Controversies about psychiatry#Compulsory sterilization

File:Narrenturm Vienna June 2006 575.jpg's Narrenturm — German for "fools' tower" — was one of the earliest buildings specifically designed as a "madhouse". It was built in 1784.]]

Since the 1960s there have been challenges to the concept of mental illness. Sociologists Erving Goffman and Thomas Scheff argued that mental illness was merely another example of how society labels and controls non-conformists,{{Cite book |last1=Robertson |first1=Michael |url=https://books.google.com/books?id=Hk3OBQAAQBAJ |title=Ethics and Mental Health: The Patient, Profession and Community |last2=Walter |first2=Garry |date=2013-09-26 |publisher=CRC Press |isbn=978-1-4441-6865-5 |language=en}}{{Rp|102}} behavioral psychologists challenged psychiatry's fundamental reliance on unchallengable or unfalsifiable concepts,{{cite book |last1=Read |first1=J. Don |last2=Lindsay |first2=D. Steve |title=Recollections of Trauma: Scientific Evidence and Clinical Practice |date=11 November 2013 |publisher=Springer Science & Business Media |isbn=978-1-4757-2672-5 |url=https://books.google.com/books?id=5P_pBwAAQBAJ&pg=PA404 |language=en}} "...one finds two non-intersecting conceptual universes: that of psychiatry and traumatology-unrealistic, un-challengable and essentially unfalsifiable..." and gay rights activists criticized the APA's inclusion of homosexuality as a mental disorder in the DSM."Cured". Independent Lens. PBS. December 6, 2021. Retrieved January 23, 2022. As societal views on homosexuality have changed in recent decades, it is no longer considered a mental illness and is more widely accepted by society. As another example that challenged conceptions of mental illness, a widely publicized study by Professor David Rosenhan, known as the Rosenhan experiment, was viewed as an attack on the efficacy of psychiatric diagnosis.{{cite journal |last1=Kirk |first1=Stuart A. |last2=Kutchins |first2=Herb |date=1994 |title=The Myth of the Reliability of DSM |url=http://www.academyanalyticarts.org/kirk&kutchins.htm |url-status=dead |journal=Journal of Mind and Behavior |volume=15 |issue=1&2 |pages=71–86 |archive-url=https://web.archive.org/web/20080307115815/http://www.academyanalyticarts.org/kirk%26kutchins.htm |archive-date=2008-03-07}} Reprinted by Academy for the Study of the Psychoanalytic Arts.

{{More citations needed section|date=May 2019}}

File:Relación Médico Paciente.png

Medicalization, a concept in medical sociology, is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evidence or hypotheses about conditions, by changing social attitudes or economic considerations, or by the development of new medications or treatments.

For many years, several psychiatrists, such as David Rosenhan, Peter Breggin, Paula Caplan, Thomas Szasz, Giorgio Antonucci and critics outside the field of psychiatry, such as Stuart A. Kirk, have "been accusing psychiatry of engaging in the systematic medicalization of normality".{{cite book |last=Kirk |first=Stuart |title=Mad science: psychiatric coercion, diagnosis, and drugs |publisher=Transaction Publishers |year=2013 |isbn=978-1-4128-4976-0 |location=New Brunswick, N.J |page=185 |oclc=808769553}} More recently these concerns have come from insiders who have worked for the APA themselves (e.g., Robert Spitzer, Allen Frances).{{cite book |last=Kirk |first=Stuart A. |title=Mad Science: Psychiatric Coercion, Diagnosis, and Drugs |publisher=Transaction Publishers |year=2013}}{{rp|185}} For example, in 2013, Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".{{cite journal |author=Frances A |date=January 2013 |title=The past, present and future of psychiatric diagnosis |journal=World Psychiatry |volume=12 |issue=2 |pages=111–112 |doi=10.1002/wps.20027 |pmc=3683254 |pmid=23737411}}

The concept of medicalization was devised by sociologists to explain how medical knowledge is applied to behaviors which are not self-evidently medical or biological.{{cite book |last=White |first=Kevin |url=https://books.google.com/books?id=5bHxQBNWGHMC&pg=PA42 |title=An introduction to the sociology of health and illness |publisher=SAGE |year=2002 |isbn=978-0-7619-6400-1 |pages=42}} The term medicalization entered the sociology literature in the 1970s in the works of Irving Zola, Peter Conrad, and Thomas Szasz, among others. These sociologists viewed medicalization as a form of social control in which medical authority expanded into domains of everyday existence, and they rejected medicalization in the name of liberation. This critique was embodied in works such as Conrad's "The discovery of hyperkinesis: notes on medicalization of deviance", published in 1973 (hyperkinesis was the term then used to describe what we might now call ADHD), and Szasz's "The Myth of Mental Illness."{{cite journal |author=Conrad P |date=October 1975 |title=The discovery of hyperkinesis: notes on the medicalization of deviant behavior |journal=Soc Probl |volume=23 |issue=1 |pages=12–21 |doi=10.2307/799624 |jstor=799624 |pmid=11662312}}Szasz, Thomas S. (1974). The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Harper & Row. p. vii, xiii, xvi. {{ISBN|0-06-091151-4}}.

These sociologists did not believe medicalization to be a new phenomenon, arguing that medical authorities had always been concerned with social behavior and traditionally functioned as agents of social control (Foucault, 1965; Szasz, 1970; Rosen). However, these authors took the view that increasingly sophisticated technology had extended the potential reach of medicalization as a form of social control, especially in terms of "psychotechnology" (Chorover, 1973).

In the 1975 book Limits to medicine: Medical nemesis (1975), Ivan Illich put forth one of the earliest uses of the term "medicalization". Illich, a philosopher, argued that the medical profession harms people through iatrogenesis, a process in which illness and social problems increase due to medical intervention. Illich saw iatrogenesis occurring on three levels: the clinical, involving serious side effects worse than the original condition; the social, whereby the general public is made docile and reliant on the medical profession to cope with life in their society; and the structural, whereby the idea of aging and dying as medical illnesses effectively "medicalized" human life and left individuals and societies less able to deal with these natural processes.

Marxists such as Vicente Navarro (1980) linked medicalization to an oppressive capitalist society. They argued that medicine disguised the underlying causes of disease, such as social inequality and poverty, and instead presented health as an individual issue. Others examined the power and prestige of the medical profession, including use of terminology to mystify and of professional rules to exclude or subordinate others.{{Cite book |last=Helman |first=Cecil |url=https://books.google.com/books?id=C3BoQgAACAAJ |title=Culture, Health and Illness |publisher=Arnold |year=2007 |isbn=978-0-340-91450-2 |location=London}}

Some argue that in practice the process of medicalization tends to strip subjects of their social context, so they come to be understood in terms of the prevailing biomedical ideology, resulting in a disregard for overarching social causes such as unequal distribution of power and resources.{{cite journal |author=Filc D |date=September 2004 |title=The medical text: between biomedicine and hegemony |journal=Soc Sci Med |volume=59 |issue=6 |pages=1275–85 |doi=10.1016/j.socscimed.2004.01.003 |pmid=15210098}} A series of publications by Mens Sana Monographs have focused on medicine as a corporate capitalist enterprise.{{Cite journal |title=Medicine as a corporate enterprise, patient welfare centered profession, or patient welfare centered professional enterprise? |journal=Mens Sana Monographs | date=2005 |volume=3 |issue=2 |pages=19–55 | doi=10.4103/0973-1229.27881 | doi-access=free | pmc=3369169 | last1=Singh | first1=A. | last2=Singh | first2=S. |doi-broken-date=2024-11-02 | pmid=22679354 }}Ajai R Singh, Shakuntala A Singh, 2005, [https://web.archive.org/web/20070811102404/http://www.msmonographs.org/article.asp?issn=0973-1229;year=2005;volume=3;issue=1;spage=5;epage=35;aulast=Singh "The connection between academia and industry"], Mens Sana Monographs, 3(1), p5-35Ajai R Singh, Shakuntala A Singh, 2005, [https://web.archive.org/web/20070811103648/http://www.msmonographs.org/article.asp?issn=0973-1229;year=2005;volume=3;issue=1;spage=41;epage=80;aulast=Singh "Public welfare agenda or corporate research agenda?"], Mens Sana Monographs, 3(1), p41-80.

