PSYCHIATRIC COERCION SERVES THE DRUG CORPORATIONS AND THE RULING CLASS, NOT PATIENTS
by Justice Lover

To start this blog with this post is necessary if we are to understand the non-medical gist of psychiatry.

Unlike medicine in general, psychiatry is not based on science, although it purports to be. As we shall see in subsequent posts, psychiatry is based on speculations, arbitrary "norms", and deceptive conclusions. However, in this post we confine the examination of psychiatry to two aspects of it only : coercion and subservience to the drug corporations.

Both aspects are explained and appropriately opposed by two veteran American psychiatrists : Prof. Thomas Szasz, professor of psychiatry, on the subject of psychiatric coercion, and the late Prof. Loren Mosher, on the domination of psychiatry by the drug industry.First is the article by Prof. Szasz, then the now famous letter of resignation from the APA by Prof. Loren Mosher.

Both articles were downloaded from
http://www.stopshrinks.org/reading_room/frame_docs/1st_idx_4th.html

The Case against Psychiatric Coercion
by Thomas S. Szasz

To commit violent and unjust acts, it is not enough for a government to have the will or even the power; the habits, ideas, and passions of the time must lend themselves to their committal."---Alexis de Tocqueville (1981, 297)

Political history is largely the story of the holders of power committing violent and unjust acts against their people. Examples abound: Oriental despotism, the Inquisition, the Soviet Gulag, the Nazi death camps, and the American war on drugs come quickly to mind. Involuntary psychiatric interventions belong on this list.1When Tocqueville referred to "unjust acts," he was speaking as a detached observer, viewing state-sanctioned violence as an outsider. From the insider's point of view, state-sanctioned violence is, by definition, just. The Constitution of the United States, for example, recognized involuntary servitude as a just and humane economic policy.

Throughout the civilized world people now recognize involuntary psychiatry as a just and humane therapeutic policy. Making use of the fashionable rhetoric of rights, a prominent psychiatrist describes adding the "right to treatment" to the existing criteria for assessing civil commitment as a "policy more realistically and humanely balancing the right to be sick with the right to be rescued" (Treffert 1996).The fact that the psychiatrist is authorized to use force to impose the role of mental patient on legally competent persons against their will is prima facie evidence that the psychiatrist possesses state-sanctioned power. In 1913, Karl Jaspers ([1913] 1963)2 acknowledged the unique importance of this element of psychiatric practice. He wrote:Admission to hospital often takes place against the will of the patient and therefore the psychiatrist finds himself in a different relation to his patient than other doctors. He tries to make this difference as negligible as possible by deliberately emphasizing his purely medical approach to the patient, but the latter in many cases is quite convinced that he is well and resists these medical efforts. (839-40)

The systematic exercise of force requires legitimation. Formerly, Church and State, representing and implementing God's design for right living, performed this function. Today, Medicine and State perform it. W. H. Auden ([1962] 1968) put it thus:What is peculiar and novel to our age is that the principal goal of politics in every advanced society is not, strictly speaking, a political one, that is today, it is not concerned with human beings as persons and citizens, but with human bodies.... In all technologically advanced countries today, whatever political label they give themselves, their policies have, essentially, the same goal: to guarantee to every member of society, as a psychophysical organism, the right to physical and mental health. (87)

So long as the idea of mental illness imparts legitimacy to psychiatric coercion, the myriad uses of psychiatric compulsions and excuses cannot be reformed, much less abolished. Hence, for those opposed to psychiatric coercion, the principal adversary is its legitimacy.

The Varieties of Power In social affairs, power is usually defined as the ability to compel obedience. Its sources are coercion from above and dependency from below. By coercion I mean the legal or physical ability to deprive another person of life, liberty, or property, or to threaten such "punishment." By dependency I mean the desire or need for others as protectors or providers.3 "Nature," observed Samuel Johnson ([1709 84] 1981), "has given women so much power that the law has very wisely given them little" (172). The sexual control women wield (over men who desire them) is here cleverly contrasted with their legal subservience (a condition imposed on them by men).Because the definition of power as the ability to compel obedience fails to distinguish between coercive and noncoercive means of securing obedience, it is imprecise and potentially misleading.

For example, when Voltaire exclaimed, Écrazez l'infâme! he was using the word l'infâme to refer to the power of the church to incarcerate, torture, and kill people, not to the influence of the priest to misinform or mislead the gullible.

The distinction I draw here is not novel, yet needs to be stated and restated. As the American philosopher Alfred North Whitehead ([1933] 1961) put it, "[T]he intercourse between individuals and between social groups takes one of these two forms, force and persuasion. Commerce is the great example of intercourse by way of persuasion. War, slavery, and governmental compulsion exemplify the reign of force" (83).

I use the word force to denote the power to harm, or threaten to harm, another,4 and the word influence to refer to obedience secured by money or other rewards or temptations. The potency of force, symbolized by the gun, rests on the ability to injure or kill the Other, whereas the potency of influence rests on the ability to gratify the Other's desires. By desire I mean the experience of an unsatisfied urge, for example, for food, drugs, or sex. The experience is painful; its satisfaction is pleasurable.

Individuals who depend on another person for the satisfaction of their needs (or whose needs or desires can be aroused by another) experience the Other as having power over them. Such (though not such alone) is the power of parents over their children, of doctors over their patients, of Circe over Ulysses. In proportion as we master or surmount our desires, we liberate ourselves from this source of domination.Dependence, Domination, and PsychiatryThe paradigmatic exercise of psychiatric coercion is the imposition of an ostensibly diagnostic or therapeutic intervention on subjects against their will, legitimized by the state as protection of subjects from madness and protection of the public from the mad. Hence, the paramount source of psychiatric domination is force.

Its other source is dependency, that is, the need of the powerless for comfort and care by the powerful. Involuntary psychiatric interventions rest on coercion, voluntary psychiatric interventions on dependency. It is as absurd to confuse or equate these two types of psychiatric relations as it is to confuse or equate rape and mutually desired sexual relations. I oppose involuntary psychiatric interventions not because I believe that they are necessarily "bad" for patients but because I oppose using the coercive apparatus of the state to impose psychiatric relations on persons against their will. By the same token, I support voluntary psychiatric interventions, not because I believe that they are necessarily "good" for patients but because I oppose using the power of the state to interfere with contractual relations between consenting adults (Szasz 1982).5

When people suffer from disease, oppression, or want, they naturally seek the assistance of persons who have the knowledge, skill, or power to help them or on whom they project such attributes. In ancient times, priests, whom people believed to possess the ability to intercede with powerful gods, were the premier holders of power. For a long time, curing souls, healing bodies, and relieving social-economic difficulties were all regarded as priestly activities.6 Only in the last few centuries have these roles become differentiated, as Religion, Medicine, and Politics, each institution being allotted its "proper" sphere of influence, struggled to enlarge their scope and power over the others.

The separation of church and state represents a sharp break in Western political history. Although still paying lip service to an Almighty, the U.S. Constitution is, in effect, a declaration of the principle that only the state (government) can exercise power legitimately and that the sole source of its legitimacy is the "happiness of the people" ensured by securing "the consent of the governed." Gradually, all Western states have adopted this outlook. The Argentinean poet and novelist Adolfo Bioy Casares (1986) satirized the resulting "happiness":Well then, maybe it would be worth mentioning the three periods of history. When man believed that happiness was dependent upon God, he killed for religious reasons. When man believed that happiness was dependent upon the form of government, he killed for political reasons. After dreams that were too long, true nightmares we arrived at the present period of history. Man woke up, discovered that which he always knew, that happiness is dependent upon health, and began to kill for therapeutic reasons. (7)Among these therapeutic reasons, the treatment of mental illness occupies a unique place.

Human beings are intensely susceptible to two types of unpleasant experiences: anxiety-and-guilt and pain-and-suffering. Each is a virtually inexhaustible source of dependency, on soul doctors, body doctors, or both. Religion, by providing myth and ritual, relieves people of anxiety-and-guilt and promises a tranquil eternal life in the hereafter. Medicine, by providing diagnosis and treatment, relieves people of pain-and-suffering and promises a healthy and endlessly extended life on earth.

How does psychiatry fit into this picture?The practice of the branch of medicine we call "psychiatry" began with the confinement of troublesome persons in madhouses. As a result, two symmetrical populations came into being: the kept, called "madmen" or "mad women," and the keepers, called "mad-doctors." During the eighteenth century, the idea of insanity and the institution of the insane asylum became established as important-indeed, socially indispensable-medico-legal concepts and methods of social control. Soon, law, medicine, and popular opinion came to see the insane asylum as the proper place for housing persons authoritatively declared (diagnosed as) insane. Initially, few people were troubled because the situation of the insane in the asylum resembled the situation of the prisoner in jail.

The philosophy of the Enlightenment undermined this complacency, projecting the idea of human rights onto the center stage of Western history. Depriving mental patients of liberty had to be reconciled with society's ostensible devotion to human rights. This task was accomplished partly by conflating and confusing the concept of illness (a bodily condition) with the concept of incompetence (non compos mentis, a legal concept and, subsequently, a "mental" condition) and partly by subsuming civil commitment under the rubric of the state's police power, that is, its duty to protect the public from "dangerous" persons (lawbreakers). This dual justification of psychiatric coercion has remained essentially constant for almost 300 years (Szasz 1994).

Legitimizing Psychiatric Coercion

A crucial moment in the legitimation of modern psychiatric coercion occurred in central Europe during the early decades of this century.7 Although psychiatry and psychoanalysis arose as distinct and separate enterprises, they soon merged into a union that proved to be fateful for the future of the "mental health services" industry. Collaboration between Eugen Bleuler and Sigmund Freud and their followers created this union.

