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Controversies about psychiatry

Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis,^[1] the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent,^[2] the side effects of treatments such as electroconvulsive therapy,^[3] antipsychotics^[4] and historical procedures like the lobotomy^[5]^: 28 and other forms of psychosurgery^[5] or insulin shock therapy,^[6] and the history of racism within the profession in the United States.

In addition, there are a number of groups who are either critical towards psychiatry or entirely hostile to the field. The Critical Psychiatry Network is a group of psychiatrists who are critical of psychiatry. Additionally, there are self-described psychiatric survivor groups such as MindFreedom International and religious groups such as Scientologists that are critical towards psychiatry.

Challenges to Conceptions of Mental Illness

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,^[7]^: 102 behavioral psychologists challenged psychiatry's fundamental reliance on unobservable phenomena^{[citation needed]}, and gay rights activists criticized the APA's inclusion of homosexuality as a mental disorder in the DSM.^[8] 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, although stigma and violence against members of the LGBTQ community still exists. 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.^[9]

Medicalization

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, and critics outside the field of psychiatry, such as Stuart A. Kirk, have "been accusing psychiatry of engaging in the systematic medicalization of normality".^[10] More recently these concerns have come from insiders who have worked for the APA themselves (e.g., Robert Spitzer, Allen Frances).^[11]^: 185 For example, in 2013, Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".^[12]^[13]

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.^[14] 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."^[15]^[16]

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.^[17]

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.^[18] A series of publications by Mens Sana Monographs have focused on medicine as a corporate capitalist enterprise.^[19]^[20]^[21]

Political Abuse

In unstable countries, political prisoners are sometimes confined and abused in mental institutions.^[22]^: 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.^[23] In addition, receiving a psychiatric diagnosis can in and of itself be regarded as oppressive.^[24]^: 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.^[23] 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.^[25]^: 29 In that manner, whenever open trials are undesirable, they are avoided.^[25]^: 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."^[26] 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.^[23] 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.^[27] Political abuse of psychiatry also takes place in the People's Republic of China^[28] and in Russia.^[29] Psychiatric diagnoses such as the diagnosis of 'sluggish schizophrenia' in political dissidents in the USSR were used for political purposes.^[30]^: 77

History of racism in psychiatry in the United States

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.^[31]

Diagnosis

Psychiatric diagnoses were influenced by Black peoples’ enslaved vs. free status, as enslaved people were not considered civilized enough to be diagnosed with insanity.^[31] On the other hand, free Black people were over-diagnosed with insanity, having much higher diagnosis rates than white people.^[31] In fact, specific diagnoses in the 19th century were crafted specifically to fit Black people – drapetomania and dyaesthesia 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.^[31] Prominent political figures such as John C. Calhoun used this supposed ‘evidence’ as reasoning for why slavery must be upheld, arguing that free Black people could not be entrusted with their lives and would ultimately develop lunacy.^[31] 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.^[32]

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.” ^[33]^[34] The proportion of Black individuals confined in establishments for "flawed and imbecile" patients surged throughout the late 19th and early 20th century.^[35] 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.^[35] These communities were targeted by the eugenics and sterilization initiatives.^[36] The premise that the genes of those deemed mentally ill were considered “undesirable” was used to justify the unlawful sterilization operations frequently supervised by physicians, even psychiatrists.^[36]

Hospitals

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.^[31] 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.^[31] 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.^[37]Many hospitals, especially in the southern United States, did not admit Black patients until they were eventually mandated to do so.^[37] The last segregated hospital opened in 1933.^[37] 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.^[38] 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.^[38] In January 1966, around two-thirds of Southern hospitals were segregated facilities and many Northern facilities remain segregated in-effect.^[38] 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.^[38]

In the profession

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.^[39] 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.^[40] 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.^[40] 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.^[40] 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.^[40]

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.^[41]

Nature of diagnosis

Arbitrariness

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.^[42] Historic disorders that are no longer recognised include orthorexia nervosa, sexual addiction, parental alienation syndrome, pathological demand avoidance, and Internet addiction disorder. New disorders include compulsive hoarding and binge eating disorder.^[43]

The act of diagnosis itself has been criticized for being arbitrary with some conditions being overdiagnosed.^[44] 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.^[45]

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.^[46]^: 104

Biological basis

In 2013, psychiatrist Allen Frances said that he believes that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".^[47]^[48]^[49]

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.^[50]^: 236

She argues that the concept of schizophrenia and its biological basis serves a social function for psychiatrists. She views the concept of schizophrenia is 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.^[50]^: 238

Schizophrenia diagnosis

Underlying issues associated with schizophrenia would be better addressed as a spectrum of conditions^[51] or as individual dimensions along which everyone varies rather than by a diagnostic category based on an arbitrary cut-off between normal and ill.^[52] 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.^[53]^[54]^[55] 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.^[56]^[57]^[58]

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]}. 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.^[59]^[60] This view is supported by other psychiatrists.^[61] 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.^[51] 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.^[62]^[63]

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.^[61] Citing poor interrater reliability, some psychiatrists have totally contested the concept of schizoaffective disorder as a separate entity.^[64]^[65] The categorical distinction between mood disorders and schizophrenia, known as the Kraepelinian dichotomy, has also been challenged by data from genetic epidemiology.^[66]

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.^[67]

