The real story of psychiatry
Psychiatry’s public credibility was in trouble
Part 2 of this series, Rockefeller Foundation and the failure of psychiatry as a science, described the lack of a scientific foundation that existed within psychiatry throughout the first half of the 20th century.
Indeed, during the mid-20th century, public confidence in the credibility of psychiatry was also very low. Diagnosis of mental illness could vary wildly depending on the country one was in or the particular school of thought the psychiatrist favored. News of the appalling ‘treatments’ being used in asylums and hospitals under the ‘biological psychiatry’ banner caused a public recoil and studies found the results from psychoanalysis were no more effective than no treatment at all. 1 2
The Rockefeller Foundation’s realization that psychiatry promised a lot but delivered very little had become obvious to all, including the general public. Yet there it was, foisted on medicine as a supposed science based on few unproven theories and most importantly, unable to cure a single individual or even state with certainty what was the actual cause of any mental illness.
Despite all this, events were about to happen where psychiatry lacking any scientific credibility, made absolutely no difference at all.
The introduction of psychotropic drugs
The event in the 1950s that masked psychiatry’s lack of scientific foundation was the development of psychotropic drugs
The event in the 1950s that masked psychiatry’s lack of scientific foundation was the development of psychotropic drugs – or drugs that affect a person’s mental state.
The introduction of these drugs was eagerly welcomed by some psychiatrists desperate to move the subject beyond the often lethal buffoonery of lobotomy, electroconvulsive therapy, insulin shock, or any of the other nonsense that was passing for psychiatry in those days, as substitutes for scientific understanding. 3
The psychotherapy of Sigmund Freud, Josef Breuer, and others made advances in popularity after World War II, particularly in the USA. The introduction of these drugs, however, produced a massive shift away from psychotherapy and toward that which was trumpeted as a ‘neo-Kraepelin age’ of biological psychiatry over the last 50 or so years.
Yet at best, where they work at all, any drugs used by psychiatry only mask the symptoms of mental illness. None of these drugs were developed based on the discoveries of the cause of any mental illness and none actually address mental illness beyond suppressing symptoms.
Addressing symptoms, not causes or cures
All research for psychiatric drugs to date has been done on the basis of suppressing symptoms, not finding causes or cures.
All research for psychiatric drugs to date has been done on the basis of suppressing symptoms, not finding causes of mental illness or cures.
In fact, research on psychiatric drugs is done in the reverse of what actual science would do.
Rather than finding the reason for a mental illness and then finding a treatment to handle that, types of drugs are found that will mask symptoms. Then, knowing a type of drug that can mask symptoms, more similar drugs using the same mechanism are looked for. The result is a seemingly endless cycle of more drugs for symptoms rather than the cause of mental illness isolated and cured.
For example, the first ‘antipsychotic’ drugs were found to act to block the neurotransmitter dopamine in the brain but produced severe side effects. Later ‘antipsychotics’ using the same mechanism, not only blocked dopamine but another neurotransmitter, serotonin in an attempt to block the side effects. 4
Serendipity or simply no science
..these discoveries were not based on any existing scientific foundation for psychiatry of established causes of mental illness predicting potential treatment and cures – they were being arrived at by chance.
You will often hear that serendipity is referred to in relation to the development of psychiatric treatments and indeed serendipity played a part in the ‘discovery’ of the original psychotropic drug types. 5
And so it took 50 years from the discovery of the first mass-produced pharmaceutical, Aspirin, before a mass-produced psychotropic drug was used in the field of mental health. The reason why is that these discoveries were not based on any existing scientific foundation for psychiatry of established causes of mental illness predicting potential treatment and cures – they were being arrived at by chance.
For example, versions of the drug that was chlorpromazine, the first psychotropic drug, an antipsychotic, were used as dyes from the end of the 19th century. In the 1930s the drugs were modified by chemists and were used as antiseptics and antihistamines. Later versions of the drug chemistry in 1949 and 1950 resulted in drugs that produced a type of extreme anesthesia – an ‘artificial hibernation’ effect useful as a horse tranquilizer. It was not until 1952 that someone had the idea of extending the drug’s tranquilizing properties from horses to people who were mentally ill. But of course, the drug did not address psychosis, merely ‘tranquilized’ symptoms.
