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As the introduction of PBM so clearly states, “much like a lawyer in a courtroom, this book in essence ‘makes a case’.” But for those sincerely seeking to learn the truth, PBM cannot stand on its own. To carry forward the analogy, we need to add, at a minimum, opposing council, rebuttal, and a judge or jury to weigh the testimony.

Patients who have been victimized or harmed in the past by psychiatric practice, whether rooted in malice, manipulation, ignorance or bad luck, have done an invaluable service and have helped overturn unjust and abusive practices of the past. Those courageous people who continue to do so to this day constantly remind us that we are still too far away from where we want to be.

Patients, families, advocates, journalists, and others who have brought these stories forward, identified structural flaws and promoted changes, who critically but openly have engaged with the broader mental health community, have similarly helped move practice forward, to open the eyes of those who need them opened, and have thereby improved the lives of other patients. As have those who have told other stories about mental health and treatment, the impact on their lives of these very real illnesses, how their lives have sometimes been improved, sometimes imperfectly, with treatment. As have those who have fought to reduce stigma, make it easier for people to come forward, and to raise the level of public conversation on this topic to unprecedented levels.

Those in the antipsychiatry movement are not to be counted amongst those who have helped. They seek not to improve psychiatric practice, but destroy it. They deny the very nature of mental illness, dissuading people from coming forward and obtaining treatment that could improve their lives. They do not engage with the broader community, but reject criticism, and retreat within an echo chamber of their own making, recycling the same examples and arguments ad nauseum.

In PBM, we have a holistic, broadly-based representative of the antipsychiatry genre. It carries the trappings of rigorous knowledge: the language, references, methodologies, and ostensible blessing of an esteemed university. Yet beneath this carefully constructed façade lies a one-sided, overzealous polemic.

Not content to advocate for change, more oversight, etc., PBM takes the audacious step of claiming with absolute logical certainty that psychiatry is without any redeeming quality and must be annihilated. The ludicrousness of this overreaching attempt is revealed in its reliance on numerous overly-simplistic and fallacious arguments.

Yet, irresponsibly but predictably, no viable alternative, no concrete solution, nothing with the slightest chance of actually happening is offered instead. We are left only with a simplistic “good vs. evil” paradigm intended only to deliver recruits to an extremist movement.

Chapter 7 of PBM is entitled “Marching to ‘Pharmageddon’: Psychopharmacy Unmasked” and argues that psychiatric drugs, the “kingpin itself,” are inherently dangerous, and can only damage, not help.

We’ll pass over the sections describing the flaws in the drug creation and approval process (selectively referenced of course) and proceed to the primary argument intended to demonize psychiatric medications en masse.

The Argument

Here we’re going to be relying on the idea that mental illness has to do with imbalances (too much, too little) of several different neurotransmitters. To summarize, again from PBM:

… these substances alter brain chemistry, and given that the people being treated for “mental illnesses” in point of fact have “normal” brain chemistry, it stands to reason that these substances themselves create imbalances. [italics in original]

Sounds logical enough, leading us to the next question of whether or not people being treated for mental illnesses do have “normal” brain chemistry.

To address that, PBM leads us through an exceedingly lengthy description of neurotransmitters, how larger or smaller amounts of each can affect us behaviourally (e.g. stimulating, relaxing). The main point that she makes with respect to the argument in question is that the brain has mechanisms which automatically adjust the level of neurotransmitters to bring things back into equilibrium, to correct levels when things are too off-balance.

Because the brain does that as a normal part of its functioning, this is normal brain chemistry.

Anything that alters it is therefore abnormal brain chemistry. The drugs alter this normal functioning of the brain and its chemistry, ergo they are creating abnormal brain chemistry.

Normal

Stated that way, a lot seems to rest on this “normal” vs. “abnormal” distinction. If you’re getting a sense of deja vu, you should be, because as with the argument “mental illness has no known physical cause so it’s not real”, you have to buy the validity of this particular definition of “normal” for the argument to work.

Can we look at this another way, that is perhaps, more person-centered?

Assume that without medications, our neurotransmitters do their thing as “normal”, and our brain’s corrective mechanisms do their “normal” thing to keep everything in equilibrium. Yet oddly, for no apparent reason we’re still curled up in the fetal position on the floor in a dark room, crying and screaming 18 hours a day, like we’ve been doing for the last week.

Our spouse drags us to the doctor, who suggests a medication trial. Some psychotropic medications are added, which disrupt our brain’s “normal” way of balancing out all the neurotransmitters. We are making an “abnormal” change. Yet, we’re now able to rise, speak, eat, think, communicate with our friends and family, feel positive and negative emotions, and participate in life.

If that’s what “normal” and “abnormal” were to look like for me, sign me up.

