Case Studies in Activism #67: Battling Big Pharma and Rehumanizing Mental Health Treatment

A few weeks back I had the random pleasure of meeting Bruce Levine, clinical psychologist and author of Get Up, Stand Up and Surviving America’s Depression Epidemic.

As we introduced ourselves and he talked about his activism in the field of mental health, I was struck by something he said: “Making a difference was easier than I thought.”

I wanted to know more. He was kind enough to respond to a few questions.

What’s the back story on the mental health field?

For years, treatment reform activists in the mental health field have been fighting against invalid diagnoses and unscientific theories of mental illness. And they have been fighting for truly informed choice in terms of treatment, which includes informing patients of research truths about the effectiveness and safety of drugs, electroshock, and other treatments.

In the 1970s, for much of the general public, establishment psychiatry lacked legitimate scientific authority, and it was even okay in the mainstream to poke fun at psychiatry; for example, the 1975 film One Flew Over the Cuckoo’s Nest. Beginning in the 1980s, establishment psychiatry made a decision to “partner” with drug companies and became a drug prescribing profession. The American Psychiatric Association actually used that word “partner” with respect to their relationship with drug companies.

With drug company money behind establishment psychiatry, and with the FDA in the mid-1990s permitting TV advertising for drugs, the “psychiatric-pharmaceutical industrial complex” gained enormous clout. So, even though psychiatry’s diagnoses, theories of mental illness, and treatments were just as unscientific as ever – lacking legitimate research to back them up — psychiatry was able to persuade the mainstream media of the fiction of progress.

Organized activism began to take hold. It included ex-patients, some of whom called themselves “psychiatric survivors,” with one of their most significant organizations being MindFreedom. The longtime director of MindFreedom (until recent physical problems), David Oaks, is an amazing organizer. Oaks as a working class kid from Chicago had a difficult time fitting in at Harvard in the 1970s and ended up in psychiatric hospitals, and he resented his dehumanizing, coercive treatments. And so he found his cause for life, which was to reform mental health care.

Oaks spotted a letter to the editor that I wrote in 1994 in which I criticized the invalidity of still another new so-called mental disorder, and he turned me on to the reality that there was a “movement.” Oaks told me about other dissident psychologists and psychiatrists, and later I was to become friends with many of them. An activist organization that I’ve been a member of since the late 1990s is the International Society for Ethical Psychology & Psychiatry.

Probably Oaks’s most important organizing success was engaging investigative journalist Robert Whitaker. Whitaker was a George Polk award-winning investigative reporter for the Boston Globe and he came to see that American mental health problems were a story worthy of a book.

So in 2001, Whitaker published Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill . Whitaker wouldn’t let go of the story, and in 2010, he published Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Whitaker has become to the mental health treatment reform movement what Michael Pollan is to the healthy food movement.

When we first spoke, you mentioned that making a difference was easier than you thought it would be. Help me understand.

Early on it seemed that the financial power of pharmaceutical companies have over establishment psychiatry and mainstream media would be insurmountable. I thought it was going to be much more difficult for a relatively small group of activists — comprised of mental health professionals, patients and ex-patients and their families, and journalists — to make a dent.

But recently — thanks in large part to activist efforts — the director of the National Institute of Mental Health (NIMH), the U.S. government’s highest ranking mental health official, has made some extraordinary admissions that opens the door to real reform.

I do want to make clear that reform has a long way to go in terms of standard treatment practices. For example, quite tragically, there is an increasing number of children — especially poor kids and foster kids — prescribed dangerous antipsychotic drugs, with the majority of these kids not even diagnosed with any psychotic condition (as Archives of General Psychiatry in 2012 reported) but are just disruptive and angry — often for damn good reason. And also for adults, there continues to be a lack of truly informed choice when it comes to psychiatric treatment.

However, what’s been remarkable for me is that despite the enormous financial resources of Big Pharma — which helps fund the American Psychiatric Association, the National Alliance for the Mentally Ill, and so-called “thought leader” psychiatrists, and which also intimidates the mainstream media through its advertising clout — just how much activists have been able to get psychiatry at its highest levels to admit they’ve gotten it wrong in major areas of treatment and diagnosis.

For example in 2013, NIMH director Thomas Insel, citing the lack of scientific validity of the DSM-5, psychiatry’s latest diagnostic bible, stated that the “NIMH will be re-orienting its research away from DSM categories.” Insel agreed with activists that psychiatric disorders have not been validated, which really means that modern psychiatry is unsupported by science. As Robert Whitaker recently told me, “This is like the King of Psychiatry saying that the discipline has no clothes.”

Also in 2013, Insel announced that psychiatry’s standard treatment for people diagnosed with schizophrenia and other psychoses needs to change so as to better reflect the diversity in this population, concluding that many individuals actually do better without lifelong antipsychotic medication. This would not have happened without activists getting research out there, as I describe in the Huffington Post in October 2013. Antipsychotics grossed over $18 billion a year in the United States by 2011, and so this could result in Big Pharma losing some serious money.

