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What Is Wrong With Psychiatry?
by Al Siebert, PhD
Excerpted from Journal of Humanistic Psychology,
Vol. 40, No. 1, Winter, 2000. pp. 34-58.
Summary
An experimental interview with a young woman diagnosed with paranoid schizophrenia led to her rapid recovery. This incident and questions raised about psychiatric practices suggest that something is seriously wrong with psychiatry. It lacks insight into its own behavior, invalidates constructive criticism, avoids the kind of self-examination it urges on patients, shows little interest in accounts of successes with schizophrenic individuals, erroneously lumps all the schizophrenias (plural) together in research studies, feels help-less and hopeless about schizophrenia, dismisses evidence that con-tradicts its inaccurate beliefs, and misrepresents what is known about schizophrenia to the public and to patients. The argument is put forward that research should begin to focus on the mind of the beholder. It is time for researchers to examine the cognitive processes, personality traits, and motives of mental health professionals who perceive schizophrenia in others and insist that schizophrenia is an incurable brain disease.
Discussion
One expects mental health professionals to be exemplary models of mental health. This would include being open-minded about new and better ways to be effective and receptive to constructive feedback. But just as the writings of Thomas Szasz have been rejected and dismissed by mainstream psychiatry for over three decades (Leifer, 1997), my efforts to have this account of my interview with "Molly" published in a professional journal were, until now, unsuccessful for over 30 years. The one time the interview was published in a newspaper article, the psychiatric community reacted very negatively.
About twenty years ago a patients' rights advocate with the Mental Health Association of Oregon asked me to write one of five articles commissioned for a series critical of psychiatric practices. The series was preapproved by the editors of The Oregonian, our local newspaper. My article asserting that mental illness is a faulty paradigm included Molly's story (Siebert, 1976). It was selected to run first. The morning it was published, a group of prominent local psychiatrists demanded and were given an immediate meeting with the publisher. At that meeting they persuaded the publisher to cancel the series and not publish the other four articles. Their main argument, I was told, was that it is harmful for psychiatric patients to have doubts about the competence of their therapists.
The publication of "label dissolving" interventions by Aaron Kramer and Lucien Buck (1997) and now this article are signs that the time may have arrived for the research lens to turn around and focus on the cognitive processes, motives, and actions of those who perceive others as schizophrenic. Until now, all published research about "schizophrenia" has focused only on persons declared to have it. No professional journals have published research examining the mental processes of those who perceive "schizophrenia" in other humans.
There is ample evidence that something is wrong with psychiatry. It is predictable, for example, that current experts on "schizophrenia" will likely declare that the psychiatric staff at the University of Michigan Hospital made an incorrect diagnosis of Molly, that she wasn't really "schizophrenic," and is not representative of "schizophrenic" patients who end up in mental hospitals. The key to significant progress with "schizophrenia" may be to stop looking at what "mental health" practitioners think about their patients, but how they themselves think. Important research questions would include:
Why is the psychiatric literature silent about why psychiatric residents must try to make patients believe they are mentally ill?
The requirement that psychiatric residents must work to convince patients they are "mentally ill" appears to be a real life demonstration of research about reduction of cognitive dissonance (Festinger, 1957). A person who asserts a certain belief gradually comes to believe what he or she is saying. Would psychiatry be populated by practitioners who can see signs of mental illness in almost every human (Caplan, 1995) if this practice were changed?
A related issue is lack of insight that psychiatrists have about incongruent, "mixed messages" in their actions and words. A psychiatrist will, in effect, say to a person diagnosed as delusional, "Because you believe that people are trying to force thoughts into your mind, you must accept into your mind the thought that you are mentally ill." The psychiatrist is unaware that he or she is doing the very thing he or she is declaring is not happening. This is a "crazy-making" experience for psychiatric patients.
When someone diagnosed as schizophrenic disagrees that he or she is ill, why does the psychiatric profession insist that the person "lacks insight"?
McEvoy et al. (1989a) conducted a study to explore "failure of insight in schizophrenic patients." They concluded that "many schizophrenic patients...deny that they are ill, are unwilling to enter or remain in the hospital during exacerbations of their illness, and discontinue prescribed medications after discharge..." (p. 46). Furthermore, McEvoy et al. (1989b) found that "lack of insight operates independently from levels of psychopathology at admission and decrease of symptoms during treatment." (p. 50).