Again, relying on a dubious definition, even when surrounding it with as many examples as you’d like of bad things that psychiatric medications have done, does not make for a convincing argument.

Treating symptoms

A slight variation of the argument is also used, namely that psychotropics are inherently flawed because there is no underlying cause for mental illness, and as such there is nothing for them to work on. We’ve addressed the physical cause issue in the “Mental Illness Isn’t Real” section already.

I will just add at this point that there are hundreds if not thousands of diseases in other areas of medicine that are treated partially, primarily or solely via treating the symptoms, and not an underlying physical pathology. Those diseases with no known etiology are just a tiny fraction of that.

Are they effective?

Once we dismiss this notion that the drugs are inherently damaging, we can discuss whether or not they are effective, cause problems, how often this occurs, etc.

PBM provides all kinds of studies and examples, many from patients directly, where harms were caused (or allegedly caused, depending on the example).

The psychiatry community can bring studies and examples, many from patients directly, where the medications were helpful to them.

This is a great situation! Let’s all actually look at all the evidence, and judge it on its strengths and weaknesses. Where we’re missing evidence, or the evidence we have isn’t compelling, let’s get more. Let’s actually address this issue through evidence.

The alternative is throwing up our hands, dismissing everything as hopelessly biased as a result of the government-pharmaceutical-industrial complex, and tossing around conspiracy theories and “logical” arguments based on ridiculous premises.

Chemical Imbalance

A quick note on the whole idea of chemical imbalances as a theory for how psychotropic medications work. While the idea of “too much serotonin” or what not may have been at one time suggested by some overzealous academic looking for tenure, it’s a gross oversimplification of our current understanding of neurobiology.

It is, however, useful as a fairly easy to comprehend model for explaining the basic idea to people. It’s the same way that we’ll still refer to Newtonian mechanics and think about things through that lens, even though we know that quantum mechanics is a more accurate depiction of physics. So don’t get too caught up in arguments resting on the existence of chemical imbalances.

Summary

Having dispatched with the ridiculous notion that all psychiatric medications are inherently flawed as a concept, we are left being able to think of them as we would other medications. What are the benefits and risks, and how do they compare with the benefits and risks of either other treatments, or doing nothing?

For most people who choose to use them, psychiatric medications represent the “least bad alternative.” Just like medications for other illnesses. They may be overused in certain circumstances for all kinds of reasons (e.g., cost, “quick fix”), but are either highly recommended, or an option that should be seriously considered, in many situations for many people.

PBM makes a very long, detailed and strong-sounding case about the dangers of psychiatry and the necessity of its dissolution.

Were the purpose of the book to critique psychiatric practice for the purposes of improving it, lobbying for safeguards, different standards, etc. a series of carefully documented anecdotes, thematically joined, would suffice.

Yet, the goal is far more audacious—to logically prove that psychiatry is fundamentally and irrevocably flawed. This is a tall order, impossible perhaps. Why take that step? The only conclusion I can draw is that it’s less about the noble pursuit of truth, and more about gaining converts to the antipsychiatry movement. The more the better, and especially those who are the most militant in their convictions that psychiatry is inherently wrong and must be defeated. People reading a mountain of evidence may be persuaded, yet open to the idea that there might be another side to things. But if it’s logically proven—well, there’s no room for doubt!

Let me highlight four manipulative techniques that are used to great persuasive effect in PBM: veneer of credibility, suppressed evidence, appeal to conspiracy theories, and obscuring logical fallacies within volumes of examples.

Veneer of credibility

PBM is a large academic book. It adopts a generally appropriate academic tone, though the neutral stance is frequently supplanted by the unmistakeable passionate activist trying to restrain herself. It strings together what appear at first glance to be logical and coherent arguments. There are lots and lots of references.

The investigation into psychiatry proceeds via a formal mechanism, the institutional ethnography (and who could criticize the work if they are not familiar with that methodology?) that separates observations from bias. It relies on multiple other theories drawn from feminism, political science, social justice, phenomenology, discourse analysis, indigenous and environmental schools of thought, etc. Jargon from these disciplines is sprinkled liberally throughout.

Odd choices for a book that’s designed to appeal to the masses. But really, just the existence of the book, having the form of serious academic research, is enough. After all, if you’re reading a book or paper, do you really follow up and read the references, to see what they actually say? They sound credible; good enough.

Suppressed evidence

There are a lot of references, but almost all to the same group of works and authors you’ll find in many antipsychiatry books. Despite the dozens if not hundreds of mental health and neuroscience journals with hundreds of articles each, thousands of books, etc., you will find very few references to them here. The supporting material is specifically selected to reinforce the author’s viewpoint.

That’s not necessarily a bad thing if you’re building up a set of examples to advocate for change in a discipline. But if you’re looking to eradicate an entire discipline, a higher standard, and certainly greater attention to alternative points of view, would be in order.