The drug has been described as ‘their introduction in therapeutic use is more like the story of a drug in search of an illness’ 6
Based on the chance discovery of chlorpromazine as an ‘antipsychotic’, chemical companies went back over old drug lists looking for drugs that could have possible psychiatric applications. As a result, the chemical company J.R. Geigy located in Basel, looked again at a chemical they had hoped unsuccessfully would be a dye and then as an antihistamine and hypnotic. The chemical was later named imipramine. A psychiatrist asked the company for any drugs for testing on psychotic patients. The company sent him the drug they hoped would find a psychiatric use however it failed miserably with psychotic patients and made them worse. It was accidentally noted however that those psychotic patients who were depressed seemed to improve in their depression and so the first antidepressant was ‘discovered.’ 7
Biological psychiatry: waiting for answers where none exist
“Yet, despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition. Likewise, functional neuroimaging plays no role in clinical decision making.”
Functional neuroimaging in psychiatry and the case for failing better. 2021.
And so for 70 years, the most ‘advanced’ and often used tools of psychiatry, psychotropic drugs, have been directed at merely suppressing symptoms – something similar to in medicine repeatedly using a pain killer and yet never addressing the source of the pain or even attempting a cure.
Psychiatry has doggedly stuck to the ‘biological psychiatry’ theory – that mental illness has entirely physical origins and these can be found within the brain. While very convenient for psychiatry in terms of cementing relationships with pharmaceutical companies and resultant remuneration for drug distribution, in the 140 years since this theory was ‘thought up’, despite using sophisticated investigatory tools, there has not been a single discovery that has found it vaguely true.
“I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.” Thomas Insel, former director of the USA, National Institute of Mental Health, 2015. 8
“From the early 1990s, non-invasive functional neuroimaging, coupled with parallel developments in the cognitive neurosciences, seemed to signal a new era of neurobiologically grounded diagnosis and treatment in psychiatry. Yet, despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition. Likewise, functional neuroimaging plays no role in clinical decision making. Here, we offer a critical commentary on this impasse and suggest how the field might fare better and deliver impactful neurobiological insights.” Functional neuroimaging in psychiatry and the case for failing better. Neuron. 2022 Aug 9
“In contrast, the major mental illnesses psychosis, bipolar disorder, anxiety disorders, anorexia nervosa and depression have proved remarkably resistant to similar developments. Unfortunately, it is still not possible to cite a single neuroscience or genetic finding that has been of use to the practicing psychiatrist in managing these illnesses despite attempts to suggest the contrary.” …
“But does this not seem, after more than 30 years of failure, more akin to a religious or, albeit culturally influenced, persistent strong belief than one based on scientific grounds? Just where is the rational justification for ploughing the same furrow again and again?” David Kingdon. Emeritus Professor of Mental Health Care Delivery, University of Southampton, UK. 10
And so we are left now with nothing more than the same conclusion as the Rockefeller Foundation – that psychiatry has no scientific basis to support its insistence on ‘biological psychiatry’ and pushing out drugs. It is now 70 years since the first psychotropic drug and psychiatry has very little to show for it beyond drug profits and certainly not cures.
Diagnostic and Statistical Manual (DSM) of symptom opinions
…this revision (DSM III) would subject millions of people to psychotropic drugs and cost billions, wasn’t based on any science at all – merely the opinions of its authors.
With the emphasis placed on psychotropic drugs addressing symptoms of mental illness, the need for a diagnosing system became very important. What were the symptoms that the drug would address? This prompted an extensive revision of the Diagnostic and Statistical Manual (DSM) toward that end and what was called a ‘neo-Kraepelin revolution’ for psychiatry.
The authors of the Diagnostic and Statistical Manual (DSM) version III from 1973, which would provide this diagnostic system for psychotropic drugs, had no scientific basis for their decisions for what was to be the largest revision of the manual to date.