ADHD

ADHD, its diagnosis, and its treatment have been controversial since the 1970s.^[68]^[69]^[70] The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior^[71]^[72] to the hypothesis that ADHD is a genetic condition.^[73] Other areas of controversy include the use of stimulant medications in children,^[69]^[74] the method of diagnosis, and the possibility of overdiagnosis.^[74] 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.^[71] 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.^[75] In contrast, a 2014 peer-reviewed medical literature review indicated that ADHD is underdiagnosed in adults.^[76]

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.^[77] Some sociologists consider ADHD to be an example of the medicalization of deviant behavior, that is, the turning of the previously non-medical issue of school performance into a medical one.^[68]^[78] Most healthcare providers accept ADHD as a genuine disorder, at least in the small number of people with severe symptoms.^[78] Among healthcare providers the debate mainly centers on diagnosis and treatment in the much larger number of people with less severe symptoms.^[78]^[79]^[80]

As of 2009^[update], 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.^[81]

Treatment

Psychosurgery

Psychosurgery is brain surgery with the aim of changing an individuals behavior or psychological function. Historically, this was achieved by the removal of a lesion on a section of the brain in ablative psychosurgery 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,^[82]^: 20 for which one its creators, António Egas Moniz, received a Nobel Prize in 1949.^[83] The lobotomy fell out of favor in by 1960s and 1970s.^[84] Other forms of ablative psychosurgery were in use in the UK in the late 1970s to treat psychotic and mood disorders.^[85] 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.^[86]

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.^[87] The lobotomy was prominently depicted a means to control nonconformity in the 1962 book One Flew Over the Cuckoo's Nest.^[88]^: 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.^[88]^: 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.^[88]^: 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.^[88]^: 123

Electroconvulsive therapy

Electroconvulsive therapy is a therapy method which was used widely between the 1930s and 1960s and is, in a modified form, still used today.^[89]^[90] Electroconvulsive therapy was one treatment that the anti-psychiatry movement wanted to be eliminated from psychiatric practice.^[91] Their arguments were that ECT damages the brain,^[91] and was used as punishment or as a threat to keep the patients "in line".^[91] Since then, ECT has improved considerably,^[92]^[93] and is now performed under general anesthesia in a medically supervised environment.^[94]

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.^[95]^[96] 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.^[97]

The most common side effects of ECT include headache, muscle soreness, confusion, and temporary loss of recent memory.^[98]^[94]^[99]

Marketing of antipsychotic drugs

Psychiatry has greatly benefitted by advances in pharmacotherapy.^[100]^{: 110–112}^[101] However, the close relationship between those prescribing psychiatric medication and pharmaceutical companies, and the risk of a conflict of interest,^[101] 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.^[101] 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.^[100]^{: 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.^[102] 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.^[103]

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.^[104] 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.^[105]^[106] 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.^[107]

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]}. 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.^[108] 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.^[108] In addition, Astrazeneca faces numerous personal-injury lawsuits from former users of Seroquel (quetiapine), amidst federal investigations of its marketing practices.^[109] 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.^[110]

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.^[108]

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.^[111] 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.^[112] 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.^[113]

Pharmaceutical companies have also been accused of attempting to set the mental health agenda through activities such as funding consumer advocacy groups.^[114]

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.^[115]^: 317

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 in aspects of treatment.^[116] 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 leaves much room for opinions and interpretations.^[116]^[117] Every society, including liberal Western society, permits compulsory treatment of mental patients.^[116] 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.^[118]

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 have come to personify the movement against psychiatry, two of which are or 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. Michael Foucault challenged the very basis of psychiatric practice and cast it as repressive and controlling. 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.^[116]

Psychiatric survivors movement

The psychiatric survivors movement^[119] arose out of the civil rights era 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.^[120] The key text in the intellectual development of the survivor movement, at least in the United States, was Judi Chamberlin's 1978 text, On Our Own: Patient Controlled Alternatives to the Mental Health System.^[119]^[121] Chamberlin was an ex-patient and co-founder of the Mental Patients' Liberation Front.^[122] Coalescing around the ex-patient newsletter Dendron,^[123] 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 necessary. 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.^[124] In 2005, the SCI changed its name to Mind Freedom International with David W. Oaks as its director.^[120]

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^ About Us — MFI Portal

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[:0-5] Lévêque, Marc (2016-09-03). Psychosurgery: New Techniques for Brain Disorders. Springer International Publishing. ISBN 978-3-319-34595-6.

[6] Doroshow, Deborah Blythe (2007). "Performing a cure for schizophrenia: insulin coma therapy on the wards". Journal of the History of Medicine and Allied Sciences. 62 (2): 213–243. doi:10.1093/jhmas/jrl044. ISSN 0022-5045. PMID 17105748.

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[Kirk2013-11] Kirk, Stuart A. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers.

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[Frances_A_111–112-13] Frances A (January 2013). "The past, present and future of psychiatric diagnosis". World Psychiatry. 12 (2): 111–112. doi:10.1002/wps.20027. PMC 3683254. PMID 23737411.

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[17] Helman, Cecil (2007). Culture, Health and Illness. London: Arnold. ISBN 978-0-340-91450-2.

[18] Filc D (September 2004). "The medical text: between biomedicine and hegemony". Soc Sci Med. 59 (6): 1275–85. doi:10.1016/j.socscimed.2004.01.003. PMID 15210098.