The point here is that when people diagnosed as having "schizophrenia" disagree that they are mentally ill, many psychiatrists believe their own perceptions are "reality" and that the patients "lack insight." No consideration is given to the possibility that the so-called "schizophrenic" person's view that he or she is not "ill" is valid.
The situation is especially disturbing in light of an observation made by psychiatrist Werner Mendel (1976):
In the post-World War II literature, there are many examples of patients who went to state hospitals incorrectly diagnosed either as schizophrenic or mentally retarded and who stayed for thirty of forty years only to be discovered, during the renaissance of psychiatry after World War II, not to be ill at all. These patients show a psychological condition based entirely on having been in the hospital for thirty or forty years without any initial mental illness or mental retardation (p. 123).
What has changed since the 1940's? What if many people diagnosed as "schizophrenic" today are as right in their protests about not being "mentally ill" as were patients in the past (Farber, 1993)?
What are the cognitive processes in the mind of a person perceiving "schizophrenia" in someone else?
Why does the thought "That's schizophrenic" get triggered in the minds of clinicians when they hear a person reveal certain thoughts and feelings? Why is a disturbing person perceived as "disturbed?" Is the perception of "schizophrenia," in part, a stress reaction in the mind of the beholder?
Why does the psychiatric profession feel compelled to "treat" people diagnosed as having "schizophrenia" when, after 100 years of clinical experience and research, there is still no proof in the psychiatric literature that what is called "schizophrenia" is a medical disease with demonstrable neurophysiological dysfunction?
Emil Kraeplin presented his concept of "dementia praecox" at the University Psychiatric Clinic in Heidelberg on November 27th, 1898 (Bleuler, E., 1950; Stromgen & Wing, 1973). A few years later, in 1911, Eugen Bleuler (1950) wrote in the German edition of his classic textbook on schizophrenia: "We do not know what the schizophrenic process actually is" (p. 466). During the one hundred years since the phenomena called "schizophrenia" were first observed, research has established that:
Schizophrenia remains a diagnostic enigma (Carpenter, 1983; Gottesman & Shields, 1982; Menninger, 1970). Even though over 100,000 books and articles have been published on schizophrenia (Bleuler, M., 1979b), contemporary psychiatrists confess they still don't know what "schizophrenia" is. Cancro (1974) admits that when he was asked "What is schizophrenia?" by a psychiatric resident, his first thought was: "God only knows" (p. 1). Rifkin (1984) says, "The plain fact is that we just don't know what schizophrenia is" (p. 84). Herbert Pardes (1989), while president of the American Psychiatric Association, wrote in one of his monthly columns "I do not know what this disease is yet; I do not know how many diseases it may entail" (p. 3). The diagnosis remains now, as 100 years ago, a subjective conclusion based on being familiar with the current diagnostic indicators.
Most cases of "schizophrenia" occur in physically healthy young adults (ages 16 to 25) who often have a life history of being bright and capable. "Schizophrenia" rarely first occurs in anyone over 40, no matter how extreme the emotional and biological stressors. (Arieti, 1979; Bleuler, M., 1979a; DSM-IV, 1994; Hoffer and Osmond, 1966; Ponyat, 1992; Smith, 1982).
"Schizophrenia" occurs spontaneously with no identifiable cause (Bleuler, E., 1979b; Smith, 1982). Who will get "schizophrenia" is unpredictable and there is no immunity from it.
The diagnosis or non-diagnosis of "schizophrenia" can be more strongly influenced by the mind set and expectations of the clinicians than by the mental and emotional condition of the person diagnosed (Rosenhan, 1973; Strauss & Gift, 1977; Szasz, 1976).
People diagnosed as "schizophrenic" often have to be talked into thinking they are sick and in many cases are forced to submit involuntarily to treatment (Applebaum, Mirkin, & Bateman, 1981).
The long-term outcome for any individual diagnosed with "schizophrenia" is unpredictable (Bleuler, E., 1950; DSM-IV, 1994; Marengo, 1994; Moller & von Zerren, 1988). Some people fully recover, roughly one-half stabilize in socially acceptable ways, and the others continue to have difficulties (Warner, 1985). It is not a condition of slow, life-long, progressive deterioration (Ponyat, 1992), it does not generally progress more than five years from onset but, rather, improves (Bleuler, M., 1979a; Harding et al, 1987; Mendel, 1989).
