Some Common Anti-Psychiatry Archetypes
The anti-psychiatry movement resembles the anti-vaccine movement and HIV/AIDS denialism in many ways. Whereas anti-vaccine cranks claim that vaccine-preventable diseases are not that bad and HIV/AIDS denialists often deny the causal link between HIV and AIDS, anti-psychiatry cranks typically deny the existence of mental conditions outright (claiming they are made up or that they are “natural” states) or blame the individuals for “attracting” the illness into their lives with “too much negative thinking”. All three groups attack the underlying scientific models (e. g. mechanisms for vaccine-induced immunity and herd immunity, that HIV cause a reduction in CD4+ T helper cells, the biological basis and neurological mechanisms of mental conditions), the efficacy of the medical product, pharmaceutical companies, the government and the scientific community.
This post is an attempt to summarize seven of the most common clusters of characteristics, beliefs and approaches taken by various types of anti-psychiatry cranks: the creationist, the alt med zealot, the new age ignoramus, the “sophisticated” mysterian, the selective “skeptic”, the conspiracy lunatic and the scientologist. These archetypes are not based on published scientific studies, but rather on experience with debating anti-psychiatry cranks. Some of them overlap and not all features of a given archetype always occur. An interesting observation is that anti-psychiatry can be found across political, religious and philosophical spectra and divides. Even though a lot of the assertions made and rhetoric deployed is consistent across archetypes, different archetypes have different motivations and a slightly different focus.
The Creationist: the anti-psychiatry creationist represents the worst of two worlds: both a rejection of modern cosmology, geology and biology as well as a rejection of modern neuroscience, psychology and psychiatry. These individuals reject psychiatry and related fields because (1) neuroscience considers the mind to be a function of the brain, which is incompatible with the anti-psychiatry creationist’s faith that an immaterial soul is the entity responsible for the mind and (2) treatments of mental conditions does not involve a consideration of original sin, but focuses on medication and therapy. Although not all creationists are anti-psychiatry, those that are reject additional fields of science in order to keep their religious beliefs afloat. Depending on the individual anti-psychiatry creationist, he or she may reject the existence of mental conditions as medical conditions or go so far as to provide a religious description of mental conditions as demonic possessions or gifts from a deity.
The Alt Med Zealot: the alt med zealot embraces anti-psychiatry because he or she wrongly believes in the efficacy and safety of so-called “alternative” treatments for mental conditions. In reality, these alleged “treatments” are quackery and almost never gives any practically significant benefit above placebo. Most of the time, these individuals accepts the medical reality of mental conditions. However, they tend to shuns positions supported mainstream science, usually by ignorantly dismissing it all by shouting about “evil, multinational pharmaceutical corporations” (apparently without realizing the irony that a lot of “alternative medicine” is being produced and sold by large corporations) and accusing all critics of their beliefs of being pharma shills.
The New Age Ignoramus: although sharing many defining features with the alt med zealot, the new age ignoramus often parrot the law of attraction and wrongly claim that individuals with mental conditions have themselves to blame because they allegedly had too many negative thoughts. Seemingly ignorant about the scientific research on genetic risk factors for mental conditions, the effects of stressful life events and gene-environment interaction, the new age ignoramus rarely accept the medical reality of mental conditions. Instead, they often reject both medication and therapy, suggesting that individuals with mental conditions will attract good things in their life if they just have more positive thoughts.
The “Sophisticated” Mysterian: mysterians are typically non-religious atheists who has a negative visceral and emotional response to the notion that their beliefs, thoughts, feelings and so on are related to the function of a physical brain. The three most common approaches taken by this anti-psychiatry archetype is (1) Appeals to ignorance characterized by “we will never understand human cognitive feature X” were X is love, art appreciation, beauty, consciousness and so on, (2) point out some methodological limitation regarding questions of how the brain generates the mind in an bait-and-switch effort to attempt to undermine the scientific conclusion that the brain does generate the mind and (3) unrelenting accusations of “scientism”, “reductionism” and “determinism”. Mysterians are not seldom freelance journalists blogging for Nature News, Scientific Americans, Washington Post or the New York Times.