[19] Ajai R Singh, Shakuntala A Singh, 2005, "Medicine as a corporate enterprise, patient welfare centered profession, or patient welfare centered professional enterprise?" Mens Sana Monographs, 3(2), p19-51

[20] Ajai R Singh, Shakuntala A Singh, 2005, "The connection between academia and industry", Mens Sana Monographs, 3(1), p5-35

[21] Ajai R Singh, Shakuntala A Singh, 2005, "Public welfare agenda or corporate research agenda?", Mens Sana Monographs, 3(1), p41-80.

[Noll-22] Noll, Richard (2007). The encyclopedia of schizophrenia and other psychotic disorders. Infobase Publishing. p. 3. ISBN 978-0-8160-6405-2.

[Medicine_betrayed-23] British Medical Association (1992). Medicine betrayed: the participation of doctors in human rights abuses. Zed Books. p. 65–66. ISBN 978-1-85649-104-4.

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[Veenhoven-25] Veenhoven, Willem; Ewing, Winifred; Samenlevingen, Stichting (1975). Case studies on human rights and fundamental freedoms: a world survey. Martinus Nijhoff Publishers. p. 29. ISBN 978-90-247-1780-4.

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[124] About Us — MFI Portal

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 {{Dashboard.wikiedu.org draft template/about this sandbox}}
 = Controversies about psychiatry =
-[[Psychiatry]] is, and has historically been, viewed as controversial by those under its care, sociologists and psychiatrists themselves. Reasons cited for this controversy include the subjectivity of diagnosis,<ref name="frana">{{cite journal |author=Frances A |date=6 August 2013 |title=The new crisis of confidence in psychiatric diagnosis |journal=[[Annals of Internal Medicine]] |volume=159 |issue=2 |pages=221–222 |doi=10.7326/0003-4819-159-3-201308060-00655 |pmid=23685989 |doi-access=free}}</ref> the use of diagnosis and treatment for social and political control including [[Involuntary commitment|detaining citizens]] and [[Involuntary treatment|treating them without consent]],<ref>{{Cite journal |last=Moncrieff |first=Joanna |date=2010-11-01 |title=Psychiatric diagnosis as a political device |url=https://doi.org/10.1057/sth.2009.11 |journal=Social Theory & Health |language=en |volume=8 |issue=4 |pages=370–382 |doi=10.1057/sth.2009.11 |issn=1477-822X |s2cid=14758899}}</ref> and the side effects of treatments like [[electroconvulsive therapy]],<ref>{{Cite book |last1=Shorter |first1=Edward |url=https://books.google.com/books?id=RvXzXnskJB4C |title=Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness |last2=Healy |first2=David |date=2007 |publisher=Rutgers University Press |isbn=978-0-8135-4169-3 |language=en |chapter=8}}</ref> [[Antipsychotic|antipsychotics]]<ref>{{Cite book |last=Moncrieff |first=J. |url=https://books.google.com/books?id=yTwiAQAAQBAJ |title=The Bitterest Pills: The Troubling Story of Antipsychotic Drugs |date=2013-09-15 |publisher=Springer |isbn=978-1-137-27744-2 |pages=132 |language=en}}</ref> and historical procedures like [[lobotomy]]<ref name=":0">{{Cite book |last=Lévêque |first=Marc |url=https://books.google.com/books?id=U5EZvgAACAAJ |title=Psychosurgery: New Techniques for Brain Disorders |date=2016-09-03 |publisher=Springer International Publishing |isbn=978-3-319-34595-6 |language=en}}</ref>{{Rp|28}} and other forms of [[psychosurgery]]<ref name=":0" /> or [[insulin shock therapy]].<ref>{{Cite journal |last=Doroshow |first=Deborah Blythe |year=2007 |title=Performing a cure for schizophrenia: insulin coma therapy on the wards |url=https://pubmed.ncbi.nlm.nih.gov/17105748/ |journal=Journal of the History of Medicine and Allied Sciences |volume=62 |issue=2 |pages=213–243 |doi=10.1093/jhmas/jrl044 |issn=0022-5045 |pmid=17105748}}</ref>
+[[Psychiatry]] is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis,<ref name="frana">{{cite journal |author=Frances A |date=6 August 2013 |title=The new crisis of confidence in psychiatric diagnosis |journal=[[Annals of Internal Medicine]] |volume=159 |issue=2 |pages=221–222 |doi=10.7326/0003-4819-159-3-201308060-00655 |pmid=23685989 |doi-access=free}}</ref> the use of diagnosis and treatment for social and political control including [[Involuntary commitment|detaining citizens]] and [[Involuntary treatment|treating them without consent]],<ref>{{Cite journal |last=Moncrieff |first=Joanna |date=2010-11-01 |title=Psychiatric diagnosis as a political device |url=https://doi.org/10.1057/sth.2009.11 |journal=Social Theory & Health |language=en |volume=8 |issue=4 |pages=370–382 |doi=10.1057/sth.2009.11 |issn=1477-822X |s2cid=14758899}}</ref> the side effects of treatments such as [[electroconvulsive therapy]],<ref>{{Cite book |last1=Shorter |first1=Edward |url=https://books.google.com/books?id=RvXzXnskJB4C |title=Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness |last2=Healy |first2=David |date=2007 |publisher=Rutgers University Press |isbn=978-0-8135-4169-3 |language=en |chapter=8}}</ref> [[Antipsychotic|antipsychotics]]<ref>{{Cite book |last=Moncrieff |first=J. |url=https://books.google.com/books?id=yTwiAQAAQBAJ |title=The Bitterest Pills: The Troubling Story of Antipsychotic Drugs |date=2013-09-15 |publisher=Springer |isbn=978-1-137-27744-2 |pages=132 |language=en}}</ref> and historical procedures like the [[lobotomy]]<ref name=":0">{{Cite book |last=Lévêque |first=Marc |url=https://books.google.com/books?id=U5EZvgAACAAJ |title=Psychosurgery: New Techniques for Brain Disorders |date=2016-09-03 |publisher=Springer International Publishing |isbn=978-3-319-34595-6 |language=en}}</ref>{{Rp|28}} and other forms of [[psychosurgery]]<ref name=":0" /> or [[insulin shock therapy]],<ref>{{Cite journal |last=Doroshow |first=Deborah Blythe |year=2007 |title=Performing a cure for schizophrenia: insulin coma therapy on the wards |url=https://pubmed.ncbi.nlm.nih.gov/17105748/ |journal=Journal of the History of Medicine and Allied Sciences |volume=62 |issue=2 |pages=213–243 |doi=10.1093/jhmas/jrl044 |issn=0022-5045 |pmid=17105748}}</ref> and the history of racism within the profession in the United States.
