Shooting the Messenger
Psychiatry’s antipsychiatry obsession.
It was probably Samuel Gompers, American labour activist, who first said: “First they laugh at you, then they ignore you, then they attack you, then you win.” Something must be happening because the term “anti-psychiatry” is being sprayed around more than usual, although we can probably guess why. First, the evidence. Writing in the prestigious journal Lancet Psychiatry, Prof. David Nutt of Imperial College, London, put his “personal view” that drug development in psychiatry amounts to “fifty years of failure” [1]. Nutt is totally committed to the idea that all mental disorder is a biological disease of the brain for which drugs and ECT and other physical treatments are mandatory. However, all the major classes of drugs used in psychiatry were discovered by chance in the 1950s, and the lack of progress in drug research since then troubles him:
Despite hundreds of billions of dollars spent on research in the past 70 years, no major neuroscience-based advances have been made in psychiatric treatments for psychosis, depression, or anxiety… In the past 3 years, the EMA has approved only one new treatment in psychiatry, compared with 68 in oncology, and no clear plan is set to remedy this imbalance [1, p1].
He listed a dozen reasons why this is the case, many of them either government administrative glitches or financial and insurance worries by drug companies. First concern was “The absence of a single understood causal mechanism for most psychiatric disorders…” That is, researchers hoping to find a biological cure for mental disorder are handicapped by not having a possible biological cause:
…a previous head of research and development for GSK explained that the company pulled out of depression and pain research in 2010 because “the gaps in understanding many CNS diseases are simply too large for any one company to make a serious impact” [1, p4].
This is a roundabout way of saying “We don’t actually know what we’re doing.” Perhaps that’s why, last on his list of obstructions and impediments, we find “Anti-psychiatry lobby groups”:
Unlike other branches of medicine, psychiatry is in constant battles with lobby groups that oppose its very existence as a medical speciality. These groups deny the concept of mental illness being due to alterations in brain function, from which it follows that they do not believe in pharmacological treatments and actively campaign to have them banned or not approved in the first place … Anti-psychiatry sentiments fuel litigation against companies that sell psychiatric medicines [1, p4].
This fairly hair-raising claim was supported by three references. He mentioned how one company, GSK, spent £9million defending a claim regarding its antidepressant, paroxetine, and suggested the ever-present threat of litigation may deter some companies from the huge investments psychiatric drugs require.
As for solutions to this problem, he suggested “Psychiatry researchers should learn from history and put the problem of poor progress in mental health treatment innovation into the public domain.” He described how, twenty years ago, there was concern that research in novel antibiotics had largely ground to a halt until Pres. Obama stirred governments and companies into coordinated action. Similarly, the Covid pandemic showed how basic research and therapeutic trials can be accelerated when the urgency of the situation demands it.
Now his gloomy view is a bit unexpected: for half a century, we’ve been flooded with material from drug companies and mainstream psychiatry lavishly praising the wonders of modern psychiatry and urging how, at the slightest twitch or mental sniffle, we should rush off to our doctors for a prescription of its miracle drugs. Suddenly, one of their prime movers is saying their drugs were discovered by chance, they’re all out of date, we don’t know how they work, and we therefore have no idea how to pull new rabbits out of the pharmacological hat.
The second article [2] is by the omnipresent Dr Ronald Pies, of Boston, who, as I’ve mentioned before, has very clear ideas on what psychiatry is (biopsychosocial) and who should be allowed to criticise it (one or two of his friends). His latest concern is the “demonisation” of psychiatric drugs and to show that this is just another strand in an ancient (and irrational) “antidrug animus” which has many historical precedents. His article starts with an account from 125 years ago in Boston where a small group of cultists led by a religious crank attacked pharmacies on the basis they were poisoning people. Instead of drugs, they believed, everybody should pray for relief. In fact, when it comes to the combined toxicity and uselessness of most of the chemicals in one of those shops, they were actually on strong grounds. In the 1890s, the risks, scandals and corruption of allopathic (mainstream) medicine in the US were so great that another, opposing tradition, osteopathic medicine, was established and persists to this day.
Another thread he espies is America’s strong “Puritan heritage,” which blames people for their misfortunes, e.g. the classic “masturbatory insanity,” as in “If you’re insane, it’s because of self-abuse so we’ll stop you.” There are two notions here, one religious and one secular. The religious theme, mentioned above, says that either God or sin determines illness, but only God can relieve it so the correct form of management for any sickness is prayer – and abstinence, of course. This blurs across to the secular notion that sick people have some sort of imbalance in their "life forces" or something, which can only be cured by self-denial such as fasting, celibacy, exercises and so on. Pies doesn’t mention another branch of this notion, that illness is personal weakness and must be relieved by superhuman exertion. This is the “Pain is weakness leaving the body” mantra so popular among heroic military people who have never been sick or injured. Swirling around and through all these themes are the equally ancient traditions of naturopathy, homeopathy, vital forces, astrological influences, spiritualism, and so on. While we would like to say this is largely confined to the US, which definitely has more than its share of crackpots and whizzbangs (queue here for holotropic quantum embodiment via the bioenergetic breathing stool), a recent trial in Queensland showed it isn’t.
