“A Good Book”, via DeviantArt

The best thing the psychiatric profession could have ever asked for is having a notoriously hated enemy like the Church of Scientology as its most widely known critic. Our brains are funny things, and in the interest of saving time we often use mental shortcuts to determine whether a piece of information is reliable or not. When the topic is something like criticisms of psychiatry, we might often find ourselves thinking along the lines of:

“That person’s criticizing psychiatry. Isn’t that what Scientologists do? He’s probably a Scientologist.”

In the span of a few seconds we’ve employed a mental shortcut that helped us decide whether to continue listening to a critic on the basis that they probably are a closet scientologist, and therefore their motivations and qualifications are suspect.

The problem is, this is a bad heuristic. When we employ a shortcut like this we rob ourselves of a great deal worthwhile criticisms of psychiatry that have nothing at all to do with scientology, criticisms by professionals who deserve our attention. To that end, here are the top ten books critical of psychiatry that deserve your attention. Note, Amazon affiliate links are used.

Written by: Dr. Gary Greenberg, Psychologist.

What’s it about? The DSM, also known as “psychiatry’s bible”, is the go-to source for psychiatrists, psychologists, and clinical social workers in the United States for identification and diagnosis of mental illness. Dr. Greenberg takes us behind the scenes of the making of the latest edition of this book, the DSM-5, and exposes the arbitrariness and unscientific ways that the decisions behind which disorders stay, and which are removed, are made.

Quote:

“The power to give names to our pain is a mighty thing and easy to abuse . . . Psychiatry’s appeal is not just about the possibility of cure, which is why the profession continues to flourish even when it cures nothing and relieves symptoms only haphazardly. It’s in the naming itself.” –Gary Greenberg

Written by: Dr. Allen Frances, Psychiatrist.

What’s it about? Dr. Allen Frances is one of the biggest names in psychiatry. He spearheded the DSM-IV and DSM-IVR. Dr. Frances came out of retirement when the american psychiatric association started providing updates about their latest decisions regarding the (then) upcoming DSM-5. Frances famously criticized the development of the DSM-5 in the years leading up to its release. His criticisms primarily revolved around the secrecy surrounding the development of the DSM and the many unintended consequences of the proposed changes to the definitions and diagnoses of mental disorders. If a book written about the many dangers of psychiatric overdiagnosis written from the editor of psychiatry’s most important work isn’t enough to pay attention, nothing will.

Quote:

The business model of the pharmaceutical industry depends on extending the realm of illness — using creative marketing to expand the pool of customers by convincing the probably well that they are at least mildly sick. Disease mongering is the fine art of selling psychiatric ills as the most efficient way of peddling very profitable psychiatric pills. (pp. 28–29)

Written by: Dr. Gary Greenberg, Psychologist

What’s it about? Before The Book of Woe, Gary Greenberg produced this volume on the history of depression and the role that psychiatry and pharmaceutical companies played in shaping America’s understanding of grief and sadness into a bona fide illness. Greenberg absolutely does not deny the existence of depression, having suffered from it himself throughout his life. What he objects to is the creeping expansion of the definition of depression to include virtually most forms of sadness and grief. He outlines the history of antidepressant medications and the marketing that allowed companies like Eli Lilly (manufacturers of prozac) to directly advertise to consumers in an effort to convince them that their sadness is probably attributable to a biological illness of the brain.

Quote:

“Am I happy enough? has been a staple of American self-reflection since Thomas Jefferson declared ours the first country on earth dedicated to the pursuit of happiness. Am I not happy enough because I am sick? on the other hand is a question that has just arisen in the last twenty years. This is the sense in which depression has been manufactured — not as an illness, but as an idea about our suffering, its source, and its relief, about who we are that we suffer this way and who we will be when we are cured. Without this idea, the antidepressant market is too small to bother about. With it, the antidepressant market is virtually unlimited.”

Written by: Dr. Marcia Angell, M.D., former editor of the New England Journal of Medicine.

What’s it about? As the former editor of one of medicine’s most prestigious academic journals, Dr. Marcia Angell possesses special insight into the ways pharmaceutical companies influence academic research and the prescription habits of medical doctors. She has been especially critical of the role of pharmaceuticals in psychiatry, outlining the symbiotic relationship between drug companies and psychiatry, each one relying on the other for the financial stability and success of their respective domains.

