“As soon as one theory is discredited, the advocates of the biological paradigm turn to another, putting forward a new set of ropey, inconclusive and ambiguous studies as putative evidence. Challenging the biological model of depression feels like a game of whack-a-mole: as soon as you put one theory to bed, another one sprouts up.”
—Joanna Moncrieff, Chemically Imbalanced (2025)
Establishment psychiatry has recently switched the biological cause of mental illness from a “chemical imbalance” to a “brain circuitry defect.” There is no more important institution in establishment psychiatry than the National Institute of Mental Health (NIMH), and in 2022, psychiatrist Thomas Insel, NIMH director from 2002-2015, stated in his book Healing, “The idea of mental illness as a ‘chemical imbalance’ has now given way to mental illnesses as ‘connectional’ or brain circuit disorders.”
Nowadays, establishment psychiatry is turning to ketamine infusions and injections for not only so-called “treatment-resistant depression” (defined by them as occurring “when at least two different antidepressants don’t improve your symptoms”), but also using ketamine for post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, bipolar disorder, and anxiety disorder. This turn to ketamine is occurring despite the fact that the Food and Drug Administration has repeatedly warned that the FDA has not approved ketamine for the treatment of any psychiatric disorder (though controversially approving esketamine nasal spray).
Apparently unconcerned by this FDA warning about ketamine infusions and injections, leading figures in establishment psychiatry, including key thought leaders in university psychiatry departments, are enthusiastic about it. John Krystal, Chairman of the Department of Psychiatry at Yale, tells us “We think that one of the things that ketamine does that helps to explain its antidepressant effects is help the brain to regrow the synapses, the connections between nerve cells.”
While researching psychiatry’s current ketamine enthusiasm for the CounterPunch article “Psychiatry’s Latest Insane Magic-Bullet Treatment for Depression: Why Ketamine?” it felt like I was forever playing the arcade game of whack-a-mole. Shortly after that article was published in early 2025, I received a pre-publication copy of Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth by psychiatrist Joanna Moncrieff; and on page 177, I discovered that she had come to the same whack-a-mole conclusion.
Whack-a-Mole Number One: The Chemical Imbalance Theory
For the last fifty years, prior to its recent pivot to “connectional” or “brain circuit” explanations, establishment psychiatry has told us that mental illnesses are caused by chemical imbalances in neurotransmitters such as serotonin, norepinephrine, and dopamine.
One such chemical imbalance theory, the so-called “dopamine hypothesis of schizophrenia (DHS),” was discredited by the 1980s, and it is now acknowledged as invalid by prominent figures in psychiatry, some of whom are puzzled by its persistence. For example, one of establishment psychiatry’s most prominent researchers Kenneth Kendler noted in 2011, “Although the DHS stimulated much science, most efforts to empirically validate it have failed . . . Nonetheless, the DHS has held the status of a scientific paradigm defended by some with great avidity.” And today, there remain psychiatrists who take this theory seriously.
One major reason for some psychiatrists’ avid defense of the DHS is their observation that patients diagnosed with schizophrenia have a reduction in some symptoms—especially those related to agitation—when medicated with antipsychotic drugs that block dopamine. The belief that this is evidence that dopamine excess is the source of schizophrenia is as scientifically unfounded as a belief that a reduction in social inhibition after the consumption of alcohol is proof that shyness is caused by an “alcohol deficiency.” Establishment psychiatry has shown this same unscientific thinking in its manufacturing of other biological theories of mental illness.
Psychiatry has offered various chemical imbalance—or monoamine imbalance—theories for depression. In 2000, in “Depression: The Case for a Monoamine Deficiency,” Pedro Delgado, one of psychiatry’s most prominent researchers of this theory, reviewed the case for the idea “that the underlying pathophysiologic basis of depression is a depletion in the levels of serotonin, norepinephrine, and/or dopamine in the central nervous system.” Delgado concluded, “However, intensive investigation has failed to find convincing evidence of a primary dysfunction of a specific monoamine system in patients with major depressive disorders.”
In Moncrieff’s Chemically Imbalanced, she points out that researchers had disproven these various chemical-imbalance theories by the late 1980s, when “the chemical imbalance theory of depression . . . should have been dead in the water.”