Having introduced his demons, Pies moves to his bugbear, people who criticise psychiatry and its reliance of drugs. First, he announces that not all criticism of psychiatry is unfounded, which is a great relief to know. He has himself spent years reducing psychiatric drugs in the elderly, which reminded me of an incident in a veterans’ hospital years ago. A new junior medical officer arrived and made it clear he was only there because he’d been sent, and he wasn’t much impressed with psychiatry. After a month, he said in some astonishment: “I don’t get this. All these people come in confused and disturbed and you don’t do anything. You just wean them off their drugs and they get better.” “Yes,” I said, “that’s right.” Pies, however, can’t make up his mind. The same psychiatric drugs which he agrees have serious side-effects and are often overprescribed and abused, he says, are:
… often falsely portrayed by extremist critics as toxic, brain damaging, and powerfully addictive… these unsubstantiated claims have stigmatized many of our patients … and led to the stigmatization of psychiatrists and psychiatry.
He is, however, satisfied that demonising psychiatric drugs is nothing new and modern critics are simply marching to the same drum as religious cultists and other misguided but destructive souls. He concludes: “As clinicians, we have a responsibility to convey to our patients both the significant benefits of psychiatric medications and their attendant risks.”
Nutt’s paper is significant, not because he says anything new but because of who is saying it. As a devout biological psychiatrist, Nutt is very closely associated with a large number of drug companies and certainly knows their inner workings far better that most psychiatrists. His list of associations and affiliations with drug companies is enormous, much larger than that shown at the end of the paper. He can pick up his phone and speak directly to the heads of research in any of a dozen major drug companies around the world. He’s not some Antipodean nobody whingeing about psychiatry, he’s standing right in the middle of it. If he says psychiatry is in a hole and needs a massive jolt to get out of it, people have to listen.
The thrust of his paper is that the “gaps in understanding” are matters which can be solved with a bit of administrative fiddling and more money. On this point, he’s wrong: the problem is his insistence that what he calls mental illness is “due to alterations in brain function.” This is an unproven claim. If mental disorder is not caused by primary brain dysfunction, then searching for drugs to “cure” it is a huge waste of time and money, not to mention lives. Nutt has previously been asked to provide supportive evidence but, as is normal, he doesn’t respond (March 9th, 2018). However, he goes further:
Anti-psychiatry lobby groups … deny the concept of mental illness being due to alterations in brain function, from which it follows that they do not believe in pharmacological treatments and actively campaign to have them banned or not approved in the first place …
This is what is called a “bold” statement, and he provides three references (Nos. 106-108). Trouble is, none of the authors quoted says anything like that. To say that the critical psychiatry group around Joanna Moncrieff, in London, is “antipsychiatry” is absurd. Nutt’s goal is to blur the distinction between legitimate criticism of mainstream psychiatry and the extremist fringe, so that all critics are tarred with the crackpot brush and can therefore be ignored.
We see the same ploy in Ronald Pies’ article: guilt by association. As a start, he is very strong on quoting vaguely related events from history to blacken his opponents, rather more coy when it comes to mainstream psychiatry’s ghastly history. As usual, he doesn’t address the content of criticisms of mainstream psychiatry but makes only a crude attempt to get readers to think that modern critics of psychiatry are the intellectual heirs of crazed cultists wrecking chemist shops 125 years ago (which they deserved, but that’s another story). Yes, Dr Pies, psychiatric drugs are indeed toxic, that’s why they’re tightly restricted. I for one would like tricyclic antidepressants banned because of their cardiac toxicity but that’s out of my control. Do they cause brain damage? The jury is out on that one but addiction is settled. If Pies thinks benzodiazepines and many others aren’t addictive, I have a little experiment for him to undertake, involving just one bottle of alprazolam, or lorazepam, or any of the others. He’ll find out the hard way that they’re highly addictive. But notice how he slips that word in: “extremist.” Critics are extremist, and lead to psychiatrists being stigmatised. This is nonsense: psychiatrists were regarded as intellectually lazy if not ridiculous long before modern psychiatric drugs were invented (see [3]; also Karl Popper’s criticism of psychoanalysis from 1922 [4, p38]).