-There are a number of groups who are either critical towards psychiatry or entirely hostile to the field. The [[Critical Psychiatry Network]] is a group of psychiatrists who are critical of psychiatry; there are self-described psychiatric survivor groups such [[MindFreedom International]], religious groups like [[Scientology and psychiatry|Scientologists]].
+In addition, there are a number of groups who are either critical towards psychiatry or entirely hostile to the field. The [[Critical Psychiatry Network]] is a group of psychiatrists who are critical of psychiatry. Additionally, there are self-described psychiatric survivor groups such as [[MindFreedom International]] and religious groups such as [[Scientology and psychiatry|Scientologists]] that are critical towards psychiatry.
+== Challenges to Conceptions of Mental Illness ==
-== Background ==
-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;<ref name=":1">{{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}}</ref>{{Rp|102}} behavioral psychologists challenged psychiatry's fundamental reliance on unobservable phenomena{{Citation needed|reason=Vague statement|date=May 2019}}; gay rights activists criticized the APA's listing of homosexuality as a mental disorder. Since the social enlightenment about homosexuality, it is no longer considered a mental illness and is more widely accepted by society. A widely publicized study by [[Rosenhan experiment|Rosenhan]] in ''Science'' was viewed as an attack on the efficacy of psychiatric diagnosis.<ref>{{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.</ref> However, the neutrality of the project is nowadays often questioned.{{Citation needed|date=February 2021}}
+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,<ref name=":1">{{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}}</ref>{{Rp|102}} behavioral psychologists challenged psychiatry's fundamental reliance on unobservable phenomena{{Citation needed|reason=Vague statement|date=May 2019}}, and gay rights activists criticized the APA's inclusion of homosexuality as a mental disorder in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]].<ref>"''Cured''". ''[[Independent Lens]]''. [[PBS]]. December 6, 2021. Retrieved January 23, 2022.</ref> 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, although stigma and violence against members of the LGBTQ community still exists. As another example that challenged conceptions of mental illness, a widely publicized study by [[Rosenhan experiment|Professor David Rosenhan]], known as [[Rosenhan experiment|the Rosenhan experiment]], was viewed as an attack on the efficacy of psychiatric diagnosis.<ref>{{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.</ref>
 == Medicalization ==
-[[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, [[Preventive medicine|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.
+[[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, [[Preventive medicine|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, some psychiatrists (such as [[David Rosenhan]], [[Peter Breggin]], [[Paula Caplan]], [[Thomas Szasz]]) and outside critics (such as [[Stuart A. Kirk]]) have "been accusing psychiatry of engaging in the systematic medicalization of normality".<ref name="Kirk 2013 p. 185">{{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}}</ref> More recently these concerns have come from insiders who have worked for and promoted the APA (e.g., [[Robert Spitzer (psychiatrist)|Robert Spitzer]], [[Allen Frances]]).<ref name="Kirk2013">{{cite book |last=Kirk |first=Stuart A. |title=Mad Science: Psychiatric Coercion, Diagnosis, and Drugs |publisher=Transaction Publishers |year=2013}}</ref>{{rp|185}} In 2013, Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".<ref name="frana2">{{cite journal |author=Frances A |date=6 August 2013 |title=The new crisis of confidence in psychiatric diagnosis |journal=[[Annals of Internal Medicine]] |volume=159 |issue=2 |pages=221–222 |doi=10.7326/0003-4819-159-3-201308060-00655 |pmid=23685989 |doi-access=free}}</ref><ref name="Frances A 111–112">{{cite journal |author=Frances A |date=January 2013 |title=The past, present and future of psychiatric diagnosis |journal=[[World Psychiatry (journal)|World Psychiatry]] |volume=12 |issue=2 |pages=111–112 |doi=10.1002/wps.20027 |pmc=3683254 |pmid=23737411}}</ref>
+For many years, several psychiatrists, such as [[David Rosenhan]], [[Peter Breggin]], [[Paula Caplan]], [[Thomas Szasz|Thomas Szasz,]] and critics outside the field of psychiatry, such as [[Stuart A. Kirk]], have "been accusing psychiatry of engaging in the systematic medicalization of normality".<ref name="Kirk 2013 p. 185">{{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}}</ref> More recently these concerns have come from insiders who have worked for the [[American Psychiatric Association|APA]] themselves (e.g., [[Robert Spitzer (psychiatrist)|Robert Spitzer]], [[Allen Frances]]).<ref name="Kirk2013">{{cite book |last=Kirk |first=Stuart A. |title=Mad Science: Psychiatric Coercion, Diagnosis, and Drugs |publisher=Transaction Publishers |year=2013}}</ref>{{rp|185}} For example, in 2013, Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".<ref name="frana2">{{cite journal |author=Frances A |date=6 August 2013 |title=The new crisis of confidence in psychiatric diagnosis |journal=[[Annals of Internal Medicine]] |volume=159 |issue=2 |pages=221–222 |doi=10.7326/0003-4819-159-3-201308060-00655 |pmid=23685989 |doi-access=free}}</ref><ref name="Frances A 111–112">{{cite journal |author=Frances A |date=January 2013 |title=The past, present and future of psychiatric diagnosis |journal=[[World Psychiatry (journal)|World Psychiatry]] |volume=12 |issue=2 |pages=111–112 |doi=10.1002/wps.20027 |pmc=3683254 |pmid=23737411}}</ref>
