Controversies about psychiatry
There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis,[1] the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent,[2] the side effects of treatments such as electroconvulsive therapy,[3] antipsychotics[4] and historical procedures like the lobotomy[5]: 28 and other forms of psychosurgery[5] or insulin shock therapy,[6] and the history of racism within the profession in the United States.
[9] As societal views on homosexuality have changed in recent decades, it is no longer considered a mental illness and is more widely accepted by society.
[12]: 185 For example, in 2013, Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".
However, these authors took the view that increasingly sophisticated technology had extended the potential reach of medicalization as a form of social control, especially in terms of "psychotechnology" (Chorover, 1973).
They argued that medicine disguised the underlying causes of disease, such as social inequality and poverty, and instead presented health as an individual issue.
[23] The use of hospitals instead of jails prevents the victims from receiving legal aid before the courts, makes indefinite incarceration possible, and discredits the individuals and their ideas.
"[26] In the period from the 1960s up to 1986, abuse of psychiatry for political purposes was reported to be systematic in the Soviet Union, and occasional in other Eastern European countries such as Romania, Hungary, Czechoslovakia, and Yugoslavia.
Perpetuated by the inaccurate application of biodeterminism, specialists in neuroanatomy and psychiatry compared disproportionate numbers of brains from Black and white individuals to support their racial agendas based on "science.
[31] The founding fathers of psychiatry themselves supported the notion that Black people were inferior, lower class citizens that must be treated separately and differently from white patients.
[40] In 1969, a contingent of Black psychiatrists presented a list of 9 concerns to the APA Board of Trustees regarding experiences of structural racism in the field.
[40] For example, they called for more Black leaders on APA committees as well as the desegregation of all mental health facilities, both public and private, in the United States.
[7]: 104 In 2013, psychiatrist Allen Frances said that he believes that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".
She argues that schizophrenia and its biological basis also gives families, psychiatrists and society as a whole the ability to avoid blame for the damage they cause individuals and the ineffectiveness of treatment.
[48]: 238 Underlying issues associated with schizophrenia would be better addressed as a spectrum of conditions[49] or as individual dimensions along which everyone varies rather than by a diagnostic category based on an arbitrary cut-off between normal and ill.[50] This approach appears consistent with research on schizotypy, and with a relatively high prevalence of psychotic experiences, mostly non-distressing delusional beliefs, among the general public.
[54][55][56] Nancy Andreasen has criticized the current DSM-IV and ICD-10 criteria for sacrificing diagnostic validity for the sake of artificially improving reliability[citation needed].
[49] Neuropsychologist Michael Foster Green went further in suggesting the presence of specific neurocognitive deficits may be used to construct phenotypes that are alternatives to those that are purely symptom-based.
[72] In 2012, the National Institute for Health and Care Excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.
[91] The National Institute for Health and Care Excellence recommends ECT for the short-term treatment of severe, treatment-resistant depression, and advises against its use in schizophrenia.
[46]: 110–112 Joanna Moncrieff has argued that antipsychotic drug treatment is often undertaken as a means of control rather than to treat specific symptoms experienced by the patient.
[101] In an official review commissioned by UK government ministers it was reported that the needless use of antipsychotic medication in dementia care was widespread and was linked to 1800 deaths per year.
[104] There has also been controversy about the role of pharmaceutical companies in marketing and promoting antipsychotics, including allegations of downplaying or covering up adverse effects, expanding the number of conditions or illegally promoting off-label usage; influencing drug trials (or their publication) to try to show that the expensive and profitable newer atypicals were superior to the older cheaper typicals that were out of patent[citation needed].
Following charges of illegal marketing, settlements by two large pharmaceutical companies in the US set records for the largest criminal fines ever imposed on corporations.
[105] In addition, Astrazeneca faces numerous personal-injury lawsuits from former users of Seroquel (quetiapine), amidst federal investigations of its marketing practices.
A 2008 Senate investigation found that Biederman also received $1.6 million in speaking and consulting fees between 2000 and 2007— some of them undisclosed to Harvard— from companies including the makers of antipsychotic drugs prescribed for children with bipolar disorder.
[105] In 2004, University of Minnesota research participant Dan Markingson committed suicide while enrolled in an industry-sponsored pharmaceutical trial comparing three FDA-approved atypical antipsychotics: Seroquel (quetiapine), Zyprexa (olanzapine), and Risperdal (risperidone).
[110] Pharmaceutical companies have also been accused of attempting to set the mental health agenda through activities such as funding consumer advocacy groups.
[111] In an effort to reduce the potential for hidden conflicts of interest between researchers and pharmaceutical companies, the US Government issued a mandate in 2012 requiring that drug manufacturers receiving funds under the Medicare and Medicaid programs collect data, and make public, all gifts to doctors and hospitals.
Psychiatry is seen to involve an "unequal power relationship between doctor and patient", and advocates of anti-psychiatry claim a subjective diagnostic process, leaving much room for opinions and interpretations.
[117] Coalescing around the ex-patient newsletter Dendron,[118] in late 1988 leaders from several of the main national and grassroots psychiatric survivor groups felt that an independent, human rights coalition focused on problems in the mental health system was needed.
SCI's first public action was to stage a counter-conference and protest in New York City, in May, 1990, at the same time as (and directly outside of) the American Psychiatric Association's annual meeting.
