Psychiatry
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.
Initial psych ...
is, and has historically been, viewed as controversial by those under its care, as well as some sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis,
the use of diagnosis and treatment for social and political control including
detaining citizens and
treating them without consent, the side effects of treatments such as
electroconvulsive therapy
Electroconvulsive therapy (ECT) is a psychiatry, psychiatric treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage refractory mental disorders.Rudorfer, MV, Henry, ME, Sackeim, HA (2003)"Electroco ...
,
antipsychotic
Antipsychotics, also known as neuroleptics, are a class of Psychiatric medication, psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but ...
s and historical procedures like the
lobotomy
A lobotomy, or leucotomy, is a form of neurosurgical treatment for psychiatric disorder or neurological disorder (e.g. epilepsy) that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections to ...
and other forms of
psychosurgery
Psychosurgery, also called neurosurgery for mental disorder (NMD), is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under th ...
or
insulin shock therapy
Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks.Neustatter WL (1948) ''Modern psychiatry ...
, and the history of racism within the profession in the United States.
In addition, there are a number of groups who are either critical towards psychiatry or entirely hostile to the field. The
Critical Psychiatry Network The Critical Psychiatry Network (CPN) is a psychiatric organization based in the United Kingdom. It was created by a group of British psychiatrists who met in Bradford, England in January 1999 in response to proposals by the British government to a ...
is a group of psychiatrists who are critical of psychiatry. Additionally, there are self-described psychiatric survivor groups such as
MindFreedom International
MindFreedom International is an international coalition of over one hundred grassroots groups and thousands of individual members from fourteen nations. Based in the United States, it was founded in 1990 to advocate against Involuntary treatment, ...
and religious groups such as
Scientologists
Scientology is a set of beliefs and practices invented by American author L. Ron Hubbard, and an associated movement. It has been variously defined as a cult, a Scientology as a business, business, or a new religious movement. The most recent ...
that are critical towards psychiatry.
Challenges to conceptions of mental illness
![Narrenturm Vienna June 2006 575](https://upload.wikimedia.org/wikipedia/commons/5/57/Narrenturm_Vienna_June_2006_575.jpg)
Since the 1960s there have been challenges to the concept of
mental illness
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
. Sociologists
Erving Goffman
Erving Goffman (11 June 1922 – 19 November 1982) was a Canadian-born sociology, sociologist, Social psychology (sociology), social psychologist, and writer, considered by some "the most influential American sociologist of the twentieth ...
and
Thomas Scheff argued that mental illness was merely another example of how society labels and controls non-conformists,
behavioral psychologists challenged psychiatry's fundamental reliance on unobservable phenomena, and gay rights activists criticized the APA's inclusion of homosexuality as a mental disorder in the
DSM
DSM or dsm may refer to:
Science and technology
* Deep space maneuver
* Design structure matrix or dependency structure matrix, a representation of a system or project
* Diagnostic and Statistical Manual of Mental Disorders
** DSM-5, the fifth ed ...
. As societal views on homosexuality have changed in recent decades, it is no longer considered a mental illness and is more widely accepted by society. As another example that challenged conceptions of mental illness, a widely publicized study by
Professor David Rosenhan, known as
the Rosenhan experiment, was viewed as an attack on the efficacy of psychiatric diagnosis.
Medicalization
Medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evid ...
, a concept in
medical sociology
Medical sociology is the sociological analysis of medical organizations and institutions; the production of knowledge and selection of methods, the actions and interactions of healthcare professionals, and the social or cultural (rather than clin ...
, is the process by which human conditions and problems come to be defined and treated as
medical conditions
A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medica ...
, and thus become the subject of medical study, diagnosis,
prevention
Prevention may refer to:
Health and medicine
* Preventive healthcare, measures to prevent diseases or injuries rather than curing them or treating their symptoms
General safety
* Crime prevention, the attempt to reduce deter crime and crimi ...
, or treatment. Medicalization can be driven by new evidence or hypotheses about conditions, by changing social attitudes or economic considerations, or by the development of new medications or treatments.
For many years, several psychiatrists, such as
David Rosenhan
David L. Rosenhan (; November 22, 1929 – February 6, 2012) was an American psychologist. He is best known for the Rosenhan experiment, a study challenging the validity of psychiatry diagnoses.
Biography
Rosenhan received his Bachelor of Arts d ...
,
Peter Breggin
Peter Roger Breggin (born May 11, 1936) is an American psychiatrist and critic of shock treatment and psychiatric medication and Covid-19 response. In his books, he advocates replacing psychiatry's use of drugs and electroconvulsive therapy with ...
,
Paula Caplan
Paula Joan Caplan (July 7, 1947 – July 21, 2021) was an American psychologist, activist, writer, and artist. She was an associate at Harvard University's DuBois Institute, director of the Voices of Diversity Project, and a past Fellow at the ...
,
Thomas Szasz
Thomas Stephen Szasz ( ; hu, Szász Tamás István ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate M ...
, and critics outside the field of psychiatry, such as
Stuart A. Kirk, have "been accusing psychiatry of engaging in the systematic medicalization of normality".
More recently these concerns have come from insiders who have worked for the
APA themselves (e.g.,
Robert Spitzer,
Allen Frances
Allen J. Frances (born 2 October 1942) is an American psychiatrist. He is currently Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. He is best known for serving as cha ...
).
For example, in 2013, Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".
The concept of medicalization was devised by sociologists to explain how medical knowledge is applied to behaviors which are not self-evidently medical or biological.
The term ''medicalization'' entered the sociology literature in the 1970s in the works of
Irving Zola
Irving Kenneth Zola (1935–1994) was an American activist and writer in medical sociology and disability rights.
Early life and education
Irving Kenneth Zola, born in 1935, in Newton, Massachusetts. He came from a working class Jewish family. ...
,
Peter Conrad, and
Thomas Szasz
Thomas Stephen Szasz ( ; hu, Szász Tamás István ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate M ...
, among others. These sociologists viewed medicalization as a form of social control in which medical authority expanded into domains of everyday existence, and they rejected medicalization in the name of liberation. This critique was embodied in works such as Conrad's "The discovery of hyperkinesis: notes on medicalization of deviance", published in 1973 (
hyperkinesis was the term then used to describe what we might now call
ADHD
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inapp ...