-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.<ref name="White">{{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}}</ref> The term ''medicalization'' entered the sociology literature in the 1970s in the works of [[Irving Zola]], [[Peter Conrad (sociologist)|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 ([[Hyperkinetic disorder|hyperkinesis]] was the term then used to describe what we might now call [[ADHD]]).<ref>{{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=10.1525/sp.1975.23.1.03a00020 |pmid=11662312}}</ref>
+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.<ref name="White">{{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}}</ref> The term ''medicalization'' entered the sociology literature in the 1970s in the works of [[Irving Zola]], [[Peter Conrad (sociologist)|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 ([[Hyperkinetic disorder|hyperkinesis]] was the term then used to describe what we might now call [[ADHD]]), and Szasz's "[[The Myth of Mental Illness]]."<ref>{{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=10.1525/sp.1975.23.1.03a00020 |pmid=11662312}}</ref><ref>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 (identifier)|ISBN]] [[Special:BookSources/0-06-091151-4|<bdi>0-06-091151-4</bdi>]].</ref>
 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).
@@ Line 25: / Line 24: @@
 == Political Abuse ==
-In unstable countries, political prisoners are sometimes confined and abused in mental institutions.<ref name="Noll">{{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}}</ref>{{rp|3}} The diagnosis of mental disease allows the state to hold persons against their will and insist upon therapy in their interest and in the broader interests of society.<ref name="Medicine betrayed">{{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}}</ref> In addition, receiving a psychiatric diagnosis can in itself be regarded as oppressive.<ref name="Malterud">{{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}}</ref>{{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.<ref name="Medicine betrayed" /> The use of hospitals instead of jails prevents the victims from receiving legal aid before the courts, makes indefinite incarceration possible, discredits the individuals and their ideas.<ref name="Veenhoven">{{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}}</ref>{{rp|29}} In that manner, whenever open trials are undesirable, they are avoided.<ref name="Veenhoven" />{{rp|29}}
+In unstable countries, political prisoners are sometimes confined and abused in mental institutions.<ref name="Noll">{{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}}</ref>{{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.<ref name="Medicine betrayed">{{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}}</ref> In addition, receiving a psychiatric diagnosis can in and of itself be regarded as oppressive.<ref name="Malterud">{{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}}</ref>{{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.<ref name="Medicine betrayed" /> 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.<ref name="Veenhoven">{{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}}</ref>{{rp|29}} In that manner, whenever open trials are undesirable, they are avoided.<ref name="Veenhoven" />{{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 [[Political abuse of psychiatry in the Soviet Union|Soviet]] rule when political dissenters were labeled as "mentally ill" and subjected to inhumane "treatments."<ref name="Shah">{{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}}</ref> 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 [[Communist Romania|Romania]], [[People's Republic of Hungary|Hungary]], [[Czechoslovakia]], and [[Socialist Federal Republic of Yugoslavia|Yugoslavia]].<ref name="Medicine betrayed" /> 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.<ref name="Declan">{{cite journal |author1=Declan, Lyons |author2=Art, O'Malley |date=1 December 2002 |title=The labelling of dissent&nbsp;— 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}}</ref> Political abuse of psychiatry also takes place in the [[People's Republic of China]]<ref name="van Voren 2010">{{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}}</ref> and [[Political abuse of psychiatry in Russia|in Russia]].<ref>{{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}}</ref> Psychiatric diagnoses such as the diagnosis of '[[sluggish schizophrenia]]' in [[Political abuse of psychiatry in the Soviet Union|political dissidents in the USSR]] were used for political purposes.<ref name="Katona">{{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}}</ref>{{rp|77}}
+== History of racism in psychiatry in the United States ==
-== Nature of Diagnosis ==
+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.<ref name=":6">{{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 |language=en |doi=10.1176/appi.pn.2020.7a18}}</ref>
+=== Diagnosis ===
+Psychiatric diagnoses were influenced by Black peoples’ enslaved vs. free status, as enslaved people were not considered civilized enough to be diagnosed with insanity.<ref name=":6" /> On the other hand, free Black people were over-diagnosed with insanity, having much higher diagnosis rates than white people.<ref name=":6" /> In fact, specific diagnoses in the 19th century were crafted specifically to fit Black people – [[drapetomania]] and [[Dysaesthesia aethiopica|dyaesthesia 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.<ref name=":6" /> Prominent political figures such as [[John C. Calhoun]] used this supposed ‘evidence’ as reasoning for why slavery must be upheld, arguing that free Black people could not be entrusted with their lives and would ultimately develop lunacy.<ref name=":6" /> 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.<ref>{{Cite book |last=Hogarth |first=Rana A. |url=https://www.worldcat.org/oclc/1004770875 |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}}</ref>
+=== Scientific racism ===