Bleuler was born in 1857 in Switzerland. After a successful career in psychiatry, in 1889 he became the head of the famed Burghölzli, the public mental hospital in Zürich. Unlike most psychiatrists, Bleuler wanted to know his patients as persons. Finding the psychiatric dogma of his day useless for that purpose, he looked to Freud's writings for help. By 1902, he had read The Interpretation of Dreams8 and made three complimentary references to it (Ellenberger 1970; Clark 1980). Two years later he initiated contact with Freud, writing him "that he and all his staff had for a couple of years been busily occupying themselves with psychoanalysis and finding various applications for it" (Jones 1953 57, 2:30).In his biography of Freud, Ernest Jones commented: "Because of the increasingly prominent position Bleuler held among psychiatrists, Freud was eager to retain his support" (1953-57, 2:72). Then, displaying his incomprehension of psychiatric history, he added: "Unfortunately, this state of affairs [friendship between Freud and Bleuler] did not endure . His [Bleuler's] interests then moved elsewhere, from psychological to clinical psychiatry" (73).

This statement is wrong. Bleuler had always been a clinical psychiatrist, never relinquished his interest in the psychological understanding of patients, and never renounced his appreciation of psychoanalysis. In 1907, replying to his critics, Bleuler wrote:I consider that up to the present the various schools of psychology have contributed extremely little towards explaining the nature of psychogenic symptoms and diseases, but that psychoanalysis offers something towards a psychology which still awaits creation and which physicians are in need of in order to understand their patients and to cure them rationally. (Bleuler 1914, 26)In 1925, in a 17 February letter to Freud, Bleuler expressed this point even more strongly: "Anyone who would try to understand neurology or psychiatry without possessing a knowledge of psychoanalysis would seem to me like a dinosaur-I say 'would seem' not 'seems,' for there no longer are such people, even among those who enjoy depreciating psychoanalysis!" (Bleuler 1925, 117).

In his epochal work, Dementia Praecox or the Group of Schizophrenias, Bleuler courageously incorporated a psychoanalytic perspective in his interpretation of the behavior of schizophrenic patients. The following example is illustrative. A woman patient declares that "she is Switzerland." Bleuler ([1911] 1950) wrote: "She says, 'I am Switzerland.' She may also say, 'I am freedom,' since for her Switzerland means nothing else than freedom" (429). The patient's "symptom" reveals that she is protesting against her confinement; Bleuler's use of this example reveals that he recognized the legitimacy of her protest.

This is not the place to dwell on Bleuler's monumental work. Suffice it to note that although he defined schizophrenia as a "disease [that] is characterized by a specific type of alteration of thinking, feeling, and relation to the external world" (150), his foregoing remarks show that he recognized that schizophrenic "thinking" was a type of poetry and protest as well.9 However, by pathologizing the schizophrenic's behavior, Bleuler undermined that common-sense judgment and the psychiatric response to it: persons incarcerated in the mental hospital were made to appear as medical patients suffering from a disease; the psychiatrist incarcerating them was made to appear as a medical doctor treating a disease; and the power relations between them were buried more deeply than ever.

But Bleuler, who was honestly seeking the truth, did not let the matter rest there. In 1919, when his reputation as a psychiatrist was second to none in the world, he wrote a book, now virtually forgotten, that is largely a denunciation of psychiatric power. He wrote: "Many a case of 'latent' schizophrenia is diagnosed as total in all certainty. Never does it occur to the doctor to consider all the consequences: confinement of the patient to a mental institution, deprivation of civil rights, abandonment of his profession, etc." ([1919] 1970, 115). Who spoke of the civil rights of mental patients in those days? Not Freud. Not psychiatrists. But Bleuler did. In the final paragraph of his book on schizophrenia, he commented on "the most serious of all schizophrenic symptoms the suicidal drive":I am even taking this opportunity to state clearly that our present-day social system demands great and entirely inappropriate cruelty from the psychiatrist in this respect. People are being forced to continue to live a life that has become unbearable for them for valid reasons; this alone is bad enough. However, it is even worse, when life is made increasingly intolerable for these patients by using every means to subject them to constant humiliating surveillance. ([1911] 1950, 488)

Bleuler must have felt more than a little guilty to have advanced so disingenuous a disclaimer. No one forces a person to become a jailer confining criminals or to become a psychiatrist confining mental patients.The Moral Suicide of PsychoanalysisNotwithstanding the sloppy scholarship of many psychiatric historians, it is important to remember that Sigmund Freud was not a psychiatrist. In late nineteenth-century Europe, the term "psychiatrist" meant a physician working in the public mental hospital system. Because Jews were barred from employment in state bureaucracies, they could not be psychiatrists and hence could not force people to be their unwilling patients.Not only was Freud not a psychiatrist, most psychiatrists viewed his writings as inimical to psychiatry. For example, the prominent German psychiatrist Franz von Luschan blamed "Bleuler for his astonishing behavior in helping to promulgate the epidemic [i.e., psychoanalysis]" (Jones 1953-57, 2:119).

Psychiatrists objected to Freud's writings not because he opposed involuntary psychiatric interventions; in fact, he enthusiastically supported psychiatric excuses and coercions (Szasz [1976] 1990, 136-37). Instead, they disapproved of Freud's work because they wanted to see themselves as physicians with a professional identity firmly anchored in neurology and neuropathology; and because they wanted to see their patients as suffering from bona fide diseases, that is, bodily abnormalities with physical causes independent of the sufferer's personal history. By introducing a new set of disease-causative agents-namely, the patient's life history (especially "traumas" suffered during childhood)-Freud spoiled this purely physicalistic conception of etiology and pathology.10 At the same time, he reinforced the established social prestige of psychiatry with the seemingly scientific prestige of psychoanalysis.

The psychiatric profession now became a mighty river, formed by the confluence of two large tributaries: the state hospital system, confining and caring for some of the injured and injurious members of society in institutions; and the theory and practice of psychoanalysis, offering a system of interpreting behavior and counseling to non-institutionalized, fee-paying individuals. As a result of this expansion, psychiatric power became more impervious to criticism than ever.Although I offer no new information concerning the collaboration between Bleuler and Freud, the inference I draw concerning its impact on the history of psychiatry is, I believe, novel. Historians of psychiatry and psychoanalysis have overlooked how Freud's coveting the blessings of psychiatry combined with Bleuler's perceptive use of psychoanalytic insights reinforced the legitimacy of the psychiatric enterprise, which had previously labored under a cloud of scientific and civil-libertarian suspicion.

Consider the evidence.In his 1914, "On the History of the Psychoanalytic Movement," Freud (1953-74) wrote: "A communication from Bleuler had informed me that my works had been studied and made use of in the Burghölzli. I have repeatedly acknowledged with gratitude the great services rendered by the Zürich school of Psychiatry in the spread of psychoanalysis" (14:26-27). What did Freud mean here by "psychoanalysis"? Clearly, he could not have meant that its subjects must be voluntary clients, an element that he had identified nine years earlier as intrinsic to the practice of psychoanalysis. In 1905, Freud had declared: "Nor is the method applicable to people who are not driven to seek treatment by their own sufferings, but who submit to it only because they are forced to by the authority of relatives" (1953-74, 7: 263-64, my emphasis).

If so, psychoanalysis was even less applicable to people forced to submit to "it" by the authority of policemen, judges, and psychiatrists.It is reasonable to infer that in reference to his alliance with the psychiatrists at the Burghölzli, Freud did not use the word psychoanalysis to identify a voluntary relationship between a healer and his subject but rather a body of ideas associated with his name. This interpretation is supported by his remark that "Jung successfully applied the analytic method of interpretation to the most alien and obscure phenomena of dementia praecox [schizophrenia], so that their sources in the life-history and interests of the patient came clearly to light. After this, it was impossible for psychiatrists to ignore psychoanalysis any longer" (1953-74, 14:28, my emphasis).

As we know, it was not at all impossible for psychiatrists to ignore psychoanalysis, if the term includes respect for the current life history and civil rights of the patient. Indeed, Freud himself led the legions that joyously proceeded to ignore the most obvious life historical event in the life of the schizophrenic patient: namely, that a psychiatrist is depriving him of liberty. I have called attention elsewhere to Freud's glaring neglect of Schreber's incarceration. In 1976, I wrote:In his most famous study of schizophrenia, the Schreber case, Freud devotes page after page to speculations about the character and causes of Schreber's "illness," but not a word to the problem posed by his imprisonment or his right to freedom. Schreber, who was "psychotic," questioned the legitimacy of his confinement, and Schreber, the madman, sought and secured his freedom. Freud, who was a "psychoanalyst," never questioned the legitimacy of Schreber's confinement, and Freud, the psychopathologist, cared no more about Schreber's freedom than a pathologist cares about the freedom of one of his specimens preserved in alcohol. (Szasz 1988b, 39)

The writer and literary critic Gabriel Josipovici (1988) reminds us that "We do not decipher people, we encounter them" (307). The psychiatrist's power to coerce the patient negates the possibility of a humane encounter between them. Indeed, interpreted as a command, the rule that we should not decipher but encounter the Other violates the canons of psychiatry and the laws of the Therapeutic State. To remain a psychiatrist, the psychiatrist must view his client as a "patient" afflicted with a dangerous "mental disease," and himself as a physician whose task is not only to treat mental diseases but also to incarcerate innocent patients deemed to be "dangerous" and exculpate guilty patients deemed to be innocent by reason of insanity. No amount of semantic transfusion from the vocabulary of psychoanalysis can, or was intended to, alter these elementary facts of psychiatry, characteristic of twentieth-century life in free and totalitarian societies alike.

