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Monday 30 April 2012

BOOK REVIEW - " Crazy Like Us: The Globalization of the American Psyche. " BY ETHAN WATTERS

Review – Ethan Watters. Crazy Like Us: The Globalization of the American Psyche. 
New York: Free Press, 2010.

This book aims to demonstrate how, regrettably, over the last twenty years or so, typically American conceptions of mental illness have been exported successfully to the rest of the world. According to Watters, the often enthusiastic international reception of DSM-III and IV with its standardized descriptions of typical American forms of mental anguish, has homogenized human suffering all over the world. Psychiatry appears to be following the example of McDonald’s, which successfully homogenized (and worsened) the daily diet of humankind.

Watters presents his argument with four case studies. The first one focuses on the tragic death of an emaciated 14-year old woman in Hong Kong, who fainted and fell to her death in broad daylight in 1994. When journalists wanted to report on the case, they quickly found out, using Google, about the symptoms and causes of anorexia nervosa. Soon after, awareness campaigns and prevention programs were organized based on Western insights—and lo and behold, the number of young women in Hong Kong suffering from anorexia nervosa increased dramatically. By way of contrast, Watters describes the research and ideas of Dr. Sing Lee, who had studied a small number of women patients who had deliberately starved themselves. Interestingly, they did not display the symptoms of anorexia nervosa. They did not have a morbid fear of becoming overweight, did not have body image issues, and did not starve themselves to look thin and attractive. It appeared that Dr. Lee had found a rare form of mental illness which might be unique to Asia, and which resembled anorexia nervosa, but was a distinct disease entity. Unfortunately, he was not able to cure this condition with the aid of traditional Chinese medicine and other approaches based on local culture. His only patient with this condition died of starvation.

The second case focuses on the effort to relieve the trauma of the inhabitants of Sri Lanka after the tsunami. The descriptions of NGOs falling over each other and investing significant resources in turf wars are familiar by now. The conclusion that construction materials were needed more urgently than trauma counsellors can come as no surprise. Nevertheless, Watters judges the influence of these counsellors to be relatively benign—ending his chapter with the bemused smiles of young children drawing and painting, not having the faintest idea of what the art therapist who gave the material to them was up to. The third case study focuses on the way an individual with schizophrenia was maintained by his family in Zanzibar. The narrative is moving but because it only involves one individual, it is hard to make any generalizations.

The last study deals with the mega-marketing of depression in Japan. It details the successful efforts of GlaxoSmithKline, the producers of Paxil, to introduce new conceptions of sadness and depression to Japan. Previously, Japanese psychiatry and popular thinking only acknowledged a rare and very severe form of depression, which required institutionalization. Medical anthropologists and open-minded psychiatrists were feted in exclusive holiday resorts and received generous honoraria for their willingness to share their insights with CEOs and marketing experts. A smart marketing campaign then presented new images of depression—after all, experience in the Western world had demonstrated that marketing disease leads to much higher sales that marketing specific cures. The image of depression that was presented to the Japanese public was left deliberately vague, but it was one that could affect almost everyone, in particular the young, the smart, the aspiring, and the successful. Ask-your-doctor commercials appeared everywhere, de-stigmatizing depression and encouraging individuals to take charge of their own condition by requesting prescriptions. At the same time (around the year 2000), as we now know, the evidence in favour of Paxil (and many other SSRIs) remained flimsy, incomplete, and inconclusive. Undesirable side-effects (including, possibly, akathisia, violent behaviour and increased risk of suicide) had been deliberately swept under the carpet. Nevertheless, marketing campaigns do not let questionable science stand in the way of good sales figures.

Of course, it should be emphasized that the pharmaceutical industry is very interested in Japan, because it is a wealthy country. This contrasts with its complete lack of interest in many developing nations, which are often deprived of much-needed medications. The chapter on the mega-marketing of SSRIs in Sri Lanka, for example, would be remarkably brief.

There is much to commend about Watters’ book. It is a page-turner which hardly ever fails to engage its reader. It is significant that recent developments in the history of psychiatry are discussed—after all, we know an awful lot about the asylum by now, but not much about what happened after the 1960s. Studies focusing on the post-World War II world are still relatively rare, even though significant developments in psychiatry and mental health care have taken place over the last sixty years (deinstitutionalization and the development of psychopharmacology, to mention only two). Also appealing is Watters’ discussion of the “rest of the world.” Thus far, most historians of psychiatry have focused on psychiatry in the Western world. Over the past twenty years, colonial psychiatry has received ample scholarly attention, but studies on this topic have often focused on the activities of Western psychiatrists in far-away places (articulating theories in which “race” took the place of “class”). Unfortunately, the reactions, ideas, initiatives, and theories of the original inhabitants of these far-away places are rarely taken into account.  This is exactly what Watters does—although he presents Western (or, more accurately, American) psychiatry as decisively hegemonic. As a consequence, psychiatrists, other mental health care workers, and media types concerned about mental illness in the rest of the world appear almost exclusively reactive. The flow of ideas, however pernicious in its effect, moves from the United States to the rest of the world—and, strangely enough, the rest of the world enthusiastically embraces it, discarding much more refined and interesting indigenous approaches (even though they do not actually work in the examples given in the book—and many more examples of traditional healing methods in the developing world could be mentioned that are inhumane and cruel). The four case studies are sufficiently diverse to compare and contrast responses to mental illness and Western psychiatry.

Nevertheless, a feeling remains that the story fits together too well. Criticizing American initiatives has been a favourite activity of academics for some time now—Watters’ analysis therefore has a familiar feel.  Nevertheless, one could imagine countless scenarios in which psychiatrists and other mental health care workers in the non-Western world maintain a more level-headed approach to the patients they see (in all fairness, Watters’ ire is mostly reserved for uncritical media types and pharmaceutical corporations, rather than for physicians). After all, many American mental health care practitioners often view picking a DSM-diagnosis as a bureaucratic exercise after which the real treatment can begin. The importance of DSM in many developing countries appears to be somewhat overstated.

If the influence of American psychiatric ideas could be diminished, psychiatric anthropologists would be able to conduct more interesting research projects. At least that appears to be Watters’ opinion. His interest in the rest of the world is laudable. Nevertheless, he completely overlooks the fact that in most developing countries, there are hardly any psychiatrists and access to psychotropic drugs is very difficult. As a consequence, many individuals do not receive the care they need and suffer unnecessarily. If Watters’ caution were widely heeded, this situation would likely only worsen.

Lastly, why should we be particularly concerned about the disappearance of various culturally-specific forms of mental suffering? Watters compares the disappearance of exotic forms of mental illness (often described as culture-bound syndromes) to the increasing extinction of plant and animal species, which is impoverishing the bio-sphere. The metaphor of disappearing species is not altogether convincing—who would, after all, advocate preserving the current diversity in suffering? Because Watters often appears to be critical of American psychiatry, his descriptions of reactions to mental illness in the rest of the world are often empathic, generous, and positive, while American approaches only appear in a negative light. Seen that way, the pervasive influence of American psychiatric thinking is easily regarded as pernicious—in particular if it is a poor fit with the experiential world of non-American patients. The often cruel and pointless treatment methods that are still widespread in the non-Western world do not find a place within this book.

Hans Pols, University of Sydney

BOOK REVIEW - "MAKING US CRAZY" - by Herb Kutchins & Stuart A. Kirk


Book Review
MAKING US CRAZY by Herb Kutchins & Stuart A. Kirk; Constable, London, 1999.

Miles Clapham

 "Making us Crazy" is a book for those who want to look at the politics of how certain psychiatric diagnoses have been included or excluded from the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA). It is a history of the downfall of homosexuality as a psychiatric illness, of masochistic personality disorder (read Stepford Wives Syndrome), and the, somewhat ironic, battle to include post traumatic stress disorder (PTSD) as a diagnosis. It also examines some of the vicissitudes of the diagnosis of borderline personality disorder, particularly when it seems to let male psychiatrists and therapists off the hook for sleeping with their screwed up but ever so seductive female patients. Importantly it looks at the effects of racism on psychiatric diagnosis both historically and as it continues today.

There is a lot of detailed reportage on the pressure groups, such as Vietnam veterans and gay and lesbian groups as well as the psychiatrists who responded to or opposed these groups. In some areas the debate still rages, for example there was fury a few years ago when Socarides, who is a major proponent of the position that homosexuality is an illness, came to speak in the UK about his ideas.