+{{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.” <ref>{{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 |language=en |doi=10.1176/appi.pn.2020.8a16}}</ref><ref>{{Cite book |last=Rusert |first=Britt |url=https://www.worldcat.org/oclc/986540274 |title=Fugitive science : empiricism and freedom in early African American culture |date=2017 |isbn=978-1-4798-0470-2 |location=New York |oclc=986540274}}</ref> The proportion of Black individuals confined in establishments for "flawed and imbecile" patients surged throughout the late 19th and early 20th century.<ref name=":8">{{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 |language=en |doi=10.1176/appi.pn.2020.8b13}}</ref> 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.<ref name=":8" /> These communities were targeted by the [[Eugenics in the United States|eugenics]] and sterilization initiatives.<ref name=":9">{{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 |language=en |doi=10.1176/appi.pn.2020.9a20}}</ref> The premise that the genes of those deemed mentally ill were considered “undesirable” was used to justify the unlawful sterilization operations frequently supervised by physicians, even psychiatrists.<ref name=":9" />
+=== Hospitals ===
+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.<ref name=":6" /> 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.<ref name=":6" /> 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.<ref name=":7" />Many hospitals, especially in the southern United States, did not admit Black patients until they were eventually mandated to do so.<ref name=":7">{{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 |language=en |doi=10.1176/appi.pn.2020.7b27}}</ref> The last segregated hospital opened in 1933.<ref name=":7" /> 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.<ref name=":4">{{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 |language=en |doi=10.1176/appi.pn.2020.9b17}}</ref> 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.<ref name=":4" /> In January 1966, around two-thirds of Southern hospitals were segregated facilities and many Northern facilities remain segregated in-effect.<ref name=":4" /> 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.<ref name=":4" />
+=== In the profession ===
+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''.''<ref>{{Cite book |url=https://www.worldcat.org/oclc/39655923 |title=Black psychiatrists and American psychiatry |date=1999 |publisher=American Psychiatric Association |others=Jeanne Spurlock |isbn=0-89042-411-X |edition=1st ed |location=Washington, DC |oclc=39655923}}</ref> During the [[Civil rights movement|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.<ref name=":5">{{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 |language=en |doi=10.1176/appi.pn.2020.10a33}}</ref> 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.<ref name=":5" /> 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.<ref name=":5" /> 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.<ref name=":5" />
+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.<ref>{{Cite journal |last=Wyse |first=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 |url=https://doi.org/10.1007/s40596-020-01276-z |journal=Academic Psychiatry |language=en |volume=44 |issue=5 |pages=523–530 |doi=10.1007/s40596-020-01276-z |issn=1545-7230}}</ref>
+== Nature of diagnosis ==
 === Arbitrariness ===
-Psychiatry has been criticized for its [[List of mental disorders|broad range of mental diseases and disorders]]. Which diagnoses exist are considered valid have changed over time depending on society's [[Social norm|norms]]. Homosexuality was considered mental illness but due to changing sociological attitudes, it is no longer recognised as an illness.<ref>{{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 |url=https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30059-8/fulltext |journal=The Lancet}}</ref> Historic disorders that are no longer recognised include [[orthorexia nervosa]], [[sexual addiction]], [[parental alienation syndrome]], [[pathological demand avoidance]], [[Internet addiction disorder]]. New disorders include [[compulsive hoarding]] and [[Binge Eating Disorder|binge eating disorder]].<ref>{{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}}</ref>
+Psychiatry has been criticized for its [[List of mental disorders|broad range of mental diseases and disorders]]. Which diagnoses exist and are considered valid have changed over time depending on society's [[Social norm|norms]]. Homosexuality was considered a mental illness but due to changing attitudes, it is no longer recognised as an illness.<ref>{{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 |url=https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30059-8/fulltext |journal=The Lancet}}</ref> Historic disorders that are no longer recognised include [[orthorexia nervosa]], [[sexual addiction]], [[parental alienation syndrome]], [[pathological demand avoidance]], and [[Internet addiction disorder]]. New disorders include [[compulsive hoarding]] and [[Binge Eating Disorder|binge eating disorder]].<ref>{{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}}</ref>
-The act of diagnosis itself has been criticized for being arbitrary with some conditions being overdiagnosed.<ref name="Paris20202">{{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}}</ref> Individuals may be diagnosed with a disease despite having perceiving there as being no issues with their behaviour. In Virginia USA, it was found up to 33% of white boys are diagnosed with ADHD leading to alarm in the medical community.<ref>{{cite web |date=16 March 2017 |title=Is ADHD overdiagnosed and overtreated? |url=https://www.health.harvard.edu/blog/is-adhd-overdiagnosed-and-overtreated-2017031611304 |url-status=dead |archive-url=https://web.archive.org/web/20170316190618/https://www.health.harvard.edu/blog/is-adhd-overdiagnosed-and-overtreated-2017031611304 |archive-date=16 March 2017}}</ref>
+The act of diagnosis itself has been criticized for being arbitrary with some conditions being overdiagnosed.<ref name="Paris20202">{{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}}</ref> 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.<ref>{{cite web |date=16 March 2017 |title=Is ADHD overdiagnosed and overtreated? |url=https://www.health.harvard.edu/blog/is-adhd-overdiagnosed-and-overtreated-2017031611304 |url-status=dead |archive-url=https://web.archive.org/web/20170316190618/https://www.health.harvard.edu/blog/is-adhd-overdiagnosed-and-overtreated-2017031611304 |archive-date=16 March 2017}}</ref>