I want to offer some additional observations concerning Freud's contributions to the enhancement and legitimation of psychiatric power. In 1914, in his essay "On Narcissism," Freud wrote: "Patients of this kind [schizophrenics] display two fundamental characteristics: megalomania and diversion of their interest from the external world-from people and things. In consequence of the latter change, they become inaccessible to the influence of psychoanalysis and cannot be cured by our efforts" (1953-74, 14:74). Characterizing the schizophrenic as a person who, by turning away from "things and people," deprives himself of the benefits of psychoanalytic treatment is like characterizing the atheist as a person who, by turning away from God, deprives himself of the benefits of religious salvation.

Instead of acknowledging that the schizophrenic's avoidance of the ministrations of a psychoanalyst is a decision, similar to a person's decision to avoid the ministrations of a chiropractor or Christian Science healer, Freud defined it as itself a symptom of schizophrenia and implied that if the schizophrenic were willing to submit to the analyst, psychoanalysis could cure him.Although psychiatrists as well as psychoanalysts now treat psychoanalysis as a branch of psychiatry, the truth is that before psychoanalysis was absorbed into psychiatry, the two enterprises were almost antithetical. Politically, the essence of the psychoanalytic relationship was the absence of the coercions traditionally present in relations between psychiatrists and mental patients. Practically, this meant that the analyst's failure to respect the patient's personal autonomy or the analyst's interference in the client's life was incompatible with the psychoanalytic relationship.

The respective aims, values, and practices of psychiatry and psychoanalysis may be summarized as follows:- To effect a cure, psychiatrists coerce and control their "patients": they incarcerate the (involuntary) victims and impose various unwanted chemical and physical interventions on them.- To conduct a dialogue, psychoanalysts contract and cooperate with their "patients": they listen and talk to the (voluntary) interlocutors, who pay for the services they receive (Szasz 1988a).Before psychoanalysis became institutionalized as a profession, the psychoanalytic relationship represented a genuinely new social development, namely, a noncoercive, secular help ("therapy") for problems in living (called "neuroses"). The term "psychoanalysis" then denoted a confidential dialogue between an expert and a client, the former rejecting the role of custodial psychiatrist, the latter assuming the role of responsible, voluntary patient.

The psychiatric and psychoanalytic enterprises rested on totally different premises and entailed mutually incompatible practices:- Traditional psychiatrists were salaried physicians who worked in a mental institution; their source of income was the state; they functioned as agents of bureaucratic superiors and the patient's relatives. Typical mental hospital inmates were poor persons, cast in the patient role against their will, housed in a public mental hospital.- Traditional psychoanalysts were self-employed professionals who worked in private offices; their source of income was patients; they functioned as agents of the patients. Typical analytic patients were rich persons (usually wealthier than the analyst) who cast themselves in the patient role and lived in their own home or wherever they pleased.

As soon as Freud achieved the recognition he craved, he destroyed the core value of the psychoanalytic relationship. I refer to his assuming the authority of certifying competence in psychoanalysis and requiring that individuals seeking to become psychoanalysts undergo a so-called training analysis. If voluntariness is an essential element of the psychoanalytic relationship, then a compulsory training analysis is a contradiction in terms.11 The betrayal of confidentiality intrinsic to training analysis drove a stake through the heart of the role of the psychoanalyst. The result was the destruction of the moral integrity and healing potential of the human encounter called "psychoanalysis" (Szasz 1958, 1960).

"Power Is Not a Means"

For more than forty years I have argued that the institution of psychiatry rests on civil commitment and the insanity defense and that each is a paradigm of the perversion of medical power. If the persons called "patients" break no law, they have a right to liberty. And if they break the law, they ought to be adjudicated and punished in the criminal justice system. It is as simple as that. Nevertheless, so long as conventional wisdom decrees that mental patients must be protected from themselves, that society must be protected from mental patients, and that both tasks rightfully belong to psychiatrists wielding powers appropriate to the performance of these duties, psychiatric power will remain unreformable.

Of course, many people do threaten society: they assault, injure, rob, and kill others. Some are regarded and managed as criminals, others as mental patients. In either case, society needs protection from the aggressors. What does psychiatry contribute to the management of such persons? Civil commitment and the insanity defense: inculpating the innocent and exculpating the guilty. Both interventions authenticate as "real" the socially useful fictions of mental illness and psychiatric expertise. Both create and confirm the illusion that we are coping wisely and well with vexing social problems, when in fact we are obfuscating and aggravating them.

Alas, psychiatric power corrupts not only the psychiatrists who wield it and the patients who are subjected to it, but the community that supports it as well.As Orwell's (1949) nightmarish vision of Nineteen Eighty-Four nears its climax, O'Brien explains the functional anatomy of power to Winston:[N]o one seizes power with the intention of relinquishing it. Power is not a means; it is an end. One does not establish a dictatorship in order to safeguard a revolution; one makes the revolution in order to establish the dictatorship. The object of persecution is persecution. The object of torture is torture. The object of power is power.

Now do you begin to understand me? (266)The empire of psychiatric power is more than three hundred years old and grows daily more all-encompassing. But we have not yet begun to acknowledge its existence, much less to understand its role in our society.

ReferencesAuden, W. H. [1962] 1968. The Dyer's Hand, and Other Essays. New York: Vintage.Bleuler, Eugen. 1914. Quoted in Sigmund Freud, On the History of the Psychoanalytic Movement. In The Standard Edition of the Complete Psychological Works of Sigmund Freud, translated and edited by J. Strachey, vol. 14 (London: Hogarth, 1953-74).---. 1925. Letter to Sigmund Freud (February 17). Quoted in Ernest Jones, The Life and Work of Sigmund Freud, vol. 3 (New York: Basic Books, 1953-57).---. [1911] 1950. Dementia Praecox or the Group of Schizophrenias. Translated by Joseph Zinkin. New York: International Universities Press.---. [1919] 1970. Autistic Undisciplined Thinking in Medicine and How to Overcome It. Translated and edited by Ernest Harms, with a preface by Manfred Bleuler. Darien, Conn: Hafner.Casares, Adolfo Bioy. 1986. Plans for an Escape to Carmelo. New York Review of Books, 10 April.Clark, W. R. 1980. Freud: The Man and the Cause. London: Jonathan Cape and Weidenfeld and Nicolson.Ellenberger, H. F. 1970. The Discovery of the Unconscious. New York: Basic Books.Freud, Sigmund. 1953-74. The Standard Edition of the Complete Psychological Works of Sigmund Freud. Translated and edited by James Strachey. 24 vol. London: Hogarth.Jaspers, K. [1913, 1946] 1963. General Psychopathology. 7th ed. Translated by J. Hoenig and M. W. Hamilton. Chicago: University of Chicago Press.Johnson, Samuel. [1708-84] 1981. Quoted in The Viking Book of Aphorisms: A Personal Selection. Edited by W. H. Auden and L. Kronenberger. New York: Dorset.Jones, Ernest. 1953-57. The Life and Work of Sigmund Freud. 3 vol. New York: Basic Books.Josipovici, Gabriel. 1988. The Book of God: A Response to the Bible. New Haven: Yale University Press.Orwell, G. 1949. Nineteen Eighty-Four. New York: Harcourt Brace.Szasz, T. S. 1958. Psychoanalytic Training: A Socio-Psychological Analysis of Its History and Present Status. International Journal of Psychoanalysis 39:598-613.---. 1960. Three Problems in Contemporary Psychoanalytic Training. A.M.A. Archives of General Psychiatry 3:82-94. ---. 1982. The Psychiatric Will. American Psychologist 37:762-70.---. [1965] 1988a. The Ethics of Psychoanalysis. Syracuse, N.Y.: Syracuse University Press. ---. [1976] 1988b. Schizophrenia: The Sacred Symbol of Psychiatry. Syracuse, N.Y.: Syracuse University Press.---. [1976] 1990. Anti-Freud: Karl Kraus's Criticism of Psychoanalysis and Psychiatry. Syracuse, N.Y.: Syracuse University Press.---. 1994. Cruel Compassion: Psychiatric Control of Society's Unwanted. New York: Wiley.Tocqueville, Alexis de. 1981. Quoted in The Viking Book of Aphorisms: A Personal Selection. Edited by W. H. Auden and L. Kronenberger. New York: Dorset.Treffert, D. A. 1996. Dangerousness (Letters). Psychiatric News 31:14.Whitehead, Alfred N. [1933] 1961. Adventures of Ideas. New York: Free Press.Acknowledgments: This paper is a revised version of an address presented at the conference on "The Construction of Psychiatric Authority," University of Newcastle, Newcastle-upon-Tyne, 18-20 June 1996.*

Thomas Szasz is Professor of Psychiatry Emeritus at State University of New York Health Science Center in Syracuse, New York.