Establishment psychiatry is still in the process of getting all its members on board with the switch away from the serotonin imbalance theory. Apparently not yet having gotten the memo, the president of the American Psychiatric Association (APA) told a podcaster in 2023, “We know that serotonin has been strongly associated with depression” and antidepressants “work on neurotransmitters, the chemicals in our brain, to rebalance the relative levels.”
The idea that serotonin is crucial to depression has been difficult for establishment psychiatry to relinquish because this belief has long been used to convince depressed patients to take serotonin-enhancing drugs such as the selective serotonin reuptake inhibitors (SSRIS). Establishment psychiatrist Awais Aftab, holding on to a serotonin connection with depression, tells us that the idea that depression is caused by low levels of serotonin is only one way “in which we might understand the relationship between depression and serotonin.” In Aftab’s 2025 attack on Joanna Moncrieff (“Dummies Guide to ‘The British Professor Leading the Controversial Backlash Against Antidepressants’”), he tells us that there are many other ways that serotonin may be related to depression and offers a few such theories:
“Depression, generally or in some subset of patients, involves alterations of the serotonin signaling system (e.g. in the distribution or sensitivity of certain sorts of serotonin receptors).
“The serotonergic system mechanistically links depressive symptoms and neurobiological dysfunctions in other aspects of brain functioning (e.g. neurogenesis or neuroplasticity).
The serotonin system is generally involved in the regulation of mood and temperament, and there may be no specific abnormality in the serotonin system in depression, by and large, but it still provides us a target for intervention with serotonergic antidepressants.”
Aftab’s “Dummies Guide” can be taken seriously only by those with little regard for the scientific method, as Moncrieff points out:
“Aftab’s basic point . . . is simply this: although we haven’t found them yet, depression might be associated with specific brain processes, including those involving serotonin. And because it might be, we should assume it is. . . . This argument . . . inverts the most basic precepts of science. An idea or theory is unproven until it is proven, not the other way round. This has to be the case because anyone can propose anything—and they do. There are scores of theories about links between this or that biological process or chemical and depression.”
The Latest Whack-a-Mole: Brain Circuits and Ketamine
While some establishment psychiatrists such as Aftab continue to hold on to unproven serotonin theories of depression, others promote brain region theories of depression; Harvard Health Publishing, in “What Causes Depression,” reported in 2022, “Research shows that the hippocampus is smaller in some depressed people.” In addition to these theories, today’s “cutting-edge” members of establishment psychiatry are offering up new neurotransmitter theories and “repurposing” old drugs to fit these theories; for example, the International Bipolar Foundation 2017 presentation: “Ketamine, Glutamate, and the Future of Mood Therapeutics.”
Historically, psychiatry has simultaneously offered multiple biological theories of depression and its other disorders, but the theories that stick are those that are effective marketing devices for money-making drugs. The serotonin deficiency theory of depression sold SSRIs; and today, the selling of ketamine infusions and injections rests on theories about how ketamine affects glutamate and the NDMA receptor.
While the serotonin-imbalance theory of depression was simply wrong, it did not seem bizarre when it was proposed. In contrast, the claims today by cutting-edge psychiatrists of ketamine “helping to regrow synapses” (psychiatrist John Krystal) or that ketamine is a “brain fertilizer” (psychiatrist Michael Banov) appear whacky in the face of what is known about ketamine’s toxic effects on the brain and other organs.
Specifically, in 2024, internist and epidemiologist G. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins, told Psychiatric News, “There’s lots of evidence that ketamine is toxic to neurons, and it’s toxic in a dose- and duration-dependent fashion.”
Moreover, in a 2022 review, “Brain Changes Associated With Long-Term Ketamine Abuse, A Systematic Review,” published in Frontiers in Neuroanatomy reported:
“Long-term recreational ketamine use was associated with lower gray matter volume and less white matter integrity, lower functional thalamocortical and corticocortical connectivity. The observed differences in both structural and functional neuroanatomy between ketamine users and controls may explain some of its long-term cognitive and psychiatric side effects, such as memory impairment and executive functioning.”