), and Szasz's "
The Myth of Mental Illness
''The Myth of Mental Illness: Foundations of a Theory of Personal Conduct'' is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticizes psychiatry and argues against the concept of mental illness. It received much publicity, an ...
."
These sociologists did not believe medicalization to be a new phenomenon, arguing that medical authorities had always been concerned with social behavior and traditionally functioned as agents of social control (Foucault, 1965; Szasz, 1970; Rosen). However, these authors took the view that increasingly sophisticated technology had extended the potential reach of medicalization as a form of social control, especially in terms of "psychotechnology" (Chorover, 1973).
In the 1975 book ''Limits to medicine: Medical nemesis'' (1975),
Ivan Illich
Ivan Dominic Illich ( , ; 4 September 1926 – 2 December 2002) was an Austrian Roman Catholic priest, theologian, philosopher, and social critic. His 1971 book '' Deschooling Society'' criticises modern society's institutional approach to edu ...
put forth one of the earliest uses of the term "medicalization". Illich, a philosopher, argued that the medical profession harms people through
iatrogenesis
Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 27 ...
, a process in which illness and social problems increase due to medical intervention. Illich saw iatrogenesis occurring on three levels: the ''clinical'', involving serious
side effects
In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequence ...
worse than the original condition; the ''social'', whereby the general public is made docile and reliant on the medical profession to cope with life in their society; and the ''structural'', whereby the idea of aging and dying as medical illnesses effectively "medicalized" human life and left individuals and societies less able to deal with these natural processes.
Marxist
Marxism is a Left-wing politics, left-wing to Far-left politics, far-left method of socioeconomic analysis that uses a Materialism, materialist interpretation of historical development, better known as historical materialism, to understand S ...
s such as
Vicente Navarro
Vicente is an Italian, Spanish, and Portuguese name. Like its French variant, Vincent, it is derived from the Latin name ''Vincentius'' meaning "conquering" (from Latin ''vincere'', "to conquer").
Vicente may refer to:
Location
*São Vicente, Cap ...
(1980) linked medicalization to an oppressive
capitalist
Capitalism is an economic system based on the private ownership of the means of production and their operation for profit. Central characteristics of capitalism include capital accumulation, competitive markets, price system, priva ...
society. They argued that medicine disguised the underlying causes of disease, such as
social inequality
Social inequality occurs when resources in a given society are distributed unevenly, typically through norms of allocation, that engender specific patterns along lines of socially defined categories of persons. It posses and creates gender c ...
and poverty, and instead presented health as an individual issue. Others examined the power and prestige of the medical profession, including use of terminology to mystify and of professional rules to exclude or subordinate others.
Some argue that in practice the process of medicalization tends to strip subjects of their social context, so they come to be understood in terms of the prevailing biomedical
ideology
An ideology is a set of beliefs or philosophies attributed to a person or group of persons, especially those held for reasons that are not purely epistemic, in which "practical elements are as prominent as theoretical ones." Formerly applied pri ...
, resulting in a disregard for overarching social causes such as unequal distribution of power and resources. A series of publications by
Mens Sana Monographs
The ''Mens Sana Monographs'' is a peer-reviewed open-access monographic series of mental and physical medicine. It is published by Medknow Publications on behalf of the Mens Sana Research Foundation. Every volume is also published as a book, wit ...
have focused on medicine as a
corporate
A corporation is an organization—usually a group of people or a company—authorized by the state to act as a single entity (a legal entity recognized by private and public law "born out of statute"; a legal person in legal context) and re ...
capitalist enterprise.
Political abuse
In unstable countries, political prisoners are sometimes confined and abused in mental institutions.
The diagnosis of mental illness allows the state to hold persons against their will and insist upon therapy in their interest and in the broader interests of society.
In addition, receiving a psychiatric diagnosis can in and of itself be regarded as oppressive.
In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials.
The use of hospitals instead of jails prevents the victims from receiving legal aid before the courts, makes indefinite incarceration possible, and discredits the individuals and their ideas.
In that manner, whenever open trials are undesirable, they are avoided.
Examples of political abuse of the power, entrusted in physicians and particularly psychiatrists, are abundant in history and seen during the Nazi era and the
Soviet
The Soviet Union,. officially the Union of Soviet Socialist Republics. (USSR),. was a List of former transcontinental countries#Since 1700, transcontinental country that spanned much of Eurasia from 1922 to 1991. A flagship communist state, ...
rule when political dissenters were labeled as "mentally ill" and subjected to inhumane "treatments."
In the period from the 1960s up to 1986, abuse of psychiatry for political purposes was reported to be systematic in the Soviet Union, and occasional in other Eastern European countries such as
Romania
Romania ( ; ro, România ) is a country located at the crossroads of Central Europe, Central, Eastern Europe, Eastern, and Southeast Europe, Southeastern Europe. It borders Bulgaria to the south, Ukraine to the north, Hungary to the west, S ...
,
Hungary
Hungary ( hu, Magyarország ) is a landlocked country in Central Europe. Spanning of the Carpathian Basin, it is bordered by Slovakia to the north, Ukraine to the northeast, Romania to the east and southeast, Serbia to the south, Croatia a ...
,
Czechoslovakia
, rue, Чеськословеньско, , yi, טשעכאסלאוואקיי,
, common_name = Czechoslovakia
, life_span = 1918–19391945–1992
, p1 = Austria-Hungary
, image_p1 ...
, and
Yugoslavia
Yugoslavia (; sh-Latn-Cyrl, separator=" / ", Jugoslavija, Југославија ; sl, Jugoslavija ; mk, Југославија ;; rup, Iugoslavia; hu, Jugoszlávia; rue, label=Pannonian Rusyn, Югославия, translit=Juhoslavija ...
.
The practice of incarceration of political dissidents in mental hospitals in Eastern Europe and the former USSR damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community.