1. Unless the context calls for a restricted use of the words psychiatry and psychiatrist, I use these terms to refer to all mental health professions and professionals.
2. Jaspers later abandoned psychiatry for philosophy.
3. The spheres of legitimacy of power and dependency are defined by law, custom, and tradition.
4. The legally unauthorized use of force is a felony.
5. Some psychiatric critics, opposing the use of psychiatric drugs, electric shock treatment, or psychotherapy, advocate the legal prohibition of these methods or relationships on the ground that people need protection from the "exploitation" intrinsic to the practice of psychiatry and psychotherapy. I regard state-sanctioned "protection" from psychiatric treatment as just as patronizing as state-sanctioned protection from psychiatric illness. Both are state-imposed denials of the basic human right to engage in, or refrain from, making contracts.
6. Jesus and Mother Teresa still project this sort of image.
7. The introduction of antipsychotic drugs in the 1950s further legitimated psychiatric coercion. Today, it is reinforced by brain-scanning methods allegedly demonstrating that mental diseases are brain diseases that, nevertheless, ought to be treated by psychiatrists rather than by neurologists.
8. The Interpretation of Dreams was published in 1900, the watershed date in the history of psychoanalysis.
9. The points I wish to emphasize here are, first, that thinking, feeling, and relating to the external world are, prima facie, not matters of medical concern; and second, that whatever an "alteration of thinking and feeling" might be, it is patently an inadequate justification for depriving a person of liberty.
10. Depending on one's point of view, one might also say that Freud improved these concepts. In any case, by adding psychogenesis to somatogenesis, and psychogenic diseases (for example, perversions) to somatogenic diseases (for example, pneumonia), Freud expanded the conceptual categories of etiology and pathology.
11. Because children are, by definition, involuntary subjects, child analysis is also a contradiction in terms.The Independent Review, Vol.I, No.4, Spring 1997, ISSN 1086-1653, Copyright 1997, pp. 485-498.
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Letter of Resignation from the American Psychiatric Association
4 December 1998
Loren R. Mosher, M.D. to Rodrigo Munoz, M.D., President of the American Psychiatric Association (APA)

Dear Rod,

After nearly three decades as a member it is with a mixture of pleasure and disappointment that I submit this letter of resignation from the American Psychiatric Association.

The major reason for this action is my belief that I am actually resigning from the American Psychopharmacological Association. Luckily, the organization's true identity requires no change in the acronym.Unfortunately, APA reflects, and reinforces, in word and deed, our drug dependent society. Yet it helps wage war on "drugs".

"Dual diagnosis" clients are a major problem for the field but not because of the "good" drugs we prescribe. "Bad" ones are those that are obtained mostly without a prescription. A Marxist would observe that being a good capitalist organization, APA likes only those drugs from which it can derive a profit -- directly or indirectly. This is not a group for me.

At this point in history, in my view, psychiatry has been almost completely bought out by the drug companies. The APA could not continue without the pharmaceutical company support of meetings, symposia, workshops, journal advertising, grand rounds luncheons, unrestricted educational grants etc. etc. Psychiatrists have become the minions of drug company promotions.

APA, of course, maintains that its independence and autonomy are not compromised in this enmeshed situation. Anyone with the least bit of common sense attending the annual meeting would observe how the drug company exhibits and "industry sponsored symposia" draw crowds with their various enticements, while the serious scientific sessions are barely attended.

Psychiatric training reflects their influence as well: the most important part of a resident's curriculum is the art and quasi-science of dealing drugs, i.e., prescription writing.

These psychopharmacological limitations on our abilities to be complete physicians also limit our intellectual horizons. No longer do we seek to understand whole persons in their social contexts -- rather we are there to realign our patients' neurotransmitters. The problem is that it is very difficult to have a relationship with a neurotransmitter -- whatever its configuration. So, our guild organization provides a rationale, by its neurobiological tunnel vision, for keeping our distance from the molecule conglomerates we have come to define as patients.

We condone and promote the widespread use and misuse of toxic chemicals that we know have serious long term effects -- tardive dyskinesia, tardive dementia and serious withdrawal syndromes. So, do I want to be a drug company patsy who treats with their fory? No, thank you very much.

It saddens me that after 35 years as a psychiatrist I look forward to being dissociated from such an organization. In no way does it represent my interests. It is not within my capacities to buy into the current biomedical-reductionistic model heralded by the psychiatric leadership as once again marrying us to somatic medicine. This is a matter of fashion, politics and, like the pharmaceutical house connection, money.

In addition, APA has entered into an unholy alliance with NAMI (I don't remember the members being asked if they supported such an association) such that the two organizations have adopted similar public belief systems about the nature of madness. While professing itself the "champion of their clients" the APA is supporting non-clients, the parents, in their wishes to be in control, via legally enforced dependency, of their mad/bad offspring: NAMI with tacit APA approval, has set out a pro-neuroleptic drug and easy commitment-institutionalization agenda that violates the civil rights of their offspring.

The shortsightedness of this marriage of convenience between APA, NAMI, and the drug companies (who gleefully support both groups because of their shared pro-drug stance) is an abomination. I want no part in a psychiatry of oppression and social control. "Biologically based brain diseases" are certainly convenient for families and practitioners alike. It is no-fault insurance against personal responsibility. We are all just helplessly caught up in a swirl of brain pathology for which no one, except DNA, is responsible. Now, to begin with, anything that has an anatomically defined specific brain pathology becomes the province of neurology (syphilis is an excellent example).

So, to be consistent with this "brain disease" view, all the major psychiatric disorders would become the territory of our neurologic colleagues. Without having surveyed them I believe they would eschew responsibility for these problematic individuals. However, consistency would demand our giving over "biologic brain diseases" to them. The fact that there is no evidence confirming the brain disease attribution is, at this point, irrelevant. What we are dealing with here is fashion, politics and money.

This level of intellectual /scientific dishonesty is just too egregious for me to continue to support by my membership.I view with no surprise that psychiatric training is being systematically disavowed by American medical school graduates. This must give us cause for concern about the state of today's psychiatry. It must mean -- at least in part that they view psychiatry as being very limited and unchallenging. To me it seems clear that we are headed toward a situation in which, except for academics, most psychiatric practitioners will have no real, relationships -- so vital to the healing process -- with the disturbed and disturbing persons they treat. Their sole role will be that of prescription writers -- ciphers in the guise of being "helpers".

Finally, why must the APA pretend to know more than it does? DSM IV is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more a political than scientific document. To its credit it says so -- although its brief apologia is rarely noted. DSM IV has become a bible and a money making best seller -- its major failings notwithstanding. It confines and defines practice, some take it seriously, others more realistically. It is the way to get paid. Diagnostic reliability is easy to attain for research projects.

The issue is what do the categories tell us? Do they in fact accurately represent the person with a problem? They don't, and can't, because there are no external validating criteria for psychiatric diagnoses. There is neither a blood test nor specific anatomic lesions for any major psychiatric disorder. So, where are we? APA as an organization has implicitly (sometimes explicitly as well) bought into a theoretical hoax. Is psychiatry a hoax -- as practiced today? Unfortunately, the answer is mostly yes.

What do I recommend to the organization upon leaving after experiencing three decades of its history?

1. To begin with, let us be ourselves. Stop taking on unholy alliances without the members' permission.
2. Get real about science, politics and money. Label each for what it is -- that is, be honest.
3.Get out of bed with NAMI and the drug companies. APA should align itself, if one believes its rhetoric, with the true consumer groups, i.e., the ex-patients, psychiatric survivors etc.
4.Talk to the membership -- I can't be alone in my views.We seem to have forgotten a basic principle -- the need to be patient/client/consumer satisfaction oriented. I always remember Manfred Bleuler's wisdom: "Loren, you must never forget that you are your patient's employee."

In the end they will determine whether or not psychiatry survives in the service marketplace. " (Emphasis added by Justice Lover).

HAS MODERN PSYCHIATRY GONE INSANE OR IS ITS DOGMA BASED ON A FRAUD PERPETRATED BY THE DRUG CORPORATIONS ? by Justice Lover

The following ariticle was written by an American psychiatrist and I have downloaded it with comments by an American neurologist. Both doctors oppose Biological Psychiatry, which is what modern psychiatry is all about. It is obvious from their analysis ,and from their conclusions,that modern psychiatry, as it has been practiced worldwide, is detrimental to humanity (to say the least !).

Here are the article and the comments,

http://www.adhdfraud.org/commentary/11-07-00-2.htm:11/6/00,

Fred A. Baughman Jr., MD: I cannot think of a stronger, more accurate, analysis of‘biological psychiatry’ than this by David Kaiser, MD, psychiatrist, humane physician. This cannot be said of any psychiatrist who has deserted the 'mind'of the patient, pretending to diagnose and treat the brain, doing this for profit—for their own profit as well as for that of their paymaster, the pharmaceutical industry. My comments are inserted within Dr. Kaiser’s text inbrackets […] .

The following article is by David Kaiser M. D.- who has written a number of journal articles and is on the staff of Northwestern University Medical School Hospital.http://myweb.rust.net/~norman/kaiser.html Date: 11/5/00 12:35:42 AM Pacific Standard Time

NOT BY CHEMICALS ALONE: A HARD LOOK AT "PSYCHIATRIC MEDICINE"
BY DAVID KAISER M.D.

As a practicing psychiatrist, I have watched with growing dismay and outrage the rise and triumph of the hegemony known as biologic psychiatry. Within the general field of modern psychiatry, biologism now completely dominates the discourse on the causes and treatment of mental illness, and in my view this has been a catastrophe with far-reaching effects on individual patients and the cultural psyche at large.

It has occurred to me with forcible irony that psychiatry has quite literally lost its mind, and along withit the minds of the patients they are presumably supposed to care for.

Even a cursory glance at any major psychiatric journals is enough to convince me that the field has gone far down the road into a kind of delusion,whose main tenets consist of a particularly pernicious biologic determinism and a pseudo-scientific understanding of human nature and mental illness.[Dr. Baughman: thus my encountering not just parents, but grandparents as well—twogenerations—that believe that the normal rambunctiousness of their children and grand children are ‘diseases, due a ‘chemical imbalances’ of the brain. No longer can they understand all that is the trying, challenging normalcy of childhood—things they themselves are best-suited, with common sense and parental instinct to care for and guide. Now they see such behaviors as‘diseases’, as ‘chemical imbalances’ that need diagnosing by psychiatrists and other mentalhealth professionals, and that need, in virtually every case, ‘chemical balancers’—pills. Nolonger can they see all that is the width and breadth of normal emotions and behavior inthemselves, their families, communities. They will have been deceived into believing that all ofthis need, diagnosis, interpretation, management and treatment from psychiatry and themammoth, burgeoning mental health (teachers included) industry.]