The book raises some serious general issues. At one level there is the tie up between the health insurance industry and the APA, which are perhaps not so uneasy bed partners in deciding what is a disorder, and what treatment is appropriate, or at least what treatment will be funded by the insurers. There is a crucial point here for those that see the NHS following the US model. In order to get treatment paid for a person has to have a classifiable disorder - so according to Kutchins and Kirk, supposedly rigorously determined criteria may be bent; and the treatment must fit the disorder - so, although the authors don't draw this point out, there is an ever greater tendency towards practice guidelines, "evidence based" practice, and conformity in treatment.

The DSM, ever since the third edition, has had a descriptive approach to diagnosis, listing the necessary criteria for each disorder. As "Making us Crazy" shows, it is possible with some disorders, especially of personality, to have a very different symptom list and still have the same diagnosis. This has implications for both the validity and reliability of these diagnostic categories, which are the twin pillars of both clinical practice and research. The authors also discuss how changes from DSM III, to DSM III R, to the current DSM IV, also raise the issue of validity and reliability, especially when research evidence based on changed categories from DSM III is used to inform current service delivery. For example, obsessive compulsive disorder according to DSM III affected 2.6% of the population (lifetime risk) but the more restrictive DSM III R criteria categorize far fewer people as having OCD.

The authors do ask the question, what is a mental disorder? They point out some of the philosophical and ethical issues here but do not manage to really address them. How do we say what it is about a particular state of being that makes it a mental illness? For example, is Hamlet mad, or do the twists of his thought reflect and interpret the murder of his father by his uncle, and the incestuous marriage between his uncle and his mother? Are both true? Is a multiply sexually abused girl who hears voices of her abusers telling her to kill herself, and frequently tries to obey, responding understandably to the abuse, or psychotic, or both?

Others have attacked psychiatry for its diagnostic systems and its self-justification. Notoriously Laing said, "schizophrenia is a condition attributed by psychiatrists to people they call schizophrenic." Kutchins and Kirk also show the circularity inherent in many psychiatric diagnoses but cannot arrive at a more fundamental critique. They are not helped by an Introduction by Dorothy Rowe that gives itself over to the sort of anti-psychiatric polemic that Laing himself repudiated later in his life. Rowe's mocking of attempts to find "the schizophrenia gene" takes no account of the science nor the humane efforts involved and runs the risk of putting off more serious readers.

Foucault has shown in "Madness and Civilization" how psychiatric power can be used as one arm of social control, and how diagnosing madness invalidates the experiences of the mad. But psychiatry also is fundamentally informed by concern for the other's suffering, and the tragedy of mental illness. This ambivalence is to some extent addressed by the chapter on PTSD, and the long campaign by Vietnam veterans and supporters to get this diagnosis recognized so that veterans could get help for the effects of the combat they had to live with. In this case the recognition of the disorder was seen as validating the experiences of the ex-soldiers.

The chapter on borderline personality disorder addresses more the question of doctors and therapists having sexual relationships with their patients. This is an important area that involves an exploitation of power and trust. The argument that patients' claims of abuse are invalidated by labeling them as personality disordered is off the point. There is an inherent invalidation of the patient in such a situation, as there is in any abuse, and any abuser worth the term will do everything he or she can to wiggle out of responsibility. The claim that the borderline diagnosis "purports to explain how difficult and angry women seduce their unsuspecting therapist" is spurious. There are many other questions about this diagnosis that require serious discussion that the authors do not take up.

"Making us Crazy" is a social history of some aspects of recent psychiatric practice, and the behind the scenes goings on that "inform" some diagnostic categories. It is an interesting read, allowing for its polemical intent. Its weakness is that although its intention is to call into question the validity of psychiatric diagnoses, its focus on historical detail means that it cannot address the fundamental issues involved when one person sits down with another, and one attempts to objectively categorize the other for the purposes of psychiatric treatment. Kutchins and Kirk are saying that psychiatry often makes us crazy when we are "just human", but they do not show the deep complexity of the problem, and of the ethical and practical issues involved.

Sunday 29 April 2012

BOOK REVIEW - "The Myth of Autism: Medicalising Men's and Boys' Social and Emotional Competence." - BY SAMI TIMIMI ET AL.

The Myth of Autism: Medicalising Men's and Boys' Social and Emotional Competence
by Sami Timimi, Neil Gardner, Brian McCabe

In this unique text a prominent critic of mainstream child and adolescent psychiatric theory and practice, Sami Timimi, collaborates with two ex-service users to re-examine, deconstruct and critique modern mainstream theory and practice in relation to autism. They track changes in the conceptualisation of autism in the West from a rare disorder affecting a small number of individuals with moderate to severe learning difficulties to becoming a broad continuum mainly diagnosed in males deemed to have poor social or emotional competence. Arguing that this change is primarily ideological -- the result of a change in the way we think about social and emotional competence, rather than any new scientific discovery -- the authors illustrate how the medicalisation of boys' and men's social and emotional behaviour has a close relationship to social, political, economic, and cultural changes that have occurred in Western culture in recent decades. Their conclusion is controversial- the concept of Autism has become a hindrance rather than a help and so our whole approach to the diagnosis needs re-consideration, including the possibility that this diagnosis has gone past its sell-by date and should be abandoned.

Hardcover, 180 pages
Published December 15th 2010 by Palgrave Macmillan

BOOK REVIEW - "Pathological Child Psychiatry And The Medicalization Of Childhood." - BY PROFESSOR SAMI TIMIMI



Pathological Child Psychiatry And The Medicalization Of Childhood

5.0 of 5 stars 5.00  · 
Currently, it is common practice among the child psychiatric establishment to prescribe powerful and potentially addictive drugs to children who have emotional or behavioural problems. Pathological Child Psychiatry and the Medicalization of Childhood is a strong challenge to this way of thinking.
Sami Timimi uses a wide variety of sources that shape our understanding including his personal experiences to highlight the role of culture, beliefs, science, social hierarchy and power, in shaping our understanding of childhood problems and how to deal with them. He urges professionals who work with children to question their assumptions in a manner that will enable them to access a greater variety of potentially helpful therapeutic frameworks.
Since the 1960s, psychiatry has had to learn to accommodate critical analysis of its beliefs and methods. The legitimacy of its core assumptions continues to be questioned. Now child psychiatry too must engage with such a debate, if it wishes to develop into a genuinely democratic and inclusive profession. Pathological Child Psychiatry and the Medicalization of Childhood will be of great interest to professionals and trainees in psychiatry and child psychiatry, social work, family therapy and other psychotherapies for children and adolescents.

BOOK REVIEW - "Critical voices in child and adolescent mental health."

Critical voices in child and adolescent mental health.

Sami Timimi, Begum Maitra

Free Association Books, 2006 - Medical - 228 pages

There is a crisis of credibility within child and adolescent psychiatry. Child and adolescent mental health theory and practice have come to be dominated by a narrow biomedical frame. Rising numbers of children are being diagnosed with psychiatric illnesses and given psychotropic medication to treat these illnesses. This text brings together knowledgeable specialists across the spectrum of child and adolescent psychiatry, which are deeply critical about current mainstream theory and practice. These critical voices drawing upon research and writing from related disciplines, radically question many of psychiatry's most cherished assumptions and offer new ways of thinking about theory and practice. This courageous book brings marginal voices into the mainstream. Exploring the influence of drug companies, the impact of trauma, the crisis in academic medicine, systemic perspectives, adolescent in-patient units, ADHD, childhood depression, and the role of diet and nutrition.


The Myth of Mental Illness
From Wikipedia, the free encyclopedia.

The 1984 Harper Perennial edition
Author(s)     Thomas Szasz
Country     United States of America
Language     English
Genre(s)     Psychology
Publisher     Harper & Row
Publication date     1961

The Myth of Mental Illness: Foundations of a Theory of Personal Conduct is a book by Thomas Szasz first published in 1961. It is perhaps the best known argument against the tendency of psychiatrists to label people who are 'disabled by living' as mentally ill. Richard Webster notes that its arguments are similar to his in a number of significant respects, but that their views of hysteria and the work of Jean-Martin Charcot are quite different, since Szasz assumes that hysteria was an emotional problem and that Charcot's patients were not genuinely mentally ill.[1]

The Myth of Mental Illness was described by David Cooper as "a decisive, carefully documented demystification of psychiatric diagnostic labelling in general."[2]

    1 References
    2 See also
    3 Citation
    4 External links


    ^ Webster, Richard (2005). Why Freud Was Wrong: Sin, Science and Psychoanalysis. Oxford: The Orwell Press. pp. 595–596. ISBN 0-9515922-5-4.
    ^ Cooper, David (1978). The Language of Madness. London: Allen Lane. p. 129. ISBN 0-7139-1118-2.