There is no known cure for "schizophrenia." Medication makes some people with "schizophrenia" worse (Buckley, 1982; Cohen, 1994; Rappaport, Hopkins, & Hall, 1978) and hospitalization makes some people worse (Kiesler, 1982).
Why do psychiatrists who specialize in schizophrenia misrepresent what is known about schizophrenia to the public?
Prominent schizophrenia psychiatrists such as Nancy Andreasen, Editor-in-Chief of the American Journal of Psychiatry, David Pickar, Chief of the Experimental Therapeutics Branch of the National Institute of Mental Health, and E. Fuller Torrey have stated in national broadcast interviews that schizophrenia is a brain disease like Alzheimer's, Parkinson's, or multiple sclerosis (Farnsworth, 1998; Torrey, 1983, 1988, 1997a; Yolken & Torrey, 1995). These statements are inconsistent, however, with research facts and scientific evidence.
Neurologists cannot independently confirm the presence or absence of schizophrenia with laboratory tests as they can with Alzheimer's, multiple sclerosis, and Parkinson's diseases. Post-mortem studies of deceased "schizophrenic" patients find no Alzheimer-like neuropathology (Baldessarini et al., 1997). The large majority of people diagnosed as having schizophrenia show no neuropathological or biochemical abnormalities and a few people without any symptoms of schizophrenia have the same biophysiological abnormalities as do a few people with "schizophrenia" (Siebert, 1999).
No one can catch a schizophrenia from someone else. During the entire history of psychiatry no psychiatrist, psychologist, nurse, social worker, aide, or family member has ever caught or developed a schizophrenia from contact with so-called "schizophrenic" persons (Bernheim & Lewine, 1979; Cooper & King, 1987; Gottesman, 1991).
No one dies from schizophrenia, even when untreated (Mendel, 1989), although the suicide rate is above average in persons treated for "schizophrenia" by the mental health system (Caldwell & Gottesman, 1992; Roy, 1982).
Contrary to the assertion that schizophrenia is a devastating, dementing illness of progressive deterioration of cognitive processes (Lindenmeyer & Kay, 1992; Maddox, 1988; McGlashen, 1988), research shows no decline in IQ from childhood into adult years (Russell et al. 1997). Richard Warner (1994), reviewed all published "long-term follow-up studies of schizophrenics" and found that "complete recovery occurs in roughly 20-25 percent of schizophrenics and social recovery in another 40-45 percent" (p. 79). Longitudinal studies of thousands of ex-patients in many countries show that one-half to two-thirds of the individuals diagnosed as schizophrenic are found, many years later, to have achieved full recovery or made significant improvement (Harding et al, 1987; Siebert, 1999).
No one with Alzheimer's, Parkinson's, or multiple sclerosis has recovered from their condition with psychotherapy, but many people have achieved full recovery from schizophrenia as a result of psychotherapy and/or milieu therapy, often without medications used (Artiss, 1962; Colbert, 1996; Jung, 1961; Karon, 1998; Laing, 1967; Perry, 1974; Sechehaye, 1951; Sullivan, 1962).
Individuals diagnosed as "schizophrenic" may be unusually perceptive, insightful, enjoy rich inner lives, and achieve successful professional careers (Arieti, 1979; Bleuler, M., 1979a; Buck & Kramer, 1977; Grant, 1975; Rokeach, 1981; Smith, 1982). Psychologist Fred Frese is an outstanding example (Buie, 1989).
A few people diagnosed with "schizophrenia" have recovered on their own with no treatment of any kind (Brody & Redlich, 1952; French & Kasonin, 1941; Hoffman, 1985; Nasar, 1998; Rubins, 1969).
Why is the psychiatric literature silent about the personality characteristics of people who fully recovered from schizophrenia?
Malcom Bowers, Jr. (1979), reports that "...some psychotic patients recover and go on to progress psychologically and socially; that is, continue to grow" (p. 151). Karl Menninger (1963) stated "Not infrequently we observe that a patient...gets as well as he was, and then continues to improve still further. He becomes, one might say, 'weller than well.'...there are thousands of unknown examples who have not been discovered or who have not yet written about their experiences" (p. 406).
What are people like who were made better by their so-called "schizophrenic" experience (Bleuler, E., 1950; Pickering, 1976, Sannella, 1981)? What is the frequency of "spontaneous remission" from schizophrenia? Why does psychiatry demonstrate no interest in people who fully recover from schizophrenia?
Why is psychiatry indifferent to pioneering breakthroughs that demonstrate effectiveness with people diagnosed as "schizophrenic?"
