved, but mental “illnesses” are still real “illnesses”.  And they’re trying to present this blatant contradiction as a virtue – “…psychiatry was ahead of most medical fields…”.  Meanwhile, the vast majority of psychiatrists are like lost sheep, still parroting the real-illness-just-like-diabetes nonsense, but vaguely aware that this isn’t quite right.  And of course, a very small number of psychiatrists are trying to carve out ethical niches in this labyrinth of wholesale deception.  But the fact remains that the very act of handing a client a prescription, regardless of any reassuring verbal concomitants, implies that an illness is being targeted.  It’s almost impossible to be an ethical psychiatrist without embracing the principles of anti-psychiatry.

Trope # 7:

“‘Psychiatrists seek to ‘medicalize normal.’”


“The boundary between health and disease is ‘fuzzy’ across all of medicine, where the treatment of disease overlaps with health promotion. Generally speaking, psychiatry focuses on emotional suffering and impairments to functioning, whether it is an ‘expected reaction’ or not.” [Emphasis added]

Emotional suffering and functional impairments are the current vogue in psychiatry as substitutes for physiological pathology.  But they’re fooling no one but themselves.

Psychiatry not only seeks to medicalize normal.  They actually do medicalize normal.  Cause-neutrality has been an integral part of psychiatric “diagnosis” since DSM-III, though some of the ground was prepared in DSM-II.  The essential point of cause-neutrality is that it doesn’t matter why a person is depressed or inattentive or obsessive, etc.  All that matters, from the perspective of the “diagnosis”, is that he/she meets the required number of hits on the particular checklist.  So, a person who is emotionally devastated by the death of a spouse or a child; or has just lost a limb in an accident; or who has learned that he/she has a terminal illness, can be “diagnosed” with major depressive disorder, provided only that five of the nine inherently vague criteria are met, and can be “legitimately” drugged, even against his/her will, if a psychiatrist considers this necessary.  I have written extensively on the subject of cause-neutrality here.  It’s pretty sordid reading – psychiatry at its worst.

Trope #8:

“‘Mental illness doesn’t exist.’”


“The definitions and boundaries of particular mental disorders fluctuate over time, reflecting our shifting understanding of the biological, psychological, and social phenomena that account for them. Mental disorders can best be understood as symptom clusters that co-occur in patterns that can be recognized and identified with good ‘inter-rater reliability’ in order to guide evidence-based treatment approaches.” {Emphasis added]

This is interesting because I’ve always been given the impression that psychiatrists considered “mental disorders” to be illnesses, and they’ve been spilling a good deal of ink over the last fifty years trying to convince the general public, the legislators, the media, and potential clients (that’s all of us, by the way) that this is the case.  “Symptom clusters” are a far cry from bona fide illnesses.  And incidentally, the inter-rater reliability isn’t all that good.  Though this is a moot point because the validity is zero.

So, to repeat the oft-repeated clarification:  “mental illnesses” have no validity because, despite enormous efforts to prove otherwise, no characteristic biological pathology has ever been identified in any so-called disorder except those that are clearly caused by a general medical condition, e.g. Alzheimer’s dementia, brain damage due to infection, etc.


Stea et al continue:

“Unfortunately, debunking anti-psychiatry claims outside of a therapeutic relationship is an ethical duty that can feel like a personal attack to those with lived experience who identify as being harmed by psychiatry.”

Actually, psychiatric debunking of anti-psychiatry claims usually IS a personal attack.  For instance, the recent “debunking” perpetrated by the most illustrious and scholarly psychiatrist Ronald Pies, MD, was nothing less than a scurrilous attack on the credibility of the psychiatric survivors, unless their claims could be confirmed by the psychiatrist involved.  My response to Dr. Pies is here.

. . . . . . . . . . . . . . . .

“On the one hand, medical side effects are real and patients sometimes feel too uncomfortable to speak up with or feel otherwise unheard by their treating clinicians.”

Adverse effects of psychiatric drugs are indeed real and are frequently permanent and devastating.  But we have heard too many reports from people who say they were never informed of these possibilities, to go on assuming that they must all be mistaken or deceptive.  I have personally heard several psychiatrists express the belief that one can’t provide full informed consent to “mentally ill” patients because they wouldn’t understand the issues and would never take the drugs!

Joseph Glenmullen, MD, in his book Prozac Backlash (2000), reports hearing a leading psycho-pharmacologist at a Harvard conference state:

“‘You can’t tell patients whom you’re giving something that’s supposed to help them that it may poison them.’”  He insisted, “‘We have to put the best face on our treatments.’” (p 62)

And, of course, to compound the matter further, we have the practice of covert or concealed medication, which is not uncommon.

But there’s also a deeper issue here.