See also

    Liberation by Oppression
    The Politics of Experience
    Psychiatry: An Industry of Death


Szasz, Thomas Stephen, "The myth of mental illness; foundations of a theory of personal conduct", New York : Hoeber-Harper, 1961.
External links

    Text of the original paper The Myth of Mental Illness




    Biopsychiatry controversy
    Critical psychiatry
    Eli Lilly controversies
    History of mental disorders
    Involuntary commitment
    Involuntary treatment
    Outline of the psychiatric survivors movement
    Political abuse of psychiatry
    Psychiatric survivors movement
    Psychiatry: An Industry of Death
    Psychoanalytic theory
    Recovery model
    Rosenhan experiment
    Self-help groups for mental health
    Therapeutic community


    American Association for the Abolition of Involuntary Mental Hospitalization
    Citizens Commission on Human Rights
    Hearing Voices Network
    Icarus Project
    Mad Pride
    Mental Disability Rights International
    MindFreedom International
    National Empowerment Center
    Radical Psychology Network
    Paranoia Network
    World Network of Users and Survivors of Psychiatry


    Linda Andre
    Franco Basaglia
    Fred Baughman
    Clifford Whittingham Beers
    Lauretta Bender
    Richard Bentall
    Peter Breggin
    Ted Chabasinski
    Judi Chamberlin
    David Cooper
    Lyn Duff
    Michel Foucault
    Leonard Roy Frank
    James Gottstein
    R.D. Laing
    Peter Lehmann
    Kate Millett
    Loren Mosher
    David Oaks
    Elizabeth Packard
    Thomas Szasz
    Robert Whitaker


    Against Therapy
    Anatomy of an Epidemic
    Asylums (book)
    Crazy Therapies
    Interpretation of Schizophrenia
    Liberation by Oppression: A Comparative Study of Slavery and Psychiatry
    Mad in America
    Madness and Civilization
    The Protest Psychosis: How Schizophrenia Became a Black Disease
    The Gene Illusion
    The Myth of Mental Illness
    The Politics of Experience
    We've Had a Hundred Years of Psychotherapy – And the World's Getting Worse

BOOK REVIEW - "Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands." - COURTESY OF THE CRITICAL PSYCHIATRY WEBSITE


Essay review of Cultures of Psychiatry and Mental Health Care in Postwar Britain and the Netherlands (eds) Gijswijt-Hofstra M & Porter R. Amsterdam: Wellcome Institute 1998

Sufficient time has elapsed to reflect on the history of "anti-psychiatry". One prevailing version of that history is that it was a passing phase (Tantam 1991). Another view places anti-psychiatry in its broader cultural context and sees it in terms of its continuities. The book Cultures of Psychiatry takes the latter refreshing approach. It is one of a productive series in the History of Medicine from the Wellcome Institute (series editors WF Bynum and Roy Porter). The contents emerged from a workshop held in June 1997 in Amsterdam organised by the Wellcome Institute for the History of Medicine (London) and the Dutch Huizinga Institute for Cultural History. Cross-national comparisons are made between post-war Britain and the Netherlands, exploring how these similar but contrasting national cultures have had an impact on the presence of critical psychiatry. Fourteen papers are presented, matched in Anglo-Dutch pairs, with two concluding commentatory chapters.

The quality of contributions naturally varies. Some chapters fail to provide a novel perspective, whereas others are an inspiring stimulus for further research. In all, the book deserves to be better known. This essay review concentrates on those aspects of the book which illuminate the nature of anti-psychiatry.

The first chapter by Joan Busfield sets an overview of twentieth century developments in mental health services in Britain. It includes the recent influence of the Thatcherite ideological bias for competition and private provision rather than public sector expenditure. In the matching chapter, Paul Schnabel focuses on Dutch psychiatry after the second world war. There may be something to learn for the current reform of the Mental Health Act in England and Wales from the fact that the present Dutch 'lunacy act' followed a parliamentary debate that took more than 20 years.

Mathew Thomson recognises the roots of anti-psychiatry in the social psychiatry of the Second World War and postwar reconstruction. As he notes, there was no earlier British equivalent of the lay critique of psychiatry by Clifford Beers, leader of the American mental hygiene movement. The links between mental hygiene and the promotion of peace are apparent in a letter drafted by the Netherlands Medical Association in 1935 and signed by 339 leading psychiatrists around the world. The psychological ideas related to mental hygiene came together in the formation of the World Federation of Mental Health in 1948 at an International Congress in London, of which J R Rees, who had been Consulting Psychiatrist to the British Army, was President. The pursuit of the positive concept of mental health by this movement laid itself open to the charge that it idealised dominant western values. The war had revealed the dangers of unbridled human drives, leading to an acceptance of the need for "social control", although not totalitarianism. Anti-psychiatry, in contrast, promoted personal self-discovery as a form of mental well-being without social control.

Leonie de Goei similarly notes the strengthening of the Dutch Mental Hygiene Movement by the experience of the Second World War. H C Rümke was elected Chairman of the Executive Board of the World Federation of Mental Health. Although he was an adherent of the medical model, his disciple C J B J Trimbos proclaimed a non-medical branch of psychiatry and recognised the socioplastic nature of mental disorder in his 1959 thesis entitled Mental Health Science and Mental Health Care. The revolutionary step of anti-psychiatry was the conviction that society and the family themselves are directly pathogenic, not just factors which alter the presentation of mental illness.

E M Tansey examines the origins of modern psychopharmacology, concentrating on British contributions. Developments were driven by the pharmaceutical companies and in the early years, much less than in current practice, there was controversy about whether psychoactive drugs were an advance in treatment. In the corresponding Dutch chapter on the influence of psychopharmacology, Stephen Snelders investigates the role of LSD in the elaboration of both biomedical and social concepts of mental illness. As LSD has effects on the brain, the resemblance of the hallucinogenic effect of LSD to psychotic phenomena gave support to biological models of mental illness. In contrast, the use of LSD in the counterculture of the 1960s promoted a comparison of transcendental and psychotic experience, particularly by R D Laing.

Jonathan Andrews concentrates on R D Laing's involvement as a psychiatric trainee in the 'Rumpus Room' experiment at Gartnavel hospital in the early 1950s. The emphasis on the importance of the hospital environment paralleled the therapeutic community approach of Maxwell Jones. The interpersonal psychiatry of J L Cameron, one of the co-authors of the Lancet article on the 'Rumpus Room', had more of an influence on Laing than is generally acknowledged, although Laing did make a distinctive contribution to part of the overall project. Laing was probably the most significant British "anti-psychiatrist"; his counterpart in Holland was Jan Foudraine, author of Not made of wood, as it was entitled in english translation, originally published in Holland in 1971. Gemma Blok describes Foudraine's disappointment as an assistant-psychiatrist with the lack of 'human dignity' in traditional psychiatric practice. He was also frustrated with the psychoanalytic approach of Chestnut Lodge in America, where he worked for a few years, transforming his ward there into a 'school for life'. He himself admitted he was confused by the reaction to his best-selling book and he became the 'personal ambassador' in Holland of Baghwan Shree Rajneesh.

The experiment from 1969 in Holland at the Dennendal Clinic for the learning disabled is set in context by Ido Weijers. The attempt to end the use of the medical model in the clinic is seen as driven by the prevailing "personalist" culture, stressing the dignity of the person, manifest for example in the School of Utrecht. The institution examined in the comparative British chapter is the Maudsley hospital, which occupies a special position in British psychiatry. Keir Waddington notes the lack of attention to anti-psychiatry at a formal level at the Maudsley hospital, and describes the impact of the ensuing conflict resulting from the Maudsley's merger with the Bethlem hospital in 1948.