The Selective “Skeptic”: these are self-described “skeptics” who mock anti-vaccine cranks and HIV/AIDS denialists for their flawed assertions and dishonest debating tactics (like misunderstanding basic science, quoting scientists out of context, creating a manufactroversy, false balance, playing the martyr card, misusing statistics and so on), yet has no problem using these exact pseudoscientific tactics when attacking psychiatry. Pointing this out is not sufficient to break the bubble of cognitive dissonance and will usually be met with rationalizations and denial. Published scientific evidence in favor of psychiatric models and treatments are met with extreme skepticism, whereas random blog posts online that attacks psychiatry is often accepted with little skepticism.
The Conspiracy Lunatic: this anti-psychiatry archetype is essentially a misguided freedom fighter stuck in Soviet Union of the 1960s. The conspiracy lunatic thinks that all mental conditions are supposedly without any foundation in reality and allegedly invented by evil psychiatrists in collusion with the government and/or pharmaceutical companies. All treatments are believed to be a form of human enslavement. Medication is allegedly used either to brainwash people or keep them pacified while the government, banks or alien reptiles take over the world. Involuntary psychiatric treatment is seen as kidnapping and imprisonment of dissenters instead of a way to protect a person who is at high risk of serious harm or death. ECT, a last-resort treatment given to individuals with severe and treatment resistant depression when all else fail and the life of the person hangs in the balance, is wrongly seen as cruel punishment (despite the fact that individuals undergoing that treatment are given general anesthesia and a muscle-relaxant and that brain scans show that brain damage does not occur).
The Scientologist: this anti-psychiatry archetype is associated with scientology, but it shares many core features in common with the other six archetypes. This is presumably because of the early and close historical links between the two movements. Some scientologists consider themselves at war with psychiatry: they believe that mental illness is a fraud and thinks that psychiatrists are crime-causing terrorists who kidnap, torture and murder innocent people.
Although not empirically validated by any means, these archetypes are useful representations of some of the common themes and clusters of ideologies that defenders of mainstream psychiatry come across when refuting mental illness deniers and anti-psychiatry proponents.
References:
Overview of Anti-Psychiatry
Lieberman, J. A. (2013). DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice. Scientific American Mind Guest Blog. Accessed: 2013-08-07.
The Debunking Anti-Psychiatry Category on Debunking Denialism.
Steven Novella’s excellent series on mental illness denial.
Mieszkowski, K. (2005). Scientology’s war on psychiatry . Salon. Accessed: 2013-08-07.
Safety and Efficacy of ECT
Abrams, Richard. (2000). … and there’s no proof of lasting brain damage. Nature, 403(6772), 826-826.
Devanand D.P., Dwork A.J., Hutchinson E.R., Bolwig T.G., Sackeim H.A. (1994). Does ECT alter brain structure? Am J Psychiatry. 151(7):957-70.
Fink, Max. (2000). ECT has proved effective in treating depression … Nature, 403(6772), 826-826.
Giltay, E. J., Khol, K. H., Blansjaar, B. A. (2008). Serum markers of brain-cell damage and C-reactive protein are unaffected by electroconvulsive therapy. The World Journal of Biological Psychiatry, 9(3), 231-235.
Lilienfeld, Scott O., Lynn, Steven Jay, Ruscio, John, & Beyerstein, Barry L. (2011). 50 Great Myths of Popular Psychology: Shattering Widespread Misconceptions about Human Behavior. West Sussex: Wiley-Blackwell.
Mayo Clinic. (2012). Electroconvulsive therapy (ECT). Accessed: 2013-08-07.
Palmio, Johanna, Huuhka, Martti, Laine, Seppo, Huhtala, Heini, Peltola, Jukka, Leinonen, Esa, . . . Keränen, Tapani. (2010). Electroconvulsive therapy and biomarkers of neuronal injury and plasticity: Serum levels of neuron-specific enolase and S-100b protein. Psychiatry Research, 177(1–2), 97-100.
Reisner AD. (2003). The electroconvulsive therapy controversy: evidence and ethics. Neuropsychol Rev. 13(4):199-219.
Zachrisson, Olof C. G., Balldin, Jan, Ekman, Rolf, Naesh, Ole, Rosengren, Lars, Ågren, Hans, & Blennow, Kaj. (2000). No evident neuronal damage after electroconvulsive therapy. Psychiatry Research, 96(2), 157-165.
Your article does science a disfavour in two ways: firstly, you classify psychiatry as a scientific discipline, despite its obvious issued with its scientific status (in contrast to cognitive neuroscience or neurology); Secondly, you present your own argument as if it had some relation to science, when really it is nothing more than an extended ad Hominem based on stereotypes and prejudice.