Confused as to whether ketamine is a brain fertilizer that helps to regrow synapses or whether it is toxic to neurons? First, keep in mind that Yale psychiatrist John Krystal begins with “We think”—not “We know”—in his statement: “We think that one of the things that ketamine does that helps to explain its antidepressant effects is help the brain to regrow the synapses”; and psychiatrist Michael Banov, who tells us that ketamine is a “brain fertilizer,” is the medical director of Psych Atlanta, a ketamine infusion clinic. Still confused? You might want to spend some time with recreational ketamine users to see if ketamine has improved or damaged their memory and executive functioning.
What is especially troubling about the assumption that ketamine is a brain fertilizer that helps grow synapses is that it encourages heavy use of a substance that is now easily attainable. Psychiatric News reported in 2024 that “nearly half (47%) of individuals who are receiving ketamine therapy [are] doing so outside of a clinical setting and in their own homes, ingesting a compounded formulation such as a lozenge or lollipop after being prescribed the medication via a virtual clinic.” This should be extremely disturbing because it is uncontroversial that heavy use of ketamine results in damage to the bladder. In 2025, Urology & Continence Care Today reported in “Ketamine Bladders: What Community Nurses Should Know”:
“In recent years, the link between ketamine use and damage to the urinary tract has become apparent, with estimation that at least 26–30% of users experience at least one bladder symptom. . . .Using ketamine at least three times a week over a period of two years has been shown to result in altered bladder function, with some patients complaining of severe urological problems. . . .This syndrome is often called ‘ketamine bladder’ or ‘ketamine cystitis’ in the literature.”
In much of the world outside of the United States, the horrors of ketamine bladder are widely known (for example, see the U.K. news story, “I Lost Everything’: Inside Britain’s ‘Worrying’ Ketamine Problem”).
How to Stop Playing Whack-a-Mole
The alternative to a life of playing whack-a-whacky theory and whack-a-whacky treatment is to delegitimize the manufacturer of the whacky game, establishment psychiatry, which is comprised of mental illness institutions that: (1) do not take science seriously; (2) are corrupted by drug companies; (3) have an impoverished view of emotional suffering, behavioral disturbances, and humanity; and (4) do not adhere to what should be the first rule of medicine: “above all, do no harm.”
Before demonstrating these four sad realities of establishment psychiatry, it needs to be made clear that defenders of establishment psychiatry conflate establishment psychiatry with psychiatry. The reality is that there are psychiatrists who are embarrassed by establishment psychiatry.
Psychiatrists who are critics of establishment psychiatry include Joanna Moncrieff; she has not only debunked the serotonin-imbalance theory in Chemically Imblanced, but in previous books, has explained how psychiatric drugs do not cure any underlying diseases but simply affect our feelings and behavior in the same sort of way that alcohol and recreational drugs affect them. Other psychiatrists embarrassed by establishment psychiatry include Mark Horowitz and Josef Witt-Doerring, who take seriously the scientific reality of psychiatric drugs and help people safely taper off of them (see their discussion “Psychiatrist Hurt by Drugs He Once Prescribed Now Challenges the Whole Profession”).
A handful of other psychiatrists have gone public with their embarrassment with establishment psychiatry, and there are other psychiatrists who are privately embarrassed but fearful of speaking out publicly against the following realities of establishment psychiatry:
(1) Establishment Psychiatry Does Not Take Science Seriously
In addition to the previously noted disregard by establishment psychiatry for the fundamentals of science with respect to its theories of mental illness, it has little regard for the scientific method in its claims of treatment effectiveness.
A major area of establishment psychiatry’s disregard for science is its bastardization of the randomized control trial (RCT), which is the critical test to assess whether a treatment is actually scientifically effective. Any genuine scientist is aware of the power of patient expectations and the placebo effect, which can result in patient positive reports following any “treatment”—including bloodletting. So a genuine scientist takes seriously the essence of the RCT, while establishment psychiatry debases the RCT.
Specifically, a trial is not a controlled trial unless the participant subjects and the researchers are truly blinded as to who is receiving the hypothesized treatment and who is taking the placebo. In establishment psychiatry trials of antidepressants and other drugs, such blinding has routinely been absent because the easily noticeable side effects of antidepressants result in patients ascertaining whether they are taking the drug or a placebo.