{{Main|Political abuse of psychiatry}}

In unstable countries, political prisoners are sometimes confined and abused in mental institutions.{{cite book |author=Noll, Richard |url=https://books.google.com/books?id=jzoJxps189IC&pg=PA3 |title=The encyclopedia of schizophrenia and other psychotic disorders |publisher=Infobase Publishing |year=2007 |isbn=978-0-8160-6405-2 |page=3}}{{rp|3}} The diagnosis of mental illness allows the state to hold persons against their will and insist upon therapy in their interest and in the broader interests of society.{{cite book |author=British Medical Association |title=Medicine betrayed: the participation of doctors in human rights abuses |publisher=Zed Books |year=1992 |isbn=978-1-85649-104-4 |page=[https://books.google.com/books?id=bMTu_oIfVsIC&pg=PA65 65]–[https://books.google.com/books?id=bMTu_oIfVsIC&pg=PA66 66] |author-link=British Medical Association}} In addition, receiving a psychiatric diagnosis can in and of itself be regarded as oppressive.{{cite book |author1=Malterud, Kirsti |url=https://books.google.com/books?id=6K41rxULV34C&pg=PA94 |title=Chronic myofascial pain: a patient-centered approach |author2=Hunskaar, Steinar |publisher=Radcliffe Publishing |year=2002 |isbn=978-1-85775-947-1 |page=94}}{{rp|94}} In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials. The use of hospitals instead of jails prevents the victims from receiving legal aid before the courts, makes indefinite incarceration possible, and discredits the individuals and their ideas.{{cite book |author1=Veenhoven, Willem |url=https://books.google.com/books?id=RdazE7TGYjgC&pg=PA29 |title=Case studies on human rights and fundamental freedoms: a world survey |author2=Ewing, Winifred |author3=Samenlevingen, Stichting |publisher=Martinus Nijhoff Publishers |year=1975 |isbn=978-90-247-1780-4 |page=29}}{{rp|29}} In that manner, whenever open trials are undesirable, they are avoided.{{rp|29}}

Examples of political abuse of the power, entrusted in physicians and particularly psychiatrists, are abundant in history and seen during the Nazi era and the Soviet rule when political dissenters were labeled as "mentally ill" and subjected to inhumane "treatments."{{cite journal |vauthors=Shah R, Basu D |date=July–September 2010 |title=Coercion in psychiatric care: Global and Indian perspective |journal=Indian Journal of Psychiatry |volume=52 |issue=3 |pages=203–206 |doi=10.4103/0019-5545.70971 |pmc=2990818 |pmid=21180403 |doi-access=free }} In the period from the 1960s up to 1986, abuse of psychiatry for political purposes was reported to be systematic in the Soviet Union, and occasional in other Eastern European countries such as Romania, Hungary, Czechoslovakia, and Yugoslavia. The practice of incarceration of political dissidents in mental hospitals in Eastern Europe and the former USSR damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community.{{cite journal |author1=Declan, Lyons |author2=Art, O'Malley |date=1 December 2002 |title=The labelling of dissent — politics and psychiatry behind the Great Wall |journal=Psychiatric Bulletin |volume=26 |issue=12 |pages=443–444 |doi=10.1192/pb.26.12.443 |doi-access=free}} Political abuse of psychiatry also takes place in the People's Republic of China{{cite journal |author=Voren, Robert van |date=January 2010 |title=Political Abuse of Psychiatry—An Historical Overview |journal=Schizophrenia Bulletin |volume=36 |issue=1 |pages=33–35 |doi=10.1093/schbul/sbp119 |pmc=2800147 |pmid=19892821}} and in Russia.{{cite book |author=Voren, Robert van |url=http://www.europarl.europa.eu/RegData/etudes/etudes/join/2013/433723/EXPO-DROI_ET(2013)433723_EN.pdf |title=Psychiatry as a tool of coercion in post-Soviet countries |publisher=The European Parliament |year=2013 |isbn=978-92-823-4595-5 |doi=10.2861/28281}} Psychiatric diagnoses such as the diagnosis of 'sluggish schizophrenia' in political dissidents in the USSR were used for political purposes.{{cite book |last1=Katona |first1=Cornelius |url=https://books.google.com/books?id=OSJRHpAtqPUC&pg=PA77 |title=Psychiatry at a glance |last2=Robertson |first2=Mary |publisher=Wiley-Blackwell |year=2005 |isbn=978-1-4051-2404-1 |page=77}}{{rp|77}}

The history of racism in psychiatry dates back to the days of slavery and segregation in the United States. Such racism in psychiatry exemplifies the concept of scientific racism, which falsely alleges that science and other empirical evidence supports racism and proves certain racial inferiorities.{{Cite journal |last=Geller |first=Jeffrey |date=2020-06-23 |title=Structural Racism in American Psychiatry and APA: Part 1 |url=https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2020.7a18 |journal=Psychiatric News |volume=55 |issue=13 |language=en |doi=10.1176/appi.pn.2020.7a18|s2cid=225573055 |url-access=subscription }}

Psychiatric diagnoses were influenced by Black people's status as free or enslaved. Enslaved people were not considered civilized enough to be diagnosed with insanity, while free Black people were over-diagnosed with insanity, having much higher diagnosis rates than white people. Specific diagnoses in the 19th century were crafted specifically to fit Black people – drapetomania and dysesthesia aethiopica, disorders meant to explain why slaves ran away and why they were lazy or lacked a strong work ethic, respectively, and justify the institution of slavery. Prominent political figures such as John C. Calhoun used this supposed evidence to argue for slavery, arguing that free Black people could not be entrusted with their lives and would ultimately develop lunacy. All in all, throughout the 19th century, psychiatric diagnoses and scientifically racist theories were used to medicalize Blackness and uphold systems of slavery and racism, further constraining the rights, freedom, and humanity of Black people.{{Cite book |last=Hogarth |first=Rana A. |title=Medicalizing blackness: making racial differences in the Atlantic world, 1780-1840 |date=2017 |isbn=978-1-4696-3288-9 |location=Chapel Hill |oclc=1004770875}}

{{Main|Scientific racism}}

Proponents of scientific racism have historically attempted to "prove" that Black people are physiologically and cognitively inferior to white people based on faulty assumptions and prejudices. Perpetuated by the inaccurate application of biodeterminism, specialists in neuroanatomy and psychiatry compared disproportionate numbers of brains from Black and white individuals to support their racial agendas based on "science."{{Cite journal |last=Geller |first=Jeffrey |date=2020-07-28 |title=Structural Racism in American Psychiatry and APA: Part 3 |url=https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2020.8a16 |journal=Psychiatric News |volume=55 |issue=15 |language=en |doi=10.1176/appi.pn.2020.8a16|s2cid=243650598 |url-access=subscription }}{{Cite book |last=Rusert |first=Britt |title=Fugitive science: empiricism and freedom in early African American culture |date=2017 |isbn=978-1-4798-0470-2 |location=New York |oclc=986540274}}

{{Main|Compulsory sterilization}}

The proportion of Black individuals confined in establishments for "flawed and imbecile" patients increased throughout the late 19th and early 20th century.{{Cite journal |last=Geller |first=Jeffrey |date=2020-08-13 |title=Structural Racism in American Psychiatry and APA: Part 4 |url=https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2020.8b13 |journal=Psychiatric News |volume=55 |issue=16 |language=en |doi=10.1176/appi.pn.2020.8b13|s2cid=225206945 |url-access=subscription }} Psychiatry contributed towards the inaccurate and racist belief that if they were left to their respective means, they would not be able to remain in decent condition. At the beginning of the 20th century, Black people were disproportionally sterilized in eugenics programs that compulsorarily sterilized those classed as feebleminded or who received welfare payments.{{Cite journal |last=Geller |first=Jeffrey |date=2020-08-26 |title=Structural Racism in American Psychiatry and APA: Part 5 |url=https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2020.9a20 |journal=Psychiatric News |volume=55 |issue=17 |language=en |doi=10.1176/appi.pn.2020.9a20|s2cid=242361073 |url-access=subscription }} The premise that the genes of those deemed mentally ill were undesirable was used to justify sterilization which was frequently supervised by physicians, including psychiatrists.