While I understand that the article is somewhat tongue-in-cheek (and yes, some of the archetypes were spot-on, and funny too) I wonder where you would choose to fit the many scientists fighting to increase the transparency (and hence the reliability) of medical trials. I really don’t see a place for Dr. Ben Goldacre in your piece, or the many scientists working on the Cochrane Collaboration, or David Healy – I could go on listing scientists and doctors who have been highly critical of the field for some time – where do they fit in your little diatribe?
Recent evidence suggests that many of the most egregious abuses of the pharmaceutical approval system have been related to psychiatric drugs, drugs whose effects are in many cases experienced subjectively, and thus are most difficult to separate from placebo. Not only is efficacy difficult to test, but the enormous profits garnered from the successful approval of psychiatric drugs is an additional distorting factor. Finally, factors that (at the very least) exacerbate psychiatric symptoms, such as poverty, abuse,social isolation, drug abuse, alienation and so on, are hugely difficult and expensive to treat. As a result many types of mental anguish have been treated with inappropriate psychoactive drugs, which were not designed to
None of this, please note, is an attack on science. Rather, it is an observation many of the solutions currently offered by psychiatry are not supported by reliable evidence and remains a disciplines which make unfalsifiable claims that would be found unacceptable in any other scientific field (except perhaps psychology). As a result, the pharmacological theories used to explain the action of the most common psychiatric medications are highly questionable, at best.
Many of those who suffer from mental illness and those who care for them feel that psychiatry is doing a very poor job of looking after the interests o their clients. Some of these may feel betrayed enough by the failures of the past to consider themselves anti-psychiatry. This, however, does not make them anti-science.
Science, after all, is not about certainty, it is about testing our ideas and theories of the world against the world itself. The world is a complex place, and it will require utmost honesty and diligence to unlock its secrets; two attributes sorely lacking in psychiatry today.
Psychiatry is a scientific discipline and a lot of evidence exists for the existence of mental conditions, the efficacy of treatments and a lot of scientific progress has been made regarding the causes of mental conditions.
The fact that there exists an internal scientific debate about details is in no way an argument against the scientific status of psychiatry, just like a debate about whether Homo floresiensis is its own species or not is not an argument against common descent. In other words, you are deploying the following common denialist tactic:
You do not appear to understand what an ad hominem is. An ad hominem is of the form “person X has characteristics Y, therefore person X is wrong”. I never made that claim. Rather, I described some common features of clusters that one can anecdotally observe when debating proponents of anti-psychiatry. I specifically mentioned this several times throughout my post.
Scientists who fight for increased transparency in clinical trials are not anti-psychiatry. Ben Goldacre, a defender of science-based medicine and a vocal critic of pseudoscience, has a background in mainstream psychiatry. He is not at all anti-psychiatry.
What evidence is this?
No, it is not inherently more difficult to study subjective outcomes than objective ones, and trials of psychiatric medications involve both subjective and objective outcomes. Also, “subjective” does not mean what you think it means. You are confusing “subjective” in the “not based on reality” with “subjective” in the “personal” sense. For instance, tinnitus is “subjective” in the sense that it is personal, but it is not subjective in the “not based on reality” sense.
I also find it ironic that you simultaneously claim that the efficacy of psychiatric medication is difficult to test and insinuate that they are ineffective. Guess you did not notice that contradiction.
It is certainly an attack on science, because most of the treatments offered in psychiatry are supported by reliable evidence. The effect size of psychiatric medication and cognitive behavioral therapy are practically significantly above placebo for many mental conditions. I have discussed that in relation e. g. depression many times on this blog before. I also posted a lot of references for the safety and efficacy of ECT in the reference section. Guess you did not bother to read that.
You claim that psychiatry makes unfalsifiable claims, yet you provide no evidence of this. It is also ironic that you claim that psychiatry makes unfalsifiable claims at the same time as you claim that “recent evidence” contradict mainstream psychiatry. You cannot have it both ways.
Even if we had no idea how psychiatric medication worked (we do), that is completely unrelated to the question of efficacy. Again, you are confusing the question of “how” with the question of “whether” (a classic denialist tactic).
It is possible for people to be badly treated by cardiologists, but that does not mean that anti-cardiology is a valid stance to take. Anti-psychiatry is dangerous anti-science.
There will always be things we do not know, but the question is if the established mass of knowledge outweighs the residual uncertainty. Psychiatry is both scientific and testable. New studies and research are being carried out and new papers are published continually. Sometimes, these contribute vital and new understanding about mental conditions that we did not know about before.