Political abuse of psychiatry also takes place in the
People's Republic of China
China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...
and
in Russia. Psychiatric diagnoses such as the diagnosis of '
sluggish schizophrenia
Sluggish schizophrenia or slow progressive schizophrenia (russian: вялотеку́щая шизофрени́я, translit=vyalotekushchaya shizofreniya) was a diagnostic category used in the Soviet Union to describe what was claimed to be a for ...
' in
political dissidents in the USSR were used for political purposes.
History of racism in psychiatry in the United States
The history of racism in psychiatry dates back to the days of slavery and segregation in the United States. Such racism in psychiatry exemplifies the concept of
scientific racism
Scientific racism, sometimes termed biological racism, is the pseudoscience, pseudoscientific belief that empirical evidence exists to support or justify racism (racial discrimination), racial inferiority, or racial superiority.. "Few tragedies ...
, which falsely alleges that science and other empirical evidence supports racism and proves certain racial inferiorities.
Diagnosis
Psychiatric diagnoses were influenced by Black people's status as free or enslaved. Enslaved people were not considered civilized enough to be diagnosed with insanity, while free Black people were over-diagnosed with insanity, having much higher diagnosis rates than white people.
Specific diagnoses in the 19th century were crafted specifically to fit Black people –
drapetomania
Drapetomania was a supposed mental illness that, in 1851, American physician Samuel A. Cartwright hypothesized as the cause of enslaved Africans fleeing captivity. This hypothesis centered around the belief that slavery was such an improvement up ...
and
dyaesthesia aethiopica, disorders meant to explain why slaves ran away and why they were lazy or lacked a strong work ethic, respectively, and justify the institution of slavery.
Prominent political figures such as
John C. Calhoun used this supposed evidence to argue for slavery, arguing that free Black people could not be entrusted with their lives and would ultimately develop lunacy.
All in all, throughout the 19th century, psychiatric diagnoses and scientifically racist theories were used to medicalize Blackness and uphold systems of slavery and racism, further constraining the rights, freedom, and humanity of Black people.
Scientific racism
Proponents of scientific racism have historically attempted to "prove" that Black people are physiologically and cognitively inferior to white people based on faulty assumptions and prejudices. Perpetuated by the inaccurate application of biodeterminism, specialists in neuroanatomy and psychiatry compared disproportionate numbers of brains from Black and white individuals to support their racial agendas based on "science."
Compulsory Sterilization
The proportion of Black individuals confined in establishments for "flawed and imbecile" patients increased throughout the late 19th and early 20th century.
Psychiatry contributed towards the inaccurate and racist belief that if they were left to their respective means, they would not be able to remain in decent condition.
At the beginning of the 20th century, Black people were disproportionally sterlized in
eugenics
Eugenics ( ; ) is a fringe set of beliefs and practices that aim to improve the genetic quality of a human population. Historically, eugenicists have attempted to alter human gene pools by excluding people and groups judged to be inferior or ...
programs that
compulsorarily sterilized those classed as feebleminded or who received welfare payments.
The premise that the genes of those deemed mentally ill were undesirable was used to justify sterilization which was frequently supervised by physicians, including psychiatrists.
Hospitals
Segregation within mental institutions and hospitals is another example of the history of racism within psychiatry. Many psychiatric hospitals in the 19th century either excluded or segregated Black patients or admitted Black slaves to work at the hospital in exchange for care.
The founding fathers of psychiatry themselves supported the notion that Black people were inferior, lower class citizens that must be treated separately and differently from white patients.
With time, racial segregation within hospitals became interspersed with entirely separate hospitals for white and Black patients, each with differential treatment and quality of care. Political figures in the post-Civil War era argued that emancipation had led to a significant increase in insanity cases amongst Black individuals, and they cited the need to accommodate this increase via segregated and Black-only insane asylums.
Many hospitals, especially in the southern United States, did not admit Black patients until they were eventually mandated to do so.
The last segregated hospital opened in 1933.
Popular arguments also circulated that Black patients were more difficult to take care of in mental institutions, making psychiatric care for them more difficult and justifying the need for segregated facilities.
Until the late 1960s, many hospitals remained segregated.
This affected the experiences of racial minorities accessing psychiatric care in mental institutions and hospitals in the United States. When Lyndon B. Johnson's administration stated that no segregated hospital would receive federal Medicare funds, hospitals began to integrate quickly in order to be able to continue to access such funding.
In January 1966, around two-thirds of Southern hospitals were segregated facilities and many Northern facilities remain segregated in-effect.
One year later, by January 1967, there were very few hospitals in the United States that remained segregated. Segregation within mental institutions and hospitals is one example of the history of racism within psychiatry.
In the profession
Black psychiatrists often experienced racism as practitioners within the field. Some of this history is detailed in
Jeanne Spurlock's book titled ''Black Psychiatrists and American Psychiatry,'' published in 1999, in which she profiles Black psychiatrists who were influential in American psychiatry and their experiences in the profession''.'' During the
Civil Rights Movement
The civil rights movement was a nonviolent social and political movement and campaign from 1954 to 1968 in the United States to abolish legalized institutional Racial segregation in the United States, racial segregation, Racial discrimination ...
, Black psychiatrists expressed concerns to the APA that the needs of Black communities and Black psychiatrists were being ignored by the professional organization.
In 1969, a contingent of Black psychiatrists presented a list of 9 concerns to the APA Board of Trustees regarding experiences of structural racism in the field.
Their '9 points' represented a wide array of experiences of discrimination, both from the experiences of practitioners and patients, and on the institutional and individual level and the group demanded change from within the APA.
For example, they called for more Black leaders on APA committees as well as the desegregation of all mental health facilities, both public and private, in the United States.
As of 2020, within psychiatry, historically underrepresented groups continue to be less represented as residents, faculty, and practicing physicians in comparison to their proportion in the U.S. population.
Nature of diagnosis
Arbitrariness
Psychiatry has been criticized for its
broad range of mental diseases and disorders. Which diagnoses exist and are considered valid have
changed over time depending on society's
norms. Homosexuality was considered a mental illness but due to changing attitudes, it is no longer recognised as an illness. Historic disorders that are no longer recognised include
orthorexia nervosa Orthorexia nervosa (also known as orthorexia) (ON) is a proposed eating disorder characterized by an excessive preoccupation with eating healthy food. The term was introduced in 1997 by American physician Steven Bratman, M.D. He suggested that som ...
