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Carl Elliott on the Dark Side of Medicine

On the future of mental health

Eric Maisel
Source: Eric Maisel

The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.


Interview with Carl Elliott

EM: You are involved in what is known as “bioethics.” Can you tell us what bioethics is and how it relates to the current, dominant paradigm of “diagnosing and treating mental disorders”?

CE: Bioethics is the propaganda ministry for the medical-industrial complex. We play Goering to academic medicine’s Hitler. It’s our job to sell the illusion that academic medicine is a humanitarian enterprise, so that it can avoid the kind of formal regulation that the American public might demand for a rapacious, for-profit corporate machine.

It’s not a bad gig, unless you are bothered by the absence of a soul. I don’t really miss mine.

Just kidding (sort of). The conventional definition of bioethics is that it’s the study of ethical issues in medicine and biology. As for the diagnosis and treatment of mental disorders: well, to be honest, it’s not something that bioethicists have paid much attention to (see preceding paragraph).

EM: You’re the author of White Coat, Black Hat: Adventures on the Dark Side of Medicine. Can you tell us its top points and/or findings?

CE: Have you ever read “Sinners in the Hands of an Angry God?” Kind of like that, only with the pharmaceutical industry.

EM: You are also the author of A Philosophical Disease: Bioethics, Culture and Identity. Can you share your thoughts on how language helps “create” what may be non-existing entities like “mental disorders”?

CE: Wittgenstein has a famous thought experiment in the Philosophical Investigations called the beetle box game. Imagine a game, writes Wittgenstein. "Suppose everyone had a box with something in it: we call it a “beetle” -- beetle here in scare quotes. “No one can look into anyone else’s box, and everyone says he knows what a beetle is by looking only as his beetle.”

Now it would be quite possible for each person to have something different in his box, Wittgenstein writes. It would even be possible for the contents of the boxes to be constantly changing. In fact, it would even be possible for all the boxes to be empty -- and still the players could use the term “beetle” to talk about the contents of their boxes. There don't have to be any actual beetles in the boxes for the game to be played.

What's the point here? The point is that the words that we use to describe our inner lives -- words like "depression" and "anxiety" and "fulfillment" -- get their meanings not by pointing to inner mental states but from the rules of the game: the social context in which they are used. They are like the word "beetle" in Wittgenstein's game. We learn how to use the words not by looking inward and naming what we find there, but by taking part in the game.

The players do not all need to be experiencing the same thing in order for the words to make sense. I say I am depressed, you say you are depressed, we both understand what the other means -- yet this does not mean that our inner psychic states are the same. We can all talk about our "beetles" yet all have different things in our boxes.

Now this doesn't mean that psychological suffering isn't real. It's a point about the grammar of psychological language. Generally speaking, there are no independent, objective tests for mental disorders: no blood work, no imaging devices, no Ontological Lapsometer. Psychiatrists can't just open up the box and look at the beetle. The diagnoses they give to patients are determined not by what they see in the box, but by the rules of the game.

And psychiatrists don't write the rules. The rules are organic, flexible, and constantly changing: new mental disorders come and go every year. Even if psychiatrists could write rules for what counts as a mental disorder, as in the DSM, they would still be indeterminate, because of the grammar of psychological experience. Everybody can have something different in his box, and still play the game.

EM: You’ve begun to use social media as an activism tool. Can you tell us what prompted you to do that and whether you see social media as a useful tool for social activism in the mental health arena?

CE: I started using social media mainly as way to get the world to pay attention to the research misconduct taking place at my own institution, the University of Minnesota – mainly, the case of Dan Markingson, who committed suicide after he was coerced into an industry-funded antipsychotic trial. Has it been useful? Well, I suppose so. We tried so many different avenues to draw attention to that episode that it’s hard to say which ones worked and which one’s didn’t. In the end, I would say that social media did not work as well as the more traditional methods, such as investigative journalism.

EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?

CE: I’d talk to someone with the right expertise that I trust. I am lucky that one of my brothers is very good psychiatrist. I also have like-minded friends and colleagues in clinical psychology and psychiatry that I can turn to when I need help or advice.


Carl Elliott MD PhD is Professor in the Center for Bioethics at the University of Minnesota. His books include White Coat, Black Hat: Adventures on the Dark Side of Medicine and Better than Well: American Medicine Meets the American Dream. In addition to the usual academic publications, he has written feature articles for The New Yorker, The Atlantic, Matter and Mother Jones.


Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at, visit him at, and learn more about the future of mental health movement at

To learn more about and/or to purchase The Future of Mental Health visit here

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