This revision which would subject millions of people to psychotropic drugs and cost billions wasn’t based on science at all – merely the opinions of its authors.
The following quotes are from interviews with DSM Task Force members obtained by James Davies, a Reader in medical anthropology and psychology at the University of Roehampton in London and made available in the paper How Voting and Consensus Created the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), 2016: 11
“[As] psychiatry is unable to depend on biological markers to justify including disorders in the DSM, we looked for other things – behavioural, psychological – we had other procedures….Our general principle was that if a large enough number of clinicians felt that a diagnostic concept was important in their work then we were likely to add it as a new category. That was essentially it. It became a question of how much consensus there was to recognise and include a particular disorder. (Interview with author 2012)” Robert Spitzer, DSM III Task Force Chair.
“I don’t have specific recollections, some things were discussed over a number of different meetings, [which would sometimes be] followed by an exchange of memoranda about it, and then there would simply be a vote… people would raise hands, there weren’t that many people. (Interview with author, 2012)” Henry Pinsker, DSM III Task Force
“There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous. I think the majority of us recognised that the amount of good, solid science upon which we were making our decisions was pretty modest. (Angell 2009, 29).” Theodore Millon. DSM III Task Force
“There are very few disorders whose definition was a result of specific research data. For borderline personality disorder there was some research that looked at different ways of defining the disorder. And we chose the definition that seemed to be the most valid. But for the other categories rarely could you say that there was research literature supporting the definition’s validity. (Interview with author, 2012)” Robert Spitzer, DSM III Task Force Chair.
DSM IV and later editions are built on DSM III with no attempt made then or since to replace these opinions with anything remotely based on science.
Placebo, the mystery variable
An important part of looking at psychiatry’s address of mental illness symptoms is the subject of placebo or the placebo effect. The placebo effect is the patient getting better and yet the reason cannot be assigned to the treatment he or she is receiving. 12
An aspect of the placebo effect, the intention of the patient to get well, has been seen in the subject of mental health going back centuries, i.e. many people in asylums when treated with decency and not abused could get well on their own accord.
It is also relevant in trials of drugs (or any treatment) in seeing if they actually work. For example, it is acknowledged that 35% to 40% of the response rate to antidepressants is due to the placebo effect. 13
Although a very, very significant ‘mystery variable’ in anything to do with mental health, psychiatry does not know why the placebo effect works and it is mostly ignored. More evidence of psychiatry’s lack of scientific credibility.
‘Antipsychotics’, the chemical straightjacket
These types of drugs were originally correctly labeled as powerful tranquilizers, with the label of ‘antipsychotics’ arriving later. These drugs do not cure psychosis, merely suppress its symptoms. Psychiatry has no idea what causes psychosis let alone what would cure it and so use these drugs as they have nothing else.
The mechanism involves suppression of the neurotransmitter dopamine and with later versions, serotonin as well. Parts of the brain are blocked off and while a person could remain psychotic, they could not appear to be nor act psychotic. Thus the ‘chemical straitjacket’ label these drugs have been given. Remove the drug and the person could again manifest the symptom of psychosis, i.e. the psychosis had never been addressed, let alone cured. 14
The drugs have a shotgun effect as while they can suppress psychotic symptoms they can also suppress many other features of a person’s personality. The shotgun effect also results in notable side effects beyond psychotic symptoms.
“People (both with mental illness and volunteers) who’ve taken antipsychotics also report a state of physical, mental and emotional suppression. Those suffering from mental disorders describe how the drugs can help to diminish disturbing thoughts and experiences, but at the cost of stifling important aspects of their personality such as initiative, motivation, creativity and sexual drive.” 15
Antidepressants’ – marketing before science
And simply, even if these ‘imbalances’ theories were valid observations, any scientist who was actually a scientist and not already bought off by pharmaceutical companies would ask: ‘Why is there an imbalance?’
Antidepressants are by far the largest example of the use of psychotropic drugs and yet are also the most controversial.
