The Vice article, The Movement Against Psychiatry, opened with a disturbing story about two women who sought help from the mental health system, but received very different and ultimately harmful results. One woman refused to take medication or see her therapist and her condition deteriorated until she was eventually psychotic and incarcerated. The second woman served as a sergeant in the Army and sought psychiatric help while she was receiving medical care in Germany when she learned her convoy hit a roadside bomb in Iraq. “I walked straight down the hallway to the psychiatry office because I thought that’s what you do when you need help.” That began 13 years of being treated with 45 different medications, up to 18 at the same time until she said enough.
“The Movement Against Psychiatry” by Shayla Love used these two women to illustrate the contrasting position at the center of the debate of how to fix—or to do away with—the way we treat mental illness: over and under medication. At the core of this issue are the differences between psychiatry and what is called anti-psychiatry or critical psychiatry. But Love does not give a very fair presentation of the so-called anti-psychiatry position. This assessment is shared by Robert Whitaker, the journalist, author, and founder of madinamerica.com, which Love said was probably “the most active and legitimate critical psychiatry platform that exists today.”
Whitaker wrote a response to the Love’s article, “Vice, MIA and The Movement Against Psychiatry,” in which he presented a three-pronged assessment of what Love wrote. First, he gave an explanation of the mission of Mad in America. Then he addressed a common criticism made against himself and the Mad in America website that Love repeated, namely that Whitaker and his webzine distort the scientific record of psychiatry. Lastly, he saw the article as an opportunity to illustrate how the media, represented by Vice, perpetuated the conventional narrative about psychiatry.
In a section of his article titled: “Understanding Mad in America,” Whitaker gave a description of how the webzine seeks to be a forum for developing a new narrative to guide society’s thinking and care about psychiatry and its drug treatments. He then went on in “Deconstructing the Vice Article,” to describe some surprising details about what seems to be Love’s failure to remain unbiased. Love did not interview Whitaker for her article, instead she contacted him by email one week before her article was to be published. Whitaker also invited her to contact the researchers whose work he was said to have misinterpreted in order to see whether they thought his reporting of their work was inaccurate.
It seems she also failed to do that as well. Whitaker said, “All she needed to do was read the studies, call Harrow or Jobe, and she could have had a blockbuster article, anchored by research that revealed there was a scientific rationale for a “movement against psychiatry.”
Martin Harrow and Thomas Jobe had investigated long-term outcomes of patients diagnosed with psychotic disorders. They found at the 15-year mark that the recovery rate for schizophrenia patients off medication was eight times better than those who were medication compliant. Whitaker noticed in their data that even patients with milder psychotic disorders who stayed on antipsychotics had worse long-term outcomes than those with schizophrenia who got off medications. Harrow and Jobe later published further analysis of their long-term data and cited him and Joanna Moncrieff among those who questioned the received narrative for long-term outcomes for those who were using antipsychotics. Harrow and Jobe said:
Overall, the longitudinal studies cited do not provide conclusive proof of a causal relationship between being off medications and being psychosis free. They do clearly indicate that not all schizophrenia patients need continuous antipsychotics for a prolonged period, providing extensive evidence of samples of medication-free schizophrenia patients with favorable outcomes.
Whitaker’s deconstruction of “The Movement Against Psychiatry” illustrates how the article reinforces the conventional narrative of psychiatry. Read an op-ed article for MedPage Today, “Why Anti-Psychiatry Now Fails and Harms,” if you want an example of what is meant by the conventional narrative. Coincidentally, two of the three authors of the MedPage Today article were cited or quoted by Love as supporting the conventional narrative.
The Vice article was presented as an exploration of the “movement against psychiatry,” and yet you can see, once it is deconstructed, how it told a story that surely pleased the promoters of the conventional narrative, and put the “critics” on the defensive at almost every turn.
The concluding comments in Whitaker’s article appear to invite further dialogue between psychiatry and so-called “anti-psychiatry,” but he seems to be frustrated with the way many media outlets—Vice being the example here—protect and perpetuate the conventional narrative of psychiatry:
I hope that deconstructing this article—and revealing the journalistic standards that are on display—helps reveal the depth of the challenge for those who would like to see “psychiatry reimagined.” Unfortunately, this struggle is regularly hindered by the fact that media are often poised to report in ways that protect the conventional narrative, and look askance at those who would challenge it. But as is the case in any struggle, it’s always good to know what you are up against.
It also seems that Love may have misrepresented more than just Whitaker and Mad in America. Awais Aftab, a psychiatrist and author of an interview series for Psychiatric Times,” was prompted to clarify the context surrounding Love’s quotes of him the day after “The Movement Against Psychiatry” was published in: “The VICE Story: Beyond Anti-psychiatry.” Dr. Aftab appeared to be attempting a corrective against the potential for “the VICE Story” to lead too far into a “polarizing discourse.” He said he does not identify as a “critical psychiatrist,” because he does not think “critical” serves well as an identity function. He also said “anti-psychiatry” is an imperfect term because very few individuals today self-identify their views as being anti-psychiatry. Nevertheless, “one can still recognize the tremendous need for reform, and acknowledge the valid ways in which an exclusive emphasis on medical conceptualization can be harmful.”
This is a delicate and qualified position and navigating a dialogue from such a position is subject to the constant pressure for the dialogue to collapse into one polar position or another. I do not always succeed in that, but I try. That has precisely been the function of my interview series for Psychiatric Times, “Conversations in Critical Psychiatry”, where I try to engage with various critical and philosophical perspectives.
Attempting to maintain that dialogue, he noted how Love recognized the need to resist a polarizing discourse in her article. He pointed out that Love said it was nearly as useless to be steadfastly pro-psychiatry as it was to be anti-psychiatry. He concluded by saying: “One can recognize the need for meaningful criticisms and structural reform without delegitimizing the medical basis of psychiatry.”
Although Shayla Love did not interview Robert Whitaker for her article, John Horgan did interview him for an opinion piece published online for Scientific American, “Has the Drug-Based Approach to Mental Illness Failed?” When asked if he saw himself as a journalist or an activist, Whitaker said he didn’t see himself as an activist at all. He then quoted the mission statement for Mad in America, which said its mission was to serve as a catalyst for rethinking psychiatry. The current psychiatric paradigm has failed. Scientific research and the lived experience of those who have been diagnosed with a psychiatric disorder both call for a profound change.
The usual practice in “science journalism” is to look to the “experts” in the field and report on what they tell about their findings and practices. However, while reporting and writing Mad in America, I came to understand that when “experts” in psychiatry spoke to journalists they regularly hewed to a story that they were expected to tell, which was a story of how their field was making great progress in understanding the biology of disorders and of drug treatments that—as I was told over and over when I co-wrote the series for the Boston Globe—fixed chemical imbalances in the brain. But their own science, I discovered, regularly belied the story they were telling to the media. That’s why I turned to focusing on the story that could be dug out from a critical look at their own scientific literature.
Dr. Aftab’s comment above, about doing meaningful criticism and structural reform without delegitimizing the medical basis of psychiatry, may have captured the essence of the struggle between psychiatry and “anti-psychiatry.” Psychiatry wants to hold on to its identity as a medical specialty and sees the critique of Whitaker and others as a distinct threat to that identity. Perhaps the way forward lies with Lisa Cosgrove’s remarks quoted in “The Movement Against Psychiatry.” She said the fact that there are not any biomarkers doesn’t make psychiatry irrelevant as a medical discipline. “It just makes it different from other subspecialties in medicine.” Psychiatry needs to embrace its difference.