 [[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 disorder|personality disorders]] are seen as not very factual and very value-laden while delirium is quite factual and not very value-laden.<ref name=":12">{{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}}</ref>{{Rp|104}}
@@ Line 41: / Line 60: @@
 In 2013, psychiatrist [[Allen Frances]] said that he believes that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".<ref name="tburns">{{cite book |last=Burns |first=Tom |title=Psychiatry: A very short introduction |publisher=Oxford University Press |year=2006 |isbn=978-0-19-280727-4}}</ref><ref name="Frances A 111–1122">{{cite journal |author=Frances A |date=January 2013 |title=The past, present and future of psychiatric diagnosis |journal=[[World Psychiatry (journal)|World Psychiatry]] |volume=12 |issue=2 |pages=111–112 |doi=10.1002/wps.20027 |pmc=3683254 |pmid=23737411}}</ref><ref name="nasral">{{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}}</ref>
-[[Mary Boyle (psychologist)|Mary Boyle]] argues  that psychiatry is actually the study of behaviour, but acts as if it is the study of the brain based on a presumed connection between patterns of behaviour and the biological function of the brain. She argues that in the case of schizophrenia it is the bizarre behaviour of individuals that justifies the presumption of a biological cause for this behaviour rather than the existence of any evidence.<ref name=":2">{{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}}</ref>{{Rp|236}}
+[[Mary Boyle (psychologist)|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.<ref name=":2">{{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}}</ref>{{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 is 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.<ref name=":2" />{{Rp|238}}
@@ Line 53: / Line 72: @@
 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]].<ref name="competing07" /> Citing poor [[interrater reliability]], some psychiatrists have totally contested the concept of schizoaffective disorder as a separate entity.<ref name="pmid17551352">{{cite journal |author=Lake CR, Hurwitz N |date=July 2007 |year=2007 |title=Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease—there is no schizoaffective disorder |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00001504-200707000-00011 |journal=[[Curr Opin Psychiatry]] |volume=20 |issue=4 |pages=365–79 |doi=10.1097/YCO.0b013e3281a305ab |pmid=17551352}}</ref><ref name="pmid18199238">{{cite journal |author=Malhi GS, Green M, Fagiolini A, Peselow ED, Kumari V |date=February 2008 |year=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}}</ref> The categorical distinction between mood disorders and schizophrenia, known as the [[Kraepelinian dichotomy]], has also been challenged by data from genetic epidemiology.<ref name="pmid15863738">{{cite journal |author=Craddock N, Owen MJ |date=May 2005 |year=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 |pages=364–6 |doi=10.1192/bjp.186.5.364 |pmid=15863738}}</ref>
+[[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.<ref>{{Cite book |last=M. |first=Metzl, Jonathan |url=http://worldcat.org/oclc/869378233 |title=The protest psychosis : how schizophrenia became a black disease |date=2014 |publisher=Beacon Press |isbn=978-0-8070-8593-6 |oclc=869378233}}</ref>
 === ADHD ===
@@ Line 68: / Line 89: @@
 {{See also|History of psychosurgery}}
-[[Psychosurgery]] is brain surgery with the aim of changing an individuals behaviour or psychological function. Historically, this was achieved by removing of lesioning a section of the brain in ablative psychosurgery but more recently [[deep brain stimulation]] is used to remotely stimulate sections of the brain.
+[[Psychosurgery]] is brain surgery with the aim of changing an individuals behavior or psychological function. Historically, this was achieved by the removal of a lesion on a section of the brain in ablative psychosurgery 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,<ref name=":02">{{Cite book |last=Lévêque |first=Marc |url=https://books.google.com/books?id=U5EZvgAACAAJ |title=Psychosurgery: New Techniques for Brain Disorders |date=2016-09-03 |publisher=Springer International Publishing |isbn=978-3-319-34595-6 |language=en}}</ref>{{Rp|20}} for which one its creators, [[António Egas Moniz]], received a [[Nobel Prize]] in 1949.<ref>{{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}}</ref> The lobotomy fell out of favour in by 1960s and 1970s.<ref>{{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}}</ref> Other forms of ablative psychosurgery were in use in the UK in the late 1970s, to treat psychotic and mood disorders.<ref>{{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}}</ref> [[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.<ref>{{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 |issn=2095-5138 |pmc=8288968}}</ref>
+One such practice was the [[lobotomy]], that was used between the 1930s and 1950s,<ref name=":02">{{Cite book |last=Lévêque |first=Marc |url=https://books.google.com/books?id=U5EZvgAACAAJ |title=Psychosurgery: New Techniques for Brain Disorders |date=2016-09-03 |publisher=Springer International Publishing |isbn=978-3-319-34595-6 |language=en}}</ref>{{Rp|20}} for which one its creators, [[António Egas Moniz]], received a [[Nobel Prize]] in 1949.<ref>{{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}}</ref> The lobotomy fell out of favor in by 1960s and 1970s.<ref>{{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}}</ref> Other forms of ablative psychosurgery were in use in the UK in the late 1970s to treat psychotic and mood disorders.<ref>{{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}}</ref> [[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.<ref>{{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 |issn=2095-5138 |pmc=8288968}}</ref>