Common antidepressant drugs these days – selective serotonin reuptake inhibitors – suppress the natural function of nerve endings absorbing the neurotransmitter serotonin (the process of ‘reuptake’) in the brain. The reasons a person is depressed are never looked for nor handled. As with ‘antipsychotics’, antidepressants mess with brain chemistry and bring about a whole catalog of disturbing side effects, and are very difficult to withdraw from. 16
Considerable marketing occurred with the release of these drugs from the 1960s forward including the completely false statement that depression was caused by a lack of serotonin in the brain – a chemical imbalance – which psychiatrists, working with pharmaceutical marketing, used to make the drugs popular.
This ‘theory’ began to unravel with the first observations some of the results of these antidepressant drugs’ were simply a placebo response:
“We identified 252 placebo-controlled trials (26 324 patients on placebo) done between 1978 and 2015. There was a structural break in 1991, and since then, the average placebo response rates in antidepressant trials have remained constant in the range between 35% and 40%”. Placebo response rates in antidepressant trials: a systematic review of published and unpublished double-blind randomised controlled studies. 2016. 17
Then it was found that one-third of all patients said to have major depressive disorder simply did not respond to antidepressants – explained by a new label: Treatment-Resistant Depression 18
And in 2022 a major review of all available evidence regarding the serotonin theory of depression found there was no scientific evidence at all:
“This review suggests that the huge research effort based on the serotonin hypothesis has not produced convincing evidence of a biochemical basis to depression. This is consistent with research on many other biological markers. We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.” 19
And simply, even if these ‘imbalances’ theories were valid observations, any scientist who was actually a scientist and not already bought off by pharmaceutical companies would ask: ‘Why is there an imbalance?’
Appalling side effects are often played down or not mentioned at all
As psychotropic drugs mess with the natural brain chemistry they will produce side effects.
Common side effects of antipsychotic and antidepressant drugs can include compulsive movement (akathisia) and twisting of body parts (dystonia).
Patients with schizophrenia were found with 24% having chronic akathisia and 18% “pseudoakathisia” (only having objective symptoms).
Studies of groups of persons who were taking antidepressants for a bipolar, or manic depression diagnosis found they will develop akathisia in 10 to 18% of cases. 20
Other major side effects can include weight gain, sexual dysfunction, conditions resulting in heart, lung, and kidney failure, pneumonia, and death.
Patients are not always informed of the potential side effects of the drugs they are being prescribed. A 2019 study found that 70% of more than 800 persons surveyed could not recall they had been informed of drug side effects when prescribed and 70% had tried stopping the drugs due to concerns over side effects (64%) and their long-term physical health (52%). 21
In some cases, side effect information from drug trials is not made available. The risk of akathisia with SSRI antidepressants was known and yet withheld for years until finally disclosed. For example, it was known that 3.5% of Prozac patients either attempted or committed suicide due to the stresses of akathisia.
At the time a Pfizer employee, Roger Lane, stated in a 1998 paper: “It may be less of a question of patients experiencing fluoxetine-induced suicidal ideation than patients feeling that ‘death is a welcome result’ when the acutely discomforting symptoms of akathisia are experienced on top of already distressing disorders.” 22
Some side effects will clear up when the drug is no longer taken however some will take months or years to resolve or as is the case of tardive akathisia or tardive dyskinesia (uncontrolled body movements and twisting) can be untreatable and permanent.
Again, psychiatry does not know enough about the drugs that they are prescribing to say why these side effects occur in some people. It is simple Russian roulette.
Electroconvulsive ‘therapy’
Do not look for any science here as psychiatry has no understanding of why ECT works when it does.
When the drugs fail to suppress symptoms psychiatry reverts to the barbarity of electroconvulsive therapy, ECT.
Do not look for any science here as psychiatry has no understanding of why ECT works, when it does. And, here again, what is occurring is merely the suppression of symptoms, absolutely no cures, and again playing ‘Russian roulette’ with a long list of potentially debilitating side effects.