In contrast to Britain, one professional organisation, the Dutch Association for Psychiatry and Neurology, represented both neurologists and psychiatrists in the Netherlands until 1974. Separate sections for neurology and psychiatry were only created from 1962. Harry Oosterhuis and Saskia Wolters describe the impact on the professional identity of psychiatry in the Netherlands of the increasing separation of psychiatry and neurology, which encouraged a multicausal, bio-psycho-social approach to psychiatry as opposed to the one-sided somatic emphasis of neurology. They see the professional dilemma of psychiatrists in the conflict between their separate status as scientific medical specialists and the need to be more than medical specialists if they are to influence other professionals. Peter Barham describes how the dehumanising potential of the asylum, with its aim of containing madness, has failed to be replaced by a commitment to a socially inclusive mental health policy in the community.

Hans Binnevald describes the development over the last decade of the Dutch psychological assistance service for UN peace-keeping operations. Holland is the only NATO country where such a system exists just for peace-keeping operations, and reflects the lack of any real Dutch military psychiatry previously. Roy Porter sees anti-psychiatry's emphasis on the pathogenic nature of the family as having its origins in the legacy of Freud, which he contrasts with the pre-Freudian worldview where the family was paramount and psychiatry dealt with mad relatives on its behalf.

In the first of the concluding chapters, Colin Jones examines what he calls "the act of negation and inversion at the heart of the [anti-psychiatry] movement ", or, in other words, "the 'anti' element in anti-psychiatry". Objectification of the mentally ill makes psychiatry part of the problem rather than the solution of mental illness. The attack on the biomedical model of mental illness and the centrality of the asylum encourages an anti-authoritarian stance. However, the language of opposition obscures how much the ideas which amounted to anti-psychiatry predated its emergence. Furthermore, Laing and Foudraine at times tried to maintain their links with the psychiatric profession and sought its endorsement. Their ideas were populist and associated with the counter-culture of the 1960s. Yet their quest for personal authenticity meant they were unable to carry through their ideas politically. Nonetheless, despite their personal fates, as Jones says, it is misleading "to reduce anti-psychiatry to a set of largely depassé ideas and concepts" and "the force and freshness of the 'anti-psychiatry movement' in western culture" should not be underestimated.

In the final chapter, David Ingleby also sees Laing as being more interested in the larger goal of changing the world than changing psychiatry. He suggests anti-psychiatry had a more sympathetic reception in Holland because by the seventies Holland had become a byword for liberalism and progressive social policies. For example, Kees Trimbos, one of the founders of Dutch social psychiatry, in his book Anti-psychiatrie warned against imagining that it was just a fad: "after all, anti-psychiatry is also psychiatry!". However, over recent years the pendulum has swung more towards medical rather than social models of mental illness. The definition of illness has broadened and demand for treatment overloads services. In academia, as Ingleby notes, "there has been a noticeable shift ... away from socially critical perspectives, which are increasingly regarded as an embarrassing hangover from the seventies". His sobering conclusion is that, in contrast to anti-psychiatry, the character of the mental health professions has become highly bureacratic and rationalised.

The chapters in the book concentrate on elucidating the origins of anti-psychiatry. There is less discussion of the reasons for its subsequent marginalisation and the cultural factors which were associated with this development. There may need to be more distance in time to be able to analyse this reaction historically.

Although the influence of American culture is acknowledged incidentally, the focus on Britain and the Netherlands in the book, despite simplifying the nature of anti-psychiatry and therefore leading to productive insights, avoids the complexities of a complete international understanding of its character. In particular, there is only one reference to Thomas Szasz, in Jones' concluding chapter, and this is not to discuss his theories, but merely to acknowledge his affinity with anti-psychiatry. If Laing and Foudraine are seen as the embodiments of anti-psychiatry in Britain and Holland respectively, their equivalent in the USA is Szasz. Associating Szasz with the former, however, does not do justice to their differences, which are substantial in many respects. Szasz remains vehemently hostile to Laing; in 1976, he scathingly entitled an article on Laing in The New Review 'Anti-psychiatry: The paradigm of a plundered mind'. A principle complaint was that Laing was inconsistent. Szasz's position is logically coherent in that the reality of mental illness is inevitably repudiated from the assumption that the term 'illness' implies physical pathology. Hence the title of Ssasz's (1972) original book The myth of mental illness, the theme of which and its implications, eg.the lack of justification for involuntary hospitalisation, have led to a plethora of books regurgitating Szasz's libertarian, free-market principles. Laing insisted he never rejected the existence of emotional turmoil, merely that it was more socially intellible than commonly assumed. It is clear from the transcript of recorded conversations that he made with Bob Mullan (1995) in the two years before he died that Laing was not concerned to work through his differences with Szasz. He was surprised that he was not more of an ally. For them to be seen as on the same side of the argument despite their substantial differences justifies Colin Jones' notion that the essence of anti-psychiatry derives from the sense in which psychiatry itself is regarded as part of the problem.

The case can evidently be made that Szasz's version of anti-psychiatry has links with the dominant capitalist culture of the USA. There are also clear connections between the reaction against anti-psychiatry and the evolution of the DSM-III, which ultimately had effects on ICD-10, through DSM-IIIR and DSM-IV. In particular, Robert Spitzer, who chaired the DSM-III Task Force, was concerned about the study by Rosenhan (1973). Accomplices of Rosenhan managed to gain admission to psychiatric hospital and acquire a diagnosis of schizophrenia merely by feigning a mundane, simple hallucination, indicating they were hearing a voice say "thud", "empty" or "hollow". Rosenhan concluded that professionals were unable to distinguish the sane from the insane, which raised the fear for Spitzer that unreliable diagnoses may invalidate the whole process of psychiatric practice (Spitzer & Fleiss 1974). Operationalisation of psychiatric criteria arose as a response in an attempt to create objectification in diagnosis. This movement in classification has been called neo-Kraepelinian (Klerman 1978) and essentially usurped Adolf Meyer's influence. Meyer devalued single-word diagnoses in favour of a full assessment of the patient as a person. His philosophy could be seen as providing roots for the British and Dutch versions of anti-psychiatry analysed in Cultures of Psychiatry. For example, the link with mental hygiene was examined by Mathew Thompson in his chapter in the book. Clifford Beers, who was the leader of the movement in the USA, was promoted by Adolf Meyer. More generally, Meyer's emphasis on understanding coincides with the "personalist" cultural influences described in the chapter by Ido Weijers. Meyer's ideas came to Britain via Aubrey Lewis and David Henderson. Of interest is how their transmutation led ultimately to anti-psychiatry's lack of influence.

What remains to be seen is whether cultural forces will lead to a resurrection of interest in anti-psychiatry. The Critical Psychiatry Network (http://www.criticalpsychiatry.co.uk) has recently been formed in Britain to develop a critique of the current psychiatric system. Other mental health professionals have challenged the biomedical dominance of psychiatry, but medical authority has been sustained by the avoidance of complexity and uncertainty. Current trends for the humanising of medicine in general may eventually produce change. The ideological implications of anti-psychiatry seem to have foundered for two main reasons: some of its main advocates were ultimately more interested in personal and spiritual growth; and its message became diluted and confused by combining conflictual viewpoints. The book Cultures of Psychiatry may help anti-psychiatry to clarify its origins and allow it to be reconstructed.


Klerman G L (1978) The evolution of a scientific nosology. In Schizophrenia: Science and Practice (Ed. J. C. Shershow). Cambridge, Mass: Harvard University Press

Mullan B (1995) Mad to be normal. Free Association Books: London

Spitzer, R.L. & Fleiss, J.L. (1974) A reanalysis of the reliability of psychiatric diagnosis. British Journal of Psychiatry, 125: 341-347

Szasz T S (1972) The myth of mental illness. Paladin: London

Tantum D (1991) The anti-psychiatry movement. In 150 Years of British Psychiatry, 1841-1991 (eds Berrios G E and Freeman H). Gaskell: London

BOOK REVIEW - "QUIET - The power of introverts in a world that can't stop talking." by SUSAN CAIN.


QUIET (reviewed on November 15, 2011) FROM THE KIRKUS WEBSITE

An enlightened Wall Street survivor exhorts wallflowers everywhere to embrace their solitude-seeking souls and fully appreciate the power of the lone wolf.