,
sexual addiction
According to proponents of the concept, sexual addiction, also known as sex addiction, is a state characterized by compulsive participation or engagement in sexual activity, particularly sexual intercourse, despite negative consequences. The c ...
,
parental alienation syndrome
Parental alienation syndrome (PAS) is a term introduced by child psychiatrist Richard Gardner in 1985 to describe signs and symptoms he believed to be exhibited by children who have been alienated from one parent through manipulation by the othe ...
,
pathological demand avoidance, and
Internet addiction disorder
Problematic internet use or pathological internet use is generally defined as problematic, compulsive use of the internet, that results in significant impairment in an individual's function in various life domains over a prolonged period of time. ...
. New disorders include
compulsive hoarding
Compulsive behavior is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. The act is usually a small, restricted and repetitive behavior, yet not disturbing in a pa ...
and
binge eating disorder
Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFE ...
.
The act of diagnosis itself has been criticized for being arbitrary with some conditions being overdiagnosed.
Individuals may be diagnosed with a mental disorder despite having been perceived as having no issues with their behavior. In Virginia, U.S., it was found up to 33% of white boys are diagnosed with ADHD leading to alarm in the medical community.
Thomas Szasz
Thomas Stephen Szasz ( ; hu, Szász Tamás István ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate M ...
argued that mental health diagnoses were used as a form of labelling violations of societies norms. Bill Fullford, introduced the idea of "value-laden" mental health diagnosis with mental health lying between physical health and a moral judgment. Under this system
personality disorder
Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...
s are seen as not very factual and very value-laden while delirium is quite factual and not very value-laden.
Biological basis
In 2013, psychiatrist
Allen Frances
Allen J. Frances (born 2 October 1942) is an American psychiatrist. He is currently Professor and Chairman Emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. He is best known for serving as cha ...
said that he believes that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".
Mary Boyle argues that psychiatry is actually the study of behavior, but acts as if it is the study of the brain based on a presumed connection between patterns of behavior and the biological function of the brain. She argues that in the case of schizophrenia it is the bizarre behavior of individuals that justifies the presumption of a biological cause for this behavior rather than the existence of any evidence.
She argues that the concept of schizophrenia and its biological basis serves a social function for psychiatrists. She views the concept of schizophrenia as necessary for psychiatry to be considered as a medical field, that the claimed biological link gives psychiatrists protection from accusations of social control, and that the belief in the biological basis for schizophrenia is maintained through
's misrepresentation of underlying data. She argues that schizophrenia and its biological basis also gives families, psychiatrists and society as a whole the ability to avoid blame for the damage they cause individuals and the ineffectiveness of treatment.
Schizophrenia diagnosis
Underlying issues associated with schizophrenia would be better addressed as a spectrum of conditions
or as individual dimensions along which everyone varies rather than by a diagnostic category based on an arbitrary cut-off between normal and ill.
This approach appears consistent with research on
schizotypy
In psychology, schizotypy is a theoretical concept that posits a continuum of personality characteristics and experiences, ranging from normal dissociative, imaginative states to extreme states of mind related to psychosis, especially schizophrenia ...
, and with a relatively high prevalence of psychotic experiences, mostly non-distressing delusional beliefs, among the general public.
In concordance with this observation, psychologist Edgar Jones, and psychiatrists
Tony David
Tony David (born 11 September 1967) is an Australian former professional darts player, who played under the nickname The Deadly Boomerang. He is the only Australian player to have been a senior singles world darts champion, having won the 200 ...
and
Nassir Ghaemi
Nassir Ghaemi (born 1966) is an academic psychiatrist, author, and Professor of Psychiatry at Tufts University School of Medicine in Boston. He has written several books on mental illness and mood disorders, and has contributed to many scientifi ...
, surveying the existing literature on delusions, pointed out that the consistency and completeness of the definition of delusion have been found wanting by many; delusions are neither necessarily fixed nor false, and need not involve the presence of incontrovertible evidence.
Nancy Andreasen
Nancy Coover Andreasen (born November 11, 1938) is an American neuroscientist and neuropsychiatrist. She currently holds the Andrew H. Woods Chair of Psychiatry at the Roy J. and Lucille A. Carver College of Medicine at the University of Iowa.
...
has criticized the current DSM-IV and ICD-10 criteria for sacrificing diagnostic
validity
Validity or Valid may refer to:
Science/mathematics/statistics:
* Validity (logic), a property of a logical argument
* Scientific:
** Internal validity, the validity of causal inferences within scientific studies, usually based on experiments
** ...
for the sake of artificially improving
reliability
Reliability, reliable, or unreliable may refer to:
Science, technology, and mathematics Computing
* Data reliability (disambiguation), a property of some disk arrays in computer storage
* High availability
* Reliability (computer networking), a ...
. She argues that overemphasis on psychosis in the diagnostic criteria, while improving diagnostic reliability, ignores more fundamental cognitive impairments that are harder to assess due to large variations in presentation.
This view is supported by other psychiatrists.
In the same vein,
Ming Tsuang
Ming Tso Tsuang (; born 1931 in Tainan, Taiwan) is an American psychiatrist and Distinguished Professor of Psychiatry at the University of California, San Diego. He is considered a pioneering researcher in the genetic epidemiology of schizophrenia ...
and colleagues argue that psychotic symptoms may be a common end-state in a variety of disorders, including schizophrenia, rather than a reflection of the specific etiology of schizophrenia, and warn that there is little basis for regarding DSM's operational definition as the "true" construct of schizophrenia.
Neuropsychologist Michael Foster Green went further in suggesting the presence of specific
neurocognitive deficit
Neurocognitive functions are cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain, ultimately served by the substrate of the brain's neurological matrix (i.e. at the cellular a ...
s may be used to construct
phenotypes
In genetics, the phenotype () is the set of observable characteristics or traits of an organism. The term covers the organism's morphology or physical form and structure, its developmental processes, its biochemical and physiological proper ...
that are alternatives to those that are purely symptom-based. These deficits take the form of a reduction or impairment in basic psychological functions such as
memory
Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remembered, ...