A genuine scientist—who actually wants to get to the truth as to whether or not a hypothesized treatment is effective—takes special care into ensuring that subjects and researchers are truly blinded. This true blinding can be accomplished with what scientists call “active placebos”; for example, instead of placebo sugar pills or saline solutions, substances used for placebos result in noticeable side effects. Such active placebos are not routinely used in establishment psychiatry drug trials, which makes antidepressants failure to meaningfully distance themselves from placebos—the “clinically negligible” nature of antidepressants—even more damning.
The same disregard for the scientific method that establishment psychiatry evidenced in standard antidepressant drug trials is now evident with ketamine. Psychiatric News reported in 2024 that PubMed shows more than 400 trials of ketamine as a depression treatment in the past decade; however, it also reports that G. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins, told them:
“. . . .much of that research is plagued by nontrivial limitations, including studies that were too short in duration, had too few participants, were conducted by researchers with conflicts of interest, had no active comparator, or failed to systematically and comprehensively measure safety. The ‘dealbreaker,’ he said, was researcher and participant bias due to lack of blinding.”
What does genuine scientific research on ketamine as a treatment for depression look like? A 2023 Stanford University study, lead-authored by anesthesiologist Theresa Lii was designed to create a true RCT. Lii and her co-researchers used a subject pool of patients diagnosed with major depressive disorder (MDD) who were scheduled to undergo surgery; this allowed researchers to give all participants standard surgical anesthetic with half randomly assigned to receive ketamine, and this created the type of blinding necessary for a true RCT. In comparing the effectiveness between the placebo group and the ketamine group, Lii concluded: “A single dose of intravenous ketamine compared to placebo has no short-term effect on the severity of depression symptoms in adults with major depressive disorder . . . . Our results suggest that ketamine may actually be ineffective for the short-term treatment of MDD.”
Establishment psychiatry’s routine bastardization of the RCT is only one of many scientific reasons why their treatment effectiveness claims are meaningless. Antidepressant trials have been debased by the same previously noted issues that have debased ketamine trials (too short in duration, lack of blinding, conducted by researchers with conflicts of interest, and failure to systematically and comprehensively measure safety), along with other trial-design biasing (for example, in outcome measures) that dice-load the study to favor the hypothesized drug.
In addition, establishment psychiatry researchers have resorted to overt scientific misconduct; and the 2006 Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, the highly influential year-long antidepressant study, has been criticized as fraudulent. STAR*D researchers did not adhere to their original protocol; and most egregiously, they moved a large group of subjects who were previously excluded as being non-evaluable into the evaluable category, knowing full well that this (and other maneuvers such as switching outcome measures in mid-study) would dramatically inflate the remission rate. Even with STAR*D researchers’ scientific misconduct inflating results, their reported remission rate was still worse than the year-long remission rate of depressed patients receiving no medication reported in a 2006 NIMH study.
(2) Establishment Psychiatry Is Corrupted by Drug Companies
STAR*D researchers had extensive financial relationships with drug companies that manufacture the antidepressant drugs used in the STAR*D study, however, such a conflict of interest is not seen as unethical by establishment psychiatry.
The American Psychiatric Association (APA), the guild of American psychiatrists, is a key member of establishment psychiatry, and in the APA’s “Commentary on Ethics in Practice” (2015), in the section “Relations with the Pharmaceutical and Other Industries,” it states: “Psychiatrists may interact with industry in many ways, including . . . . accepting personal or office gifts or corporate donations from industry.” While psychiatrists are advised that a conflict of interest has the potential for compromised integrity, the APA does not prohibit such a conflict of interest, stating that “the mere appearance or existence of a conflict of interest does not by itself imply wrongdoing.”
In defending the financial relationship between psychiatry and drug companies in 1992, the then APA Medical Director, Melvin Sabshin, called the relationship: “a responsible, ethical partnership that uses the no-strings resources of one partner and the expertise of the other.” The APA publishes the DSM diagnostic manual, and PLOS Medicine reported in 2012, “69% of the DSM-5 task force members report having ties to the pharmaceutical industry.”
In 2004, Marcia Angell, former editor in chief of The New England Journal of Medicine, published The Truth About the Drug Companies, and she offered the following example of drug-company influence on another key member of establishment psychiatry, a prestigious university psychiatry department. Angell reported that the head of the psychiatry department at Brown University Medical School made over $500,000 in one year by consulting for drug companies that make antidepressants, and she noted, “When The New England Journal of Medicine, under my editorship, published a study by him and his colleagues of an antidepressant agent, there wasn’t enough room to print all the authors’ conflict-of-interest disclosures. The full list had to be put on the website.”
