Freedom versus Fraud and Force in Psychiatry

According to psychiatrist Thomas Szasz (1920-2012), the discipline of mental healing resembles religion, rather than medicine or science. At the beginning, psychiatrists were neuropathologists who were expert in the histopathology of the central nervous system. Today however, they are psychopharmacologists who are expert in creating and uncreating psychiatric diagnoses, attaching these diagnoses to bad behaviour, and prescribing drugs to persons labeled with such diagnoses (Szasz, 2004).

Szasz states that there are two kinds of brain diseases; 1) proven or real brain diseases like strokes, for which clear evidence of damaged brain tissue is present, and 2) putative or fake brain diseases like schizophrenia, for which specific evidence of physiological brain damage is lacking. Mental illnesses do not exist; they are diseases of the brain, not the mind. Diagnoses should be driven by identifying bodily lesions and their material causes, rather than by non-medical considerations and incentives (Szasz, 1994). According to Szasz, psychiatrists have the power to accredit their own claims as scientific facts and sound treatment, to discredit the claims of their mental patients, and to enlist coercive power to impose their own views (Szasz, 1994). His main point is that psychiatrists function as legislators, rather than as scientists, confining and controlling the ‘deviant’. Szasz concludes that psychiatry is a branch of the law and a secular religion, rather than a real science or therapy (Szasz, 1994).

E. Fuller Torrey is the most prominent advocate of forced psychiatric treatment in the United States today. He considers using coerced therapy as so medically and socially important, that it justifies actively deceiving the patient. Torrey advocates actively deceiving the ‘severely mentally ill’ and compelling them to be drugged with chemicals that Torrey deems good for them (Szasz, 2004). According to Szasz, Torrey’s active deception is against the patient’s free will. Szasz draws the religion-like parallel of Torrey’s practice with Christian servants in Jewish households who used to baptize their children ‘to save them from going to hell’.

All diseases, either putative or proven, with all its symptoms and societal consequences, fall on a continuum, making it difficult to draw the line between ‘serious enough to justify coercion’ and ‘free will may not be denied’.  Therefore, the question should be: Who is allowed to and has the capability of making this distinction and hence to make policy and take responsibility for all consequences of this policy? The answer is probably that nobody can. That’s why we need more communication and collective awareness regarding the way we construed our psychiatric system. Perhaps Szasz would have agreed on the statement that it is ironic that psychiatrists resemble scientists most in the sense that they mainly consider their own interests, rather than the interests of their very ‘mentally ill’ patients. It would do no harm if psychiatrists open themselves to critically review and reflect their roles in the psychiatric system and to check whether they still have the intended highest priority; that of the patient. That is, if the patient himself wants to have this priority.

References

Szasz, T. (1994). Mental Illness Is Still a Myth. Society, 34-39.

Szasz, T. (2004). Psychiatric Fraud and Force: A Critique of E. Fuller Torrey. Journal of

Humanistic Psychology, 44, 416-430.

Change the academic system to change academic decision making

The lecture given by Jelte Wicherts made us clear that the academic (incentive) system needs to be changed and that scientific researchers in psychology might be in need for a stronger methodological consciousness. It is not that the system is dramatically inadequate per se or that we as researchers would be gruesomely corruptible and fallible. The problem is that the way we are allowed to execute research by the system gives us the freedom and opportunity to find and validate reasons for turning doubtful or wrong decisions into ‘good’ decisions.

This freedom can for instance be used regarding the magical p-value of .05. This specific p-value gives us comfortable and consequent closure about when to reject and when not to reject a certain hypothesis, but unfortunately, there are some tricks to still reach this p-value when one in fact didn’t. Researchers might consider a p-value of somewhat or even much further above .05 as evidence that their theory is correct, that an effect does exist, and therefore use one of the following strategies; they may be inclined to add more participants to their sample – even more than once – until their results reach significance; they might choose for other dependent variables than planned to reach significance; participants might be excluded on the basis of ‘strange behaviour’ without formally defining this behaviour; there may be searched for outliers in the data and these may be excluded on the basis of criteria that are not being made clear; a one-tailed p-value might be used when it is not justified.

The system should be adapted in such a way that researchers will think twice about making ‘decisions towards significance’. The key here is total transparency and getting every detail about each research fully fixed in advance in a controlled system. The exact research set up should be made public in advance, including the specific predictions, dependent and independent variables, statistical analyses, and criteria about when to exclude data and outliers. Decisions about data, findings, and possible follow up research stages need to be justified, be made public, and be controlled for by other researchers. In the current system, the goal seems to be to reach significant results and journal publications. The researchers’ interests have priority and go against the interest of the academic field, of psychological science. An adapted, transparent system will make the researcher’s range of (unintended) corruptibility and fallibility much narrower. Then, the researcher can finally be reminded that practicing good science is not about massaging data and results in their own interest, but about having their findings to come into the world (truth)fully - as these findings were actually found.