Many reports of psychotherapeutic successes with people diagnosed as schizophrenic have been published (Artiss, 1962; Cobert, 1996; Jung, 1961; Karon 1998; Laing, 1967; Mosher, 1978; Perry, 1974, 1999; Sullivan, 1954), but the psychiatric profession shows little interest in learning from these successes.
Why is psychiatry different from other medical specialties when better ways of being successful (other than prescribing the latest neuroleptic drug) are discovered?
When Warner (1985) compared recovery rates from schizophrenia decade by decade, he found that "recovery rates from schizophrenia are not significantly better now than they were the first two decades of the century" (p. 79).
Why has psychiatry lagged so far behind, in light of solid breakthroughs achieved by other medical specialties in the last 100 years?
Why do psychiatrists react to reports of successful treatment of schizophrenia by rejecting the original diagnosis? Has psychiatry developed a closed belief system?
Carl Jung (1961), after describing some of his early successes with schizophrenic patients between 1905 and 1909, wrote: "While I was still at the clinic, I had to be most circumspect about treating my schizophrenic patients, or I would have been accused of woolgathering. Schizophrenia was considered incurable. If one did achieve some improvement with a case of schizophrenia, the answer was that it had not been real schizophrenia" (p. 128).
Kenneth Artiss (1962) reports the same reaction from a group of psychiatrists who heard him explain how, by using milieu therapy, he had achieved a 64 percent recovery rate from a group of 42 patients all diagnosed as schizophrenic by qualified psychiatrists. Some psychiatrists in his audience wrote to him afterward saying "We are amazed and incredulous concerning your reports about the speed with which symptoms disappear. We wonder if the cases treated are really schizophrenic at all" (p. 136).
When faced with evidence that many people once diagnosed as "schizophrenic" have fully recovered, psychiatrists appear to have developed a closed belief system when they declare that the diagnosis was wrong instead of questioning what they believe about "schizophrenia" (Sarbin, 1990).
Why is psychiatry not able to understand the difference between psychotic breakdowns and transformational breakthroughs?
Some people not only fully recover from a "schizophrenic" episode, the experience has beneficial effects, leading to favorable changes in personality and improvements in psychological strengths (Arieti, 1979; Bernheim and Lewine, 1979; Bleuler, E., 1950; Cancro, 1974; French and Kasonin, 1941; Jung, 1961; Rubins, 1969; Silverman, 1970; Sullivan, 1962; Warner, 1985).
Elements of transcendent experiences and the highest states of consciousness are typically confused with symptoms of "schizophrenia" by psychiatrists (Fischer, 1971; Huxley, 1972; Maslow, 1971; Prince & Savage, 1966; Siebert, 1986, 1993, 1996; Wapnick, 1969).
Why do research reports about schizophrenia refer to all patients as having the same unitary illness? Why does psychiatry's lack of critical thinking and scientific inaccuracy go unchallenged?
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994), states that "no single symptom is pathognomic of schizophrenia" (p. 274). There is no simple, objective diagnostic criterion for schizophrenia--no defining symptom, no psychological test result, no brain image, no blood test. All basic psychiatric references, starting with Emil Kraeplin, say that the symptoms of "schizophrenia" vary widely between people and within individuals, and that the "schizophrenias" (plural) are best understood as heterogeneous group of conditions (Andreasen, 1985; Bleuler, E., 1950; Kraeplin, 1902; O'Donnell and Grace, 1998).
Despite what the basic references say, however, all published schizophrenia studies refer to subjects as being "schizophrenic" (singular). The authors of research reports about schizophrenia speak as though all the subjects in their research had identical symptomatology.
Why do editors and publishers of psychiatric publications tolerate this glaring lack of critical thinking and scientific inaccuracy in schizophrenia researchers? Do they even notice?
Is the erroneous belief that "schizophrenia" is a brain disease with no known cure a symptom of a profession that feels helpless and hopeless?
E. Fuller Torrey (1983) and the National Alliance for the Mentally Ill have unequivocably stated for many years that schizophrenia is a brain disease without a cure (Johnson, 1989). Many psychiatrists who specialize in schizophrenia have themselves so convinced that it is an incurable brain disease (Andreasen, 1995, 1997; Torrey, 1988, 1995; Weikert & Weinberger, 1998; Zigun & Weinberger, 1992), they make discouraging statements to their "patients." Gotkin and Gotkin (1992) report that as Janet Gotkin was being discharged from a psychiatric hospital a staff nurse said to her: "Of course you feel good now, but there's one thing you must remember. Wherever you go, whatever you do, however you feel, you will always have to take care. You will never be like the rest of us, you will always be schizophrenic" (p. 380).