,
attention
Attention is the behavioral and cognitive process of selectively concentrating on a discrete aspect of information, whether considered subjective or objective, while ignoring other perceivable information. William James (1890) wrote that "Atte ...
,
executive function
In cognitive science and neuropsychology, executive functions (collectively referred to as executive function and cognitive control) are a set of cognitive processes that are necessary for the cognitive control of behavior: selecting and succe ...
and
problem solving
Problem solving is the process of achieving a goal by overcoming obstacles, a frequent part of most activities. Problems in need of solutions range from simple personal tasks (e.g. how to turn on an appliance) to complex issues in business an ...
.
The exclusion of affective components from the criteria for schizophrenia, despite their ubiquity in clinical settings, has also caused contention. This exclusion in the DSM has resulted in a "rather convoluted" separate disorder—
schizoaffective disorder
Schizoaffective disorder (SZA, SZD or SAD) is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis is made when the person has symptoms of both schizophrenia (usually psychosis) and a mood disorder: ...
.
Citing poor
interrater reliability
In statistics, inter-rater reliability (also called by various similar names, such as inter-rater agreement, inter-rater concordance, inter-observer reliability, inter-coder reliability, and so on) is the degree of agreement among independent obse ...
, some psychiatrists have totally contested the concept of schizoaffective disorder as a separate entity.
The categorical distinction between mood disorders and schizophrenia, known as the
Kraepelinian dichotomy
The Kraepelinian dichotomy is the division of the major endogenous psychoses into the disease concepts of dementia praecox, which was reformulated as schizophrenia by Eugen Bleuler by 1908, and manic-depressive psychosis, which has now been recon ...
, has also been challenged by data from genetic epidemiology.
Jonathan Metzl
Jonathan Michel Metzl (born December 12, 1964) is an American psychiatrist and author. He is the Frederick B. Rentschler II Professor of Sociology and Psychiatry at Vanderbilt University, where he is also Director of the Center for Medicine, Heal ...
, in his book ''
The Protest Psychosis,'' argues that the
Ionia State Hospital
Michigan State Asylum may refer to any number of early mental institutions in the state. Michigan became a state in 1837 and five years later accepted that the principal caring for the mentally afflicted was a state problem. In 1848 a joint resolut ...
in Ionia, Michigan disproportionately diagnosed African Americans with schizophrenia because of their civil rights activism.
ADHD
ADHD, its diagnosis, and its treatment have been controversial since the 1970s.
The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior
to the hypothesis that ADHD is a genetic condition. Other areas of controversy include the use of stimulant medications in children,
the method of diagnosis, and the possibility of overdiagnosis.
In 2012, the
National Institute for Health and Care Excellence
The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in England that publishes guidelines in four areas:
* the use of health technologies withi ...
, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.
In 2014,
Keith Conners
Carmen Keith Conners (March 20, 1933 – July 5, 2017) was an American psychologist, best known for establishing the first standards for the diagnosis of attention deficit hyperactivity disorder (ADHD).
Conners was born on March 20, 1933, in Bing ...
, one of the early advocates for recognition of the disorder, spoke out against overdiagnosis in an article in ''
The New York Times
''The New York Times'' (''the Times'', ''NYT'', or the Gray Lady) is a daily newspaper based in New York City with a worldwide readership reported in 2020 to comprise a declining 840,000 paid print subscribers, and a growing 6 million paid ...
''. In contrast, a 2014 peer-reviewed medical literature review indicated that ADHD is underdiagnosed in adults.
With widely differing rates of diagnosis across countries, states within countries, races, and ethnicities, some suspect factors other than the presence of the symptoms of ADHD are playing a role in diagnosis.
Some sociologists consider ADHD to be an example of the
medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evid ...
of deviant behavior, that is, the turning of the previously issue of school performance into a medical one.
Most healthcare providers accept ADHD as a genuine disorder, at least in the small number of people with severe symptoms.
Among healthcare providers the debate mainly centers on diagnosis and treatment in the much larger number of people with less severe symptoms.
, 8% of all United States
Major League Baseball
Major League Baseball (MLB) is a professional baseball organization and the oldest major professional sports league in the world. MLB is composed of 30 total teams, divided equally between the National League (NL) and the American League (AL), ...
players had been diagnosed with ADHD, making the disorder common among this population. The increase coincided with the League's 2006 ban on
stimulant
Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and inv ...
s, which has raised concern that some players are mimicking or falsifying the symptoms or history of ADHD to get around the ban on the use of stimulants in sport.
Treatment
Psychosurgery
Psychosurgery
Psychosurgery, also called neurosurgery for mental disorder (NMD), is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under th ...
is brain surgery with the aim of changing an individuals behavior or psychological function. Historically, this was achieved through ablative psychosurgery that removed or deliberately damaged (lesioning) a section of the brain, but more recently
deep brain stimulation
Deep brain stimulation (DBS) is a neurosurgical procedure involving the placement of a medical device called a neurostimulator, which sends electrical impulses, through implanted electrodes, to specific targets in the brain (the brain nucleu ...
is used to remotely stimulate sections of the brain.
One such practice was the
lobotomy
A lobotomy, or leucotomy, is a form of neurosurgical treatment for psychiatric disorder or neurological disorder (e.g. epilepsy) that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections to ...
, that was used between the 1930s and 1950s,
for which one its creators,
António Egas Moniz
António Caetano de Abreu Freire Egas Moniz (29 November 1874 – 13 December 1955), known as Egas Moniz (), was a Portuguese neurologist and the developer of cerebral angiography. He is regarded as one of the founders of modern psychosurgery, ...
, received a
Nobel Prize
The Nobel Prizes ( ; sv, Nobelpriset ; no, Nobelprisen ) are five separate prizes that, according to Alfred Nobel's will of 1895, are awarded to "those who, during the preceding year, have conferred the greatest benefit to humankind." Alfr ...
in 1949. The lobotomy fell out of favor in by 1960s and 1970s. Other forms of ablative psychosurgery were in use in the UK in the late 1970s to treat psychotic and mood disorders.