“…patients sometimes feel too uncomfortable to speak up with or feel otherwise unheard by their treating clinicians.”

This is a truly extraordinary admission on the part of the authors.  But they don’t even seem to notice.  They don’t bother to ask whyWhy do “patients” feel too uncomfortable to speak up?  Why do “patients” feel unheard by their psychiatrists?  Isn’t helping clients to feel “comfortable” an inherent requirement of the job?  Isn’t it also an inherent part of the job to make sure that clients are being heard, and that they feel that they are being heard and that their concerns are being taken seriously?

And then, more condescending arrogance:

“The internet provides a useful outlet to vent feelings of anger and resentment and to seek camaraderie from people with similar experiences.”

So people who have been abused and damaged by psychiatry resort to the Internet just to vent their feelings and to seek camaraderie!  There, there.  Have a good rant.  It will make you feel better.  Wake up, Drs. Stea, Black, and Pierre!  People who have been damaged by psychiatry go to the Internet to find the help that psychiatry, with its cookie-cutter “treatments”, spurious diagnoses, coerced “treatment”, and its rampant deceptions failed to provide.  And for the most part, they seem to find more help there than they ever found from psychiatry.

“Generalizing criticism from one medication or one interaction to all of psychiatry invalidates the benefits that many people derive from psychiatric care and that psychiatrists witness in clinical practice.”

Are Drs. Stea et al seriously under the impression that the criticism that anti-psychiatry directs towards psychiatry is based on one medication or one interaction?  If not, then why do they seek to muddy the waters with such a patently false description?

“While human beings tend to see subjective, lived experience as an irrefutable reality as well as a source of great meaning, psychiatrists – perhaps more than anyone – know that subjective perceptions are biased and often wrong.”

This stuff keeps getting worse.  Is there no end to their self-serving arrogance and condescension?

“…human beings tend to see subjective, lived experience as an irrefutable reality as well as a source of great meaning…” [Emphasis added]


“…psychiatrists – perhaps more than anyone – know that subjective perceptions are biased and often wrong.”

It is clear that Drs. Stea et al are placing themselves above the rest of us human beings because they (not being human beings?) know – perhaps more than anyone – that subjective perceptions are biased and often wrong.

So, setting aside the arrogance, let’s take a look at a common subjective experience routinely reported by most psychiatrists – i.e.. that their “diagnoses” and “treatments” are routinely helpful and effective.  They don’t as a matter of routine subject this flattering assertion to rigorous scientific scrutiny.  In fact, I have never encountered a psychiatrist who did this, or even considered it an important matter.  Instead, they go through the med-check never entertaining the possibility that the person sitting across the desk is being damaged by the drugs or the shocks or by the TMS.  If the “patient” complains, of course, they might take note, but as the authors earlier made clear, “…patients sometimes feel too uncomfortable to speak up with or feel otherwise unheard by their treating clinicians.”  So relying on “patient” feedback, helpful as it might be, is no substitute for genuine scientific feedback.

I once discussed these matters with a psychiatrist.  I asked him about the need for feedback, particularly as to the progress made by people who had been assigned a “diagnosis” of “schizophrenia”.  His reply was:

“I learned in psychiatry school that schizophrenia is an incurable, progressive disease.  I don’t expect them to get better.”

And, of course, they didn’t, largely because the psychiatrist continued to prescribe high doses of neuroleptic drugs, and continued to commit the clients involuntarily to the State “Hospital” once or twice a year.

No, Drs. Stea et al, psychiatrists are almost totally oblivious of their own biases and the effects these biases have on their misguided efforts to help people in distress.

“The scientific method is an antidote to that bias, with truth being determined by repeated, objective, and controlled observations and experiments.”

This is absolutely true, but only if the experiments are free from contamination from pharma money, and the results are reported honestly and without partisan massaging, none of which conditions apply to a great deal of psychiatric research.

“The inherent tension between objective assessment and subjective experience risks invalidating lived experience unless negotiated carefully and compassionately outside of a therapeutic relationship.”

This statement is not entirely clear.  Presumably the contention is that psychiatrists’ assessments are “objective” and therefore valid, while those of the damaged clients are “subjective” and therefore invalid.  But, the authors tell us, the inherent tension between these poles needs to be “negotiated carefully and compassionately outside of a therapeutic relationship.”  I can’t fathom the significance of the phrase “outside of a therapeutic relationship”, but I’m pretty sure that most of the people who have been damaged by psychiatry don’t want their care and compassion.  They just want them to stop damaging people!