The purpose of this piece is not to attempt a full critique or history of this occurrence, but merely to present some of the glaring problems of this movement, as I believe significant harm is being done to patients under the guise of modern psychiatric treatment. I am a psychiatrist trained in the late 1980s and early 1990s, and I use both psychotherapy and medication in my approach to patients. I state these facts to make it clear that this is not an anti-psychiatry tract, and I am speaking from within the field of psychiatry, although I find it increasingly impossible to identify with this profession, for reasons which will become clear below.

Biologic psychiatrists as a whole are unapologetic in their view that they have found the road to truth, namely, that mental illnesses for the most part are genetic in origin and should be treated with biologic manipulations,i.e., psychoactive medications, electroconvulsive treatment (which has made an astounding comeback) and in some cases psychosurgery.[Dr. Baughman: they are unapologetic and dictatorial, but, one-on-one, are easily challengedand intimidated. A young father asked his son’s psychiatrist: "Why the Ritalin?" The psychiatristresponded: "He has ADHD, due to a ‘chemical imbalance of the brain!" The young father thenasked: "Show me the lab work!" The psychiatrist hemmed and hawed, because of course therewas no lab work there never is, there is never a test or proof of any kind (why I call ADHD,and all biological psychiatry a total, 100% fraud). The young father persisted, saying, "I want tosee the results of any tests you have done." The psychiatrist, grew flustered and finally ‘lost it’ atwhich point he banished both father and son from his office (there is never an examining room),firing the boy as his patient. I am fond of saying that the "Is it a disease—yes or no?"question—if ‘yes’ show me the lab work, the scan, the biopsy report, the x-ray, is, to thebiological psychiatrist, like the crucifix to Count Dracula. Both are destroyed by the light of day.Further, I can tell any lawyer, barrister, how to destroy any biological psychiatrist with the lightof day in any courtroom.]

Although they admit a role for environmental and social factors, these are usually relegated to a secondary status. Their unquestioning confidence in their biologic paradigms of mental illness is truly staggering. In my opinion, this modern version of the ideology of biologic/genetic determinism is a powerful force that demands a response. And when I use the word ideology here, I mean it in its most pernicious form, i.e., as a discourse and a practice of power whose true motivations and sources are hidden to the public and even to the practitioners themselves, and which causes real harm to the patients at the receiving end.

Biologic psychiatry as it exists today is a dogma that urgently needs to be unmasked.[Dr. Baughman: this is as accurate a description of ‘biological psychiatry’ as I have seen. Having said that, all that is ‘biological psychiatry’ must now be identified; fingered, exposed to the fulllight of day, in all of the proper court rooms, especially in those courtrooms that order parents,under threat of loss of custody, to consent to treat and to—themselves actively participate in the treatment of their children with powerful toxic chemicals for the diseases of biological psychiatry that simply do not exist and, what’s more, will never exist.]

One of the surest signs that dogmatists are at work here is that they rarely question or attempt to problematize their basic assumptions. Infact, they seem blissfully unaware that there is a problem here. They act in seeming unawareness that they are caught up in larger historical and cultural forces that underwrite their entire "scientific" edifice.These forces include the medicalization of all public discourse on how to live our lives, a growing cultural denial of psychic pain as inherent in living as human beings, the well-known American mixture of a historicism and belief in limitless scientific progress, and the growing power of the pharmaceutical and managed care industries.[Dr. Baughman: It is mainly the growing, now-awsome power of the pharmaceutical industry,and unlimited pharmaceutical dollars (drug money) that permeate the US political process, that have brought us to this point. Their acquisition—buying of psychiatry (once a profession) was accomplished without a whimper. Their acquisition of psychology and all else that is ‘mental health’ (an oxymoron) is largely complete as well. ]

The self-proclaimed visionaries, oblivious to all of this, boast of real scientific progress over what they consider to be the dogma of psychoanalysis, which had up until recently reigned as psychiatry's premier paradigm.Now, it is not my intention to defend psychoanalysis, which had its own unfortunate excesses, although I do use psychoanalytic principles in the kind of psychotherapy I do. However it is quite clear to me that the grandiose claims of biologic psychiatry are wildly overstated, unproven and essentially self-serving.

Biologic psychiatry has had its successes, particularly with recent antidepressants like Prozac and newer medications such asClozaril.Medications can effectively improve depression, relieve severe anxiety,stabilize serious mood-swings and lessen psychotic symptoms. These successes are real in that they improve the quality of life of patients who aregenuinely suffering. But in reality, i.e., the reality of treatingpatients, medications have profound limitations. I know that if the only tool I had in treatment was a prescription pad, I would be a poor psychiatrist.

The center of treatment will always need to be listening to and speakingwith the patients coming to me. This means listening seriously to whatthey say about their lives and history as a whole, not symptoms which might
respond to medications. Although it seems astounding that I would haveto state this, biologic psychiatrists as a whole really only listen to that portion of thepatient's discourse that corresponds to their biologic paradigms of mentalillness.[Dr. Baughman: As a neurologist my primary role for each new patient was to determine, by history (subjective) and examination (objective), lab, x-ray, scanning, etc. (objective) whether abnormality—disease, was present or not. About 2/3 or so of patients I saw had no disease but had symptoms that were psychological, that is, emotional and behavioral. Where these were not ingrained and deep-seeded, I would venture brief treatment for them myself. A brief explanationof how, having ruled out physical (organic) disease left the psychological explanation, the only alternative, often went a long way toward relieving the patient’s worries, putting them on a footing to adapt, to ‘pull themselves up by their bootstraps’ and to prevail—getting back to normal. By the early 80’s, psychiatrists had embraced the ‘biological’ model such that all almostevery patient I referred to them got was a pill--no talking too, no understanding of where fromamongst their life’s travails, their worrisome symptoms might be coming from. At that time Istopped sending patients to them and began referring such patients only to mental healthproviders without prescription pads. They are much more difficult to avoid nowadays]It is the nature of dogma that its practitioners hear only what they want to hear.So what are the limitations of biologic psychiatry? First of all,medications lessen symptoms, they do not treat mental illness per se. Thisdistinction is crucial. Symptoms by definition are the surface presentationof a deeper process. This is self-evident. However, there has been a vast andlargely unacknowledged effort on the part of modern (i.e., biologic)psychiatry to equate symptoms with mental illness.For example, the "illness" major depression is defined by its set ofspecific symptoms. The underlying "cause" is presumed to be abiologic/genetic disturbance, even though this has never been proven in thecase of depression.[Dr. Baughman: or in any psychiatric disorder/disease that is known. In not a single one is therea confirmatory, objective finding, abnormality or exam, lab, scan, biopsy, culture,anything—It—biological psychiatry is a total fraud. ]

The errors in logic here are clear. A set of symptoms is given a name such as "major depression," which is then "treated" with a medication, despite the fact that the underlying cause of the symptoms remains completely unknown and essentially untreated.I have seen repeatedly that, for example, once medications lessen the symptoms, I am still sitting across from a suffering patient who wants to talk about his unhappiness.

This process of equating symptoms with illnesses has been repeated with every diagnostic category, culminating in perhaps one of the greatest sophistries psychiatry has pulled off in its illustrious history of sophistries, namely the creation of the Diagnostic and Statistical Manual (currently in its fourth incarnation under the name DSM-IV), the bibleof modern psychiatry.In it are listed all known "mental disorders," defined individually by their respective symptom lists. Thus mental illnesses are equated with symptoms.

The surface is all there is.The perverse beauty of this scheme is that if you take away the patient's symptoms, the disorder is gone. For those who do serious work with patients, this manual is useless, because for me it is simply irrelevant what name you give to a particular set of symptoms. It is an absolute myth created by modern psychiatrythat these "disorders" actually exist as discrete entities that have a cause and treatment. This is essentially a pseudo-scientific enterprise that grew out of modern psychiatry's desire to emulate modern medical science, despite the very real possibility that psychic pain, because of its existential nature, may always elude the capture of modern medical discourse and practice.[Dr. Baughman: Fail to understand that biological psychiatry is an absolute myth and you fail to understand ‘biological psychiatry.’ ]

Despite its obvious limitations, the DSM-IV has become the basis for psychiatric training and research. Its proponents claim that it is a purely a phenomenological document stripped of judgments and prejudices about the causes of mental illness. What in fact it has done is the defining and shaping of a vast industry of research designed to validate the existing diagnostic categories and to find ways to lessen symptoms, which has basically meant biologic research. Virtually all of the major psychiatric journals are now about this, and as such I find them useless to help me deal with real patients.[Dr. Baughman: I have begun to write an analysis of the fraudulence of all ‘biological psychiatry’research. The duplicity is unimaginable and it is just this that they count on. ]

Patients are suffering from far more than symptoms. Symptoms are the signs and clues to direct us to the real issues. If you take away the symptoms too quickly with medications or suggestion, you lose the opportunity to help apatient in a more profound way. As an aside, modern psychiatrists, becausethey have forgotten or dismissed the real power of transference, vastly underestimate the extent which symptom reduction is caused by mere suggestion. Not that patients should be left to suffer needlessly from what are often crippling symptoms. Relief of symptoms is a part of treatment.