Segregation within mental institutions and hospitals is another example of the history of racism within psychiatry. Many psychiatric hospitals in the 19th century either excluded or segregated Black patients or admitted Black slaves to work at the hospital in exchange for care. The founding fathers of psychiatry themselves supported the notion that Black people were inferior, lower class citizens that must be treated separately and differently from white patients. With time, racial segregation within hospitals became interspersed with entirely separate hospitals for white and Black patients, each with differential treatment and quality of care. Political figures in the post-Civil War era argued that emancipation had led to a significant increase in insanity cases amongst Black individuals, and they cited the need to accommodate this increase via segregated and Black-only insane asylums.{{Cite journal |last=Geller |first=Jeffrey |date=2020-07-08 |title=Structural Racism in American Psychiatry and APA: Part 2 |url=https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2020.7b27 |journal=Psychiatric News |volume=55 |issue=14 |language=en |doi=10.1176/appi.pn.2020.7b27|s2cid=225598173 |url-access=subscription }} Many hospitals, especially in the southern United States, did not admit Black patients until they were eventually mandated to do so. The last segregated hospital opened in 1933. Popular arguments also circulated that Black patients were more difficult to take care of in mental institutions, making psychiatric care for them more difficult and justifying the need for segregated facilities.

Until the late 1960s, many hospitals remained segregated.{{Cite journal |last=Geller |first=Jeffrey |date=2020-09-09 |title=Structural Racism in American Psychiatry and APA: Part 6 |url=https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2020.9b17 |journal=Psychiatric News |volume=55 |issue=18 |language=en |doi=10.1176/appi.pn.2020.9b17|s2cid=241307698 |url-access=subscription }} This affected the experiences of racial minorities accessing psychiatric care in mental institutions and hospitals in the United States. When Lyndon B. Johnson's administration stated that no segregated hospital would receive federal Medicare funds, hospitals began to integrate quickly in order to be able to continue to access such funding. In January 1966, around two-thirds of Southern hospitals were segregated facilities and many Northern facilities remain segregated in-effect. One year later, by January 1967, there were very few hospitals in the United States that remained segregated. Segregation within mental institutions and hospitals is one example of the history of racism within psychiatry.

Black psychiatrists often experienced racism as practitioners within the field. Some of this history is detailed in Jeanne Spurlock's book titled Black Psychiatrists and American Psychiatry, published in 1999, in which she profiles Black psychiatrists who were influential in American psychiatry and their experiences in the profession.{{Cite book |title=Black psychiatrists and American psychiatry |date=1999 |publisher=American Psychiatric Association |editor=Jeanne Spurlock |isbn=0-89042-411-X |location=Washington, DC |oclc=39655923}} During the Civil Rights Movement, Black psychiatrists expressed concerns to the APA that the needs of Black communities and Black psychiatrists were being ignored by the professional organization.{{Cite journal |last=Geller |first=Jeffrey |date=2020-09-22 |title=Structural Racism in American Psychiatry and APA: Part 7 |url=https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2020.10a33 |journal=Psychiatric News |volume=55 |issue=19 |language=en |doi=10.1176/appi.pn.2020.10a33|s2cid=224935611 |url-access=subscription }} In 1969, a contingent of Black psychiatrists presented a list of 9 concerns to the APA Board of Trustees regarding experiences of structural racism in the field. Their '9 points' represented a wide array of experiences of discrimination, both from the experiences of practitioners and patients, and on the institutional and individual level and the group demanded change from within the APA. For example, they called for more Black leaders on APA committees as well as the desegregation of all mental health facilities, both public and private, in the United States.

As of 2020, within psychiatry, historically underrepresented groups continue to be less represented as residents, faculty, and practicing physicians in comparison to their proportion in the U.S. population.{{Cite journal |last1=Wyse |first1=Rhea |last2=Hwang |first2=Wei-Ting |last3=Ahmed |first3=Awad A. |last4=Richards |first4=Erica |last5=Deville |first5=Curtiland |date=2020-10-01 |title=Diversity by Race, Ethnicity, and Sex within the US Psychiatry Physician Workforce |journal=Academic Psychiatry |language=en |volume=44 |issue=5 |pages=523–530 |doi=10.1007/s40596-020-01276-z |pmid=32705570 |s2cid=220721976 |issn=1545-7230}}

Psychiatry has been criticized for its broad range of mental diseases and disorders. Which diagnoses exist and are considered valid have changed over time depending on society's norms. Homosexuality was considered a mental illness but due to changing attitudes, it is no longer recognised as an illness.{{cite journal |last=Helen Spandler, Sarah Carr |title=Hidden from history? A brief modern history of the psychiatric "treatment" of lesbian and bisexual women in England |journal=The Lancet|year=2019 |volume=6 |issue=4 |pages=289–290 |doi=10.1016/S2215-0366(19)30059-8 |pmid=30765328 |s2cid=73454144 |doi-access=free }} Historic disorders that are no longer recognised include orthorexia nervosa,{{Citation needed|date=July 2024}} sexual addiction, parental alienation syndrome, pathological demand avoidance, and Internet addiction disorder. New disorders include compulsive hoarding and binge eating disorder.{{cite web |title=15 new mental illnesses in the DSM-5 |url=https://www.marketwatch.com/story/15-new-mental-illnesses-in-the-dsm-5-2013-05-22 |website=Market watch}}

The act of diagnosis itself has been criticized for being arbitrary with some conditions being overdiagnosed.{{cite book |author=Joel Paris |url=https://books.google.com/books?id=EbvyDwAAQBAJ |title=Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes |publisher=Oxford University Press |year=2020 |isbn=978-0-19-750427-7}} Individuals may be diagnosed with a mental disorder despite having been perceived as having no issues with their behavior. In Virginia, U.S., it was found up to 33% of white boys are diagnosed with ADHD leading to alarm in the medical community.{{cite web |date=28 March 2016 |title=Keith Connors, Father of ADHD, Regrets Its Current Misuse|url=https://www.psychologytoday.com/us/blog/saving-normal/201603/keith-connors-father-adhd-regrets-its-current-misuse}}

Thomas Szasz argued that mental health diagnoses were used as a form of labelling violations of societies norms. Bill Fullford, introduced the idea of "value-laden" mental health diagnosis with mental health lying between physical health and a moral judgment. Under this system personality disorders are seen as not very factual and very value-laden while delirium is quite factual and not very value-laden.{{Rp|104}}

{{See also|Biological psychiatry|Biopsychiatry controversy}}

In 2013, psychiatrist Allen Frances said that he believes that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".{{cite book |last=Burns |first=Tom |title=Psychiatry: A very short introduction |publisher=Oxford University Press |year=2006 |isbn=978-0-19-280727-4}}{{cite journal |last=Nasrallah |first=Henry A. |date=December 2011 |title=The antipsychiatry movement: Who and why |url=http://www.currentpsychiatry.com/fileadmin/cp_archive/pdf/1012/1012CP_Editorial.pdf |url-status=dead |journal=Current Psychiatry |volume=10 |issue=12 |pages=4, 6, 53 |archive-url=https://web.archive.org/web/20150207004541/http://www.currentpsychiatry.com/fileadmin/cp_archive/pdf/1012/1012CP_Editorial.pdf |archive-date=2015-02-07 |access-date=2015-06-03}}

Mary Boyle argues that psychiatry is actually the study of behavior, but acts as if it is the study of the brain based on a presumed connection between patterns of behavior and the biological function of the brain. She argues that in the case of schizophrenia it is the bizarre behavior of individuals that justifies the presumption of a biological cause for this behavior rather than the existence of any evidence.{{Cite book |last=Boyle |first=Mary |url=https://books.google.com/books?id=2QMOAAAAQAAJ |title=Schizophrenia: A Scientific Delusion? |date=1990-01-01 |publisher=Routledge |isbn=978-0-415-04096-9 |language=en}}{{Rp|236}}