Cherry-picking references in this matter, from the antipsychiatry “echo chamber” provides a nicely encapsulated, closed circle of information that appeals to the intended readers’ confirmation biases (i.e. they think psychiatry is bad, and this just confirms it). It’s one sided, and it’s used to persuade, and to remove the possibility of doubt, not to inform.

Critics are neutralized and dismissed in a pro forma manner. Practitioners are automatons so enmeshed within the dominant system that they cannot see beyond the next drug company kickback in front of them. Patients who claim they have received benefit from medications have simply been “subdued” by their medications.

This, from a book that identifies its specific contribution is that “it elucidates and ‘maps’ the institution as a whole” [italics added].

Appeal to conspiracy theories

A reasonable argument can be made (and at times is made) for various biases of psychiatrists, researchers, pharmaceutical companies. There are documented examples where psychiatry has been used as a means of punishment or coercion by state or other actors. Yet, the extent to which this appears to actually occur according to PBM is truly breathtaking (again, using specific examples, but lacking evidence of the extent to which it occurs). The terminology throughout, e.g. “regime,” or “madness industry,” only emphasizes this.

When most actors are assumed to be motivated by malicious and nefarious reasons, we’ve gone past a healthy concern for bias and into the realm of serious broad-based conspiracy theories, which of course appeals to those who are most fanatical and tend to traffic in conspiracy theories. It also weakens any doubt or resistance in terms of accepting arguments and evidence that are presented.

It’s hyperbole at best, blatant manipulation at worst. What it certainly is not is a massive all-encompassing government and/or Big Pharma conspiracy.

Logical fallacies, obscured by examples

The most obvious evidence of departure from rigorous academic work is the blatant reliance on logical fallacies to “prove” the rather more extreme positions. Or to put it another way, key arguments, intended to show the inherent flaws of psychiatry as an entire discipline, are completely bogus.

Suppressed evidence is one example of a type of fallacy carried throughout the book. The fallacies of composition and overgeneralization (i.e. one part is bad so the whole thing is bad) are frequently encountered as well, including with respect to conspiracy theories. Several rather incongruous definitions of terms form the foundation for other arguments. There are a multitude of others. The next sections will detail the flaws and fallacies of several of the key arguments, highlighting the ways in which arguments are incorrectly constructed.

It’s not surprising of course to find significant logical fallacies at the heart of claims that an entire discipline is logically flawed.

If these logical flaws stood alone, they would perhaps be more obvious. They are, however, presented in a way that is intended to obscure their simplicity. First, the incorrect logical argument is made, as a “preliminary” step, though the full intended conclusion is already contained. Then, a large number of examples, references, and explanations are appended, thematically related to the argument, to highlight the horrible practices, abuses, biases, violations, and so on (and yes, the Nazi comparison’s come quickly).

While the examples do not provide additional logical support to the argument already made, they do their best to portray psychiatry and its practitioners as horrible people committing horrible acts, to the point that the reader would believe there is no level they would not stoop to, and so have no doubts as to the veracity of the earlier argument.

Yet, painting psychiatry as “the bad guy” via a seemingly endless stream of selective examples (in effect, “induction by attrition”) does not meet the standard of logical proof that PBM has inexplicably set for itself.

Summary

If PBM, and antipsychiatry writing in general, were merely meant to inform the public about abuses and violations, it could do so without resort to the manipulative techniques I’ve outlined here. In fact, there are legitimate critics of psychiatry who stick to actual facts, do not overstate their conclusions, and are open to differing arguments, opinions, and evidence. These reasonable voices contribute to a valuable and important conversation. But that is not the antipsychiatry movement.

That such an activist movement as antipsychiatry exists I can understand, and though I disagree with it and feel it is very harmful, they have the right to express their opinions, unless they descend into e.g. hate speech. I can even (at times) understand such a movement that would not consider authentically engaging with any of its critics.

What I have great difficulty with is the notion that an extreme activist movement, spewing grandiose arguments that would embarrass a first year philosophy student, apparently unwilling to entertain open dialog and criticism, appears to have pockets well-entrenched within serious academia. That such poor scholarship (in my opinion) might gain credibility from the stature of an environment known for openness and reason is truly disappointing.

With that said, let’s move on to look at some of the arguments in detail.

Having addressed the veracity of some of the key arguments, we probably have a healthy skepticism of this claim at the start of PBM’s last chapter, “Dusting Ourselves Off and Starting Anew”:

One conclusion that has already been reached is that the institution of psychiatry must go.

Again, while many critics of psychiatry propose what PBM calls “tinkering,” this notion here, as is typical with antipsychiatry, is rejected wholesale.

A frequent criticism of the movement is that no viable solution is offered to replace what we are throwing out, the theory being that at least removing all this harm is a massive improvement over the current situation.