Modern psychiatry would have us believe that this is all treatment should be.Meaning, desire, loss and death are no longer the province of thepsychiatrist. In this process patients are reduced to something less thanfully human, as they become an abstract collection of symptoms withoutmeaning to be "managed" by technicians called psychiatrists.This is in the service of medical progress and enlightened scientific thought. The biologic psychiatrist will not make the mistake of imposing their value systems on patients like in the bad old psychoanalytic days. This is, of course, a sham. Modern psychiatry now foists on patients the view that their deepest and most private ills are now medical problems to be managed by physician psychiatrists who will take their symptoms and return them to"normal functioning."

This is a bit more than malignant.One of the dominant discourses that runs through the DSM-IV and modern psychiatry in general is the equating of mental health with "normal functioning" and adaptation. There is a barely concealed strain of a specific form of Utopianism here which blithely announces that our psychic ills are primarily biologic and can be removed from our lives without difficulty,leaving us better adapted and more productive. What is left completely out, of course, are anynotions that our psychic ills are a reflection of cultural pathology. In fact, this new biologic psychiatry can only exist to the extent it can deny not only the truths of psychoanalysis, but also the truths of any serious cultural criticism.[Dr. Baughman: leaving such problems un-addressed, in fact, denying that they exist as they insert biologic defects of the brain’s hard-wiring and of genes (such as the ‘DNA Roulette’ of Harold Koplewicz of NYU, my alma mater), they give patient’s pills and pills-alone leading to an end-result that invariably equates to net damage for every patient’s encounter with psychiatry.]

It is then no surprise that this psychiatry thrives in this country presently,where such denials are rampant and deeply embedded. I am constantly amazed by how many patients who come to see me believe or want to believe that their difficulties are biologic and can be relieved by a pill. This is despite the fact that modern psychiatry has yet to convincingly prove the genetic/biologic cause of any single mental illness. However, this does not stop psychiatry from making essentially unproven claims that depression, bipolar illness, anxiety disorders, alcoholism and a host of other disorders are in fact primarily biologic and probably genetic in origin, and that it is only a matter of time until all of this is proven.

This kind of faith in science and progress is staggering, not to mention naïve and perhaps delusional..As in any dogma there is no perspective within biologic psychiatry that can effectively question its own motives, basic beliefs and potential blindspots. And thus, as in any dogma, there is no way for the field to curb it sown excesses, or to see how it might be acting out certain specific cultural fantasies and wishes. The rise and fall of biologic determinism in a culturelikely has complicated and interesting causes, which are beyond the scope ofthis paper.

A few comments will have to suffice.This is a culture increasingly obsessed with medical science and medical health as a sign of virtue. It is not surprising that our psychic ills would be pulled into this dominant medical discourse, essentially medicalizing our specific forms of psychic pain. It seems to me that modern psychiatry in step with a culture which created it, assumes any suffering to be unequivocally bad, an impediment to the "good life" of progress, productivity and progress.It is now almost heresy in psychiatry to say that perhaps suffering can teachus something, deepen our experience, or point us to different possibilities.Now if you are depressed or anxious, it has no real meaning, because as abiologic illness similar to, say, diabetes, it is separate from the world of meaning and merely is.

Now any thoughtful person knows that something as fundamental as depression has meanings such as loss, facing mortality,unlived desires, lack of power or control, etc., and that these meanings willcontinue to exist even if Prozac makes us feel better. There is much more tolife than feeling better or living without pain, and only a superficial andpathologic culture would deny this. Yet conclusions such as "depression is achemical imbalance" are created out of nothing more than semantics and the wishful thinking of scientist/psychiatrists and a public who will believe anything now that has the stamp of approval of medical science. It seems to me that modern psychiatry is acting out a cultural fantasy having to do withthe wish for an omniscient authority who armed with modern science, will magically take away the suffering and pain inherent in existing as human beings, and that rather than refusing this projection (which psychoanalystswere better able to do), modern psychiatry has embraced the role wholeheartedly, reveling in its new-found power and cultural legitimacy.

I would be remiss if I left out the obvious economic factors in psychiatry'smovement toward the biologic. Pharmaceutical corporations now contributeheavily to psychiatric research and are increasingly present and a part ofpsychiatric academic conferences. There has been little resistance in the field to this, with the exception of occasional token protest, despite its obvious corrosive and corrupting effects.It is as if psychiatry, long marginalized by science and the rest ofmedicine because of its "soft" quality, is now rejoicing in its new-found legitimacy, and thus does not have the will to resist its own degradation.The fact that the drug companies embrace and fund this New Psychiatry is cause enough for alarm.

Equally telling is a similar embrace by the managed care industry, which obviously likes its quick-fix approach and simplistic approach to complicated clinical problems.When I talk to a managed care representative about the care of one of my patients, they invariably want to know what medications I am using and little else, and there is often an implication that I am not medicating aggressively enough. There is now a growing cottage industry within psychiatry in advocating ways to work with managed care, despite the obvious fact that managed care has little interest in quality care and realistic treatmentapproaches to real patients. This financial pressure by managed carecontributes added pressure for psychiatry to go down a biologic road and to avoid more realistic treatment approaches.What this means in real terms is that psychotherapy is left out.

There has been a triple partnership created between this New Psychiatry, drug companies and managed care, each part supporting and reinforcing the other in the pursuit of profits and legitimacy. What this means to the patients caught in this squeeze is that they are increasingly overmedicated, denied access to psychotherapy and diagnosed with fictitious disorders, leaving them probably worse off in the long run.[Dr. Baughman: I do not think managed care’s dalliance with the pill model of psychiatry willlast or that it is so different in managed care than in what remains of fee-for-service mentalhealth. Given nothing but a pill, patients are not better off for long, nor do they have an illusion ofbeing better off for long (as long as it takes for placebo effect to wear off) . Come the time that the vast majority come back to managed care’s door, not better off but worse, managed care will take note and will adjust and will find what it takes to get people symptom free and stayingthat way, not forever at their door]

It is quite depressing to listen to the discourse of modern psychiatry. In fact, it has become embarrassing to me. One gets the strong impression that patients have become abstractions, black boxes of biologic symptoms, disconnected from the narratives of their currentand past lives. This pseudo scientific discourse is shot through withinsecurity and pretense, creating the illusion of objectivity, an inevitablemarch of progress beyond the hopeless subjectivity of psychoanalysis.Psychotherapy is dismissed and relegated to non-medical therapists.I actually have no objections to real science inthe field, if, for example,it can help me make better medication decisions or develop newer and better medications. But in general, biologic psychiatry has not delivered on its grandiose and utopian claims, as today's collection of medications are woefully inadequate to address the complicated clinical issues that come before me every day. This is all not terriblysurprising, given what I have outlined in this piece.

There will be no substitute for the difficult work of engaging with patients at the level of their livedexperience, of helping patients piece together meaning and understanding inthe place of their pain,fragmentation and confusion.Patients these days are not suffering from "biologic illnesses." What I generally see is patients suffering from current or past violence, traumaticloss, loss of power or control over their lives and the effects of culturalfragmentation, isolation and impoverishment that are specific to this cultureat this time. How this manifests in any individual is absolutely specific;therefore, one should resist any attempt to generalize or classify, as science forces us to do.

Once you go down the route of generalization, you have ceased listening to the patient and the richness of their lived experience.Unfortunately what I also see these days are the casualties off this newbiologic psychiatry, as patients often come to me with many years of pasttreatment. Patients having been diagnosed with "chemical imbalances" despitethe fact that no test exists to support such a claim, and that there is no real conception of what a correct chemical balance would look like. Patients with years of medication trials which have done nothing except to reify in them an identity as a chronic patient with a bad brain.

This identification as a biologically impaired patient is one of the most destructive effects of biologic psychiatry.Modern psychiatrists seem unaware of what psychoanalysts know well, namelyhow powerful are the words that a patient hears from an authority figure likea psychiatrist. The opportunity here for suggestion, coercion andmanipulation are quite real. Patients are often looking to psychiatrists for answers and definitions as they struggle with questions such as who am I, or what is happening to me. Of course we all struggle with these questions, and the human condition is such that there are no definitive answers, and any one who comes along claiming they have answers is essentially a fraud.Biologic psychiatry promises easy answers to a public hungry for them.

To give a patient nothing but a diagnosis and a pill demonstrates arrogance,laziness and bad faith on the part of the psychiatrist. Any psychiatrist needs to be continually aware of the very real possibility that they are or can easily become agents of social control and coercion.[Dr. Baughman: they are becoming this at a very rapid rate and they revel in the power and in their allegiance both with political might and monetary—corporate might ]

The way to resist this is to refuse to take on the role assigned through cultural fantasy, namely the role of omniscient dispenser of magical potions.As a whole, modern biologic psychiatry has enacted this role with particular vigor and enthusiasm. At the level of individual patients this means a growing number of over-diagnosed, over-medicated and disarticulated people less ableto define and control their own identities and lives.[Dr. Baughman: As a medical-therapeutic pretense the net outcome is invariably negative. In sum, this is a monstrous crime]

At the level of our culture this has meant an impoverishment of the discourse around such questions as what is wrong with us, as "scientific"answers replace more potentially fruitful and truthful psychological and cultural questioning.

If psychiatry is to regain any semblance of legitimacy and integrity, it must strip itself of false and hubristic scientificclaims and humbly submit itself to the urgent task of listening to individual patients with patience and intelligence. Only then can we have any realsense of what to say back to them.The sole philosophic basis for this New Psychiatry is the championing of empiricism above all other measures of truth. Something is valid only if it can be demonstrated through the experimental method, otherwise it is disregarded or relegated to "subjective" experience, which is presumed to be inferior.