She argues that the concept of schizophrenia and its biological basis serves a social function for psychiatrists. She views the concept of schizophrenia as necessary for psychiatry to be considered as a medical field, that the claimed biological link gives psychiatrists protection from accusations of social control, and that the belief in the biological basis for schizophrenia is maintained through secondary source's misrepresentation of underlying data. She argues that schizophrenia and its biological basis also gives families, psychiatrists and society as a whole the ability to avoid blame for the damage they cause individuals and the ineffectiveness of treatment.{{Rp|238}}

{{Main|Diagnosis of schizophrenia}}

Underlying issues associated with schizophrenia would be better addressed as a spectrum of conditions{{cite journal |vauthors=Tsuang MT, Stone WS, Faraone SV |year=2000 |title=Toward reformulating the diagnosis of schizophrenia |journal=American Journal of Psychiatry |volume=157 |issue=7 |pages=1041–50 |doi=10.1176/appi.ajp.157.7.1041 |pmid=10873908}} or as individual dimensions along which everyone varies rather than by a diagnostic category based on an arbitrary cut-off between normal and ill.{{cite journal |author=Peralta V, Cuesta MJ |date=June 2007 |title=A dimensional and categorical architecture for the classification of psychotic disorders |journal=World Psychiatry |volume=6 |issue=2 |pages=100–1 |pmc=2219908 |pmid=18235866}} This approach appears consistent with research on schizotypy, and with a relatively high prevalence of psychotic experiences, mostly non-distressing delusional beliefs, among the general public.{{cite journal |author=Verdoux H, van Os J |year=2002 |title=Psychotic symptoms in non-clinical populations and the continuum of psychosis |journal=Schizophrenia Research |volume=54 |issue=1–2 |pages=59–65 |doi=10.1016/S0920-9964(01)00352-8 |pmid=11853979|s2cid=33168322 }}{{cite journal |author=Johns LC, van Os J |year=2001 |title=The continuity of psychotic experiences in the general population |journal=Clinical Psychology Review |volume=21 |issue=8 |pages=1125–41 |doi=10.1016/S0272-7358(01)00103-9 |pmid=11702510}}{{cite journal |vauthors=Peters ER, Day S, McKenna J, Orbach G |year=2005 |title=Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI) |journal=Schizophrenia Bulletin |volume=30 |issue=4 |pages=1005–22 |doi=10.1093/oxfordjournals.schbul.a007116 |pmid=15954204|doi-access=free }} In concordance with this observation, psychologist Edgar Jones, and psychiatrists Tony David and Nassir Ghaemi, surveying the existing literature on delusions, pointed out that the consistency and completeness of the definition of delusion have been found wanting by many; delusions are neither necessarily fixed nor false, and need not involve the presence of incontrovertible evidence.{{cite journal |author=Jones E |year=1999 |title=The Phenomenology of Abnormal Belief: A Philosophical and Psychiatric Inquiry |journal=Philosophy, Psychiatry, & Psychology |volume=6 |issue=1 |pages=1–16}}{{cite journal |author=David AS |year=1999 |title=On the impossibility of defining delusions |url=https://muse.jhu.edu/article/28274 |journal=Philosophy, Psychiatry, & Psychology |volume=6 |issue=1 |pages=17–20 |access-date=2008-02-24}}{{cite journal |author=Ghaemi SN |year=1999 |title=An Empirical Approach to Understanding Delusions |url=https://muse.jhu.edu/article/28277 |journal=Philosophy, Psychiatry, & Psychology |volume=6 |issue=1 |pages=21–24 |access-date=2008-02-24}}

Nancy Andreasen has criticized the current DSM-IV and ICD-10 criteria for sacrificing diagnostic validity for the sake of artificially improving reliability.{{Citation needed|reason=outdated opinion|date=May 2019}} She argues that overemphasis on psychosis in the diagnostic criteria, while improving diagnostic reliability, ignores more fundamental cognitive impairments that are harder to assess due to large variations in presentation.{{cite journal |author=Andreasen NC |date=March 2000 |title=Schizophrenia: the fundamental questions |journal=Brain Res. Brain Res. Rev. |volume=31 |issue=2–3 |pages=106–12 |doi=10.1016/S0165-0173(99)00027-2 |pmid=10719138|s2cid=8545249 }}{{cite journal |author=Andreasen NC |date=September 1999 |title=A unitary model of schizophrenia: Bleuler's "fragmented phrene" as schizencephaly |journal=Archives of General Psychiatry |volume=56 |issue=9 |pages=781–7 |doi=10.1001/archpsyc.56.9.781 |pmid=12884883}} This view is supported by other psychiatrists.{{cite journal |author=Jansson LB, Parnas J |date=September 2007 |title=Competing definitions of schizophrenia: what can be learned from polydiagnostic studies? |url=http://schizophreniabulletin.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17158508 |journal=Schizophr Bull |volume=33 |issue=5 |pages=1178–200 |doi=10.1093/schbul/sbl065 |pmc=3304082 |pmid=17158508}} In the same vein, Ming Tsuang and colleagues argue that psychotic symptoms may be a common end-state in a variety of disorders, including schizophrenia, rather than a reflection of the specific etiology of schizophrenia, and warn that there is little basis for regarding DSM's operational definition as the "true" construct of schizophrenia. Neuropsychologist Michael Foster Green went further in suggesting the presence of specific neurocognitive deficits may be used to construct phenotypes that are alternatives to those that are purely symptom-based. These deficits take the form of a reduction or impairment in basic psychological functions such as memory, attention, executive function and problem solving.{{cite journal |author=Green MF, Nuechterlein KH |year=1999 |title=Should schizophrenia be treated as a neurocognitive disorder? |url=http://schizophreniabulletin.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=10416733 |journal=Schizophr Bull |volume=25 |issue=2 |pages=309–19 |doi=10.1093/oxfordjournals.schbul.a033380 |pmid=10416733|doi-access=free }}{{cite book |author=Green, Michael |title=Schizophrenia revealed: from neurons to social interactions |publisher=W.W. Norton |year=2001 |isbn=0-393-70334-7 |location=New York}}

The exclusion of affective components from the criteria for schizophrenia, despite their ubiquity in clinical settings, has also caused contention. This exclusion in the DSM has resulted in a "rather convoluted" separate disorder—schizoaffective disorder. Citing poor interrater reliability, some psychiatrists have totally contested the concept of schizoaffective disorder as a separate entity.{{cite journal |author=Lake CR, Hurwitz N |date=July 2007 |title=Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease—there is no schizoaffective disorder |url=https://dx.doi.org/10.1097/YCO.0b013e3281a305ab |journal=Curr Opin Psychiatry |volume=20 |issue=4 |pages=365–79 |doi=10.1097/YCO.0b013e3281a305ab |pmid=17551352|s2cid=37664803 |url-access=subscription }}{{cite journal |vauthors=Malhi GS, Green M, Fagiolini A, Peselow ED, Kumari V |date=February 2008 |title=Schizoaffective disorder: diagnostic issues and future recommendations |journal=Bipolar Disorders |volume=10 |issue=1 Pt 2 |pages=215–30 |doi=10.1111/j.1399-5618.2007.00564.x |pmid=18199238}} The categorical distinction between mood disorders and schizophrenia, known as the Kraepelinian dichotomy, has also been challenged by data from genetic epidemiology.{{cite journal |author=Craddock N, Owen MJ |date=May 2005 |title=The beginning of the end for the Kraepelinian dichotomy |url=http://bjp.rcpsych.org/cgi/pmidlookup?view=long&pmid=15863738 |journal=Br J Psychiatry |volume=186 |issue=5 |pages=364–6 |doi=10.1192/bjp.186.5.364 |pmid=15863738|s2cid=1429221 |doi-access=free }}

