Bonnie Burstow’s brilliant, comprehensive, new book, Psychiatry and the Business of Madness,* is part of a tradition of trenchant critiques, including the great feminist psychologist pioneer Phyllis Chesler’s book Women and Madness in 1972; Jeffrey Mousaieff Masson’s The Assault on Truth in 1984; Peter Breggin’s Toxic Psychiatry in 1991; Bob Whitaker’s Mad in America in 2001 and Anatomy of an Epidemic in 2010; and James Davies’ book, Cracked, in 2013.  There is the brave work of attorneys Jim Gottstein and Tina Minkowitz, the late anti-electroshock activist Leonard Roy Frank – who taught me never to use the term “ECT,” because the “T” stands for “therapy,” MindFreedom founder David Oaks, Will Hall, the tireless multi-sphere, activist and survivors’ encyclopedia Amy Smith, and many others who work to expose abuses in the systems that are officially supposed to reduce emotional suffering and sometimes do that but often increase it.

I am a clinical and research psychologist and belonged to the American Psychological Association until I resigned because of their allowing psychologists to participate in torture and because of their frantic, well-funded push to get states to allow psychologists to prescribe psychiatric drugs. While still a member, I stood outside the annual convention one year and realized I was loathe to enter. Many psychologists and other therapists are humane, respectful, caring, and careful to avoid dogma and dangers to those they try to help. But Burstow shows with scrupulous care the ways that various systems make such therapists all too rare, and she lets those who have been harmed speak up in heartbreaking detail. As a result, instead of reading that Irit Shimrat tore off her clothes and ran down the hall of her apartment building banging on doors to warn people of the dangers or war…and thinking to ourselves, “Well, she was clearly nuts!” Burstow gives us Shimrat’s own words and then points out, in effect, how strange it is that so few of us are in close enough touch with the horrors of war that we bang doors in warning. We would do well to consider this.

Burstow does not romanticize what some people call madness, and she lets us in on the acute fears and confusion and other kinds of suffering that some people experience. Her entire book is aimed at revealing how traditional mental health systems and their affiliates (e.g., the diagnostic juggernaut, insurance companies, governments, courts, intake and other official forms, Pharma) too often prevent us from allaying the suffering and way too often make it worse.

The title of Burstow’s book refers to psychiatry, but she describes how also psychologists, social workers, and nurses sometimes reduce suffering but often dehumanize sufferers, drug them, shock them, inflict various kinds of physical and psychological violence on them. Depressingly often, I have also heard marriage and family therapists, counselors, and even clergy – for heaven’s sake, clergy! who are supposed to know oppression and spiritual or existential crisis when they see them!  -- leaping to assign or perpetuate psychiatric labels, misinterpret behavior in the most bizarre of ways, and push drugs even when they are harmful and isolation. Something is very wrong when a minister describes grief over the loss of a loved one as a Major Depressive Episode, as the DSM-IV did (on the fourth page of the listing of that category).

Burstow takes us through some of the powerful forces that help maintain a harmful system and, using heartbreaking quotations from those who have been harmed,  reveals the human costs. She mentions how media actively promote dangerous so-called treatments, and I want to mention the role of major media in a  recent, mysterious failure to report the greatest corruption in the mental health system in decades. Columbia University medical ethics expert Dr. David Rothman wrote an expert witness report scrupulously documenting this: In 1995, the very year after DSM-IV appeared, three powerful psychiatrists were paid nearly $1 million by Jansen Pharmaceuticals to write a “Practice Guideline” for treating Schizophrenia, and the guideline – as promised – had the conclusion that Jansen’s new drug Risperdal was the best option. As Dr. Rothman noted, this was in utter disregard of what the research showed. Besides the guideline, what the three men did for their pay was to create a detailed program for marketing Risperdal by – among other things -- bringing hired-gun psychiatrists to give “Continuing Education” courses to promote the drug.  Risperdal is one of the most dangerous of all psychiatric drugs.   Most people are unaware of this corruption, which I call “Diagnosisgate.”** This is because although there were five major media stories about the Rothman Report, in not one were the three psychiatrists, their “practice guideline,” or their nearly million-dollar pay mentioned. In my article called “Diagnosisgate,” I said it was an unexplained mystery why this was, but despite calling attention to the media’s blackout, that blackout continues.

Another major player in concealing harm is the legislator, because it is so easy to propose laws and earmark funding that perpetuate the traditional approaches, playing into the common fear that deviating from the “standard of care” – primarily psychotherapy and drugs -- must be dangerous.  And in our chapter in Bias in Psychiatric Diagnosis,*** Jeffrey Poland and I wrote, as does Burstow, about a number of interlocking systems that perpetuate harm in the mental health system, and our focus was on psychiatric diagnosis. We included as the perpetuating entities some of those that Burstow examines, as well as Medicare and Medicaid, contemporary people’s desperate need in their overly busy lives to find silver bullet answers to their problems and a deep-seated and unquestioning belief in science/medicine/technology.

Burstow presents an entire set of wonderful, and wonderfully radical, proposals for transforming the ways we deal with people who suffer emotionally, as she will tell you. I heartily endorse them all, for they are about the importance of love, respect, compassion, and wholehearted listening to those in our communities…and to strengthening our communities.

I want to highlight both the most fundamental cause of harm and what we can do about it. Every problem in the mental health system begins with psychiatric diagnosis. After all, until they have labeled you mentally ill, they are not supposed to treat you, and once you are labeled, there is little they cannot do to you. As I learned from my two years on two DSM-IV committees, psychiatric diagnoses are unscientific, do not necessarily lead to reduction of suffering, and carry enormous risks of harm, including deprivation of every conceivable human right. “Patients” are socialized to feel grateful that their alleged mental illness has been named, and they are virtually never informed that getting a label can destroy their lives, so there is no informed consent. Nine people filed complaints about harm from psychiatric diagnosis with the American Psychiatric Association’s ethics committee, and these were dismissed with no attention to their merits. The Civil Rights Office of the US Department of Health and Human Services did the same with complaints that we filed. We have therefore demonstrated that not only is psychiatric diagnosis totally unregulated but that the one private entity and one government entity that by all rights ought to regulate it, redress harm, and prevent future harm, refuse to take a single step to do so.

Many years ago I proposed holding Congressional Hearings about psychiatric diagnosis as a major step toward exposing its harms and creating a national conversation about what’s to be done.

Burstow describes hearings about harm in the system and hearings about electroshock that were held in Canada. One thing we can all immediately do is to follow this lead and demand such public hearings in our own countries and on global scales.   

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*Burstow, Bonnie. (2015). Psychiatry and the business of madness: An ethical and epistemological accounting. New York: Palgrave Macmillan. http://www.barnesandnoble.com/w/psychiatry-and-the-business-of-madness-b...

** Caplan, Paula J. (2015). Diagnosisgate: Conflict of interest at the top of the psychiatric apparatus. APORIA:The Nursing Journal 7(1), 30-41.  http://www.oa.uottawa.ca/journals/aporia/articles/2015_01/commentary.pdf 

*** Poland, Jeffrey, & Caplan, Paula J. (2004) The deep structure of bias in psychiatric diagnosis. In Paula J. Caplan & Lisa Cosgrove (Eds.), Bias in psychiatric diagnosis. Livingston, NJ: Jason Aronson.

©Copyright 2015 by Paula J. Caplan                    All rights reserved

About the Author

Paula J. Caplan, Ph.D.

Paula J. Caplan, Ph.D., a clinical and research psychologist, is an associate at Harvard University's DuBois Institute and former fellow in Harvard Kennedy School's Women and Public Policy Program.

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