Could up to one-half of a nation obsessed with Jersey Shore narcissism and American Idol fame really be inhabited by reserved, sensitive types? According to Cain, yes—and we better start valuing their insight. Extroverts have their place, but things can quickly go haywire when we start confusing assertiveness with competence—the economic meltdown on Wall Street was the most stunning recent example. Had there been a few more conscientious, contemplative introverts in the boardroom (and had they made themselves heard), Cain writes, the country’s fortunes would now be decidedly different. But today’s prevailing susceptibility to “reward sensitivity,” as embodied by alpha-dog Wall Street types, wasn’t always the norm. Cain provides fascinating insight into how the United States shifted from an introvert-leaning “cult of character” to an extrovert-leaning “cult of personality” ruled by the larger-than-life Tony Robbinses of the world. Readers will learn that the tendency for some to be reserved is actually hardwired, and as every evolutionary biologist will tell you, innate characteristics are there for a reason—to help humans survive and thrive. The author also boldly tackles introverts themselves, as well as the ambivalence many often feel about being relegated to the corner. “Stick to your guns,” writes fellow introvert Cain. The author’s insights are so rich that she could pen two separate books: one about parenting an introverted child, and another about how to make an introvert/extrovert relationship work.

An intriguing and potentially life-altering examination of the human psyche that is sure to benefit both introverts and extroverts alike.



Read Christopher Lane's recent op-ed contribution in the New York Times, "Shy on Drugs."

"[A] fascinating behind-the-scenes look at the making of the bible of modern psychiatry [that] explains how a once-ordinary affliction became a profitable disease."—Michael Agger, Mother Jones

“This is not only an important account of the creation of a modern disease and its treatment, it is an explosive indictment of a system that is too simply materialist in both philosophy and behavior.”—Harold J. Cook, Wellcome Trust Centre for the History of Medicine at UCL

“A marvelous book: disturbing and perturbing, a book that will be widely talked about and debated. It is extraordinarily well written, balanced, witty, and engrossing. Bravo!”—Arthur Kleinman, Esther and Sidney Rabb Professor and Chair of Anthropology, Professor of Medical Anthropology, and Professor of Psychiatry, Harvard University

“In Shyness, Christopher Lane outlines an apparatus that is one of the most powerful cultural forces in the world today. In pulling back the drapes and revealing the bumbling and hamfistedness of the new engineers of human souls, Chris Lane might help restore sanity to Oz.”—David Healy, M.D., author of Let Them Eat Prozac and The Antidepressant Era

"Written with Chris Lane's brand of verve and scholarship, Shyness is a riveting book about how certain so-called illnesses are complex cultural artifacts and certain so-called doctors are casting spells called diagnoses. A smart and bracing book about shyness—not to mention a shrewd and subtle book about psychiatric classification—is long overdue; after reading Shyness it is clear that only Lane could have written it."—Adam Phillips, psychoanalyst, author of Side-Effects

"Lane finds a trove of troubling (and previously unpublished) material in the APA archive and in drug company memorandums, laying bare the APA's internal politics and showing the growing influence of drug companies on psychiatry practice. Similarly alarming are Lane's dissections of big pharma's marketing of anti-depressants and description of how information about side-effects and withdrawal symptoms associated with popular prescription drugs such as Prozac and Paxil were withheld from the public. This controversial and well-documented book will spark its share of debates."—Publishers Weekly

"[An] excellent new book. . . . Shyness is a welcome contribution to psychiatric discourse."—Juliet Lapidos, New York Observer 

"Having gained access to archival materials from the APA, Lane provides a behind-the-scenes look at the haphazard, unscientific process used to revise The Diagnostic and Statistical Manual of Mental Disorders. . . . [A] superb, iconoclastic cultural study. . . . Highly recommended for university and large public libraries."—Library Journal

"There is a great deal that's interesting in this book. . . . I recommend this book as a thought-provoking and informative read."—John D. Mullen, Metapsychology 

"[A] stunning and revelatory book. . . . For a book that's about the invention of a medical condition, Shyness is as riveting as a detective story. Lane writes elegantly and passionately about the need to maintain our consciousness about the maddeningly rich complexity of human emotion and thought."—Yasmin Nair, Windy City Times

"This well-written book is a thoughtful examination of shyness and its relation to psychopathology. . . . I very much enjoyed reading Lane's thought-provoking book, and I would highly recommend it for psychiatry residents, graduate students in clinical psychology, and other mental health professionals in training who are interested in the field of anxiety disorders, and more broadly in psychopathology and general mental health."—Brian J. Cox, New England Journal of Medicine 

"Having gained access to archival materials from the APA, Lane provides a behind-the-scenes look at the haphazard, unscientific process used to revise The Diagnostic and Statistical Manual of Mental Disorders. . . . [A] superb, iconoclastic cultural study. . . . Highly recommended for university and large public libraries."—Library Journal (starred review) 

"In his brilliant Shyness: How Normal Behaviour Became a Sickness, Christopher Lane painstakingly shows how the category of 'mental disorder' has been expanded in recent decades, so that what were once considered normal emotions or everyday foibles—shyness, rebelliousness, aloofness, and so on—have been relabelled as phobias, disorders and syndromes."—Brendan O'Neill, New Statesman and Society

"An important new book. . . . The achievement of Shyness is to chart for the first time the events preceding the rise and fall of the SSRIs. Lane has marshalled a cache of unpublished data to explain the academic framework that allowed the rise to happen. [He] tells the complex story with impressive clarity. . . . Lane has done a valuable job in tracing the roots of the current crisis and he certainly isn’t calling for a reinstatement of Freudianism; what is needed now is another map to indicate a way out."—Jerome Burne, Times Literary Supplement

"Fascinating . . . persuasive . . . [and] painstaking, [Shyness] should be read by anyone interested in stopping the rot in the discussion of human emotion and thought."—Helene Guldberg, Spiked Review of Books

"Overall, Lane's scholarly account of this saga ensures that if you're not already concerned about the over-medicalization of our mental lives, you will be."—Christian Jarrett, BBC Focus

"Christopher Lane's polemical Shyness features the manipulations that promoted social anxiety disorder to a national emergency."—Frederick Crews, New York Review of Books

"As Lane’s research reveals, the cost of blaming anxieties on brain chemistry imbalance goes beyond dollars, to drug dependency, debilitating side effects and consumers convinced they’re hamstrung by their physiology."—Robin Tierney, San Francisco Examiner

"Lane "charges that the task force, dominated by neuropsychiatrists, often used bad science or no science at all, that it turned ordinary human emotions into diseases and that it created a climate in which pharmaceutical companies could get rich creating cures for often nonexistent complexes."—Richard Hicks, Atlanta Journal-Constitution (op-ed)

"Would Henry David Thoreau and Emily Dickinson be given drugs today? In the1980s a small group of leading psychiatrists revised the profession’s diagnostic manual called the DSM for short, adding social anxiety disorder—aka shyness—and dozens of other new conditions. Christopher Lane . . . uses previously secret documents, many from the American Psychiatric Association archives, to support his argument that these decisions were marked by carelessness, pervasive influence from the pharmaceutical industry, academic politics, and personal ambition."—Scientific American

"Lane . . . notes that when psychiatrists diagnose the shy as suffering from social phobia, they mistake a variation in human temperament for a mental disorder; if anything, the diagnosis only adds to the sense of unease felt by shy people. He is also right in observing that the psychiatrists’ Diagnostic and Statistical Manual (DSM), the profession’s standard 900-page reference work, errs by designating other kinds of normal human variation as mental disorders and so exaggerates the incidence of mental illness. . . . [Shyness] provides vivid portraits of how DSM-III was constructed, over the course of six years."—Paul McHugh, Wall Street Journal

"Christopher Lane deconstructs the new psychiatric condition ‘social anxiety disorder’ as a creation of corporate psychiatry’s alliance with the pharmaceutical industry. He argues that shyness became a medical condition best treated by drugs as a result of battles between psychiatrists over diagnostic techniques. . . . This book compares best to Ray Moynihan and Alan Cassels’ Selling Sickness. Highly recommended for general readers, healthcare professionals and practitioners."—Choice

"Christopher Lane . . . calls psychiatry's growing focus on children 'the perfect storm' for overdiagnosis. 'You've got a constituency—children—who cannot make informed medical decisions for themselves,' Lane says. In a fast-moving culture that heaps stress and high expectations on children, 'parents are in many cases under great pressure to ensure their child succeeds and is socially proficient. A child that doesn't negotiate rapidly those hurdles can look very quickly as if he or she is falling behind, or displaying behavior that warrants medical concern.'"—Melissa Healy, Los Angeles Times

"A provocative look at an important chapter in the history of modern psychiatry."—Judith Graham, Chicago Tribune