In 2008, such corruption of psychiatry by drug companies was still considered “news,” as the New York Times published several articles about the 2008 Congressional hearings on the relationship between pharmaceutical companies and establishment psychiatry, including key thought leader psychiatrists such as Harvard psychiatrist Joseph Biederman, who received $1.6 million in consulting fees from drug makers from 2000 to 2007. Such exposures led to federal legislation in 2013 requiring drug companies to disclose their payments to physicians, resulting in the creation of an Open Payments database.
In 2021, utilizing the Open Payments database, journalist Robert Whitaker reported: “From 2014 to 2020, pharmaceutical companies paid $340 million to U.S. psychiatrists to serve as their consultants, advisers, and speakers, or to provide free food, beverages and lodging to those attending promotional events.” Whitaker noted that approximately 75 percent of the psychiatrists in the United States “received something of value from the drug companies from 2014 through 2020.” Unfortunately, while the Open Payments database has now made the corruption of psychiatry by drug companies easy to see, it has not stopped it.
(3) Establishment Psychiatry Has an Impoverished View of Humanity
While establishment psychiatry claims to have a “bio-psycho-social” view of mental illness, it has been dominated by a biological perspective. In recent years, in the face of undeniable research and political pressure, establishment psychiatry has acknowledged the significance of trauma and adverse childhood experience to later emotional suffering and behavioral disturbances; but this has made virtually no dent in establishment psychiatry treatment practices which, overwhelmingly, consist of brief “medical management” adjustments to medication.
With establishment psychiatry’s biological domination, other perspectives that fall outside of this monopolistic one are denied and marginalized. So establishment psychiatry continues to ignore important psychological and social causes of emotional suffering and behavioral disturbances.
Prior to the domination of the current perspective, psychiatrists would not be accused of being “irresponsible” for considering the idea that notions such as “mental illness” and “mental health” were meaningless—recognizing that all human beings are capable of deteriorations that cause suffering to themselves and others; but that in any given society, such deteriorations are labeled differently, from sinful, to criminal, to unethical, to mentally ill, to successful.
So in U.S. society, deteriorations into corruption and greed are not seen as “mental illness”; instead labeled by some as sinful, criminal, or unethical, but increasingly rewarded with political and financial success. However, in another society, such deteriorations are evidence of a kind of mental or spiritual illness, and many indigenous societies would view thought-leader psychiatrist Joseph Biederman very differently than mainstream U.S. society viewed him. Biederman, as noted, received $1.6 million from drug companies from 2000 to 2007, and he is credited with creating pediatric bipolar disorder—resulting in millions of young children, including pre-schoolers, being psychiatrically drugged for such “symptoms” as a short temper, extreme irritability, and intense happiness or silliness for long periods of time. In some indigenous societies, Biederman may well have been viewed as mentally or spiritually ill.
In contrast to today’s monopolistic biological era of establishment psychiatry, there were once several prominent psychiatrists who actually spent significant time with their patients attempting to understand their lives, and who were interested in the complexity of human psychology.
Some such psychiatrists called themselves psychodynamic, psychoanalytic, or analytic; and fifty years ago, following in the footsteps of Harry Stack Sullivan and his Interpersonal Theory of Psychiatry (1953), there were many well-known psychiatrists—including Eric Berne, Murray Bowen, Nathan Ackerman, Salvador Minuchin, Don Jackson, and Stephen Karpman—who observed interactions and transactions in families and other groups. Psychiatrists with an interpersonal, interactional, and contextual perspective distinguished between transactional and loving bonds, and recognized that emotional suffering and behavioral disturbances—rather than being the result of any biological defect—are often the result of dysfunctionality in families and in a society in which people were forced to be mere objects devoid of much of their humanity.
All this is to say that there were prominent psychiatrists, even throughout much of the twentieth century, who did not have an impoverished view of humanity.
(4) Establishment Psychiatry Does Not Adhere to “Above All, Do No Harm”
Perhaps the more serious indictment of establishment psychiatry is that it does not adhere to what should be the first rule of medicine: “above all, do no harm.” There are multiple examples of this.