ECT has long been proclaimed as a treatment of last resort where to keep the patient alive, the brutality of the treatment and resulting side effects were somehow justified. And yet, a 2022 study found the reverse to be true. The study found there was no significant protection from the risk of suicide in the 30 days after treatment. In fact, typically in psychiatry, the actual result of receiving ECT included a 30% greater risk of suicide in the following year compared to those who had not received treatment. 23
Withdrawal from, change of medication or dosage of psychiatric drugs can result in serious side effects. Please only do so under the supervision of a competent medical doctor
- Rebecca A Johnson. “Pure” Science and “Impure” Influences: The DSM at a Scientific and Social Crossroads DePaul J. Health Care
- Shorter E. The history of nosology and the rise of the Diagnostic and Statistical Manual of Mental Disorders. Dialogues Clin Neurosci. 2015.
- López-Muñoz F, Alamo C, Cuenca E, Shen WW, Clervoy P, Rubio G. History of the discovery and clinical introduction of chlorpromazine. Ann Clin Psychiatry. 2005
- Li P, Snyder GL, Vanover KE. Dopamine Targeting Drugs for the Treatment of Schizophrenia: Past, Present and Future. Curr Top Med Chem. 2016
- Ban TA. The role of serendipity in drug discovery. Dialogues Clin Neurosci. 2006.
- López-Muñoz F, Alamo C, Cuenca E, Shen WW, Clervoy P, Rubio G. History of the discovery and clinical introduction of chlorpromazine. Ann Clin Psychiatry. 2005
- López-Muñoz F, D’Ocón P, Romero A, Guerra JA, Álamo C. Role of serendipity in the discovery of classical antidepressant drugs: Applying operational criteria and patterns of discovery. World J Psychiatry. 2022.
- E. Fuller Torrey, Wendy W. Simmons, Elizabeth Sinclair Hancq, John Snook. The Continuing Decline of Clinical Research on Serious Mental Illnesses at NIMH Psychiatry Online. 2021.
- Nour MM, Liu Y, Dolan RJ. Functional neuroimaging in psychiatry and the case for failing better. Neuron. 2022 Aug
- David Kingdon. Why hasn’t neuroscience delivered for psychiatry? Cambridge University Press. 2021.
- James Davies. How Voting and Consensus Created the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) 2016.
- Emma Bryce. Video. The powder of the placebo effect.
- Furukawa TA, Cipriani A, Atkinson LZ, Leucht S, Ogawa Y, Takeshima N, Hayasaka Y, Chaimani A, Salanti G. Placebo response rates in antidepressant trials: a systematic review of published and unpublished double-blind randomised controlled studies. Lancet Psychiatry. 2016 Nov;3(11):1059-1066.
- Li P, Snyder GL, Vanover KE. Dopamine Targeting Drugs for the Treatment of Schizophrenia: Past, Present and Future. Curr Top Med Chem. 2016
- Joanna Moncrieff. Story of antipsychotics is one of myth and misrepresentation. The Conversation. 2013.
- National Library of Medicine, USA. Selective Serotonin Reuptake Inhibitors
- Furukawa TA, Cipriani A, Atkinson LZ, Leucht S, Ogawa Y, Takeshima N, Hayasaka Y, Chaimani A, Salanti G. Placebo response rates in antidepressant trials: a systematic review of published and unpublished double-blind randomised controlled studies. Lancet Psychiatry. 2016.
- V Popova, E J. Daly, M Trivedi, K Cooper, R Lane, P Lim, C Mazzucco, D Hough, M E Thase, R C Shelton, P Molero, E Vieta, M Bajbouj, H Manji, W C Drevets, J B. Singh. Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study 2019. American Journal of Psychiatry.
- Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry. 2022
- Haitham Salem, Caesa Nagpal, Teresa Pigott and Antonio Lucio Teixeiraa. Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges Curr Neuropharmacol. 2017.
- Read J, Williams J. Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients. Curr Drug Saf. 2019
- Evelyn Pringle. SSRI-Induced Akathisia’s Link To Suicide 2007.
- Watts BV, Peltzman T, Shiner B. Electroconvulsive Therapy and Death by Suicide. J Clin Psychiatry. 2022