"Lane's authority in these matters is considerable since he had access to previously confidential documents for the American Psychiatric Association archives. . . . Highly recommended. All readers, but especially the general public and healthcare professionals and practitioners."—Choice

"Lane argues in this well-researched . . . controversial book that shyness [has been] pathologized, to the detriment, especially, of children and teenagers"—Elsa Dixler, New York Times Book Review (Paperback Row)

“Lane’s thorough trawling of the archives of the American Psychiatric Association, his discovery of unpublished internal memos from drug companies, and most especially his accounts of the deliberately obstructive activities of the companies’ marketing teams, make for compelling reading.” - Martin Guha, Journal of Mental Health

"Lane's book is worth reading because...he does such an admirable job of exposing how the psychiatric profession and the pharmaceutical industry together manage to develop and popularize new 'mental diseases' and the accompanying treatments apparently designed to increase profits...It is a solid book and one that is likely to remain current for several years, if not decades, to come."--Tana Dineen, Journal of Scientific Exploration

Friday 27 April 2012



The Psychopath Test by Jon Ronson – review

Jon Ronson's tour of the psy-professions keeps Will Self enthralled.   

        guardian.co.uk, Friday 27 May 2011 11.39 BST

It's all in the timing ... Emmanuel 'Toto' Constant, who once boasted that voodoo and the CIA shielded him from trouble, at a press conference in Port-au-Prince, Haiti, 1994. 

In Leo Rosten's unparalleled encyclopedia of the Jewish world-view, The Joy of Yiddish, he writes: "To define a nebech simply as an unlucky man is to miss the many nuances, from pity to contempt, the word affords." And then, as is always the way with Rosten – and Yiddish – he sharpens ones understanding illustratively: "A nebech is sometimes defined as the kind of person who always picks up what a shlemiel knocks over." To the non-Jewish reader this, of course, raises the question of what a shlemiel is – but you don't need to go out and buy a copy of Rosten in order to reach an understanding of this, you simply need to read the works of Jon Ronson.         

In a series of bravura feature articles, documentary films and three books (one of which, The Men Who Stare at Goats, has been made, counter-intuitively, into a major motion picture starring George Clooney), Ronson has comprehensively mapped the slapstick gavotte that the nebech and the shlemiel dance together – treading on each other's feet, tearing their clothes and cannoning into other couples on the dancefloor of life. It's a comic method of which Ronson himself is by no means unaware; in his latest peregrination, The Psychopath Test, he writes of Toto Constant, a sinister Haitian leader of death-squads, to whom Ronson has applied the "test" of the title: "There had been something reassuringly familiar about him at the beginning. He'd seemed diminutive, self-deprecating, nebbishy, which are all the things I am. Could he have been mirroring me, reflecting myself back at me?"

To which the only possible answer is: why yes, of course, because all the characters in a Ronson book are nebeches until they're exposed for the shlemiels they truly are. I say "characters" advisedly, because Ronson's books are ostensibly documentary in form, with the nebech protagonist – seemingly by chance – setting out on a quest that leads him, with many a twist and turn, through the dark hinterland of the human psyche; the truth is that such is the artfulness of Ronson's arrangement of material and dialogue, that the finished result feels as if it is verging on the fictive. Let me state for the record: at his best, Ronson is one of the finest comic writers working today. I began The Psychopath Test late at night, tired, dispirited and ill – then found myself laughing like the proverbial loon for page after page, for approximately the first 40, at least.

It's all about timing, of course: by inserting his own character with a forensic skill into the very real and frightening world that surrounds us all, Ronson achieves a gag-rate that puts him on a par with that master nebech Woody Allen. But like Allen, Ronson has an instability – or rather, a dirty secret – that both shades his comedy in stark relief and also undermines it. This is that most destructive of desires for the farceur: the need to be taken seriously. In Allen this took the form of making sub-Bergmanesque films, in Ronson it's his choice of subject-matter.

The Psychopath Test begins with Ronson being called upon by a friend of a friend to investigate a mysterious and lavish handmade book, Being or Nothingness, that has been circulated throughout a worldwide community of academic wonks. A further chance encounter with an academic studying psychopathy leads Ronson to Bob Hare, the man who has formulated the definitive questionnaire for diagnosing psychopaths. Ronson flies to Gothenburg in Sweden to track down the author of the mysterious text, and also attends Hare's course in order to become an accredited psychopath-spotter. It's these two, divergent narratives – the one bizarre and whimsical, the other bizarre and anything but – that uncoil throughout a text populated with Ronson's trademark eccentrics.

There's Petter Nordlund, the enigmatic author of the mysterious text, and Hare, the equally enigmatic Van Helsing of psychopathy. There are Elliott Barker and Gary Maier – both latterly of the Oak Ridge Hospital for the Criminally Insane in Ontario – who far from viewing psychopaths as incurable, decided that what they needed were marathon LSD-fuelled encounter sessions. There's "Tony", a diagnosed psychopathic Broadmoor patient Ronson is introduced to by "Brian", a Scientologist who works for CCHR (Citizen's Commission on Human Rights), the cult's anti-psychiatry pressure group. This gives him an opportunity to reprise the straightforwardly nutty career of Scientology's founder, L Ron Hubbard – just as the Oak Ridge boys' tale allows him to recount that of the reliably fruit-cakey anti-psychiatrist, RD Laing.

Ronson's quest for psychopaths takes him to upstate New York to visit the aforementioned Toto Constant in Coxsackie Correctional Institution, and down to Shubuta, Mississippi, for a testing encounter with Al Dunlap, a sort of maximum Gordon Gekko figure, who laid waste to the workforce of the valetudinarian Sunbeam Toasters. And so the gyre goes on widening, to take in such figures as David Shayler, quondam spy and latter-day transvestite-cum-messiah, and misguided ones such as Paul Britton, the clinical psychologist and criminal profiler whose work contributed to the wrongful arrest of Colin Stagg for the murder of Rachel Nickell.

However, just as this schema does a disservice to the teeming variety of The Psychopath Test, so my use of slang epithets for mental illness glosses over the instability that undermines Ronson's comedic genius. In truth, there's nothing remotely funny about the Stagg case, any more than there is about the DSM (Diagnostic and Statistical Manual of Psychiatric Disorders), the vast and ever-ramifying catalogue of aberrancy put out by the American Psychiatric Association. The epiphanic moment in The Psychopath Test comes when Ronson asks Robert Spitzer, the editor under whose aegis the DSM expanded from a slim booklet to a biblical tome, whether it's possible that "he'd inadvertently created a world in which some ordinary behaviours were being labelled mental disorders", and Spitzer answers: "I don't know."

Ronson wants us to understand how imperfectly the psy-professions have mapped the shifting sands of sanity – and that's a laudable aim; but his methodology, which is to take his own neurotic persona and use its self-examination as a yardstick against which to judge the psychoses and personality disorders of the seriously disturbed, isn't really fit for purpose. There is no comparison possible between the nebech and the homicidal maniac, none at all; while nor can all the world's malefactors be characterised as shlemiels. Ronson's investigation of the genie that emerged from the pages of the DSM takes in the ghastly lockstep between Big Pharma and the psychiatric profession, which has led to such neo-medieval tortures as the medicating of children for bipolar disorder, and the runaway diagnoses of autism and attention deficit disorder. "I don't know" is hardly an acceptable mea culpa.

By now you'll hopefully have grasped what a schlemiel is – basically a more unlikeable, and more culpable, form of the nebech. Rosten says: "You feel sorry for a nebech; you can dislike a shlemiel." So mild – and, dare I say, humane – is the tendency of Ronson's satire that when he ventures out into the world of political extremists, or military fanatics, or psychiatric persecutors, he is determined to see the nebech in everyone – until they're revealed as shlemiels. But just as there was a break-point in The Men Who Stare at Goats, one that occurred when the heirs to the new age military theorists actually began torturing Iraqi detainees with hideous ditties from kids' TV shows, so there's a break-point in The Psychopath Test when this reader, at least, began to think: these people aren't merely shlemiels, they're utter bastards. From then on the humour is sucked out of the text into the vacuum of a dark and cruel space.