And let’s go back to the notion that psychiatric assessments are objective and therefore unbiased.  The fact is that the unspoken purpose of most psychiatric assessment is to produce a “diagnosis” that will justify enrolling a client for “treatment”.  The criteria for the “diagnoses” are ridiculously vague and very fudgeable.  But even beyond that, the DSM encourages such fudging.  Here’s a quote from DSM-IV’s Introduction:

“…the exercise of clinical judgment may justify giving a certain diagnosis to an individual even though the clinical presentation falls just short of meeting the full criteria for the diagnosis as long as the symptoms that are present are persistent and severe.” (p xxiii)

So, if the criteria require five out of nine items, four is OK.  Why?  Because we psychiatrists say so.  We created the system, so we can change it at will.

This is followed immediately by:

“On the other hand, lack of familiarity with DSM-IV or excessively flexible and idiosyncratic application of DSM-IV criteria or conventions substantially reduces its utility as a common language for communication.” (same page)

Note the final phrase: “reduces its utility as a common language for communication.”  The manual does not say that this kind of flexibility should be avoided.  In other words – it’s OK for psychiatrists to “fudge” their “diagnoses”.  Lack of familiarity with DSM or excessively flexible or even idiosyncratic application of the criteria or conventions – none of that matters.  Just assign the diagnosis and write the scrip – next please!

In DSM-5, the message is repeated with some alterations:

“When full criteria [for a diagnosis] are not met, clinicians should consider whether the symptom presentation meets criteria for an “other specified” or “unspecified” designation.” (p 21)

In other words, psychiatrists can still fudge the “diagnosis” (and presumably bill insurance for the service provided), but shouldn’t try to hide what they are doing.

And if this isn’t enough to undermine psychiatry’s claim to objectivity in its assessments, let’s recall that the DSM-5 field trials yielded Kappa scores for “major depressive disorder” and “general anxiety disorder” of 0.28 (fair) and 0.20 (none to slight) respectively (here):

“Unfortunately, some patients who identify with being harmed by psychiatry have given up on finding that kind of relationship and instead attempt to find meaning in identity as an injured party.”

Note the phrase “who identify with being harmed by psychiatry”.  Why not simply say people who have been harmed by psychiatry?  Use of the predicate identify with implies that the allegations of harm are just allegations that can’t be trusted.  Are Drs. Stea et al really doubting that there are vast numbers of individuals worldwide who have been harmed by psychiatry?

“…have given up on finding that kind of relationship…”

Yes, Dear Doctors, many of those damaged by psychiatry have given up on the possibility of finding a careful and compassionate helping relationship with a psychiatrist.  And those that haven’t may find the content and condescending tone of your article sufficient to tip them over that particular edge.

“It might be said that the Achilles’ heel of modern anti-psychiatry lies in its inevitable conflation of scientific scrutiny with moralistic criticism.”

Inevitable conflation.  Wrong again doctors.  I critique psychiatry on scientific grounds largely because most of its studies, papers, practice guides, and research are based on junk science.  On my website, you will find numerous posts where I’ve critiqued psychiatric research on scientific grounds.  But I also criticize psychiatry on moralistic grounds, because I have seen first hand the damage that they have caused, and it engenders within me, as I think it would in most people, feelings of moral outrage.

For instance, in my experience, the vast majority of the general public in America (and probably elsewhere) still believe that tardive dyskinesia and akathisia are symptoms of “mental illness” rather than the effects of psychiatric drugs.  The fact that psychiatrists have done nothing to correct this misperception is a moral outrage.  It would be a simple matter for the APA to take out full-page ads in every major newspaper in the country acknowledging the cause of this stigmatizing affliction.  But they have never taken any such step, and there’s no indication of any plans or readiness in that direction.  Instead, they conveniently lay the blame for the stigma on those of us who dare to criticize their self-serving and destructive practices.

“This is no doubt an unfortunate result of many within the anti-psychiatry movement feeling excluded from the ‘inner circle’ of scientific self-scrutiny, so that moralistic criticism seems like the only option.”

So, our putative inability to distinguish scientific from moral criticism is no doubt the result of our feeling excluded “from the ‘inner circle’ of scientific self-scrutiny”.  The inner circle to which Drs. Stea et al and presumably most, or perhaps all, psychiatrists belong.

“It is easy to be a critic, especially when one has a bone to pick.”

Actually, to be a conscientious critic on general scientific or moral issues is not that easy.  But critiquing material like the piece to hand is like shooting fish in a barrel.

“Anti-psychiatry rhetoric distracts from legitimate criticisms of psychiatry: over-diagnosis related to insurance reimbursement, over-prescribing to the exclusion of psychosocial therapies, and the profit-driven influence of ‘Big Pharma.’”

So there are legitimate criticisms of psychiatry.  They are “over-diagnosis related to insurance reimbursement”, “over-prescribing” to the exclusion of psychosocial therapies, and “the profit-driven influence of ‘Big Pharma’”.

