Psychiatry under the Influence

Institutional corruption, social injury, and prescriptions for reform

Robert Whitaker and Lisa Cosgrove
2015, 2018

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 down.'"

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 prescription?

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 economies of influence that conceal psychiatry's being scam medicine.

MeTZelf thanks Dr. Robert Yoho for donating this book to our library.

Copyright MeTZelf