And not just Insel, but other establishment psychiatry figures are finally admitting psychiatry has had it wrong in major ways. Their “chemical-imbalance” theory of depression was an extremely effective way of marketing antidepressant drugs but this theory had actually been rejected by researchers a few decades ago; and finally establishment psychiatrists are admitting this. Ronald Pies, editor-in-chief emeritus of the Psychiatric Times stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend.”

This opens the door to completely rethinking emotional suffering and not continuing to reduce it to bio-chemical defects. And this means the possibility of a more holistic/integrative view that includes psychological, spiritual, social, cultural, and political realities.

What challenges did you/others encounter?

The psychiatric-pharmaceutical industrial complex had convinced the mainstream media, including NPR and the NY Times, that criticism of psychiatry was criticizing mental health treatment. Of course this was not true, as people who are critical of nuclear energy and fossil fuels are not anti-energy but are for safer, renewable energy.

The psychiatric-pharmaceutical industrial complex had been, until recently, fairly effective in convincing the general public that critics of psychiatry were part of “nut religious groups” such as Scientologists. This ploy is very similar to “red baiting” that labeled people as Communists if they were critical of U.S. government policies.

How did you overcome these marginalizing efforts?

We knew that our struggle was really at the center, not at the margins of public opinion. At the center of public opinion is valid science, informed choice, and human rights. That’s what we are fighting for. At the center is where social movements win.

To counter their “baiting,” in my articles and my many media interviews, I would make clear that I wasn’t a Scientologist, and that most professionals who are critics of psychiatry are not Scientologists. In 2008, I did a piece about this for the Huffington Post called Thinking Critically About Scientology, Psychiatry, and Their Feud.

What energizes you when it comes to mental health issues?

Originally I was energized by embarrassment with the mental health profession, and wanted to distance myself from it. In the 1990s, I used to say, half-seriously, that when kids found out what had been done to them — including shrinks’ pathologizing and drugging their reasonable rebellion — these kids, when they grew up, would go after mental health professionals, and I was hoping that by speaking out that they would spare me.

I was only half-joking.

In addition to embarrassment, as I delved into the research for my 2001 book, Commonsense Rebellion, I increasingly became outraged by the lies, injustice, and immorality of the cover up. Beyond unscientific and damaging treatment, the diseasing and bio-chemicalizing of our suffering was distracting the American public from societal and cultural sources for our depression and other emotional difficulties.

Later I became energized by community, as I connected and became friends with professional dissidents, “psychiatric survivors,” and journalists who actually cared about exposing truths.

Most recently, I’ve been energized by success that the mental health treatment reform movement has had. Lately, it’s been sort of like the psychiatry establishment has been “routed” and in “undisciplined retreat,” and we are winning more ground all the time. With the pseudoscience of their diagnoses, biochemical theories, and treatments exposed, this opens the door to radically rethinking treatment and incorporating psychological, spiritual, social, cultural, and political realities.

This is what I care most about and have written about in all my books — rehumanizing aspects of our society and culture that are causing emotional suffering.

It’s interesting to me to hear someone from within the field talk about the field itself as a “pseudoscience”. Isn’t there value to the science?

By way of analogy, the mainstream Democratic Party has as much to do with genuine democracy as mainstream psychiatry has to do with genuine science of what causes emotional suffering and how to alleviate it.

Many people who passionately believe in genuine democracy — a government of, by, and for the people — are upset by the Democratic Party, which in recent times is far more about promoting corporate interests. And many people who passionately believe in genuine mental health are upset by mainstream psychiatry, which has become corrupted by drug companies.

Big Pharma helps fund establishment professional institutions such as the American Psychiatric Association, psychiatry departments at universities, so-called “thought leader” psychiatrists who create and proliferate new diagnoses lacking scientific validity, and funds drug research used for FDA approval.

As I detail in both Commonsense Rebellion and Surviving America’s Depression Epidemic, research used for FDA approval of drugs is not performed by the FDA; instead, the research that is used by the FDA is done by the drug’s manufacturer. So, you can see there are all kinds of incentives for drug companies to do studies that appear to be scientific but are in fact not so; and this is what has happened — and thus the term pseudoscientific.

This is why in the history of psychiatric drugs, they are always, when they first appear, proclaimed as safe, effective, with no potential for dependence, but always the case is the opposite, which drug companies finally reveal when these drugs go off patent and can be purchased generically and inexpensively — and then the process starts all over again with new expensive, patent-protected drugs.