Bilateral cingulotomy
Bilateral cingulotomy is a form of psychosurgery, introduced in 1948 as an alternative to lobotomy. Today, it is mainly used in the treatment of depression and obsessive-compulsive disorder. In the early years of the twenty-first century, it was ...
was used to treat substance abuse disorder in Russia until 2002.
Deep brain stimulation
Deep brain stimulation (DBS) is a neurosurgical procedure involving the placement of a medical device called a neurostimulator, which sends electrical impulses, through implanted electrodes, to specific targets in the brain (the brain nucleu ...
is used in China to treat substance abuse disorders.
In the US, the lobotomy, while initially received with positivity in the late 1930s, came to be seen more negative in the late 1940s and early 1950s. ''The New York Times'' discussed the personality changes of lobotomy in 1947, and in the same year the ''
Science Digest
''Science Digest'' was a monthly American magazine published by the Hearst Corporation from 1937 through 1988.
History
''Science Digest'' was first published in January 1937 in an 8 x 5 inch digest size format of about 100 pages. ...
'' reported on papers questioning the effects of lobotomy on personality and intelligence. The lobotomy was prominently depicted a means to control nonconformity in the 1962 book ''
One Flew Over the Cuckoo's Nest''.
Psychosurgery was criticized in the US in the late 1960s and 1970s by psychiatrist
Peter Breggin
Peter Roger Breggin (born May 11, 1936) is an American psychiatrist and critic of shock treatment and psychiatric medication and Covid-19 response. In his books, he advocates replacing psychiatry's use of drugs and electroconvulsive therapy with ...
. He identified all psychosurgery with the lobotomy as a rhetorical device to criticize the practice of psychosurgery more broadly.
He stated that "psychosurgery is a crime against humanity, a crime that cannot be condoned on medical, ethical, or legal grounds". Psycho-surgeons
William Beecher Scoville and
Petter Lindström said that Breggin's critique was emotional and not based on facts.
Psychosurgery was investigated by the US Senate in the 1973 by the Health Subcommittee of the Senate's Committee on Labor and Public Welfare chaired by Senator Edward Kennedy due to growing concern about the ethical boundaries of science and medicine. At this committee Breggin argued that newer forms of psychosurgery were the same as the lobotomy since it had the same effects "emotional blunting, passivity, reduced capacity to learn" and said that psycho-surgeons "represent the greatest future threat that we are going to face for our traditional American values", arguing that if the US became a totalitarian regime lobotomy and psychosurgery would be the equivalent of the secret police. The subcommittee published a report in 1977 suggesting that data should be carefully collected about psychosurgery and that it should not be performed upon children or prisoners.
Electroconvulsive therapy
Electroconvulsive therapy
Electroconvulsive therapy (ECT) is a psychiatry, psychiatric treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage refractory mental disorders.Rudorfer, MV, Henry, ME, Sackeim, HA (2003)"Electroco ...
is a therapy method which was used widely between the 1930s and 1960s and is, in a modified form, still used today. Electroconvulsive therapy was one treatment that the anti-psychiatry movement wanted to be eliminated from psychiatric practice.
[.] Their arguments were that ECT damages the brain,
and was used as punishment or as a threat to keep the patients "in line".
Since then, ECT has improved considerably,
and is now performed under general anesthesia in a medically supervised environment.
The
National Institute for Health and Care Excellence
The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in England that publishes guidelines in four areas:
* the use of health technologies withi ...
recommends ECT for the short-term treatment of severe, treatment-resistant depression, and advises against its use in schizophrenia. According to the Canadian Network for Mood and Anxiety Treatments, ECT is more efficacious for the treatment of depression than antidepressants, with a response rate of 90% in first line treatment and 50-60% in treatment-resistant patients.
The most common side effects of ECT include headache, muscle soreness, confusion, and temporary loss of recent memory.
Marketing of antipsychotic drugs
Psychiatry has greatly benefitted by advances in pharmacotherapy.
However, the close relationship between those prescribing psychiatric medication and pharmaceutical companies, and the risk of a conflict of interest,
is also a source of concern. This relationship is often described as being part of the
medical-industrial complex. This marketing by the pharmaceutical industry has an influence on practicing psychiatrists, which affects prescription.
Child psychiatry is one of the areas in which prescription of psychotropic medication has grown massively. In the past, prescription of these medications for children was rare, but nowadays child psychiatrists prescribe
psychotropic substances, such as
Ritalin
Methylphenidate, sold under the brand names Ritalin and Concerta among others, is the most widely prescribed central nervous system (CNS) stimulant medication used to treat attention deficit hyperactivity disorder (ADHD) and, to a lesser extent ...
, on a regular basis to children.
Joanna Moncrieff has argued that antipsychotic drug treatment is often undertaken as a means of control rather than to treat specific symptoms experienced by the patient.
Moncreiff has further argued, in the controversial and non-
peer review
Peer review is the evaluation of work by one or more people with similar competencies as the producers of the work (peers). It functions as a form of self-regulation by qualified members of a profession within the relevant field. Peer review ...
ed journal ''
Medical Hypotheses
''Medical Hypotheses'' is a not-conventionally-peer reviewed medical journal published by Elsevier. It was originally intended as a forum for unconventional ideas without the traditional filter of scientific peer review, "as long as (the ideas) are ...
'', that the evidence for antipsychotics from discontinuation-relapse studies may be flawed, because they do not take into account that antipsychotics may sensitize the brain and provoke psychosis if discontinued, which may then be wrongly interpreted as a relapse of the original condition.
Use of this class of drugs has a history of criticism in residential care. As the drugs used can make patients calmer and more compliant, critics claim that the drugs can be overused. Outside doctors can feel pressure from care home staff. In an official review commissioned by UK government ministers it was reported that the needless use of antipsychotic medication in dementia care was widespread and was linked to 1800 deaths per year. In the US, the government has initiated legal action against the pharmaceutical company
Johnson & Johnson
Johnson & Johnson (J&J) is an American multinational corporation founded in 1886 that develops medical devices, pharmaceuticals, and consumer packaged goods. Its common stock is a component of the Dow Jones Industrial Average and the company i ...
for allegedly paying
kickbacks
A kickback is a form of negotiated bribery in which a commission is paid to the bribe-taker in exchange for services rendered. Generally speaking, the remuneration (money, goods, or services handed over) is negotiated ahead of time. The kickbac ...
to
Omnicare
Omnicare is an American company working in the health care industry. It was established in April 1981 as a spinoff of healthcare businesses from Chemed and W. R. Grace and Company. It is currently a pharmacy specializing in nursing homes. In 20 ...
to promote its antipsychotic
risperidone
Risperidone, sold under the brand name Risperdal among others, is an atypical antipsychotic used to treat schizophrenia and bipolar disorder. It is taken either by mouth or by injection (subcutaneous or intramuscular). The injectable versions ...
