reviewed by Mira de Vries
Corruption is encouraged by the
"twin economies of influence" namely the
alliance between psychiatrists and drug
companies. This mantra recurs throughout the
book. "Research on implicit biases and cognitive
dissonance explains why conflicts of interest
may bias research." The authors studied this
issue for a year at Harvard's Edmond J. Safra
Center for Ethics which is called a lab for the
study of institutional corruption.
Psychiatrists, as the authors bemoan, tend to
attack their critics personally rather than
refute arguments, so perhaps the Harvard
backdrop is intended as a defense against this
type of attack. You and I don't need to spend a
year of research at a university to know that
financial interests cause bias.
The book is well organized and written in
language that is clear and businesslike. Beyond
that it has major flaws.
Firstly, it tells us nothing new. The bias that
informs psychiatry is well-known. Hundreds of
books and thousands of articles have been
written about it. Whitaker himself has written
two fine books on the subject. Whoever hasn't
read at least one of them is unlikely to read
this one either.
Secondly, bias is endemic to all of medicine,
not unique to psychiatry. The authors explain:
"In other areas of medicine, diagnoses may be
bounded by nature, with biological markers
helping to distinguish between disease states,
but in psychiatry they are fungible..." What is
fungible, the diagnoses, the biological markers,
or the disease states? Perhaps they mean
fudgable? Or fabricatable?
Anyway, they are wrong. In the absence of
biological markers, diagnoses are illegitimate
A legitimate diagnosis requires the presence of
an objectively observable pattern which makes it
possible to prove or disprove an abnormal state.
Without this quality there is no science. And
without science there is no medicine. "In
psychiatry, there are no biological markers that
separate a patient with a 'disease' from someone
without it." So fungible, fudgable, or
fabricatable, the diagnoses are fake.
The authors state that "from a scientific
standpoint, psychiatry is clearly facing a
legitimacy crisis." Clearly it is not. From "a
scientific standpoint" nothing has changed.
Psychiatry has in its 250+ year history never
been legitimate yet it sits more firmly in the
saddle now than ever, with more power, more
money, more practitioners, more clients, more
pseudo-diagnoses, more drugs, and
proportionately fewer critics.
Furthermore, the authors contradict themselves
by suggesting precisely the presence of
biological markers when quoting "Imaging studies
have shown that there is an integration of
cognitive processes with emotion-processing
areas of the brain such as the hippocampus and
amygdala" and "In functional magnetic resonance
imaging (fMRI) experiments of brain activity
during dissonant settings ... 'the
reasoning areas of the brain virtually shut
They are speaking about the brains of people
with biases, not people with psychiatric
diagnoses. Nonetheless, this type of biobabble
only serves to pull the wool over the public's
eyes. Brain imaging for anything more than
tumors and clots is but high-tech phrenology.
Such images cannot show thought. Besides, how
much reasoning can a person do with his head
stuck in an MRI scanner?
In the final chapter we discover that the
authors do not deliver the "prescriptions for
reform" promised by the subtitle. The medical
model of psychiatry needs to be reconsidered,
they propose. This is silly. There cannot be any
other model. Psychiatry is by definition
medical. If it isn't legitimate it should be
abolished, not reconsidered. Even sillier is "it
is necessary for society to fundamentally
rethink psychiatry's authority over psychiatric
care." What else would have authority over it?
The authors' proposal to involve "a broad
collection of people: psychiatrists,
psychologists, social workers, philosophers of
the mind, sociologists, and so forth" is far
from revolutionary. Minus the philosophers (no
poets?) these are precisely the professionals
the mental health industry has been employing
for decades. It changes nothing except that the
smokescreen is even less penetrable.
Then, after an entire book dedicated to
persuading the reader that psychiatric
medications are never effective and always
harmful, they propose, "Remedies for ...
psychological difficulties might include the
selective use of psychiatric drugs..." Why? What
is selective use? How would those drugs suddenly
become effective and safe, justifying their
The reference to "psychological difficulties" as
though those are the only difficulties that
psychiatry is asked to deal with was probably
written by Cosgrove who is a psychologist by
profession. Whitaker is a journalist.
The book's biggest flaw is that it constantly
refers to "twin economies of influence" where
there should be triplets
. The missing
sibling is clients
. Without clients,
psychiatry cannot exist. There are two types:
indirect and direct.
Indirect clients (my term) are those who, aided
and abetted by law and courts and at the expense
of insurers or taxpayers, use psychiatry to
dispose of annoying or unwanted persons. Said
persons are called "patients" but actually they
are prisoners. Those who cooperate to imprison
them are unconcerned about their health. They
are happy for psychiatrists to break their
brains as long as it keeps them out of their
hair. On the contrary, the pretense of medicine
is welcome for its propensity to sooth the
spasms of conscience some might have about the
gross violations of human rights.
Direct clients are the ones who seek
psychiatry's attention for themselves or a loved
one. More than gullible, they are eager to
believe that a pill will solve their emotional,
social, or existential problems. They are not
asking for effectiveness or safety. They are
asking for (false) hope. They resemble the
customers of lotteries or schemes to lose weight
without self-restraint. And like the market for
illegal drugs, as long as demand remains high,
supply will rise to meet it.
It appears that the prestige of Harvard
University and the science implied by a year's
study failed to alert the authors to the core
corruption of psychiatry: the triplet
of influence that conceal psychiatry's being
thanks Dr. Robert Yoho for donating this
book to our library.