Anti-psychiatry, on the other hand, does not modify or accept evidence. This is because the movement regurgitates the same tired, old arguments over and over.
Thanks for your thoughtful reply. Due to a paucity of time, I am forced to reply a small chunk at a time.
Part. 1
—–‘Psychiatry is a scientific discipline’—–
By far the largest part of psychiatry is not a scientific discipline, it is a body of clinical practice focussed on the treatment of patients by medical practitioners (who are not themselves scientists or researchers). Psychiatry is not a bunch of scientists striving for truth in a lab, it is a complex community of stakeholders, all of which have various interests at stake.
The clinical methods used by psychiatrists may be based more or less on science. You make the claim that it is based on science, I claim that it is not, that is the essence of our dispute. You cannot, however, hope to claim that psychiatry IS science, and subsequently win the argument by definition.
——‘…and a lot of evidence exists for the existence of mental conditions’——-
The phrase ‘mental conditions’ is highly ambiguous, which may explain why it barely appears in the literature. By using ‘mental’ to define the illness, you define illness or dysfunction which appears in the mind as opposed to the brain. The mind, and categories of mental experience cannot be directly observed.The only evidence for mental illness in this sense, are the Krapelinian methods used to categorise human behaviour into a nosology of human disease. Is this what you mean about evidence?
——-‘….the efficacy of treatments and a lot of scientific progress has been made regarding the causes of mental conditions.’——–
Very little scientific progress has been made regarding aetiology, as was noted earlier this year by the director of the NIMH, Thomas Insel. In general, the DSM has always been aetiology neutral. Initially, this was due to a compromise made between the biological psychiatrists and the Freudians in the mid 70s – as their key dispute was the cause of mental illness. Since then, various attempts have been made to find the causal factors of mental illness. Various hypotheses have been proposed, focussing on genetic, biological, developmental, psychological and environmental factors. More recently, some interactionist models have been proposed, but these remain almost purely theoretical. With the exception of PTSD, no reliable aetiology has been discovered for any of the conditions listed in DSM5. This suggests that either DSM nosolgy is invalid, or that mental illnesses are multiply determined.
———–‘You do not appear to understand what an ad hominem is. An ad hominem is of the form “person X has characteristics Y, therefore person X is wrong”.———
An Ad Hominem is not (as you have tried to suggest) a logical fallacy of argument. It is an appeal to pathos, or emotion, by attacking the person who makes the argument rather than the argument itself. By making comic stereotypes members of the anti-psychiatry movement, you focus on the people, not the argument; this is an AD Hominem.
——‘Rather, I described some common features of clusters that one can anecdotally….’——-
He heh. Let me guess, you’re actually a psychiatrist right?
——-‘Scientists who fight for increased transparency in clinical trials are not anti-psychiatry.’——–
What about scientists who feel that real transparency would reveal that psychiatry is a discipline composed largely of pseudo-science. What about those people? Are they anti-psychiatry?
——‘No, it is not inherently more difficult to study subjective outcomes than objective ones, and trials of psychiatric medications involve both subjective and objective outcomes. Also, “subjective” does not mean what you think it means. You are confusing “subjective” in the “not based on reality” with “subjective” in the “personal” sense. For instance, tinnitus is “subjective” in the sense that it is personal, but it is not subjective in the “not based on reality” sense.’——-
How do you know what I think subjective means? Some things can be observed only by the person who is having that experience. Tinnitus is a good example, although pain is more salient to most people. We cannot measure pain with an instrument, we cannot accurately measure pain on an interval scale, we cannot compare one persons experience of pain with another.
For this reason, subjective measures depend (by definition) on self-report. The sensitivity of self-report to various forms of suggestion and distortion have plagued psychology for over a century. Although psychology has developed many ingenious methods to get around these problems, they remain far from trivial, and it is no coincidence that psychology chose to ignore subjective experience for almost half a century (i.e. behaviorism). The mere existence of the placebo effects presupposes that subjective measures are difficult to measure than others.
This is important for the following reason. Science in the twentieth century has used various forms of operationalism and instrumentalism in order to guarantee that theoretical concepts are reliably grounded in empirical fact. This is with good reason; science divorced from reliable methods of verification can be nothing but pseudoscience.
