By Brian L. Grant MD

Years ago, long before I had decided to become a psychiatrist, I read the work of psychiatrist Thomas Szasz, MD. He was critical of the concept of mental illness and the role that psychiatry plays in society.

His provocative writings continue to challenge, but did not deter me from becoming a psychiatrist. The idea of understanding human motivation and behavior in what may be the most holistic specialty in medicine appealed greatly and I have learned a great deal over the years and hopefully helped a few patients along the way. 

In my years in psychiatry, I have witnessed the movement from a specialty with a foundation in the mind and a focus on psychotherapy as a significant treatment modality, to one where medications reign and therapy has been devalued by many.

Most disturbing to me has been a clear distortion of the profession, driven by overdiagnosis and the labeling of psychopathology attributed to many normal conditions of life — including distractibility being labeled as attention deficit disorder (ADD), and sadness upon the death of a loved one being labeled as bereavement disorder. Many more examples can be found in the culture by looking at those diagnoses that have increased many fold, such as autism, post-traumatic stress disorder, and bipolar disorder in children.

My critique is not meant to apply to a particular individual who deserves individual assessment, but rather the significant trends that are taking place that should cause concern for anyone in distress seeking help and those whose job it is to help.

Of course human suffering exists and significant mental disorders including schizophrenia and major depression are real and deserve careful assessment and effective treatment. Likewise other diagnoses should be scrutinized for individual patients as well as being examined in the aggregate.

Marcia Angell, MD, former editor of the New England Journal of Medicine and one of the thought leaders in American medicine has written incisive reviews of several books:

• The Emperor’s New Drugs: Exploding the Antidepressant Myth by Irving Kirsch
• Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker Crown
• Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations About a Profession in Crisis by Daniel Carlat
• Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) by American Psychiatric Association

Her  review, published in two parts in the New York Review of Books in 2011, was followed by an exchange with some notable psychiatrists who responded to her critiques and her response to them.

• The Epidemic of Mental Illness: Why? — Marcia Angell
• The Illusions of Psychiatry — Marcia Angell
• ‘The Illusions of Psychiatry’: An Exchange — John Oldham, Daniel Carlat, Richard Friedman, and Andre Nierenberg, reply by Marcia Angell

I was disheartened and disturbed upon reading her reviews. Not because I disagreed, but because at its core, her critiques ring true and should disturb anyone in society who cares about mental health and expects those engaged in research and treatment in the field to approach their work with intellectual rigor and integrity.

The party line in current psychiatry has diverted from one of thoughtful inquiry and reflection to an unwarranted certainty, callous overdiagnosis of a significant double-digit percentage of the population as mentally ill, and a willingness to prescribe very strong drugs in, at times, a glib and excessive manner, based upon bad science, dubious statistics, and a minimization of significant side effects and potential habituation.

Angell’s review, while not short, is worth reading and passing on, especially to those who deserve to have their beliefs challenged on the nature, extent of, and treatment of mental disorders.