I could go on but the point is clear: mainstream psychiatry is highly antagonistic to criticism just because it has so much to hide. Criticism of the status quo is part and parcel of science but psychiatrists hate it because of their intellectual insecurity. Their first response to criticism is to ignore it, to smile and tell everybody “Pay no attention to that silly fellow, we’ve got the science.” When that fails, their next step is “Shoot the messenger.” However, things have changed and they’re worried. On certain matters of health, the newly-enthroned Secretary for Health in the US is a dyed-in-the-wool crackpot who sees psychiatrists as a subspecies of orcs, and has already fired opening shots at the SSRI and ADHD money machines. OMG, what are the poor misunderstood shrinks going to do? They can’t ignore him because he’s the person who controls their incomes. They can’t blacken his character as he’s already done quite a good job of that himself. They can’t appeal to the president because even before he started to dement, Trump was telling people to drink bleach and shine UV light down their throats to prevent Covid. Stay calm, everybody, they say, this is no time to panic (cue the line from Toy Story I: “You’re kidding. This is a very good time to panic”). Help is on its way.
Despite being shot at many times for my message that psychiatry has no scientific basis, and just to show there’s no hard feelings, I’ll help them, I’ll tell them what they need to do to head of this existential risk. I don’t mean that psychiatrists should all join another cult and start wrecking chemist shops, or practising exorcism rituals, I’ll give them an actual battle plan of how to get out of this mess. It’s not just a plan to outsmart attention-challenged secretaries of health, or to silence critics such as the authors of the Maudsley Deprescription Guidelines [5], I mean defanging religious cranks and finally banishing the fanatical disciples of the late Thomas Szasz to the wilderness where they can live on locusts and wild honey to celebrate their moral purity. Are you ready? Everybody seated? OK, here it is: To get rid of antipsychiatry critics, all biological psychiatry needs do is prove that mental disorder is biological. That’s it. Write a proof that not only is mental disorder biological in nature and therefore needs drugs, it can’t be otherwise. So simple. That’ll put that Kennedy upstart back in his box. Imagine the cheek of him coming into our departments and telling us we’ve got it all wrong. We’ll show him, can somebody pull out that proof? What do you mean, we haven’t got one, we must have. We all believe in biology, surely somebody wrote the proof half a century ago? No? Oh shit, we might have to get honest jobs. Yes folks, this is indeed a good time to panic.
David Nutt says psychiatry has spent 70 years and hundreds of billions of dollars on brain and drug research with nothing much to show for it (and no future directions) so you wonder why they were so intellectually lazy that they haven’t done this before. Without such a proof, modern biological psychiatry is not a science of mental disorder, it is an ideology [6], but irredeemably tainted by torrents of drug company money. However, I believe they’re wasting their time, they’re going to have to accept that this time, they can’t get away with calling critics extremist, dangerous, biased and antipsychiatry [7], and all the other abuse they regularly chuck around. Calling somebody “antipsychiatry” is not a defence to criticism, it is the cheapest of undergraduate debating ploys, an ad hominem attack, a diversion, essentially a refusal to address the criticism so I’ll save them the trouble of writing their proof: it’s all been done, but it turns out there cannot be a biological psychiatry [8]. Mental disorder is properly seen as entirely psychological in causation [9] and its management very largely psychological. Drugs can be helpful but, because of their side effects, only in the short term for the more severe cases. We desperately need entirely new classes of non-toxic, non-addictive drugs, although that may be asking too much. Maybe, after all this time, psychiatrists will have to learn how to talk to their patients as humans. I don’t think that’s asking too much.
(Nutt’s paper is 7 pages with 160 references, obviously quite a lot of work; I don’t think he wrote that just because Kennedy got his pay-off for swinging his votes behind Trump but it was certainly timely. Pies’ article is just more of his usual stuff).
References:
1. Nutt DJ (2025). Drug development in psychiatry: 50 years of failure and how to resuscitate it. Lancet Psychiatry. Available at: https://pubmed.ncbi.nlm.nih.gov/39952266/.
2. Pies RW (2025). The Ongoing Movement Against Psychiatric Medication. Psychiatric Times.
3. Scull A (2022) Desperate Remedies: Psychiatry and the mysteries of mental illness. London: Penguin.
4. Popper KR (1972). Conjectures and Refutations: the growth of scientific knowledge. London: Routledge.
5. Taylor D, Horowitz M (2024). The Maudsley Deprescribing Guidelines. London: Wiley-Blackwell.
6. McLaren N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18. DOI: 10.1891/1559-4343.15.1.7.
7. Menkes, D, Dharmawardene, V, (2019). Anti-psychiatry in 2019, and why it matters. Australian and New Zealand Journal of Psychiatry 53: 921-922.
8. McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon.
9. McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge. Amazon.
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