“In fact, such perils are healthcare system issues that most psychiatrists would love to see change.”

Well I have a few very simple suggestions:

  1. Stop over-diagnosing, the correct name for which, incidentally, is insurance fraud, and write off the disallowed insurance claims as pro-bono.
  2. Stop over-prescribing to the exclusion of psychosocial therapies.  There is nothing to prevent a psychiatrist from reducing his/her med-check activity to zero and becoming a full-time psychotherapist.  But most baulk at this because their remuneration will be about a quarter of what they can make as pill-pushers, if that.  Besides, most of the psychiatrists I’ve encountered would probably make very poor therapists.  One of the fundamental requirements of a therapist is an abiding sense of respect for his/her clients, a quality which Drs. Stea et al have not demonstrated to any marked degree in this paper.
  3. Stop taking pharma money, and stop seeing pharma reps, with their corrupting sample-bag.  Get your information on pharma products from peer reviewed research instead of the 6-week pharma-funded trials.  Oh, hang on!  The six-week pharma-funded trials are peer reviewed.  Well, just keep them at arms length.

. . . . . . . . . . . . . . . .

“…ethical psychiatric care helps people.”

This is essentially tautologous.  The question is: what proportion of psychiatrists practice ethical care?  We know that a great many are continuing to spread the chemical imbalance disinformation.

“Well-trained psychiatrists remain vigilant about over-diagnosis and over-treatment; they are patient-centered and evidence-based; they practice conservative prescribing and de-prescribing when appropriate; and they constantly preach ‘skills over pills’! Unethical care, out-of-date diagnostic considerations, and poorly informed, consented, and followed-up medication use are quite certainly the common enemies of psychiatry and anti-psychiatry, and there could be common ground shared in the volatile space that separates them.”

Well, Drs. Stea, Black, and Pierre, this is all well and good, but until I hear from a large representative sample of clients on this matter, I have no reason to afford these self-flattering assertions of yours much credibility.  But they do inspire me to offer another humble suggestion for dealing with the practitioners of unethical care, out-of-date diagnostic considerations, and poorly informed, consented, and followed-up “medication” use:  call them out.  Name the psychiatrists who practice unethical care; use out-of-date diagnoses; don’t obtain truly informed consent; don’t follow-up as necessary, etc.  Call them out.  Report them to the appropriate licensing authorities.  To allege the existence of such scalawags while allowing them to remain hidden and protected by guild secrecy is to share in their guilt!

“Ultimately, the under-recognized harm of anti-psychiatry rhetoric is the stigmatization of people who experience psychiatric disorders and its treatment, which can translate to compromised patient care.”

I don’t know whether to laugh or cry!  Far from being under recognized, this particular accusation is leveled at the anti-psychiatry movement by virtually every psychiatrist who lifts his/her pen against us.  But in fact, it’s not we who have caused the stigma – it is psychiatry.  They did this in two stages.  Firstly, by locking their victims up and subjecting them to the most appalling atrocities, they convinced the general public that people with “mental illnesses” were dangerous, almost sub-human – a stigma that has never receded.  Then, as the drugs came on line, and psychiatry pushed the chemical imbalance nonsense, the image of brain-damaged mad people, chemically-placated by drugs, followed the survivors from the “hospitals”, and persists to this day.  See Brett Deacon’s article on this topic:  The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research (2013).

“Psychiatry is far from a perfect science…”

Well we agree on one thing, because it’s not a science at all.  Its basic underlying concept “mental illness” is a meaningless assumption which can be (and is at every DSM revision) expanded at will by the consensus of an APA committee.

Consider the hypothetical conversation:

Wife:               Why is my husband so downcast?  Why does he not want to do anything? Why won’t he eat?  Why is he always tired?  Why does he keep talking about death?

Psychiatrist:     Because he has an illness called major depressive disorder.

Wife:               How do you know he has this illness?

Psychiatrist:     Because he is so downcast; he does not want to do anything; he won’t eat; he is always tired; and he keeps talking about death.

In other words, the only evidence for the “illness” are the behaviors that it purports to explain.  This applies to all psychiatric functional diagnoses, and is nothing short of chicanery and fraud.


The only real effect of the Stea et al article is to confirm what we already know – that there is no possibility of ever reaching any kind of accommodation or agreement with psychiatry on anything.  The only suggestion I can offer to psychiatrists is to cut their losses and get out.  Become real doctors again.  You may have to take a few refresher courses, or even work ER’s for a while, but you will sleep better and will start to feel like you are doing something worthwhile.  Money isn’t everything.

The notion that one can help a despondent person by giving him or her mood-altering drugs, while systematically ignoring the reason for his/her despondency is a travesty of a helping profession.







Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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