Naturally, I don't discount the possibility that Ronson is only too aware of what he's up to here – he's undoubtedly a clever and thoughtful man. By constructing his books so that they start off achingly funny then at a certain juncture become naggingly painful, he does indeed force us to think more deeply about the subject at hand. This, surely, is all that contemporary satire can achieve: in a world with a relativistic moral compass, it can't enjoin us to do the right thing – for which there is no longer any consensus – but only to think about what the right thing might possibly be. That Ronson's books, rather than providing us with the material we need to think about these questions, can only indicate the further reading we should do, is also mandated by his authorial persona. To quote Rosten again: "There is a well-known wisecrack: 'When a nebech leaves the room, you feel as if someone came in.'"

Will Self's Walking to Hollywood is published by Bloomsbury

BOOK REVIEW - "Quiet - The power of introverts in a world that can't stop talking." by Susan Cain - Courtesy of the New York Times Book Reviews

“Love is essential; gregariousness is optional.”

Susan Cain’s ‘Quiet’ Argues for the Power of Introverts
Published: February 10, 2012


My neighbor, a leadership development consultant who regularly helps people improve themselves through personality tests like the Myers-Briggs Type Indicator, once told me I was the most introverted person he’d ever met. I took this as a compliment. Who wouldn’t?


The Power of Introverts in a World That Can’t Stop Talking

By Susan Cain

333 pp. Crown Publishers. $26.

The introverts who are the subject of Susan Cain’s new book, “Quiet,” don’t experience their inwardness in quite so self-congratulatory a way.

They and others view their tendency toward solitary activity, quiet reflection and reserve as “a second-class personality trait, somewhere between a disappointment and a pathology,” Cain writes. Too often denigrated and frequently overlooked in a society that’s held in thrall to an “Extrovert Ideal — the omnipresent belief that the ideal self is gregarious, alpha and comfortable in the spotlight,” Cain’s introverts are overwhelmed by the social demands thrust upon them. They’re also underwhelmed by the example set by the voluble, socially successful go-getters in their midst who “speak without thinking,” in the words of a Chinese software engineer whom Cain encounters in Cupertino, Calif., the majority Asian-American enclave that she suggests is the introversion capital of the United States.

Many of the self-avowed introverts she meets in the course of this book, which combines on-the-scenes reporting with a wide range of social science research and a fair bit of “quiet power” cheerleading, ape extroversion. Though some fake it well enough to make it, going along to get along in a country that rewards the out­going, something precious, the author says, is lost in this masquerade. Unchecked extroversion — a personality trait Cain ties to ebullience, excitability, dominance, risk-taking, thick skin, boldness and a tendency toward quick thinking and thoughtless action — has actually, she argues, come to pose a real menace of late. The outsize reward-seeking tendencies of the hopelessly ­outer-directed helped bring us the bank meltdown of 2008 as well as disasters like Enron, she claims. With our economy now in ruins, Cain writes, it’s time to establish “a greater balance of power” between those who rush to speak and do and those who sit back and think. Introverts — who, according to Cain, can count among their many virtues the fact that “they’re relatively immune to the lures of wealth and fame” — must learn to “embrace the power of quiet.” And extroverts should learn to sit down and shut up.

Introverts may be an odd audience for a book about power and leadership — concepts that necessarily involve the tiring and unappealing prospect of having power over, and leadership of, other people. Jonathan Rauch, a contributing editor at National Journal, tapped into the inherent humor of this contradiction some years ago, when he wrote a much-read meditation in The Atlantic on introversion. Rauch dreamed about the dawning of an “Introverts’ Rights movement,” the slogan of which might someday be “Please shush.” He got the tone just right: “Remember, someone you know, respect and interact with every day is an introvert, and you are probably driving this person nuts.”

“Quiet,” a long and ploddingly earnest book, would have greatly benefited from some of this levity. But for Cain, the perils of introversion are no laughing matter. Her interest in writing on the subject, she relates, stemmed from her own agonizing difficulties with public speaking — an aversion to putting herself “out there,” which made Harvard Law School such a trial that she once threw up on the way to class. Her Cupertino “introverts” (who, I think, are probably better understood as sharing a cultural background rather than a near-universal personality trait) feel unappreciated, undervalued, resentful of their extroverted (and non-Asian) fellow students and colleagues who noisily “talk nonsense,” as a Taiwanese-born Cupertino woman puts it, and still get ahead. Her “extroverts” are, often enough, obnoxious fools: Stanford students stripping naked and running down a San Francisco street as part of a freshman “icebreaking” event; a charismatic self-help guru, raking in the dough as he flashes his too-white teeth and sells the secrets of his success to the constitutionally less exuberant. It would be easy to blame people like this for the decline of our civilization if they were, in fact, typical. But, of course, they aren’t.

Cain, who left a career in corporate law and consulting for a quieter life of writing at home with her family, is at her best on the subject of children. Her accounts of introverted kids misunderstood and mishandled by their parents should give pause, for she rightly notes that introversion in children (often incorrectly viewed as shyness) is in some ways threatening to the adults around them. Indeed, in an age when kids are increasingly herded into classroom “pods” for group work, Cain’s insights into the stresses of nonstop socializing for some children are welcome; her advice that parents should choose to view their introverted offspring’s social style with understanding rather than fear is well worth hearing.

However useful and astute her observations and advice regarding introverted kids, though, Cain’s book is about adults, and on this population, unfortunately, she’s a whole lot less convincing. For one thing, her definition of introversion — a temperamental inner-­directedness first identified as a core personality trait by Carl Jung in 1921 — widens constantly; by the end of the book, it has expanded to include all who are “reflective, cerebral, bookish, unassuming, sensitive, thoughtful, serious, contemplative, subtle, introspective, inner-directed, gentle, calm, modest, solitude-seeking, shy, risk-averse, thin-skinned.” This widening of the definition makes introversion so broad a category, including, basically, all that is wise and good, that it’s largely meaningless, except as yet another vehicle for promoting self-esteem: “a very empowering lens through which to view your personality,” as Cain puts it.

Another problem with Cain’s argument is her assumption that most introverts are actually suffering in their self-esteem. This may be true in the sorts of environments — Harvard Business School, corporate boardrooms, executive suites — that she knows best and appears to spend most of her time thinking about. Had she spent more time in other sorts of places, among other types of people — in research laboratories, for example, or among economists rather than businessmen and -women — she would undoubtedly have discovered a world of introverts quite contented with who they are, and who feel that the world has been good to them.

The need to dress up any exploration of a social or psychological phenomenon in go-go language, making interesting observations or reflections the basis for something like a new social movement (“Introverts of the World, Unite!” as The Atlantic headlined a follow-up interview with Rauch), is particularly American, and can be as noisily grating as the compulsory extroversion Cain deplores. “Quiet” is full of gratuitous sloganeering: “Love is essential; gregariousness is optional.” “The secret to life is to put yourself in the right lighting.” Such writing offsets Cain’s serious research rather badly. A more quiet argument would have been much more effective.

Judith Warner is the author, most recently, of “We’ve Got Issues: Children and Parents in the Age of Medication.”

Thursday 26 April 2012




Chapter 1: Introduction

Psychiatrists tell us that the way to fix unwanted behavior is by altering brain chemistry with a pill.

But unlike a mainstream medical drug like insulin, psychotropic medications have no measurable target illness to correct, and can upset the very delicate balance of chemical processes the body needs to run smoothly.

Nevertheless, psychiatrists and drug companies have used these drugs to create a huge and lucrative market niche.

And they’ve done this by naming more and more unwanted behaviors as “medical disorders” requiring psychiatric medication.

But should these really be called diseases?

So the question is:

How did psychotropic drugs, with no target illness, no known curative powers and a long and extensive list of side effects, become the go-to treatment for every kind of psychological distress?

And how did the psychiatrists espousing these drugs come to dominate the field of mental treatment?

Chapter 2: Psychotropic Drugs

The Story

Psychiatrists claim a history of great advances in the area of psychotropic drugs. But is this parade of brain chemicals the “scientific breakthroughs” they assert?

Sigmund Freud’s early drug marketing efforts helped create a major cocaine epidemic throughout Europe.

Psychiatrists next turned to amphetamines until those drugs were discovered to be not only ineffective, but highly toxic and addictive.

Years later, the world was told that “antidepressant” drugs were actually “lifestyle drugs” for a choose-your-mood society. Yet within ten years, staggering details of side effects such as violence and suicide could no longer be ignored—with an estimated 3.9 million adverse events on Prozac alone.

Today, the same cycle continues, with breathless news coverage of new chemical treatments promoted as “miracle drugs.”