The chemical-imbalance theory of depression — the idea that depression was caused by too little serotonin or some other such neurotransmitter within a neurosynapse sounded scientific but legitimate science rejected this notion by the 1980s. Drug companies knew this, and so too did any psychiatrist who took the time to look at the research. But we still hear about this “chemical imbalance theory” on TV drug commercials and from establishment psychiatrists. “Pseudoscientific” is a polite terms for the use of scientific-sounding language to promote unscientific realities. Less polite would be “bullshit” or “lies.”

And the director of the National Institute of Mental Health now is stating, DSM, psychiatry’s diagnostic bible, lacks scientific validity. Again, this is a polite way of saying the DSM is pseudoscientific bullshit.

Are there things you’re still working to get across that you’ve struggled gaining an audience for previously?

Back when I published Commonsense Rebellion in 2001 and Surviving America’s Depression Epidemic in 2007, it was more radical to criticize the lack of science behind psychiatric diagnoses, theories, and treatment. But this kind of criticism has become increasingly mainstream.

However, what I also wrote about in those books and in many articles is that even if you don’t care about mental health issues per se, there’s a reason to care about these issues if you care about the U.S. becoming an increasingly authoritarian society lacking economic/social justice and freedom. As, I discuss in my most recent book, Get Up, Stand Up, there are many spokes in the wheel that have increasingly pacified Americans so that they don’t fight back against injustices, and the mental health profession is one of those spokes — pathologizing and medicating rebellion.

The most obvious example is labeling rebellious kids with “oppositional defiant disorder” and medicating them. But many people who are labeled with other psychiatric disorders are essentially anti-authoritarian people who are pained by illegitimate authorities in their life; and psychiatry has kept them from gaining political consciousness by pathologizing them, and thereby kept many people, especially young people, off of democracy battlefields.

What did you learn from the experience that might help other activists?

If you look at history, expansionist/imperialist nations and institutions get addicted to their expansionism, get arrogant about what they can get away with, and eventually fall under the weight of their own arrogance and stupidity. This is true for pro-slavery expansionist forces who achieved victories in the 1850s, but their arrogance resulted in blowback. And this has been true for psychiatry, where their successful disorder/medication expansionism made them arrogant and has also caused blowback.

So, for example, in psychiatry, “thought leader” psychiatrists who have been on the take for millions of dollars from drug companies became arrogant, having no fear of consequences, and that resulted in them getting nailed by Congressional investigations in 2008, which was finally reported by the New York Times, which had the cover of Congress.

And there have been recent high-profile cases of psychiatry’s “standard of care” in children leading to death. One case that got a lot of attention was the death of 4 year-old Rebecca Riley, covered by “60 Minutes” in 2007. Rebecca was diagnosed with ADHD at 2 years, with bipolar disorder at 3 years, and prescribed three heavy-duty psychiatric drugs which killed her. Tufts-New England Medical Center (a bastion of the psychiatric establishment), which employed Rebecca’s psychiatrist, was quoted as saying “The care we provided was appropriate and within responsible professional standards.”

This is the kind of stuff that makes establishment psychiatry look out of touch with reality to the general public. Their expansionism takes them out of the mainstream, and their arrogance keeps them from seeing it.

So, one lesson for activists is this: history tells us to have hope. Eventually dehumanizing tyrants and institutions fall, often falling under the weight of their own arrogance. So the activist need not feel helpless in the face of what might look like insurmountable advantages (such as money). The arrogance and stupidity of the dehumanizing institution will be its downfall, and the activist’s job is to speed this natural process along, as well as be offering sane and humane options. That’s what we’ve done.

If you were giving advice to a college student who wanted to change the world, what 3 things would be at the top of your list?

First, see your movement as a vehicle to build community. There are so many people who are attractive, intelligent, good people but who lack a passion — and are very lonely. They don’t realize that caring about righting wrongs can be a way to connect with others and form genuine community. I’ve met many people who spent a great deal of their life as alienated outsiders diagnosed with serious mental illness, but who found genuine community when they acted on their passion to reform mental health treatment.

Second, it’s important to keep your sense of humor. There is a big difference between taking your cause seriously vs. taking yourself too seriously. People without a sense of humor turn off other potential activists, and they are more likely to eventually burn out themselves.

Third, financial support matters. It’s very difficult to sustain activism without some level of economic security. That’s why I believe that student-loan debt has been lethal for young people, not just on a personal level but on the level of social activism. That’s why fighting to liberate Americans from student-loan debt, fighting to raise the minimum wage, and other issues of economic justice are critical for all activism.

For more information, visit brucelevine.net.

Bruce Levine writes and speaks widely on how society, culture, politics and psychology intersect. He is a regular contributor to Salon, CounterPunch, AlterNet, Truthout, TakePart, Z Magazine, and the Huffington Post. His latest book is Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite (2011). Earlier books include Surviving America’s Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (2007) and Commonsense Rebellion: Taking Back Your Life from Drugs, Shrinks, Corporations, and a World Gone Crazy (2003).

Cross posted at Daily Kos.