Psychiatry is plagued by the problem of accurate measurement. As a result, many of its concepts are very difficult to validate empirically. In a similar vein, the efficacy of medication has also been difficult to gauge accurately and reliably. Because of these two issues, scientific methods that have successfully driven out pseudo-science and self-interest from most human endeavours have been unable to do so from psychiatry.
Sorry. I have to leave it there for now; In pt, 2 I’d like to reiterate that anti-psych is not anti science precisely because psychiatry is not a real science
Actually, psychiatrists are specialized medical doctors. In terms of science education, that usually requires an undergraduate degree with focus on pre-med (3 years), medical school (4-5 years) and residency (4 years) in addition to a license to practice and a board certification.
So it is not accurate to dismiss a profession that requires a scientific education of 12 years as mere “stakeholders”.
When you stated that the “clinical methods used by psychiatrists may be based more or less on science”, you more or less conceded the argument. In an unguarded moment, you admitted that psychiatry is science.
No, I used the term mental condition as a non-stigmatized synonym of “psychiatric disorder”, “mental disorder”, “mental illness” and so on. My usage of that term should not be interpreted in such a way as to suggest that mental conditions are mind dysfunctions without being brain dysfunctions.
Mental experience can be indirectly observed by various means, from interviews and clinical observation to brain scans and clinical trials. It is irrational to dismiss a scientific discipline just because it sometimes relies on indirect evidence. If you chose to go down that path, you are forced to reject a large number of scientific areas, from cosmology and geology to forensics.
You seem to confuse the DSM with the totality of scientific research on psychiatry. Nothing could be farther from the truth.
Quite the contrary, we know that many psychiatric disorders have a moderate degree of heritability and we have even reliably identified the exact nature of the genetic risk factors at play for many of them, including alcohol dependence, Alzheimer’s disease, bipolar disorder, schizophrenia, depression etc.
Here are two recent reviews published in Nature Reviews Genetics:
Burmeister, Margit, McInnis, Melvin G., & Zollner, Sebastian. (2008). Psychiatric genetics: progress amid controversy. Nat Rev Genet, 9(7), 527-540.
Sullivan, Patrick F., Daly, Mark J., & O’Donovan, Michael. (2012). Genetic architectures of psychiatric disorders: the emerging picture and its implications. Nat Rev Genet, 13(8), 537-551.
Additional studies have been done on non-genetic biological risk factors as well as social and environmental risk factors.
Thus, your statement that “Very little scientific progress has been made regarding aetiology” is demonstrably false.
You seem to be confusing ad hominem with appeal to emotion and the genetic fallacy.
Appeal to emotion is an attempt at manipulation the emotions of the readers as part of an argument. The genetic fallacy is attacking the origin of a claim rather than the claim itself. Finally, ad hominem is to attack character, circumstances, or actions and claim that this means that the person is wrong.
These archetypes are not meant to be comical, but rather an accurate representation of common clusters of beliefs that I have come across while debating anti-psychiatry proponents. If you read the descriptions of the various archetypes, they are almost exclusively related to describing the beliefs that characterize that cluster.
Why do you not admit your error? You falsely characterized e. g. Ben Goldacre as anti-psychiatry when he his argument is about increased transparency.
Actually, we can measure pain with brain scans.
Wager, Tor D., Atlas, Lauren Y., Lindquist, Martin A., Roy, Mathieu, Woo, Choong-Wan, & Kross, Ethan. (2013). An fMRI-Based Neurologic Signature of Physical Pain. New England Journal of Medicine, 368(15), 1388-1397. doi: doi:10.1056/NEJMoa1204471
There are also many reliable pain scales that can be used.
The fact remains, just because pain (or tinnitus or migraine) is more salient for the individual experiencing it than others does not mean that these issues are non-existent. In fact, the existence of pain, migraine, tinnitus and mental conditions are uncontroversial in science.
That is at best an argument for improved methodology, not an argument for anti-psychiatry. You keep performing the denialist tactic of confusing details with the broader picture.
You cannot have your cake and eat it too. You keep shifting back and forth between the claim that psychiatry is non-falsifiable and that it is empirically wrong.
Again, the fact that a method has some limitations does not mean that it is “very difficult to validate empirically”, or that it is pseudoscience.
So to sum up your response: you did not really engage any of my arguments and you did not present any evidence of your own. Furthermore, most of your claims are not even related to the blog post.
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You forgot libertarians of the Szaszian variety – Jeffrey Schaler, et al?
Yeah, that is a very good point! Perhaps split off “misguided freedom fighter” from the conspiracy lunatic category?