Jonathan Metzl, in his book The Protest Psychosis, argues that the Ionia State Hospital in Ionia, Michigan disproportionately diagnosed African Americans with schizophrenia because of their civil rights activism.{{Cite book |last=M. |first=Metzl, Jonathan |title=The protest psychosis: how schizophrenia became a black disease |date=2014 |publisher=Beacon Press |isbn=978-0-8070-8593-6 |oclc=869378233}}

{{Main|Attention deficit hyperactivity disorder controversies}}

ADHD, its diagnosis, and its treatment have been controversial since the 1970s.{{citation |last=Parrillo |first=VN |title=Encyclopedia of Social Problems, Volume 1 |url=https://books.google.com/books?id=mRGr_B4Y1CEC&q=percent%20who%20consider%20ADHD%20controversial&pg=PT107 |page=63 |year=2008 |publisher=SAGE |isbn=978-1-4129-4165-5 |access-date=7 Apr 2016}}{{cite journal |vauthors=Sim MG, Hulse G, Khong E |date=August 2004 |title=When the child with ADHD grows up |journal=Australian Family Physician |volume=33 |issue=8 |pages=615–8 |pmid=15373378}}{{Cite journal |author=Foreman DM |date=February 2006 |title=Attention deficit hyperactivity disorder: legal and ethical aspects |journal=Archives of Disease in Childhood |volume=91 |issue=2 |pages=192–194 |doi=10.1136/adc.2004.064576 |pmc=2082674 |pmid=16428370}} The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior{{citation |author=National Collaborating Centre for Mental Health |title=Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults |pages=19–27, 38, 130, 133, 317 |year=2009 |publisher=British Psychological Society |isbn=978-1-85433-471-8}}{{cite journal |author=Faraone, Stephen V |year=2005 |title=The scientific foundation for understanding attention-deficit/hyperactivity disorder as a valid psychiatric disorder |journal=Eur Child Adolesc Psychiatry |volume=14 |issue=1 |pages=1–10 |doi=10.1007/s00787-005-0429-z |pmid=15756510 |s2cid=143646869}} to the hypothesis that ADHD is a genetic condition.{{cite news |last1=Boseley |first1=Sarah |date=30 September 2010 |title=Hyperactive children may suffer from genetic disorder, says study |work=The Guardian |url=https://www.theguardian.com/society/2010/sep/30/hyperactive-children-genetic-disorder-study}} Other areas of controversy include the use of stimulant medications in children,{{cite journal |author=Cormier E |date=October 2008 |title=Attention deficit/hyperactivity disorder: a review and update |journal=J Pediatr Nurs |volume=23 |issue=5 |pages=345–357 |doi=10.1016/j.pedn.2008.01.003 |pmid=18804015}} the method of diagnosis, and the possibility of overdiagnosis. In 2012, the National Institute for Health and Care Excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature. In 2014, Keith Conners, one of the early advocates for recognition of the disorder, spoke out against overdiagnosis in an article in The New York Times.{{cite news |last1=Schwarz |first1=Alan |date=14 December 2013 |title=The Selling of Attention Deficit Disorder |work=The New York Times |issue=14 December 2013 |url=https://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html |access-date=26 February 2015}} In contrast, a 2014 peer-reviewed medical literature review indicated that ADHD is underdiagnosed in adults.{{cite journal |vauthors=Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP |year=2014 |title=Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature |journal=Prim Care Companion CNS Disord |volume=16 |issue=3 |doi=10.4088/PCC.13r01600 |pmc=4195639 |pmid=25317367 |quote=Reports indicate that ADHD affects 2.5%–5% of adults in the general population,^5–8 compared with 5%–7% of children.^9,10 ... However, fewer than 20% of adults with ADHD are currently diagnosed and/or treated by psychiatrists.^7,15,16}}

With widely differing rates of diagnosis across countries, states within countries, races, and ethnicities, some suspect factors other than the presence of the symptoms of ADHD are playing a role in diagnosis.{{cite journal |author=Elder TE |date=September 2010 |title=The importance of relative standards in ADHD diagnoses: evidence based on exact birth dates |journal=J Health Econ |volume=29 |issue=5 |pages=641–656 |doi=10.1016/j.jhealeco.2010.06.003 |pmc=2933294 |pmid=20638739}} Some sociologists consider ADHD to be an example of the medicalization of deviant behavior, that is, the turning of the previously {{nowrap|non-medical}} issue of school performance into a medical one.{{cite book |title=Medicating Children: ADHD and Pediatric Mental Health |vauthors=Mayes R, Bagwell C, Erkulwater JL |date=2009 |publisher=Harvard University Press |isbn=978-0-674-03163-0 |edition=illustrated |pages=4–24}} Most healthcare providers accept ADHD as a genuine disorder, at least in the small number of people with severe symptoms. Among healthcare providers the debate mainly centers on diagnosis and treatment in the much larger number of people with less severe symptoms.{{cite book |author=Silver LB |title=Attention-deficit/hyperactivity disorder |publisher=American Psychiatric Publishing |year=2004 |isbn=978-1-58562-131-6 |edition=3rd |pages=4–7}}{{cite journal |vauthors=Schonwald A, Lechner E |date=April 2006 |title=Attention deficit/hyperactivity disorder: complexities and controversies |journal=Curr. Opin. Pediatr. |volume=18 |issue=2 |pages=189–195 |doi=10.1097/01.mop.0000193302.70882.70 |pmid=16601502 |s2cid=27286123}}

{{As of|2009}}, 8% of all United States Major League Baseball players had been diagnosed with ADHD, making the disorder common among this population. The increase coincided with the League's 2006 ban on stimulants, which has raised concern that some players are mimicking or falsifying the symptoms or history of ADHD to get around the ban on the use of stimulants in sport.{{cite web |last=Saletan |first=William |date=12 January 2009 |title=Doping Deficit Disorder. Need performance-enhancing drugs? Claim ADHD |url=http://www.slate.com/id/2208429/ |url-status=live |archive-url=https://web.archive.org/web/20090521114505/http://www.slate.com/id/2208429/ |archive-date=21 May 2009 |access-date=2 May 2009 |publisher=Slate}}

{{See also|History of psychosurgery}}

Psychosurgery is brain surgery with the aim of changing an individual's behavior or psychological function. Historically, this was achieved through ablative psychosurgery that removed or deliberately damaged (lesioning) a section of the brain, but more recently deep brain stimulation is used to remotely stimulate sections of the brain.

One such practice was the lobotomy, that was used between the 1930s and 1950s,{{Rp|20}} for which one its creators, António Egas Moniz, received a Nobel Prize in 1949.{{Cite web |title=The Nobel Prize in Physiology or Medicine 1949 |url=https://www.nobelprize.org/prizes/medicine/1949/summary/ |access-date=2021-02-19 |website=NobelPrize.org |language=en-US}} The lobotomy fell out of favor in by 1960s and 1970s.{{Citation |last1=OpenStax |title=Biomedical Therapies |url=https://pressbooks.online.ucf.edu/lumenpsychology/chapter/biomedical-therapies/ |work=General Psychology |language=en |access-date=2021-02-19 |last2=Learning |first2=Lumen}} Other forms of ablative psychosurgery were in use in the UK in the late 1970s to treat psychotic and mood disorders.{{Cite journal |last=Larry O |first=Gostin |year=1980 |title=Ethical considerations of psychosurgery: The unhappy legacy of the prefrontal lobotomy |journal=Journal of Medical Ethics |volume=6 |issue=3 |pages=149–154 |doi=10.1136/jme.6.3.149 |pmc=1154827 |pmid=7420386}} Bilateral cingulotomy was used to treat substance abuse disorder in Russia until 2002. Deep brain stimulation is used in China to treat substance abuse disorders.{{Cite journal |last1=Ma |first1=Shuo |last2=Zhang |first2=Chencheng |last3=Yuan |first3=Ti-fei |last4=Steele |first4=Douglas |last5=Voon |first5=Valerie |last6=Sun |first6=Bomin |date=2020-03-01 |title=Neurosurgical treatment for addiction: lessons from an untold story in China and a path forward |url=https://academic.oup.com/nsr/article/7/3/702/5679895 |journal=National Science Review |language=en |volume=7 |issue=3 |pages=702–712 |doi=10.1093/nsr/nwz207 |pmid=34692088 |issn=2095-5138 |pmc=8288968}}