Michael Allen (1999) says "After 5 years of therapy and Thorazine, I knew the psychiatric community was not healing me. If I would have stayed in my doctors' care, I'd still be in the mental health system surviving day to day only with the aid of "chemical straight-jackets" (psychotropics). I had the courage, the strength and the wisdom to know when and how to go off the Thorazine. When I told the psychiatrist I was off the medicine, he told me that there was a 90% chance that I would end up in the hospital again. So I told him that meant there was a 10% chance that I wouldn't. He disagreed and said not exactly. I've been out of the community mental health system and off medications for 7 years now. I am so happy I had the strength and confidence to stop taking the Thorazine the psychiatrist demanded that I could never stop taking" (pp. 1-2).
Are schizophrenia psychiatrists projecting feelings of helplessness and hopelessness into their patients? To what extent does their gloomy prognosis and subsequent actions turn this pessimistic prediction into a self-fulfilling prophecy?
What cognitive processes had mental health professionals calling their patients "schizophrenics" for so many decades?
Sarbin and Mancusco (1980) argue that the perception that someone is "a schizophrenic" is more of a moral verdict than a medical diagnosis. What are the cognitive processes that have influenced mental health professionals to engage in diagnostic labeling that is prejudicial and lacking in objectivity (Goffman, 1961; Menninger, 1970; Scheff, 1975; Szasz, 1961; Szasz, 1976)? Why has using a pejorative noun (Menninger, 1970) in referring to patients as "schizophrenics," been such a widespread practice in psychiatry?
Why does the psychiatric profession react so defensively to feedback that it makes mistakes and could be more effective?
Mentally healthy people and competent professionals in most fields welcome constructive criticism and feedback about how they could be more effective. The psychiatric profession is not a good role model, however, for what they want their patients to do (Torrey, 1997b). For example, Rosenhan (1973) published a study in Science reporting that when he sent pseudo-patients to psychiatric facilities, all except one were diagnosed as "schizophrenic" upon admission and all were said to be "in remission" when discharged. After the study was published, every letter to the editor from psychiatrists condemned and attacked the study as being invalid, flawed, and without merit. No psychiatrist wrote a letter saying "Thank you for bringing this matter to our attention; we need to re-examine our practices."
Conclusion
Something is seriously wrong with the way the psychiatric profession thinks and acts toward people perceived as "schizophrenic." After a century of research, psychiatrists who specialize in schizophrenia admit they still don't know what it is, what causes it, or how to cure it. Even E. Fuller Torrey (1983) admits "it is likely that the twentieth century psychiatrists as a group have done more harm than good to schizophrenics" (p. 157). Despite all this, psychiatrists remain adamant in their insistence that even though "schizophrenia" is an incurable "disease," it must be "treated."
Questions raised in this article indicate that the psychiatric profession lacks insight into its own behavior, invalidates constructive criticism, avoids the kind of self-examination it urges on its "patients," shows little interest in breakthrough accounts of successes with so-called "schizophrenic" individuals, erroneously lumps all the schizophrenias (plural) together in research projects, dismisses evidence that contradict its inaccurate beliefs, and misrepresents what is known about "schizophrenia" to the public and to patients.
In addition, the psychiatric profession sustains stigmatization of people said to have "schizophrenia" (Menninger, 1970) by not challenging, disclaiming, or censuring practitioners who incorrectly describe "schizophrenia" to the public as a chronic, disabling, devastating mental illness (Lindenmeyer & Kay, 1992; Maddox, 1988).
The questions raised here are not at odds with clinical evidence that some people diagnosed as "schizophrenic" benefit from medi-cations, brief hospitalization, and therapeutic support. That is not the issue, nor is this an "antipsychiatry" article. The point is simply to assert that there will be no significant improvement in treatment outcomes with "schizophrenia" until research explores the cognitive processes, personality traits, and motives of "mental health" professionals who perceive "schizophrenia" in others and insist on treating "schizophrenia" as a brain disease.
NOTE: All patients' names in this article are pseudonyms.
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Also see file "How Non-Diagnostic Listening Led to a Rapid 'Recovery' from Paranoid Schizophrenia."