PBM differs in that it offers us a solution, admittedly preliminary in nature.

Solution revealed

Here’s the starting point:

One obvious direction that has surfaced is freeing ourselves from our frightening over-belief in and fetishization of science-the privileging of positivism, evidence-based research, and instrumental reason. What goes along with this and is likewise pivotal, we need to free ourselves from rule by “experts.”

It shortly continues:

That noted, cutting back on experts hardly suffices. Nor is insertion of peer workers into the current system. Such measures cannot simply by add-ons to an inherently injurious system. Moreover, even if we rid ourselves of psychiatry and even if we dispensed with mental health services as now know them—indeed, even if we drastically reduced our reliance on all associated workers—we would not have gone far enough.

The point is, you cannot simply separate out a part of a gestalt, part of a discourse—and our entire society is penetrated/constructed by regimes of ruling.

What follows is a remarkable vision of a society, a “eutopia” (“a good place”) that in its very structure provides a less competitive, more communal vision for how we all live with each other. Specifically related to mental distress, it posits a realm that values and thrives on diversity, peer support, local decisions that better respect autonomy and differences, without the centralized power structures that exist today. Some of it actually sounds quite lovely in many respects, though may be a bit too close to a “socialist paradise” for the comfort of many.

This eutopia would necessitate a few changes. In particular, it requires overturning every single cultural, legal, social, political, environmental, artistic, communal and economic foundation of our current society.

I therefore feel on safe footing if I take issue with the second part of this statement:

This chapter is necessarily both highly visionary and highly practical

From here to there

This sort of visioning exercise has its place in thinking about what kind of society would we ideally want, if we were able to start from scratch. Typically you’ll see this in university classes on political philosophy. Fresh from studying Rousseau, Locke, and Hobbes, our eager students imagine the creation of a new society, arising from a “state of nature” where life is “solitary, poor, nasty, brutish, and short.”

Yet, given that we’re rather further down the road in a different direction already, how do we make it happen?

Acknowledging that due to vested interests, big government nor big business will make these changes, this can only be accomplished by working outside the system.

There are some concrete suggestions for specific groups, mostly involving talking and starting to think about things a little bit differently, which sounds slow, incremental and unreliable. Mind you, PBM explicitly condemns incremental approaches as ineffectual and insufficient.

Perhaps greater hopes are pinned on a Kuhn-ian paradigm shift, where a rising tide of ideas finally overwhelms and replaces our existing systems and institutions en masse. This would be spurred on by activist movements akin to what we’ve seen during the antiglobalization protests, the environmental movement, or Idle No More. (The reader is presumably being asked to suspend disbelief that any such movement would be capable of coming to any shared understanding on even matters of terminology, let alone multiple substantive, highly-interconnected, complex organizational systems, and to say nothing of an implementation plan).

Extremism revisited

I’ve remarked since the beginning of this article that a concerted effort to logically “disprove,” at a fundamental level, an entire discipline seems distinctly like overkill. If the goal was to shed light on negative practices, to argue for substantial changes to practice, this could proceed without heavily relying on deeply flawed arguments. An openness to engage with critics and practitioners would presumably be warranted, rather than eschewed.

The deceptive cloak of objective scholarship and academia notwithstanding, the movement’s writings appear designed to persuade the reader, not inform them. To what end?

In light of the proposed “solution” suggested above, we perhaps gain new insight into the extremist “all or nothing” nature of the antipsychiatry movement.

The movement appears to literally be looking to recruit activists, the more engaged the better. Effective activist discourse is inherently one-sided, and often (as here) with a goal of not influencing the status quo, but overpowering and replacing it. The best chance to achieve a radical new vision of society, with a complete reconceptualization of mental health, can only possibly proceed through the mobilization of a vast army of unquestioning supporters.

Evidence, discussion, collaboration and compromise all lessen the chances of that happening. Black and white, good and evil, and not shades of grey must carry the day. As we have seen public discourse elsewhere fracture into “us vs. them,” “you’re with us or against us,” etc., the true message for antipsychiatry, despite the high-sounding rhetoric, is good humanity vs. evil psychiatry.

The worst thing that can happen for antipsychiatrists is legitimate progress continues to be made in psychiatry—in science, law, practice and culture. The opposite, an uptick in verifiable human suffering and abuses, though likely to be taken advantage of by the movement, is wisely left unstated.

And just as they have accused the “madness industry” itself of doing, they are preying on the weak and vulnerable, at times when they are most in need of real help.

To be clear, antipsychiatrists feel the best hope of replacing psychiatry, to improve the lives of people suffering from great anguish and distress, lies not in improving what we have. It is proposed instead that we replace almost every aspect of our entire society within a short time period, most likely to be accomplished by a (successful) activist revolution and mass uprising on a scale never before seen.