In the US, the lobotomy, while initially received with positivity in the late 1930s, came to be seen more negative in the late 1940s and early 1950s. The New York Times discussed the personality changes of lobotomy in 1947, and in the same year the Science Digest reported on papers questioning the effects of lobotomy on personality and intelligence.{{Cite journal |last1=Diefenbach |first1=Gretchen J. |last2=Diefenbach |first2=Donald |last3=Baumeister |first3=Alan |last4=West |first4=Mark |date=1999-04-01 |title=Portrayal of Lobotomy in the Popular Press: 1935–1960 |journal=Journal of the History of the Neurosciences |volume=8 |issue=1 |pages=60–69 |doi=10.1076/jhin.8.1.60.1766 |issn=0964-704X |pmid=11624138}} The lobotomy was prominently depicted a means to control nonconformity in the 1962 book One Flew Over the Cuckoo's Nest.{{Cite book |last=Johnson |first=Jenell |url=https://books.google.com/books?id=n47uBQAAQBAJ |title=American Lobotomy: A Rhetorical History |date=2014-10-17 |publisher=University of Michigan Press |isbn=978-0-472-11944-8 |language=en}}{{Rp|70}}

Psychosurgery was criticized in the US in the late 1960s and 1970s by psychiatrist Peter Breggin. He identified all psychosurgery with the lobotomy as a rhetorical device to criticize the practice of psychosurgery more broadly.{{Rp|116}} He stated that "psychosurgery is a crime against humanity, a crime that cannot be condoned on medical, ethical, or legal grounds". Psycho-surgeons William Beecher Scoville and Petter Lindström said that Breggin's critique was emotional and not based on facts.{{Rp|121}}

Psychosurgery was investigated by the US Senate in the 1973 by the Health Subcommittee of the Senate's Committee on Labor and Public Welfare chaired by Senator Edward Kennedy due to growing concern about the ethical boundaries of science and medicine. At this committee Breggin argued that newer forms of psychosurgery were the same as the lobotomy since it had the same effects "emotional blunting, passivity, reduced capacity to learn" and said that psycho-surgeons "represent the greatest future threat that we are going to face for our traditional American values", arguing that if the US became a totalitarian regime lobotomy and psychosurgery would be the equivalent of the secret police. The subcommittee published a report in 1977 suggesting that data should be carefully collected about psychosurgery and that it should not be performed upon children or prisoners.{{Rp|123}}

Electroconvulsive therapy is a therapy method which was used widely between the 1930s and 1960s and is, in a modified form, still used today.{{cite journal |last1=Tang |first1=Wai-Kwong |last2=Ungvari |first2=Gabor S. |date=January 2001 |title=Asystole during electroconvulsive therapy: a case report |journal=Australian and New Zealand Journal of Psychiatry |volume=35 |issue=3 |pages=382–385 |doi=10.1046/j.1440-1614.2001.00892.x |pmid=11437814 |s2cid=24775828}}{{cite journal |last1=Otsuka |first1=H |last2=Shikama |first2=H |last3=Saito |first3=T |last4=Ishikawa |first4=T |last5=Kemmotsu |first5=O |date=August 2000 |title=[Asystole during electroconvulsive therapy in a patient with depression and myasthenia gravis] |journal=Masui |volume=49 |issue=8 |pages=893–5 |pmid=10998885}} Electroconvulsive therapy was one treatment that the anti-psychiatry movement wanted to be eliminated from psychiatric practice.{{harvnb|Shorter|1997|p=282}}. Their arguments were that ECT damages the brain, and was used as punishment or as a threat to keep the patients "in line". Since then, ECT has improved considerably,{{citation |title=The American Psychiatric Press Textbook of Psychiatry |date=2003 |page=444 |editor1-last=Hales |editor1-first=E |edition=4th |location=Washington, DC |publisher=American Psychiatric Publishing |isbn=978-1-58562-032-6 |oclc=49576699 |editor2-last=Yudofsky |editor2-first=JA}}{{Cite journal |last1=Weiner |first1=Richard D. |last2=Reti |first2=Irving M. |date=2017-03-04 |title=Key updates in the clinical application of electroconvulsive therapy |url=https://www.tandfonline.com/doi/full/10.1080/09540261.2017.1309362 |journal=International Review of Psychiatry |language=en |volume=29 |issue=2 |pages=54–62 |doi=10.1080/09540261.2017.1309362 |issn=0954-0261 |pmid=28406327 |s2cid=205645744|url-access=subscription }} and is now performed under general anesthesia in a medically supervised environment.{{cite journal |last1=Fink |first1=M |last2=Taylor |first2=MA |date=18 July 2007 |title=Electroconvulsive therapy: evidence and challenges |journal=JAMA |volume=298 |issue=3 |pages=330–2 |doi=10.1001/jama.298.3.330 |pmid=17635894}}

The National Institute for Health and Care Excellence recommends ECT for the short-term treatment of severe, treatment-resistant depression, and advises against its use in schizophrenia.{{citation |title=Depression in adults: The treatment and management of depression in adults |date=October 2009 |url=https://www.nice.org.uk/guidance/cg90 |chapter=Guidance |chapter-url=http://www.nice.org.uk/guidance/cg90/chapter/guidance |location=London, UK |publisher=National Institute for Health and Care Excellence}}{{citation |title=The use of electroconvulsive therapy: Understanding NICE guidance – information for service users, their advocates and carers, and the public |date=April 2003 |url=http://www.nice.org.uk/guidance/ta59/resources/ta59-electroconvulsive-therapy-ect-understanding-nice-guidance2 |archive-url=https://web.archive.org/web/20141129101802/http://www.nice.org.uk/guidance/ta59/resources/ta59-electroconvulsive-therapy-ect-understanding-nice-guidance2 |location=London, UK |publisher=National Institute for Health and Care Excellence |format=PDF |isbn=978-1-84257-284-9 |access-date=2015-06-03 |archive-date=2014-11-29 |url-status=dead}} According to the Canadian Network for Mood and Anxiety Treatments, ECT is more efficacious for the treatment of depression than antidepressants, with a response rate of 90% in first line treatment and 50-60% in treatment-resistant patients.{{cite journal |last1=Kennedy |first1=SH |last2=Milev |first2=R |last3=Giacobbe |first3=P |last4=Ramasubbu |first4=R |last5=Lam |first5=RW |last6=Parikh |first6=SV |last7=Patten |first7=SB |last8=Ravindran |first8=AV |date=October 2009 |title=Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults. IV. Neurostimulation therapies |journal=J Affect Disord |volume=117 |issue=Suppl 1 |pages=S44–53 |doi=10.1016/j.jad.2009.06.039 |pmid=19656575}}

The most common side effects of ECT include headache, muscle soreness, confusion, and temporary loss of recent memory.{{Cite journal |last1=Weiner |first1=Richard D. |last2=Reti |first2=Irving M. |date=2017-03-04 |title=Key updates in the clinical application of electroconvulsive therapy |url=https://www.tandfonline.com/doi/full/10.1080/09540261.2017.1309362 |journal=International Review of Psychiatry |language=en |volume=29 |issue=2 |pages=54–62 |doi=10.1080/09540261.2017.1309362 |issn=0954-0261 |pmid=28406327 |quote=ECT is associated with both anterograde and retrograde amnesia. Studies utilizing objective measures of assessing anterograde amnesia have consistently demonstrated that any such abnormalities disappear within several months following completion of an acute ECT course. Several recent studies have even demonstrated improvement in cognitive function, compared to baseline, several weeks to months after successful treatment with ECT. An even more recently published study that reviewed 10 years of cognitive performance data in relation to ECT concluded that there is no evidence of cumulative cognitive deficits associated with repeated ECT courses. |s2cid=205645744|url-access=subscription }}{{cite journal |last1=Rose |first1=D |last2=Fleischmann |first2=P |last3=Wykes |first3=T |last4=Leese |first4=M |last5=Bindman |first5=J |date=21 June 2003 |title=Patients' perspectives on electroconvulsive therapy: systematic review |journal=BMJ |volume=326 |issue=7403 |page=1363 |doi=10.1136/bmj.326.7403.1363 |pmc=162130 |pmid=12816822}} Patients may also experience permanent amnesia.{{Cite journal |last1=Robertson |first1=Harold |last2=Pryor |first2=Robin |date=May 2006 |title=Memory and cognitive effects of ECT: informing and assessing patients† |journal=Advances in Psychiatric Treatment |language=en |volume=12 |issue=3 |pages=228–237 |doi=10.1192/apt.12.3.228 |issn=1355-5146|doi-access=free }}