This dominance of empiricism is not limited to psychiatry, and one can easily trace the invasion of the "hard" sciences into the "soft' or social studies.On a larger cultural level this can be detected in the public's infatuation with "studies," statistics and so on. This hegemony of empiricism over other ways of thinking and knowing represents an unprecedented modern achievement that has thoroughly infiltrated the cultural psyche, to the point now where the average person believes easily the claims of the biologic psychiatrist.Now, as is clear from my views already expressed, a social science dominated by empiricism is a vulgar science, and there is a vast tradition in philosophy from Plato to Nietzsche, which in my view irrefutably demonstrates this.

However, this is well beyond the scope of this piece. Suffice it to say that modern psychiatrists, like all "scientists" these days, have not time for the basic philosophic questions that have engaged the most brilliant minds of the past. Who needs questions about virtue when there is important data to collect? These biologic psychiatrists never think to ask themselves whether their own precious methods are perhaps standing on very shaky ground,e.g., their own disavowed prejudices about what constitutes the good life.Empiricism is one way of knowing, but certainly not the only or best way.

Biologic psychiatrists often use the standards of empiricism to answer their critics, in effect saying that their claims are scientifically "proven" and thus unassailable, clearly a tautological argument. I would further add that in my view many of the claims of biologic psychiatry do not even hold up to their own standards of empiric science, for example their claims about the biological and genetic bases of many mental illnesses.In my view, the methods of experimental science are inappropriate and misplaced when it comes to understanding the complexity of the human psyche,as they can only objectify the mind and remove subjectivity from the heart of human experience, thus creating an abstract entity in place of a human mind.It is no wonder that psychiatry declared the 1990s the decade of the braininstead of the decade of the mind. In their pursuit of the human brain, they have quite literally lost their minds.

One way to unmask the dogma that is biologic psychiatry is to ask the question what kind of human being is being posited as desirable, "normal," or not disordered. Judging by the DSM-IV, it would be a person not depressed oranxious, without perversions or sexual "dysfunction," in touch with"reality," not alienated from society, adapted to their work, not prone toexcessive feeling states and generally productive in their life pursuits.This is, of course, the bourgeois ideal of modern culture. We will all fit in, produce and consume and be happy about it. Anyone who dissents by choice or nature slips into the realm of the disordered or pathologic, is then located as such by medical science and is then subject to social management and control.

Now psychiatry has always provided this social function, as admirably shown by Foucalt and others. I would submit, however, that modern psychiatry, under the guise of medical and "scientific" authority and legitimacy, has surpassed all past attempts by psychiatry to identify and control dissent and individual difference. It has done this by infiltrating the cultural psyche,a psyche already vulnerable to any kind of medical discourse, to the point where it is a generally accepted cultural notion now that, say, depression is an illness caused by a chemical imbalance.Now when a person becomes depressed, for example, they are less able to read it or interpret it as a sign that there may be a problem in their life that needs to be looked at or addressed. They are less able to fashion their own personal or cultural critique which could potentially lead them to morefruitful directions. Instead they identify themselves as ill and submit to the correction of a psychiatrist, who promises to take away the depression so that they can get back to their lives as they are. In short, the very meanings of unhappiness are being redefined as illness.In my view this is a dismaying cultural catastrophe.

I do not mean to suggest that psychiatry is solely to blame for this, given how wide acultural shift this is. However, I do think that psychiatry has not only not resisted its role here, but actually has fulfilled it with considerable hubris.Thus, in my view the whole phenomenon of biologic psychiatry is itself a symptom or acting out of a larger, underlying cultural process. Unhappiness and suffering are not seen as resulting from real cultural conditions; for example, the collapse of traditional institutions and the ever-increasing hegemony of rampant consumerism in American culture.Nor is suffering seen in the context of what it means to exist as a human being in any historical period. Historical and existential discourse about unhappiness is increasingly supplanted by medical discourse, and biologic psychiatry has served as one of the major mouthpieces for this kind of pseudoscientific and frankly pathetic medical discourse about what ails us.

I am increasingly astonished about how unable the average patient is now to articulate reasons for their unhappiness, and how readily they will accept a"medical" diagnosis and solution if given one by a narrow-mindedpsychiatrist. This is a cultural pathologic dependence on medical authority.Granted, there are patients who do fight this kind of definition and continueto search for better explanations for themselves which are lessinfantalizing, but in my experience this is not common. There is afrightening choking off of the possibility for dissent and creative questioning here, a silencing of very basic questions such as "what is this pain?" or "what is my purpose?"Modern psychiatry has unconscionably participated in this pathology for itsown gain and power. It is a moral, not scientific issue at stake here, and inmy view this is why many astute Americans rightfully distrust this NewPsychiatry and its utopian claims about happiness through medical progress.

So what kind of psychiatry am I advocating here? First of all, I think it is unclear whether the field can extricate itself from its current infatuation with technology and its own power to use it. When one reads psychiatric journals now, one senses a dangerous giddiness about the field's "discoveries" and "progress," which in my view are wildly and irresponsibly overstated. All the momentum, which is mainly economically driven, is pushing psychiatry towards further biologism.What I am advocating is a psychiatry which devotes itself humbly to the taskof listening to patients in a way that other medical practitioners cannot.

[Dr. Baughman: …and the way psychiatry still did in the 60’s and 70’s. I shared an office at thistime, in Grand Rapids, Michigan with a humane, caring psychiatrist. He made no pretense that he diagnosed and treated ‘brain diseases’ as is the claim, uniformly, today.]

This means paying close attention to a patient's current and past narrative without attempting to control, manipulate or define it. From this position a psychiatrist can then assist the patient in raising relevant questions about their lives and pain.The temptation to provide answers or false solutions should be absolutely avoided here. Medications are used judiciously for lowering painful symptoms,with considerable attention paid to the psychological effects of medication treatment. Diagnosis should play a secondary and small role here, given that little is known about what these diagnoses actually mean.Above all, coercion, normalization and control need to be assiduously guarded against, as these are natural temptations that arise out of the dynamics of power that exist between psychiatrist and patient.[Dr. Baughman: all on the mental health team--teachers, all school personnel, counselors, socialworkers, psychologists, local police, pediatricians, general and family practitioners, neurologists,child neurologists, adult and child/adolescent psychiatrists, have succumbed to the power trip of‘brain diagnosis’ and of not only pontificating about the brain of another, but taking charge of it,the child, the family, by calling in the police and courts to enforce their mutual diagnoses andtheir prescriptions—and no just their IEPs—their Individualized Educational Prescription,nothing but another empty pretense to being medical practitioners.]

A more humane psychiatry, if it is even possible in today's cultural climate, must recognize the powerful potential of the uses and abuses of power if it is not to become a tool of social control and normalization. As I have outlined in this piece, these abuses of power are by no means always obvious and self-evident, and their recognition requires rigorous thought and self-examination. The psychiatrist plays a particular role in cultural and individual fantasies, and an intelligent psychiatrist must be aware of the complexity of these fantasies if he is to act in a position outside these projections and fantasies. This requires real moral awareness on the part ofa psychiatrist who wishes to act intelligently.

What I am advocating for in outline form as stated previously are the
minimal requirements necessary for the field of psychiatry to reverse
its current degradation. What is essential at this time is for psychiatrists and other clinicians to speak out against the ideology known as biologicpsychiatry.[Dr. Baughman: US biological psychiatry has positioned itself , regarding monetary and politicalpower, exactly where the ‘biological psychiatry’ of Nazi Germany had positioned itself prior to and in the early, pre-holocaust months of WWII. Biological psychiatry today, with all of the involuntary control it seeks in forcing it’s treatments upon us, is the biggest threat to theAmerican, democratic way of life to appear in our midst since the creation of the Union.Psychiatrists, even ‘biological’ psychiatrists all went to medical school and all know the difference between having disease (abnormal) and not having disease (normal). They all know in making their disease, chemical imbalance pronouncements that they have adduced a diagnostic abnormality, that they have not proven the presence of disease. For them to say so to the patient or parents of a child, nonetheless is a knowing violation of the right to informed consent and is tantamount to medical malpractice.]

PSYCHIATRIC "MEDICATIONS", DRUG CORPORATIONS BRIBES,AND MODERN PSYCHIATRY
by Justice Lover

In his article, Can Psychiatry be Retrieved from a Biological Approach?http://www.uea.ac.uk/~wp276/Can.htm ,the British psychiatrist D.B. Double, M.D. describes Biologic Psychiatry, the dogma which dominates modern psychiatry, as follows : "The basic assumption of biological psychiatry is that mental illness is due to a biochemical imbalance which can be corrected by medication." Although his definition presumes the existence of "mental illness" - something very doubtful which I strongly dispute - it does point out the gist of the fraud perpetrated on psychiatry by the drug industry. His words, "biochemical imbalance which can be corrected by medication", has got very practical meaning for the shrinks. It means that all that the shrinks have got to do is give a name to that "biochemical imbalance", thus declaring the patient "mentally ill", and presto pick up the "appropriate medication" from the drug industry manual, issue a CTO over the victim, then proceed to the next victim. Easy job, good money, and the world looks at them with admiration, or would it not ?

Mind you, the very word "medication" is false, and is a misrepresentation even according to the psychiatric dogma. Psychiatry itself never dared to claim that it has any cure for any of its list of "mental illnesses". Why, then, call it medication when it is more appropriate to call the drug poison, or psychiatric drug ,which is what it is in reality ?