Quote:

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”

Written by: Dr. Daniel Carlat, Psychiatrist

What’s it about? Dr. Carlat is an eminent psychiatrist and a former representative for pharmaceutical companies. Carlat is especially critical of the ways that pharmaceutical companies influence the medical profession by means of financial incentives. As an insider into the techniques and training of drug reps, he gives us an insight into the life of a representative of a massive corporation like Eli Lilly and their roles in convincing doctors and prescribing professionals that the companie’s drugs are a) demonstrably proven to work, and b) the harms and side effects of the drugs are negligible. Carlat is also critical on the overreliance of prescription drug treatment by psychiatrists, decrying how few (only 11%) of them still practice any form of talk therapy for their clients.

Quote:

“Pondering this typical appointment, what struck me most was what I did not do. I am an MD, having gone through four years of medical school, one year of grueling medical internship in a general hospital, and three years of psychiatric residency at Massa­chusetts General Hospital. But, like most psychiatrists, I did little to take advantage of those years of training. I did not do a physical exam, nor did I take Carol’s pulse or blood pressure. Indeed, the only times I stirred from my chair were to meet her in the waiting room at the beginning and to show her into my secretary’s office to make a follow-up appointment at the end. Just as striking to me as the lack of typical doctorly activities in psychiatry is the dearth of psychotherapy. Most people are under the misconception that an appointment with a psychiatrist will involve counseling, probing questions, and digging into the psychological meanings of one’s distress. But the psychiatrist as psychotherapist is an endangered species. In fact, according to the latest data from a group of researchers at Columbia University, only one out of every ten psychiatrists offers therapy to all their patients. Doing psycho­therapy doesn’t pay well enough. I can see three or four patients per hour if I focus on medications (such psychiatrists are called “psychopharmacologists”), but only one patient in that time period if I do therapy. The income differential is a powerful incentive to drop therapy from our repertoire of skills, and psychiatrists have generally followed the money.”

Written by: Dr. Paula Caplan, Clinical and Research Psychologist.

What’s It about? Dr. Caplan served in several communities during the development of the DSM-IV, and as such she provides us with an inside perspective as to the kinds of internal deliberations by psychiatrists that happen behind closed doors in determining the scope of mental disorders, and more broadly, how these select few doctors have the power to shape our conceptions of who counts as “normal” and who’s “abnormal” in society. She criticizes the lack of diversity of these committees, the non-scientific considerations that often bias the decision making processes, and the role of pharmaceutical companies play in the shaping of medical opinion. Many decisions are often based on political and professional considerations rather than scientific ones, and Caplan attempts to demistify this process so that those labeled abnormal by psychiatry can find comfort in the lack of validity of many DSM diagnoses.

Quote:

“Much of what is labeled 'mental illness' would more appropriately be called problems in living... What IS important for this book is that, although some DSM diagnoses supposedly have some physical origin... ALL of that labeling is based on the DSM folks' choices about whom to declare abnormal.”

Written by: Dr. James Davies, PhD in Social and Medical Anthropology.

What it’s about? Are the mental illnesses found in the DSM and treated by psychiatrists real biological entities? And if they are, just how is it that they are discovered? Why, if they are biologically discrete entities do we not posses any biological markers for any of them? How many of these disorders should really be considered illnesses as opposed to struggles of living? Probably my favorite book on this list, Davies provides the most accessible account of the problems that have plagued psychiatry since the days of the asylum, and why today, several decades later, our nosology faces the same problems it did then: lack of reliability and dubious validity.

Quote:

“Why has psychiatry become the fastest-growing medical specialism when it still has the poorest curative success? Why are psychiatric drugs now more widely prescribed than almost any other medical drugs in history, despite their dubious efficacy? And why does psychiatry, without solid scientific justification, keep expanding the number of mental disorders it believes to exist – from 106 in 1952 to 374 today? What is going on?” “Many psychiatrists’ claims are no more substantiated than are the claims of religion. This is because, in so many areas that they survey, psychiatrists do not prove things but decide things: they decide what is disordered and what is not, decide where to draw the threshold between normality and abnormality, decide that biological causes and treatments are most critical in understanding and managing emotional distress.”