For establishment psychiatry, “treatment-resistant depression” is defined, as previously noted, “when at least two different antidepressants don’t improve your symptoms,” and the “standard of care” options for treatment-resistant depression include electroconvulsive therapy (ECT) or ketamine infusions and injections. A practitioner who takes serious the rule “above all, do no harm” takes special care to ensure that the likelihood of treatment benefits far outweigh the likelihood of adverse effects. However, establishment psychiatry does not follow this rule.
The idea of defining a patient’s depression as “treatment resistant” because that patient has not gone into remission after two standard antidepressant drugs is not scientifically defensible. Research has shown that the benefits of antidepressant drugs are “clinically negligible” in comparison to a placebo in the short-term, and worse than no medication at all in the long-term.
Furthermore, many adverse effects of antidepressants are uncontroversial. The percentage of sexual dysfunction for antidepressants runs from 25%–73%, according to a 2010 examination of several studies. Furthermore, post-SSRI sexual dysfunction (PSSD), in which sexual dysfunction exists even after discontinuation of the SSRI, was first reported to regulators in 1991.When trying to reduce antidepressants, 56% of individuals experience withdrawal effects, and approximately one in four people will experience severe withdrawal symptoms. Many establishment psychiatrists continue to ignore scientific realities of withdrawal, mistakenly assuming that withdrawal symptoms following stoppage of antidepressants are evidence of a depression relapse rather than evidence of antidepressant withdrawal effects. However, withdrawal misery as well as sexual dysfunction are now acknowledged by at least some members of establishment psychiatry, which continues to deny research findings of the relationship between antidepressants with increased violence and suicide.
It gets worse. After depressed patients fail to remit following standard antidepressant treatments—that have not shown to be scientifically effective and which have significant adverse effects—establishment psychiatry next recommends treatments such ECT or ketamine infusions—which also have not shown to be scientifically effective and which have even more severe adverse effects.
The lack of effectiveness and adverse effects of ketamine have been previously noted.
ECT has also not met the scientific criteria for effectiveness, as a comprehensive 2019 review of the research on ECT effectiveness reported that there have been no randomized placebo-controlled studies since 1985; and those studies that were done prior to 1985 are of such poor quality that conclusions about efficacy are not possible. Moreover, it has been consistently shown that ECT results in serious adverse effects such as “persistent or permanent gaps in life memories, including of weddings and birthdays, somewhere between 12 and 55 per cent,” reported by psychologist John Read in 2021, who also reported that “one in 50 patients experience ‘major adverse cardiac events’.”
Similarly, the adverse effects of antipsychotic drugs as a long-term treatment for individuals diagnosed with schizophrenia far outweigh benefits. In 2007, an NIMH long-term longitudinal study reported that at the end of fifteen years, among those patients who had stopped taking antipsychotic drugs, 40 percent were judged to be in recovery, this compared to only 5 percent in recovery among those who had remained on antipsychotic drugs; and at twenty years, the researchers, Martin Harrow and Thomas Jobe, reported: “While antipsychotics reduce or eliminate flagrant psychosis for most patients with schizophrenia at acute hospitalizations, four years later and continually until the twenty-year follow-ups, patients with schizophrenia not prescribed antipsychotics had significantly better work functioning.”
Even though the Harrow-Jobe study was NIMH-funded research, the findings were completely ignored by establishment psychiatry, only brought to public attention by Robert Whitaker in Anatomy of an Epidemic (2010), after which it was dismissed by establishment psychiatry for being merely longitudinal findings; however, a RCT study was applied to this issue by researcher Lex Wunderink, who reported in 2013 in JAMA Psychiatry that at the end of seven years, the recovery rate for those who had been tapered off the antipsychotic drugs was more than twice as high as those who remained on them.
The adverse effects of antipsychotic drugs are uncontroversial. PLoS One reported in 2021: “The prevalence of antipsychotic-induced EPSEs [extrapyramidal side effects] was considerably high,” with one in five patients experiencing parkinsonism, and more than one in ten patients experiencing akathisia. American Family Physician (“Adverse Effects of Antipsychotic Medications”) reported in 2010 , “ The newer second-generation antipsychotics, especially clozapine and olanzapine, generally tend to cause more problems relating to metabolic syndrome, such as obesity and type 2 diabetes mellitus . . . All antipsychotic medications are associated with an increased likelihood of sedation, sexual dysfunction, postural hypotension, cardiac arrhythmia, and sudden cardiac death.”
In the sad history of establishment psychiatry, it is a regular occurrence for them to swear by a treatment that does far more harm than good. As late as 1969, one leading textbook of psychiatry lauded insulin coma therapy as “a landmark in psychiatric progress”; and lobotomies were still being performed in the United States throughout the 1980s and never banned.
Game Over
Establishment psychiatry is, at one level, unscientific, corrupt, impoverished, and damaging. At another level, it is just ridiculous.
Instead of critics of biological psychiatry wasting their time in the game of “whack-a-mole”—whacking the latest whacky theory or treatment—what needs to be whacked down is establishment psychiatry. While it is easy to scientifically demolish the credibility of establishment psychiatry, critics of psychiatry have had to face establishment psychiatry’s array of “rhetorical fallacy” defenses and attacks.
One of the most frequently used rhetorical fallacies by establishment psychiatry to divert attention from legitimate criticism is the ad hominem attack of “guilt by association”: falsely connecting the author of a critique with a group abhorrent for much of the general public in order not to have to deal with merits of the critique. Outside of psychiatry, a well-known example of this is the argumentum ad Nazium (or playing the Hitler card) in which the diversionary counter to an argument for the merits of vegetarianism is something like: “Hitler was a vegetarian!” Establishment psychiatry and its mainstream media supporters have commonly responded to critiques of psychiatry with such associations to abhorrent organizations or individuals who happen to have critiqued psychiatry. The abhorrent group that has been commonly used is the Church of Scientology (see “Behind Rolling Stone’s Hatchet Job on a Psychiatrist Critical of Neoliberal Capitalism”).
Another diversion from criticism is used by establishment psychiatrists such as Awais Aftab and Ronald Pies, who claim to be open to criticism of psychiatry, but only if it doesn’t delegitimize establishment psychiatry. Aftab and Pies distinguish between critics who are, in Pies’s words, “sincere and well-intentioned critics” versus those “‘critics’ whose hostile and vituperative rhetoric is clearly aimed at discrediting psychiatry as a medical discipline.” This second group, Pies tells us, falls under the rubric of “anti-psychiatry,” which he defines as: “that movement which denies the fundamental legitimacy of psychiatry as a medical specialty; consistently imputes malign or mendacious motives to the profession; and which denies the efficacy and legitimacy of psychiatric treatment, particularly its somatic treatments.”
Aftab and Pies conflate anti-psychiatry with anti-establishment psychiatry.
Establishment psychiatry also routinely conflates “anti-drug” with “anti-dishonesty about drugs.” So, I am aware of no critic of establishment psychiatry who is anti-drug and who does not acknowledge the possible short-term benefit of a tranquilizing drug in preventing hospital or prison incarceration. Unlike establishment psychiatrists, critics of establishment psychiatry such as psychiatrists Joanna Moncrieff, Mark Horowitz and Josef Witt-Doerring are fully informed about the scientific nature of psychiatric drugs, honest with their patients about these realities, and knowledgeable about the most judicious way of withdrawing from them.
Establishment psychiatry is not unique in its obfuscating conflations to marginalize critics. When millions of Americans protested the U.S. government’s Vietnam War policies, pro-war advocates called them anti-American. Another sad chapter in U.S. history was the era of the House Committee on Un-American Activities, which led to the smearing and blacklisting of many Americans; but fortunately, it was ultimately denounced by a former president, Harry Truman, as the “most un-American thing in the country today.”
For critical thinkers, the rhetorical fallacies of establishment psychiatry further destroy its credibility and authority.
While critical thinkers and freethinkers are curious about criticism of biological psychiatry, much of the rest of society seeks only validation of the narrative about psychiatry that they have acquired from a non-critically thinking mainstream media. Thus, while it is of value for psychiatry critics to engage with open-minded critical thinkers, it is a waste of time to engage with close-minded individuals who refuse to rethink narratives that have been manufactured by establishment psychiatry and their drug company partners.