(Risperdal) in nursing homes.
There has also been controversy about the role of
pharmaceutical
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...
companies in
marketing
Marketing is the process of exploring, creating, and delivering value to meet the needs of a target market in terms of goods and services; potentially including selection of a target audience; selection of certain attributes or themes to emph ...
and promoting antipsychotics, including allegations of downplaying or covering up adverse effects, expanding the number of conditions or illegally promoting off-label usage; influencing drug trials (or their publication) to try to show that the expensive and profitable newer atypicals were superior to the older cheaper typicals that were out of patent. Following charges of illegal marketing, settlements by two large pharmaceutical companies in the US set records for the largest criminal fines ever imposed on corporations.
One case involved
Eli Lilly and Company
Eli Lilly and Company is an American pharmaceutical company headquartered in Indianapolis, Indiana, with offices in 18 countries. Its products are sold in approximately 125 countries. The company was founded in 1876 by, and named after, Colonel ...
's antipsychotic
Zyprexa
Olanzapine (sold under the trade name Zyprexa among others) is an atypical antipsychotic primarily used to treat schizophrenia and bipolar disorder. For schizophrenia, it can be used for both new-onset disease and long-term maintenance. It is ta ...
, and the other involved
Bextra
Valdecoxib is a nonsteroidal anti-inflammatory drug (NSAID) used in the treatment of osteoarthritis, rheumatoid arthritis, and painful menstruation and menstrual symptoms. It is a selective cyclooxygenase-2 inhibitor. It was patented in 1995.
...
. In the Bextra case, the government also charged
Pfizer
Pfizer Inc. ( ) is an American multinational pharmaceutical and biotechnology corporation headquartered on 42nd Street in Manhattan, New York City. The company was established in 1849 in New York by two German entrepreneurs, Charles Pfizer ...
with illegally marketing another antipsychotic,
Geodon
Ziprasidone, sold under the brand name Geodon among others, is an atypical antipsychotic used to treat schizophrenia and bipolar disorder. It may be used by mouth and by injection into a muscle (IM). The IM form may be used for acute agitation ...
.
In addition,
Astrazeneca
AstraZeneca plc () is a British-Swedish multinational pharmaceutical and biotechnology company with its headquarters at the Cambridge Biomedical Campus in Cambridge, England. It has a portfolio of products for major diseases in areas includin ...
faces numerous personal-injury lawsuits from former users of
Seroquel
Quetiapine, sold under the brand name Seroquel among others, is an atypical antipsychotic medication used for the treatment of schizophrenia, bipolar disorder, and major depressive disorder. Despite being widely used as a sleep aid due to its ...
(quetiapine), amidst federal investigations of its marketing practices. By expanding the conditions for which they were indicated, Astrazeneca's Seroquel and Eli Lilly's Zyprexa had become the biggest selling antipsychotics in 2008 with global sales of $5.5 billion and $5.4 billion respectively.
[Pipelineantipsychotic drugs to drive next market evolution (2009)](_blank)
Healthcarefinancenews.com (7 August 2009).
Harvard medical professor
Joseph Biederman
Joseph Biederman (29 September 1947 - 5 January 2023) was Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital, professor of psychiatry at Harvard Medical School. Biederman ...
conducted research on bipolar disorder in children that led to an increase in such diagnoses. A 2008 Senate investigation found that Biederman also received $1.6 million in speaking and consulting fees between 2000 and 2007— some of them undisclosed to Harvard— from companies including the makers of antipsychotic drugs prescribed for children with bipolar disorder.
Johnson & Johnson
Johnson & Johnson (J&J) is an American multinational corporation founded in 1886 that develops medical devices, pharmaceuticals, and consumer packaged goods. Its common stock is a component of the Dow Jones Industrial Average and the company i ...
gave more than $700,000 to a research center that was headed by Biederman from 2002 to 2005, where research was conducted, in part, on
Risperdal
Risperidone, sold under the brand name Risperdal among others, is an atypical antipsychotic used to treat schizophrenia and bipolar disorder. It is taken either by mouth or by injection (subcutaneous or intramuscular). The injectable versions ...
, the company's antipsychotic drug. Biederman has responded saying that the money did not influence him and that he did not promote a specific diagnosis or treatment.
In 2004,
University of Minnesota
The University of Minnesota, formally the University of Minnesota, Twin Cities, (UMN Twin Cities, the U of M, or Minnesota) is a public university, public Land-grant university, land-grant research university in the Minneapolis–Saint Paul, Tw ...
research participant
Dan Markingson committed suicide while enrolled in an industry-sponsored pharmaceutical trial comparing three FDA-approved atypical antipsychotics:
Seroquel (quetiapine),
Zyprexa (olanzapine), and
Risperdal (risperidone). Writing on the circumstances surrounding Markingson's death in the study, which was designed and funded by Seroquel manufacturer
AstraZeneca
AstraZeneca plc () is a British-Swedish multinational pharmaceutical and biotechnology company with its headquarters at the Cambridge Biomedical Campus in Cambridge, England. It has a portfolio of products for major diseases in areas includin ...
, University of Minnesota Professor of Bioethics
Carl Elliott noted that Markingson was enrolled in the study against the wishes of his mother, Mary Weiss, and that he was forced to choose between enrolling in the study or being involuntarily committed to a state mental institution. Further investigation revealed financial ties to AstraZeneca by Markingson's psychiatrist, Dr. Stephen C. Olson, oversights and biases in AstraZeneca's trial design, and the inadequacy of university
Institutional Review Board (IRB) protections for research subjects. A 2005 FDA investigation cleared the university. Nonetheless, controversy around the case has continued.