Psychiatry has greatly benefitted by advances in pharmacotherapy.{{rp|110–112}}{{cite web |date=December 2012 |title=The Relationship between Psychiatrists, College of Psychiatrists of Ireland and the Pharmaceutical Industry: Position Paper EAP04/2013 |url=http://www.irishpsychiatry.ie/Libraries/External_Affairs/CPsychI_Position_Paper_Psychiatrists_relationship_with_Pharmaceutical_Companies_20_03_13.sflb.ashx |url-status=dead |archive-url=https://web.archive.org/web/20141104151949/http://www.irishpsychiatry.ie/Libraries/External_Affairs/CPsychI_Position_Paper_Psychiatrists_relationship_with_Pharmaceutical_Companies_20_03_13.sflb.ashx |archive-date=2014-11-04 |access-date=2013-04-22 |publisher=College of Psychiatrists of Ireland |format=PDF}} However, the close relationship between those prescribing psychiatric medication and pharmaceutical companies, and the risk of a conflict of interest, is also a source of concern. This relationship is often described as being part of the medical-industrial complex. This marketing by the pharmaceutical industry has an influence on practicing psychiatrists, which affects prescription. Child psychiatry is one of the areas in which prescription of psychotropic medication has grown massively. In the past, prescription of these medications for children was rare, but nowadays child psychiatrists prescribe psychotropic substances, such as Ritalin, on a regular basis to children.{{rp|110–112}}

Joanna Moncrieff has argued that antipsychotic drug treatment is often undertaken as a means of control rather than to treat specific symptoms experienced by the patient.{{cite web |last=James |first=Adam |date=2 March 2008 |title=Myth of the antipsychotic |url=https://www.theguardian.com/commentisfree/2008/mar/02/mythoftheantipsychotic |access-date=27 July 2012 |work=The Guardian |publisher=Guardian News and Media Limited}} Moncreiff has further argued, in the controversial and non-peer reviewed journal Medical Hypotheses, that the evidence for antipsychotics from discontinuation-relapse studies may be flawed, because they do not take into account that antipsychotics may sensitize the brain and provoke psychosis if discontinued, which may then be wrongly interpreted as a relapse of the original condition.{{cite journal |author=Moncrieff J |year=2006 |title=Why is it so difficult to stop psychiatric drug treatment? It may be nothing to do with the original problem |journal=Med. Hypotheses |volume=67 |issue=3 |pages=517–23 |doi=10.1016/j.mehy.2006.03.009 |pmid=16632226}}

Use of this class of drugs has a history of criticism in residential care. As the drugs used can make patients calmer and more compliant, critics claim that the drugs can be overused. Outside doctors can feel pressure from care home staff.GPs under 'pressure' to issue neuroleptics, claims professor, Chemist + Druggist, 15 January 2009 In an official review commissioned by UK government ministers it was reported that the needless use of antipsychotic medication in dementia care was widespread and was linked to 1800 deaths per year.{{cite news |author=Nick Triggle |date=12 November 2009 |title=Dementia drug use 'killing many' |newspaper=BBC |url=http://news.bbc.co.uk/2/hi/health/8356423.stm |access-date=2013-05-07}}{{cite news |date=Nov 12, 2009 |title=UK study warns against antipsychotics for dementia |newspaper=reuters |url=https://www.reuters.com/article/2009/11/12/dementia-drugs-idUSLC44347420091112 |url-status=dead |access-date=2013-05-07 |archive-url=https://web.archive.org/web/20140720105333/http://www.reuters.com/article/2009/11/12/dementia-drugs-idUSLC44347420091112 |archive-date=2014-07-20}} In the US, the government has initiated legal action against the pharmaceutical company Johnson & Johnson for allegedly paying kickbacks to Omnicare to promote its antipsychotic risperidone (Risperdal) in nursing homes.{{Cite news |author=Hilzenrath, David S. |date=16 January 2010 |title=Justice suit accuses Johnson & Johnson of paying kickbacks |newspaper=The Washington Post |url=https://www.washingtonpost.com/wp-dyn/content/article/2010/01/15/AR2010011503903.html |access-date=17 January 2010}}

There has also been controversy about the role of pharmaceutical companies in marketing and promoting antipsychotics, including allegations of downplaying or covering up adverse effects, expanding the number of conditions or illegally promoting off-label usage; influencing drug trials (or their publication) to try to show that the expensive and profitable newer atypicals were superior to the older cheaper typicals that were out of patent.{{Citation needed|reason=unreferenced opinion|date=May 2019}} Following charges of illegal marketing, settlements by two large pharmaceutical companies in the US set records for the largest criminal fines ever imposed on corporations.{{cite news |last=Wilson |first=Duff |date=October 2, 2010 |title=Side Effects May Include Lawsuits |work=The New York Times |url=https://www.nytimes.com/2010/10/03/business/03psych.html}} One case involved Eli Lilly and Company's antipsychotic Zyprexa, and the other involved Bextra. In the Bextra case, the government also charged Pfizer with illegally marketing another antipsychotic, Geodon. In addition, Astrazeneca faces numerous personal-injury lawsuits from former users of Seroquel (quetiapine), amidst federal investigations of its marketing practices.{{cite news |author=DUFF WILSON |date=27 February 2009 |title=Drug Maker's E-Mail Released in Seroquel Lawsuit |work=The New York Times |url=https://www.nytimes.com/2009/02/28/business/28drug.html |access-date=27 July 2012}} By expanding the conditions for which they were indicated, Astrazeneca's Seroquel and Eli Lilly's Zyprexa had become the biggest selling antipsychotics in 2008 with global sales of $5.5 billion and $5.4 billion respectively.[https://web.archive.org/web/20120218005726/http://www.healthcarefinancenews.com/press-release/pipeline-antipsychotic-drugs-drive-next-market-evolution Pipelineantipsychotic drugs to drive next market evolution (2009)]. Healthcarefinancenews.com (7 August 2009).

Harvard medical professor Joseph Biederman conducted research on bipolar disorder in children that led to an increase in such diagnoses. A 2008 Senate investigation found that Biederman also received $1.6 million in speaking and consulting fees between 2000 and 2007— some of them undisclosed to Harvard— from companies including the makers of antipsychotic drugs prescribed for children with bipolar disorder. Johnson & Johnson gave more than $700,000 to a research center that was headed by Biederman from 2002 to 2005, where research was conducted, in part, on Risperdal, the company's antipsychotic drug. Biederman has responded saying that the money did not influence him and that he did not promote a specific diagnosis or treatment.