Here is what another dissident American psychiatrist, Dr. Douglas C. Smith, in his brief but important article, says about psychiatric "medications" :http://www.antipsychiatry.org/drsmith1.htm

"Why Psychiatric Drugs Are Always Bad by Douglas C. Smith, M.D.

I no longer recommend psychiatric medications to anyone.This seems radical in this country because we are in the midst of the "biological revolution." Everyone seems to assume medications are specifically effective for various mental illnesses which are at least in part chemical or genetic in origin. I believe the science behind this is seriously flawed. It is based on false assumptions that lead to self-perpetuating mythology (and huge profits for drug companies).I first gave up on tranquilizers, then antidepressants, then all psychiatric drugs.

I learned that there are certain general principles that govern all psychoactive substances and biologic treatments.

General Principles:
(1) "Mental illnesses," even severe ones, are relational (I'd say spiritual as well). Psychiatry, by focusing almost exclusively on biology, is making itself increasingly irrelevant.
(2) Psychoactive substances provide at best, temporary relief, but always make things worse in the long run. They make things worse directly (chemically) and indirectly by distracting from the real issues.
(3) All psychoactive substances have rebound and withdrawal-related problems. "Relapse" rates, in general, during withdrawal from psychiatric drugs, are about 10 times higher than would be expected if the drug had never been taken.
(4) "All biopsychiatric treatments share a common mode of action -- the disruption of normal brain function" (Peter Breggin, M.D., Brain Disabling Treatments in Psychiatry, Springer Pub. Co., 1997, p. 3). Drugs never correct imbalances. They never improve the brain. They "work" by impairing the brain and dampening feelings in various ways."

The author, Douglas C. Smith, M.D., graduated from Indiana University (1982 - Phi Beta Kappa) and Indiana University School of Medicine (1986) and completed his psychiatry training in 1990 and is board certified in psychiatry. He also has had additional training in psychoanalysis. He currently lives and practices in Juneau, Alaska. He is on the board of the National Association of Rights Protection and Advocacy and the International Center for the Study of Psychiatry and Psychology.

To explain this obvious violation of the Hippocratic oath by the vast majority of psychiatrists, who follow the dogma-fraud of modern psychiatry, thus passing on to their patients the fraud perpetrated on them by the drug corporations, here is an article by the late American psychiatrist Prof. Loren Mosher :http://www.antipsychiatry.org/mosher.loren.1.htm

"How Drug Company Money Has Corrupted Psychiatry
by Loren R. Mosher, M.D.

The American Psychiatric Association (APA) is the nationwide organization to which most psychiatrists belong. In some ways it is a trade union. A large proportion of its income is from drug company advertising in its journals and newspaper. It also receives "unrestricted educational grants" and convention revenue from drug companies. Drug company sponsored symposia and exhibitions dominate the two major annual psychiatric conventions. Of course, the symposia speakers are paid handsomely for their half-day appearances. In my opinion, the APA is so dependent on pharmaceutical company support that it can not afford to criticize the overuse and misuse of psychotropic drugs.

Perhaps more importantly, the APA is unwilling to mandate education of psychiatrists about the seriousness of the short and long-term toxicities and withdrawal reactions from the drugs.The drug companies pay speakers ($1000-2000 per appearance) who give psychiatric grand rounds and/or evening speeches (dinner provided by the company) to local psychiatric societies. Speakers come from lists of psychiatrists who will basically endorse their products. Doctors training to be psychiatrists are specially targeted for these speakers.The drug companies give contracts to university based and private psychiatric research companies to conduct drug trials that are required for U.S. Food & Drug Administration (FDA) approval of the drugs they sell. The company provides the protocol and the researcher may receive as much as $40,000 per patient that completes the study. This allows the drug company considerable influence on the way the drug studies are conducted.

All of these drug manufacturer activities have increased in scope and intensity since the introduction of newly patented drugs, beginning with Prozac in 1989. They must reap the profits before patents run out.Research protocols used in studies of psychiatric drugs required for the approval of the FDA are supposed to be reviewed by Institutional Review Boards (IRB's) to be sure they do not pose undue risks to the study subjects. Members of these boards have been found to be highly paid consultants to drug companies whose protocols they review. That is, they have obvious conflicts of interests and are not objective, unbiased reviewers of the psychiatric drug studies over which they pass judgment.

The latest "novel" anti-psychotic drug that has been approved by our federal drug regulatory agency (FDA) is Zeldox, which the FDA allowed to be introduced to the US market despite Zeldox's dangers.In my view American psychiatry has become drug dependent (that is, devoted to pill pushing) at all levels - private practitioners, public system psychiatrists, university faculty and organizationally.

What should be the most humanistic medical specialty has become mechanistic, reductionistic, tunnel-visioned and dehumanizing. Modern psychiatry has forgotten the Hippocratic principle: Above all, do no harm."

As the article above hints ,bribes are not the only means the transnational drug corporations use to perpetrate and perpetuate the dogma-fraud of modern psychiatry. The professional training of psychiatrists is also under the remote control of the drug corporations. Here is the relevant part of British psychiatrist D.B. Double, M.D, from his above article, Can Psychiatry be Retrieved from a Biological Approach? ,to explain the point :

"The bias of medical trainingMedical training assumes a scientific mode of thinking. Medical students are not primed to realise that human behaviour may not follow rules of physical cause and effect. By the time trainees start psychiatric training they have been firmly indoctrinated in the belief that people can be explained and predicted. The weight of philosophical inquiry belies this view (Dilthey 1976). Students need to realise that it is legitimate to question whether an understanding of human nature can take the same form as the laws of natural science. It may come as a shock to medical students to be made aware of this potential because of the mindset which has been created by the unquestioning assumption that natural scientific methods can be applied to human behaviour. Even if students are not surprised, scientific education may have become so entrenched that it is too late for thinking to shift.

I am, of course, using science in the narrow sense of physical science. A broader definition of science would be the application of commonsense. It is in just this sense that medical training seems to be unscienific and mindless. I am aware that such a view will be dismissed as vague and uncertain.Traditional medical education has fostered in students the notion that uncertainty is a manifestation of ignorance and weakness. Factual knowledge takes precedence over critical appraisal. The inevitable denial and avoidance that result when the limits of rationalism are exposed in clinical practice are reinforced by patients who may expect them to be certain.

This vulnerability is made particularly acute in psychiatry when patients try to express their desires and self-destructiveness and describe their abuse and past traumata.Clinical schools have sometimes said they want to recognise the importance of cultivating creativity and paying closer attention to students' emotional development. Unfortunately, guidance in developing techniques to handle issues raised by uncertainty do not feature prominently in most curricula. In our "post-modern world" there is some truth in the statement that natural science on which medical training is based has now a greater acceptance of subjectivity and uncertainty. It was never realistic, however, to expect that the introduction of social science and medical ethics to undergraduate training would encourage the necessary adjustments to thinking and practice. A more profound focus on the person is required in medical training from the start of training.

Of course, I am not encouraging a dualism of mind and body. Biological knowledge needs to be integrated with personal understanding. Enlightened attitudes can only be developed by being open to the limits of medical practice.A greater recognition of the anxieties experienced by all professional disciplines involved in the delivery of health care should facilitate better use of resources. This means clinicians must explicitly acknowledge and understand the importance of imprecision before such co-operation can be productive.

The myth of biological psychiatry

By the time doctors begin psychiatric training, they are enmeshed in medical indoctrination. There should be little surprise then about their unthinking acceptance of the biological model of mental illness. "Chemical imbalance" explains aberrant behaviour and feelings, as if it understands it. Medication is the simple response and the foundations of trainees' worldview shake if the hypothesis is not true. The belief is so fundamental to the edifice of psychiatry that paradigms about neurotransmitters and receptors do not shift despite contrary pharmacological evidence. Most psychiatrists in their clinical work still think they are correcting dopamine imbalance in their treatment of schizophrenia with neuroleptics, despite the abandonment of the hypothesis by pharmacologists and the widespread acceptance of atypical neuroleptics onto the market. The amine hypothesis still figures at least in the background of psychiatrists' use of antidepressants, encouraged by pharmaceutical companies' rationales for the development of their products.

Of course, I am not dismissing psychiatry's base in medicine, which, for example, is useful for understanding the common physical complaints of psychiatric patients.Lack of self-criticism in psychiatry is stifling. Recognition by a trainee that there may be more factors than "chemical imbalance" involved in a patient’s problems may be dismissed as interesting "psychodynamics". Failure to produce the correct diagnosis in the MRCPsych clinical examination is given more weight than an attempt to understand the patient’s problems, albeit in no more than one hour. When have trainees had demonstrated to them the power of suggestion, rather than the effects of medication, or had any acknowledgement of the influence and power of using medication? Doctors with a designated interest in the mind should be expected to be more aware than other specialities of the power of the placebo. And if so, they might realise that habituation to medication is likely to be common, perhaps particularly with drugs which are thought to improve emotional states. This recognition would help trainees to appreciate why so many people have difficulty discontinuing medication, and would provide an alternative explanation to recurrence of disease when symptoms present themselves on terminating treatment.Authoritarian attitudes are not conducive to self-criticism. Challenge to the structure of training is marginalised.

Creating unhealthy, defensive doctors cannot be in the interest of patients. Narcissistic impulses will have to be renounced along with ideas of omnipotence, although there should be no fear that patients will no longer need services.And besides, how does a doctor relate to other disciplines who sense their vulnerability but have not the authority to challenge it? After all, it is the doctor who has knowledge about the body and other disciplines do not have accredited training in this field. Even if they can see the bizarreness and absurdity of biological psychiatry’s claims, they may be missing some information. In a power struggle it suits the psychiatrist to keep them thinking this way."