''Mother Jones'' resulted in a group of university faculty members sending a public letter to the university Board of Regents urging an external investigation into Markingson's death.
Pharmaceutical companies have also been accused of attempting to set the mental health agenda through activities such as funding
consumer advocacy groups
Consumer organizations are advocacy groups that seek to protect people from corporate abuse like unsafe products, predatory lending, false advertising, astroturfing and pollution.
Consumer Organizations may operate via protests, litigation, camp ...
.
In an effort to reduce the potential for hidden conflicts of interest between researchers and pharmaceutical companies, the US Government issued a mandate in 2012 requiring that drug manufacturers receiving funds under the Medicare and Medicaid programs collect data, and make public, all gifts to doctors and hospitals.
Anti-psychiatry
The term
anti-psychiatry
Anti-psychiatry is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionabl ...
was coined by psychiatrist
David Cooper in 1967 and is understood in current psychiatry to mean opposition to psychiatry's perceived role aspects of treatment.
The anti-psychiatry message is that psychiatric treatments are "ultimately more damaging than helpful to patients". Psychiatry is seen to involve an "unequal power relationship between doctor and patient", and advocates of anti-psychiatry claim a subjective diagnostic process, leaving much room for opinions and interpretations.
Every society, including liberal Western society, permits
compulsory treatment of mental patients.
The World Health Organization (WHO) recognizes that "poor quality services and human rights violations in mental health and social care facilities are still an everyday occurrence in many places", but has recently taken steps to improve the situation globally.
Electroconvulsive therapy
Electroconvulsive therapy (ECT) is a psychiatry, psychiatric treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage refractory mental disorders.Rudorfer, MV, Henry, ME, Sackeim, HA (2003)"Electroco ...
is a therapy method, which was used widely between the 1930s and 1960s and is, in a modified form, still in use today.
Valium
Diazepam, first marketed as Valium, is a medicine of the benzodiazepine family that acts as an anxiolytic. It is commonly used to treat a range of conditions, including anxiety, seizures, alcohol withdrawal syndrome, muscle spasms, insomnia, a ...
and other
sedatives
A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement. They are CNS depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but th ...
have arguably been over-prescribed, leading to a claimed epidemic of dependence. These are a few of the arguments that the anti-psychiatry movement use to highlight the harms of psychiatric practice.
Multiple authors are well known for the movement against psychiatry, including those who have been practicing psychiatrists. The most influential was
R.D. Laing
Ronald David Laing (7 October 1927 – 23 August 1989), usually cited as R. D. Laing, was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis. Laing's views on the causes and treatment of ...
, who wrote a series of books, including; ''
The Divided Self
Ronald David Laing (7 October 1927 – 23 August 1989), usually cited as R. D. Laing, was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis. Laing's views on the causes and treatment of ...
''.
Thomas Szasz
Thomas Stephen Szasz ( ; hu, Szász Tamás István ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate M ...
rose to fame with the book ''
The Myth of Mental Illness
''The Myth of Mental Illness: Foundations of a Theory of Personal Conduct'' is a 1961 book by the psychiatrist Thomas Szasz, in which the author criticizes psychiatry and argues against the concept of mental illness. It received much publicity, an ...
''.
Michael Foucault
Paul-Michel Foucault (, ; ; 15 October 192625 June 1984) was a French philosopher, historian of ideas, writer, political activist, and literary critic. Foucault's theories primarily address the relationship between power and knowledge, and how ...
challenged the very basis of psychiatric practice and cast it as repressive and controlling. The term "anti-psychiatry" itself was coined by
David Cooper in 1967.
The founder of the
non-psychiatric approach to
psychological suffering is
Giorgio Antonucci
Giorgio Antonucci (Lucca, 24 February 1933 – Florence, 18 November 2017) was an Italian physician, known for his questioning of the basis of psychiatry.
Biography
In 1963 Antonucci studied psychoanalysis with Roberto Assagioli, the founder ...
.
Divergence within psychiatry generated the anti-psychiatry movement in the 1960s and 1970s, and is still present. Issues remaining relevant in contemporary psychiatry are questions of; freedom versus coercion, mind versus brain, nature versus nurture, and the right to be different.
Psychiatric survivors movement
The
psychiatric survivors movement The psychiatric survivors movement (more broadly consumer/survivor/ex-patient movement) is a diverse association of individuals who either currently access mental health services (known as consumers or service users), or who are survivors of interv ...
arose out of the
civil rights
Civil and political rights are a class of rights that protect individuals' freedom from infringement by governments, social organizations, and private individuals. They ensure one's entitlement to participate in the civil and political life of ...
ferment of the late 1960s and early 1970s and the personal histories of psychiatric abuse experienced by some ex-patients rather than the intradisciplinary discourse of antipsychiatry.
The key text in the intellectual development of the survivor movement, at least in the US, was
Judi Chamberlin
Judi Chamberlin (née Rosenberg; October 30, 1944 – January 16, 2010) was an American activist, leader, organizer, public speaker and educator in the psychiatric survivors movement. Her political activism followed her involuntary confinemen ...
's 1978 text, ''On Our Own: Patient Controlled Alternatives to the Mental Health System''.
Chamberlin was an ex-patient and co-founder of the Mental Patients' Liberation Front. Coalescing around the ex-patient newsletter ''Dendron'', in late 1988 leaders from several of the main national and grassroots psychiatric survivor groups felt that an independent, human rights coalition focused on problems in the mental health system was needed. That year the Support Coalition International (SCI) was formed. SCI's first public action was to stage a counter-conference and
protest
A protest (also called a demonstration, remonstration or remonstrance) is a public expression of objection, disapproval or dissent towards an idea or action, typically a political one.
Protests can be thought of as acts of coopera ...
in
New York City
New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...
, in May, 1990, at the same time as (and directly outside of) the
American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
's annual meeting.
About Us — MFI Portal
/ref> In 2005 the SCI changed its name to Mind Freedom International with David W. Oaks as its director.
References
Cited texts
*
*
*
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{{Anti-psychiatry