Written by: Ethan Watters, journalist.

What’s it about? Probably the most fascinating book on this list, Watters provides us with four case studies that hint at a phenomenon barely understood: can mental illness be exported? Travel anywhere in the world and you’ll be sure to find a McDonald’s, Taco Bell, or KFC. This is known as the homogenization of culture.

American ways of thinking, living, and understanding have slowly been exported throughout the world, with the consequence of our tastes and ways of living converging upon certain commonly shared practices. Can mental illness be exported in the same way?

One fascinating case involves the rapid rise of anorexia nervosa in Japanese culture. Examining historical data, Watters uncovers that prior to the 90s the condition could seldom be found anywhere in the Japanese medical literature. Though a series of historical accidents, Japanese culture was slowly exposed to American media reports of the prevalence of this condition in the west. Suddenly, anorexia seemed to spring forth at alarming rates in a nation where it hardly existed at all. How could this be? The answer is the homogenization of mental illness.

These conditions are socially contagious, and Watters persuades us of this seemingly incredible claim by his wonderfully articulated case studies.

Quote:

“Over the past thirty years, we Americans have been industriously exporting our ideas about mental illness. Our definitions and treatments have become the international standards. Although this has often been done with the best of intentions, we’ve failed to foresee the full impact of these efforts. It turns out that how a people in a culture think about mental illnesses — how they categorize and prioritize the symptoms, attempt to heal them, and set expectations for their course and outcome — influences the diseases themselves. In teaching the rest of the world to think like us, we have been, for better and worse, homogenizing the way the world goes mad.”

Written by: Dr. Joanna Moncrieff, Psychiatrist

What’s it about? Dr. Moncrieff sets out to expose the myth that psychiatric drug treatment works in the way the profession often advertises: by targetting specific chemical imbalances of the brain. Moncrieff shows us that there is no evidence that this is the case, and how the history of the development of the disease centered model of mental illness arose not due to overwhelming scientific consensus, but on the vested interests promoted by pharmaceutical companies and the psychiatric profession.

Further, not only is there a lack of adequate evidence establishing the efficacy of these treatments, but Moncrieff argues that the problems they’re used for are not biological in nature in the first place. Attempting to tackle problems that are at root social and psychological in nature is doomed to failure and creates far more harm than good for the patients involved. Quote:

“The data surveyed in this book suggest that psychiatric drug treatment is currently administered on the basis of a huge collective myth; the myth that psychiatric drugs act by correcting the biological basis of psychiatric symptoms or diseases. We have seen that for the three main classes of drugs used in psychiatry there is no evidence to substantiate this view. Instead, the evidence suggests that these drugs induce characteristic abnormal states that can account for their so-called therapeutic effects.”

Written by: Dr. Bonnie Burstow, PhD

What’s it about?: A more philosophical work, Dr. Burstow guides us through the history of the psychiatric profession, the ethics and legal ramnifications of forced psychiatric treatment, the epistemological failures of the field’s underlying assumptions, and the ethical implications of the relationship between pharmaceutical companies and both research and clinical psychiatrists. She persuasively argues that forced psychiatric treatment is ethically indifensible and advocates holistic approaches to mental health that do not rely on the biomedical model’s approach to treatment. Dr. Burstow is a professor at the University of Toronto and spearheaded the effort to launch the very first antipsychiatry scholarship at her institution.

Quote:

“The concepts of ‘open secrets’ and ‘bad faith’ have explanatory value here. An ‘open secret’ is a truth that everyone knows but does not acknowledge publicly. Everyone knows the secret; everyone knows that everyone knows the secret, but except for the odd ‘maverick’ who can readily be dismissed, everyone respects the secrecy. Let me suggest that there are a number of open secrets in the mental health field. Open secrets that suggested themselves to me as I interviewed practitioners — mainstream practitioners especially — include: There is something wrong with the drugs. There is something wrong with much of the research. There is something wrong with the very way that we are all operating.”

If you’re interested in more book recommendations, check out my previous post here: