Critical Psychiatry Textbook, Chapter 1: Why a Critical Textbook of Psychiatry?

Editor’s Note: Over the next several months, Mad in America is publishing a serialized version of Peter Gøtzsche’s book, Critical Psychiatry Textbook. In this blog, he introduces the book. Each Monday, a new section of the book is published, and all chapters are archived here.

Students of medicine, psychology and psychiatry, and allied health professions learn about psychiatry by reading psychiatric textbooks. They generally believe what they read and reproduce it at their exams. It is therefore very important that the information conveyed in psychiatric textbooks is correct.

And that is the problem. There is a huge divide between the official psychiatric narrative and what the science shows. Much of what leading psychiatrists say and write about the reliability of psychiatric diagnoses; the causes of psychiatric disorders; if they can be seen in a brain scan or brain chemistry; and what the benefits and harms are of psychiatric drugs, electroshock, and forced treatment is incorrect. This has been extensively documented by critical psychiatrists and others.1-11

The discrepancy between opinion and science is also prevalent in psychiatric textbooks. Coming generations of healthcare professionals will therefore learn a lot during their studies that is demonstrably incorrect, to the detriment of their patients. This is why a critical textbook of psychiatry is needed.

More than in any other specialty, psychiatry is a discipline where it is of utmost importance to listen to the patients, which is the basis for the diagnostic system. But when the issue is their own practice, psychiatrists are rarely willing to listen even though the general public has experienced that psychiatry, as it is currently practised, does more harm than good.

A survey of 2,031 Australians showed that people thought that antidepressants, antipsychotics, electroshock, and admission to a psychiatric ward were more often harmful than beneficial.12 The social psychiatrists who had done the survey were dissatisfied with the answers and argued that people should be trained to arrive at the “right opinion.”

But were they wrong? I don’t think so. As I shall show in this book, their views are in accordance with the most reliable scientific information we have.

We have a situation where the “customers,” the patients and their relatives, do not agree with the “salespeople,” the psychiatrists. When this is the case, the providers are usually quick to change their products or services, but this doesn’t happen in psychiatry, which has a monopoly on treating patients with mental health issues, with family doctors as their complacent frontline sales staff that do not ask uncomfortable questions about what they are selling.

You might wonder who I am and why you should trust me rather than the psychiatrists who write textbooks. Well, it is not a question of trust but about who has the most valid arguments. That is up to you to decide. I have tried to help you by documenting carefully why I conclude that some statements in the textbooks are wrong and by dissecting research to explain why some research papers are more reliable than others.

Sound and unprejudiced debate about essential issues in psychiatry is rare. When defenders of the status quo do not have valid counterarguments against criticism of their practices, they do not respond to the criticism but attack their opponent’s credibility instead.7 If you ask questions to your teachers based on this book or other books6-8 or scientific articles I have written, you might be fobbed off with replies like, “Gøtzsche? Never heard about him” (even though they know who I am), “Don’t waste your time on him,” “Is professor Gøtzsche a psychiatrist? Has he ever managed psychiatric patients? How can he judge what we do?” Or they will say that “Gøtzsche is an anti-psychiatrist,” which is the ultimate pseudo-argument psychiatrists use.7 (page 16)

You should not accept such replies, but always ask for the evidence.

Apart from this, I think I have the necessary credentials for criticising psychiatry. I am likely the only Dane who has published more than 75 papers in “the big five” (BMJ, Lancet, JAMA, Annals of Internal Medicine and New England Journal of Medicine) and my scientific works have been cited over 150,000 times. I am a specialist in internal medicine and have worked in many specialties, including cardiology, endocrinology, haematology, hepatology, gastroenterology, infectious diseases, and rheumatology.

I have done research in psychiatry since 2007 and have uploaded my credentials in relation to this specialty on my website, scientificfreedom.dk (see under About, Staff). Briefly, I have had five PhD students in psychiatry; have been an expert witness in seven psychiatric court cases in seven countries; have received 12 awards or other academic honours; have published nine books or book chapters; have published 30 papers in medical journals with peer review and 128 other papers; and have given over 200 lectures at meetings and courses.

It took me years of close study to find out that the bottom line of psychiatry is that it does more harm than good,1,5-8 which is also what the general public tells us.12 This makes the specialty unique, and the term “psychiatric survivor” says it all.8 In no other medical specialty do some patients call themselves survivors in the sense that they survived despite being exposed to that specialty. They fought hard to find their way out of a system that is rarely helpful, and which many survivors have described as psychiatric imprisonment, or a facility where there is a door in, but not a door out.

In other medical specialties, the patients are grateful that they survived because of the treatments their doctors applied to them. We have never heard of a cardiology survivor or an infectious disease survivor. If you survive a heart attack, you are not tempted to do the opposite of what your doctor recommends, but in psychiatry, as you will see in this book, you might die or get permanently disabled if you do what your doctor tells you to do.

Many psychiatric survivors have described how psychiatry, with its excessive use of harmful and ineffective drugs, has stolen 10 or 15 years of their life before they one day decided to take the responsibility for their life back from their psychiatrists and discovered that life is much better without drugs. They often say that what woke them up was that they read some of the books about psychiatry by psychiatrists David Healy,2 Joanna Moncrieff,3,4 or Peter Breggin,11 or by science journalist Robert Whitaker1,5 or me.6-8

In 2014, Norwegian psychiatrists wrote about what they called an “alarmingly high discontinuation” rate of psychosis pills in patients with schizophrenia, 74% in 18 months.13 The psychiatrists argued it highlighted “the clinicians’ need to be equipped with treatment strategies that optimize continuous antipsychotic drug treatment.” If the psychiatrists had listened to their patients, they would have realised that these drugs should be avoided as long-term therapy.

When students have passed their exams, they will defend tooth and nail what they have learned. It is a curious trait of human psychology that once you have made up your mind, even when you were in serious doubt, you will vigorously defend your position when someone proves that the other option was the correct one.14

University textbooks are therefore a powerful tool for indoctrination–for arriving at the “right opinion” even when it is wrong. As an example, 21 out of 36 textbooks (58%) used by students in the Netherlands that discuss brain anatomy have sections on ADHD (attention deficit hyperactivity disorder) with inappropriate generalisations or ambiguous claims.15

Leading psychiatrists and their organisations rather consistently propagate misinformation in lectures, in the media, on websites, and in scientific articles.1-8 You may wonder if this is really true. Sadly, it is, but more and more critical psychiatrists have realised this and work on changing psychiatric practices. I am a member of the most important group, Critical Psychiatry Network founded by Joanna Moncrieff and based in the UK. We exchange ideas daily on an email list and discuss how we may contribute to reforming psychiatry.

In 2021, I got the idea that if I read and assessed the most commonly used textbooks in Denmark and wrote my own textbook explaining what was wrong with the other ones, this could be an eye opener for students everywhere. Danish textbooks would not be expected to be any different to those in other countries because mainstream psychiatry is the same in all countries. I hope other researchers will analyse the textbooks used in their country like I have done.

When reading books, it can be difficult to find out what is not there but should have been mentioned. Before I started reading, I therefore described in a protocol what I believe should be mentioned in psychiatric textbooks.

The pivotal issues I chose are those of obvious importance for the patients and those considered controversial, e.g. whether psychiatric disorders can be seen in a brain scan. The subheadings in my protocol were causes of psychiatric disorders, diagnoses, drug benefits, drug harms, withdrawal of psychiatric drugs, stigmatisation, informed consent, psychotherapy and other psychosocial interventions, and electroshock. As there are hundreds of psychiatric diagnoses, I focused on psychosis, depression, bipolar, ADHD, anxiety disorders, and dementia.

I identified the five psychiatric textbooks in Denmark most commonly used by medical and psychology students and evaluated if the information presented about causes, diagnosis, and treatment was adequate, correct, and based on reliable evidence. The textbooks were in Danish, had a total of 2,969 pages, and were published between 2016 and 2021.16-20

The authors included some of the most prominent Danish professors of psychiatry, but the textbooks were far from being evidence-based. They often contradicted the most reliable evidence; various author groups sometimes provided contradictory messages even within the same book; and the way they used references was insufficient. It was my clear impression that the more implausible the claims, the less likely they were referenced.

The worst book in terms of the prevalence of seriously misleading or erroneous statements did not have a single literature reference, and all the editors and authors were psychiatrists.18 The other four books had a bibliography at the end of each chapter, but often with no connection to the text. I therefore needed to guess which of the references were relevant for the statements made, if any. Sometimes, there was just a name of a person and a year in the text, with no corresponding article or book in the bibliography. In such cases, I tried to find the relevant reference in a literature search on PubMed.

Two textbooks were more truthful than the other three. In one, a psychologist was one of the two editors,17 and the other book had mostly psychologists as authors.20

I have added a page number to the textbook references and often also to references to other books to show where the information can be found. Thus,17:919 means page 919 in that textbook (or, in a few cases, 1-2 pages further ahead, when the information appeared over several pages).

Psychotropic drugs were developed based on rat experiments and selected if they disrupted the rat’s normally functioning brain.7:229,21 The pills don’t cure us, they simply change us by causing a wide array of effects in people, like all brain-active substances do, including street drugs. And they are not in any way targeted. There is nothing particularly selective about selective serotonin reuptake inhibitors (SSRIs). This term was invented by SmithKline Beecham to give paroxetine an advantage over other drugs, but it was adopted by all companies.2 There are serotonin receptors throughout the body, and the drugs have many other effects than increasing serotonin, e.g. they can affect dopamine and noradrenaline transmission and can have anticholinergic effects.22 The drugs don’t even target depression. It is therefore not surprising that a Cochrane review found that alprazolam, an old benzodiazepine, performed better than placebo for depression and similarly to tricyclic depression pills.23

Psychiatric drugs work more or less in the same way, either by suppressing emotional reactions so that people get numbed and pay less attention to significant disruptions in their lives, or by stimulating them.2,5,21

I shall therefore avoid the conventional nomenclature for drugs. It is misleading to call pills used for depression “antidepressants” and pills used for psychosis “antipsychotics.” These drugs are not “anti-” some disease.7:227 The “anti-” also gives an association to antibiotics, which save lives, but psychiatric drugs do not save lives; they take many lives.7:307 Furthermore, unlike antibiotics, they do not have disease-specific properties.3,4,7,24

I therefore talk about depression pills and psychosis pills, which do not give any false promises. If we want to reform psychiatry, we will first of all need to change the psychiatric narrative and part of that narrative is the semantics. For the same reason, I shall speak about drug harms and not drug side effects, which is a euphemism, as side effects are sometimes pleasant.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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