In 2004, University of Minnesota research participant Dan Markingson committed suicide while enrolled in an industry-sponsored pharmaceutical trial comparing three FDA-approved atypical antipsychotics: Seroquel (quetiapine), Zyprexa (olanzapine), and Risperdal (risperidone). Writing on the circumstances surrounding Markingson's death in the study, which was designed and funded by Seroquel manufacturer AstraZeneca, University of Minnesota Professor of Bioethics Carl Elliott noted that Markingson was enrolled in the study against the wishes of his mother, Mary Weiss, and that he was forced to choose between enrolling in the study or being involuntarily committed to a state mental institution.Elliott, Carl (September/October 2010). "[https://www.motherjones.com/environment/2010/09/dan-markingson-drug-trial-astrazeneca The deadly corruption of clinical trials.]" Mother Jones Further investigation revealed financial ties to AstraZeneca by Markingson's psychiatrist, Dr. Stephen C. Olson, oversights and biases in AstraZeneca's trial design, and the inadequacy of university Institutional Review Board (IRB) protections for research subjects.{{cite web |author=Carl |date=2012-11-23 |title=Dan Markingson Investigation |url=http://markingson.blogspot.com/ |access-date=February 14, 2016}} A 2005 FDA investigation cleared the university. Nonetheless, controversy around the case has continued. Mother Jones resulted in a group of university faculty members sending a public letter to the university Board of Regents urging an external investigation into Markingson's death.{{cite web |title=U of M Board of Regents Markingson Letter |url=https://www.scribd.com/doc/49659724/U-of-M-Board-of-Regents-Markingson-Letter |access-date=February 14, 2016 |work=Scribd}}

Pharmaceutical companies have also been accused of attempting to set the mental health agenda through activities such as funding consumer advocacy groups.{{cite journal |vauthors=Gosden R, Beder S |year=2001 |title=Pharmaceutical industry agenda setting in mental health policies |url=http://www.uow.edu.au/~sharonb/pharm-agenda.html |url-status=dead |journal=Ethical Human Sciences and Services |volume=3 |issue=3 |pages=147–59 |doi=10.1891/1523-150X.3.3.147 |doi-broken-date=1 November 2024 |pmid=15278977 |archive-url=https://web.archive.org/web/20100430002638/http://www.uow.edu.au/~sharonb/pharm-agenda.html |archive-date=2010-04-30 |access-date=2016-06-22}}

In an effort to reduce the potential for hidden conflicts of interest between researchers and pharmaceutical companies, the US Government issued a mandate in 2012 requiring that drug manufacturers receiving funds under the Medicare and Medicaid programs collect data, and make public, all gifts to doctors and hospitals.{{rp|317}}

{{Main|Experimentation on prisoners}}

{{Main|Anti-psychiatry}}

The term anti-psychiatry was coined by psychiatrist David Cooper in 1967 and is understood in current psychiatry to mean opposition to psychiatry's perceived role aspects of treatment. The anti-psychiatry message is that psychiatric treatments are "ultimately more damaging than helpful to patients". Psychiatry is seen to involve an "unequal power relationship between doctor and patient", and advocates of anti-psychiatry claim a subjective diagnostic process, leaving much room for opinions and interpretations.{{cite journal |last=Nasrallah |first=Henry A. |date=December 2011 |title=The antipsychiatry movement: Who and why |url=http://www.currentpsychiatry.com/fileadmin/cp_archive/pdf/1012/1012CP_Editorial.pdf |url-status=dead |journal=Current Psychiatry |volume=10 |issue=12 |pages=4, 6, 53 |archive-url=https://web.archive.org/web/20150207004541/http://www.currentpsychiatry.com/fileadmin/cp_archive/pdf/1012/1012CP_Editorial.pdf |archive-date=2015-02-07 |access-date=2015-06-03}} Every society, including liberal Western society, permits compulsory treatment of mental patients. The World Health Organization (WHO) recognizes that "poor quality services and human rights violations in mental health and social care facilities are still an everyday occurrence in many places", but has recently taken steps to improve the situation globally.{{cite web|title=WHO gives countries tools to help stop abuse of people with mental health conditions|url=https://www.who.int/mediacentre/news/notes/2012/mental_health_20120615/en/|archive-url=https://web.archive.org/web/20140314074138/http://www.who.int/mediacentre/news/notes/2012/mental_health_20120615/en/|url-status=dead|archive-date=March 14, 2014|publisher=WHO|access-date=12 June 2014}}

Electroconvulsive therapy is a therapy method, which was used widely between the 1930s and 1960s and is, in a modified form, still in use today. Valium and other sedatives have arguably been over-prescribed, leading to a claimed epidemic of dependence. These are a few of the arguments that the anti-psychiatry movement use to highlight the harms of psychiatric practice.

Multiple authors are well known for the movement against psychiatry, including those who have been practicing psychiatrists. The most influential was R.D. Laing, who wrote a series of books, including; The Divided Self.

Thomas Szasz rose to fame with the book The Myth of Mental Illness.

Michel Foucault challenged the very basis of psychiatric practice and cast it as repressive and controlling. The term "anti-psychiatry" itself was coined by David Cooper in 1967. The founder of the non-psychiatric approach to psychological suffering is Giorgio Antonucci.

Divergence within psychiatry generated the anti-psychiatry movement in the 1960s and 1970s, and is still present. Issues remaining relevant in contemporary psychiatry are questions of; freedom versus coercion, mind versus brain, nature versus nurture, and the right to be different.

{{See also|Outline of the psychiatric survivors movement}}

The psychiatric survivors movement{{Cite book| publisher = John Wiley and Sons|isbn=978-1-119-99612-5| last = Corrigan| first = Patrick W.|author2=David Roe |author3=Hector W. H. Tsang | title = Challenging the Stigma of Mental Illness: Lessons for Therapists and Advocates| date = 2011-05-23| url = https://books.google.com/books?id=mf6MIScKn0EC&q=%22MindFreedom%22&pg=PT20}} arose out of the civil rights ferment of the late 1960s and early 1970s and the personal histories of psychiatric abuse experienced by some ex-patients rather than the intradisciplinary discourse of antipsychiatry.{{cite journal | author = Oaks D | title = The evolution of the consumer movement | journal = Psychiatric Services | volume = 57 | issue = 8 | page = 1212 | date = 2006-08-01 | pmid = 16870979 | doi = 10.1176/appi.ps.57.8.1212 }} The key text in the intellectual development of the survivor movement, at least in the US, was Judi Chamberlin's 1978 text, On Our Own: Patient Controlled Alternatives to the Mental Health System.{{Cite book| publisher = Hawthorne| last = Chamberlin| first = Judi| title = On Our Own: Patient-Controlled Alternatives to the Mental Health System| location = New York| year = 1978 |isbn=978-0-8015-5523-7}} Chamberlin was an ex-patient and co-founder of the Mental Patients' Liberation Front.{{cite journal |vauthors=Rissmiller DJ, Rissmiller JH | title = Evolution of the antipsychiatry movement into mental health consumerism | journal = Psychiatric Services | volume = 57 | issue = 6 | pages = 863–6 [865] | date = 2006-06-01 | pmid = 16754765 | doi = 10.1176/appi.ps.57.6.863 | s2cid = 19635873 }} Coalescing around the ex-patient newsletter Dendron,{{cite journal| doi = 10.1176/appi.ps.57.8.1213| volume = 57| issue = 8| page = 1213| last = Ludwig| first = Gregory| title = Letter| journal = Psychiatric Services| date = 2006-08-01|pmid=16870981}} in late 1988 leaders from several of the main national and grassroots psychiatric survivor groups felt that an independent, human rights coalition focused on problems in the mental health system was needed. That year the Support Coalition International (SCI) was formed. SCI's first public action was to stage a counter-conference and protest in New York City, in May, 1990, at the same time as (and directly outside of) the American Psychiatric Association's annual meeting.[http://www.mindfreedom.org/about-us About Us — MFI Portal] In 2005 the SCI changed its name to Mind Freedom International with David W. Oaks as its director.

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• {{citation|last=Gask|first=L|date=2004|title=A Short Introduction to Psychiatry|location=London|publisher=SAGE Publications Ltd.|isbn=978-0-7619-7138-2}}
• {{citation|last=Guze|first=SB|date=1992|title=Why Psychiatry Is a Branch of Medicine|location=New York|publisher=Oxford University Press|isbn=978-0-19-507420-8}}
• {{citation|last=Lyness|first=JM|date=1997|title=Psychiatric Pearls|location=Philadelphia|publisher=F.A. Davis Company|isbn=978-0-8036-0280-9}}
• {{citation|last=Shorter|first=E|date=1997|title=A History of Psychiatry: From the Era of the Asylum to the Age of Prozac|location=New York: John Wiley & Sons, Inc.|isbn=978-0-471-24531-5}}

{{Refend}}

{{Anti-psychiatry}}