Two questions remain—where is the science that backs psychiatry up?

And how much longer will the public continue to believe false hopes, hype and outright lies?

Chapter 3: All in Favor Say Aye, DSM


Without any scientific lab tests showing the presence or absence of mental problems, how does psychiatry’s diagnostic system work—and how did it become so prevalent?

Psychiatrists published the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952, listing 112 so-called “mental disorders” based not on standard scientific procedure, but votes sent in by psychiatrists.

With every new edition of the DSM, the diagnoses have not only expanded in number, but cast a wider net, now encompassing whole population segments. As a result, nearly one million children are diagnosed as bipolar.

In 2007, half a million children and teenagers took at least one prescription for an antipsychotic. And antipsychotic drugs, powerful chemicals designed originally for only the most seriously mentally troubled, are now a $22.8 billion industry.

Yet the average person is completely unaware that psychiatric diagnoses are not medical but merely voted-on behaviors.

Which leads us to our next question: How do psychiatrists take these “disorders” and get people to believe they have them?

Chapter 4: Disease Mongering


Disease Mongering (noun): “The act of convincing essentially well people that they are sick, or slightly sick people that they are very ill.”

Psychiatrists know about it. Drug companies know about it. Advertising executives throughout the world do, too.

Disease Mongering is a highly successful strategy that turns common life situations into psychiatric disease states, getting people of every walk of life to worry about the latest “mental illness”—and to demand a pill.

And according to one marketing guru, “No therapeutic category is more accepting of condition branding than the field of anxiety and depression, where illness is rarely based on measurable physical symptoms and therefore, open to conceptual definition.”

And it works. Psychiatrists and drug companies have carved out a lucrative market niche grossing over $150,000 every minute.

But with disease mongering campaigns creating the illusion of widespread mental illness, how safe are the drugs psychiatrists are prescribing to treat it?

Chapter 5: Psychotropics on Trial

In modern psychiatry, psychotropic drugs have become the weapons of choice. But are they as safe as we’ve been led to believe?

In fact, claims of psychotropic drug safety by psychiatrists and drug companies are far from the truth.

First, drug safety testing is predominantly done by drug companies themselves, not by governmental agencies or independent labs—creating an obvious conflict of interest.

Psychiatrists have no scientific lab tests to objectively measure improvement either, which permits researchers many opportunities to skew results of drug trials in the pharmaceutical company’s favor.

And there are many, many ways of biasing trials to avoid negative findings or accentuate the positive.

As one drug expert summarized, “It can be proven that most claimed research findings are false.”

The result? Volumes of negative effects associated with psychotropic drugs have since been discovered, including homicide and suicide.

With this level of corruption pervading the testing of psychotropic drugs, one is left with the question:

Where are those entrusted with our protection?

Chapter 6: Watchdog


So why are so many dangerous psychotropic drugs being allowed on the market?

One reason may be the revolving door between government, academia and the drug industry, where panels recommending psychotropic drug approval have long been filled with psychiatrists with financial ties to drug companies.

Another may be that instead of serving a safety function as “post-marketing surveillance,” the final phase of clinical trials are now being re-cast as “post-marketing research” and repurposed into a means of testing psychotropic drugs for additional psychiatric disorders.

That is also why drug companies continue to enjoy profit margins triple the norm of most businesses.

In fact, the total profits of the top ten drug companies in the Fortune 500 exceeded the combined profits of the other 490 businesses.

And with so much money at stake it is no wonder that stockholders are never told the truth about the drugs whose companies they invest in.

But once the drug is approved, the next challenge is:

How does one convince prescribing physicians that these drugs are truly safe, effective and carrying few side effects when the drug company’s own trials prove that this is not the case?

Chapter 7: Marketing to MDs


How did psychiatrists and drug companies succeed in convincing millions of medical doctors to prescribe their powerful psychoactive drugs to a hundred million people?

Indoctrinating physicians begins at medical conferences—conferences frequently paid for by drug companies.

Respectable journals also publish studies written by drug company ghostwriters, falsely credited to prominent psychiatrists who are paid to put their names on it.

The drug industry now spends $22 billion a year marketing to doctors to increase prescriptions—an astonishing 90% of its marketing budget.

As a result, medical professionals worldwide are handing out psychotropic drugs, assured that they are safe and necessary by the “experts” in the field—psychiatrists.

But early on, psychiatrists and the pharmaceutical companies realized that promoting to doctors was not enough.

How could they reach their target demographic—the end user—and drive them into doctor’s offices to demand these drugs?

Chapter 8: Psychotropics and the Media


In 1997, drug company lobbyists pressured the US Congress to allow advertising psychotropic drugs on American television. And this opened the floodgates to a torrent of advertising which soared from $595 million a year in 1996 to $4.7 billion today, an increase of almost 700%.

In the United States, drug advertising on television accounts for fifty-five percent of the pharmaceutical industry’s Direct to Consumer advertising budget.

It is therefore no surprise that media conglomerates are loathe to bite the hand that feeds them.

That is how psychiatrists and drug companies have been able to use every communication outlet they can influence to drum out one single, relentless message: “You are sick, we’ve got the answer, and ask your doctor.”

But they are not satisfied only with media campaigns.

So their next strategy is: How do you convince even more people to take psychotropic drugs all the while remaining a hidden influence?

DAVE TRAXSON - SHOULD SHYNESS BE RECLASSIFIED AS A CHILDHOOD MENTAL ILLNESS? - OF COURSE NOT! - IT IS A NATURAL AND EVEN HEALTHY RESPONSE IN SOME SITUATIONS! "Sub-clinical, normal variation social anxiety" is the new category which will open the floodgates for medication for more and more children to be given psychotropic drugs in the U.K..- COURTESY OF THE CCHR U.K. WEBSITE




All in favour of shyness as a mental illness, raise your hand
Posted on September 15, 2011

Having been put under the psychiatric ‘microscope’, old-fashioned shyness is being reinvented as a psychiatric condition in need of ‘treatment’

The Daily Telegraph has reported on guidelines being developed in America that will lead more young people seeing their common problems regarded as illnesses that must be treated.

Shyness or ‘social anxiety’ is being subjected to the psychiatirc reinvention process. However, unlike real medicine, that process doesn’t refer to any scientific tests. It refers to and relies upon psychiatric opinion, where a show of hands can see the advent of a new ‘disorder’.

We can all have an opinion about another’s behaviour, but when a psychiatrist gives his opinion, it seems to be accepted as scientific.

Psychiatrists work hard to convince us their inventions are scientific, when in realilty they are no more than obsessive psychiatric impulses to redefine life’s problems as mental illnesses that feed the profit-driven psychiatric industry.


Mr Dave Traxson an educational psychologist from the West Midlands,U.K., was vocal on the problems relating to child drugging and in particular shyness when he spoke to the Times Educational Supplement (TES) in January this year. He said, “I feel very strongly that the time is right to challenge the growing practice of medicating our children for displaying behaviours and thought processes that until recently would have fallen within the normal range.” The new category of " sub-clinical normal variation social anxiety" is the driver for this proliferation which will undoubtedly lead to more psychotropic medications being prescribed for more children.

As even a lay person can see 'sub-clinical' and 'normal variation' should confirm it is a normal pattern of behaviour and not one that needs sledgehammer psychotropic drugs for vulnerable children.

Successfully masquerading as a science, as is the case with psychiatry, requires that certain appearances be maintained. A system for the codification of human behaviour was devised, where the number of psychiatric condemnations of behaviour has steadily increased. Shyness, cleverly marketed as Social Anxiety Disorder (SAD) is but one of a number of psychiatric condemnations listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), mental disorders section.

The cornerstone of psychiatry’s disease model today is the theory that a brain-based chemical imbalance causes mental illness. That includes shyness. Popularised by marketing, the idea is no more than fanciful wishful thinking, which has been thoroughly discredited by researchers, psychiatrists, psychologists and medical doctors.

The psychiatric industry would prefer to say or imply that only brain-based mental ‘illnesses’ can affect behaviour or thinking, that they need long-term care, and that they are incurable. These falsehoods have been so successfully disseminated throughout the mental health system and amongst the public, that countless numbers have become trapped as lifelong patients of psychiatric and psychological falsehoods.

These falsehoods must be exposed.

Read more: http://www.marketingofmadness.org.uk/all-in-favor-say-aye.htm