 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.<ref>{{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 |url=https://doi.org/10.1076/jhin.8.1.60.1766 |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}}</ref> The lobotomy was prominently depicted a means to control nonconformity in the 1962 book ''[[One Flew Over the Cuckoo's Nest (novel)|One Flew Over the Cuckoo's Nest]]''.<ref name=":3">{{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}}</ref>{{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.<ref name=":3" />{{Rp|116}} He stated that "psychosurgery is a crime against humanity, a crime that cannot be condoned on medical, ethical, or legal grounds". Psychosurgeons [[William Beecher Scoville]] and [[Petter Lindström]] said that Breggin's critique was emotional and not based on facts.<ref name=":3" />{{Rp|121}}
+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.<ref name=":3" />{{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.<ref name=":3" />{{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 psychosurgeons "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.<ref name=":3" />{{Rp|123}}
+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.<ref name=":3" />{{Rp|123}}
 === Electroconvulsive therapy ===
-[[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,<ref>{{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}}</ref><ref>{{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}}</ref> and was one treatment that the anti-psychiatry movement wanted eliminated.<ref name="Shorter282">{{harvnb|Shorter|1997|p=282}}.</ref> Their arguments were that ECT damages the brain,<ref name="Shorter282" /> and was used as punishment or as a threat to keep the patients "in line".<ref name="Shorter282" /> Since then, ECT has improved considerably,<ref name="APP textbook">{{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}}</ref><ref>{{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}}</ref> and is performed under general anesthesia in a medically supervised environment.<ref name="Fink">{{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}}</ref>
+[[Electroconvulsive therapy]] is a therapy method which was used widely between the 1930s and 1960s and is, in a modified form, still used today.<ref>{{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}}</ref><ref>{{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}}</ref> Electroconvulsive therapy was one treatment that the anti-psychiatry movement wanted to be eliminated from psychiatric practice.<ref name="Shorter282">{{harvnb|Shorter|1997|p=282}}.</ref> Their arguments were that ECT damages the brain,<ref name="Shorter282" /> and was used as punishment or as a threat to keep the patients "in line".<ref name="Shorter282" /> Since then, ECT has improved considerably,<ref name="APP textbook">{{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}}</ref><ref>{{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}}</ref> and is now performed under general anesthesia in a medically supervised environment.<ref name="Fink">{{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}}</ref>
 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.<ref>{{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}}</ref><ref>{{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}}</ref> 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.<ref name="neurostimulation1">{{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}}</ref>
-The most common side effects include headache, muscle soreness, confusion, and temporary loss of recent memory.<ref>{{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}}</ref><ref name="Fink" /><ref>{{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}}</ref>
+The most common side effects of '''ECT''' include headache, muscle soreness, confusion, and temporary loss of recent memory.<ref>{{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}}</ref><ref name="Fink" /><ref>{{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}}</ref>
 == Marketing of antipsychotic drugs ==
-Psychiatry has greatly benefitted by advances in pharmacotherapy.<ref name="tburns2">{{cite book |last=Burns |first=Tom |title=Psychiatry: A very short introduction |publisher=Oxford University Press |year=2006 |isbn=978-0-19-280727-4}}</ref>{{rp|110–112}}<ref name="Irish">{{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}}</ref> However, the close relationship between those prescribing psychiatric medication and pharmaceutical companies, and the risk of a conflict of interest,<ref name="Irish" /> is also a source of concern. This marketing by the pharmaceutical industry has an influence on practicing psychiatrists, which affects prescription.<ref name="Irish" /> Child psychiatry is one of the areas in which prescription has grown massively. In the past, it was rare, but nowadays child psychiatrists on a regular basis prescribe [[Psychotropic drugs|psychotropic substances]] for children, for instance [[Methylphenidate|Ritalin]].<ref name="tburns2" />{{rp|110–112}}
+Psychiatry has greatly benefitted by advances in pharmacotherapy.<ref name="tburns2">{{cite book |last=Burns |first=Tom |title=Psychiatry: A very short introduction |publisher=Oxford University Press |year=2006 |isbn=978-0-19-280727-4}}</ref>{{rp|110–112}}<ref name="Irish">{{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}}</ref> However, the close relationship between those prescribing psychiatric medication and pharmaceutical companies, and the risk of a conflict of interest,<ref name="Irish" /> is also a source of concern. This relationship is often described as being part of the [[Medical–industrial complex|medical-industrial complex]]. This marketing by the pharmaceutical industry has an influence on practicing psychiatrists, which affects prescription.<ref name="Irish" /> 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 drugs|psychotropic substances]], such as [[Ritalin]], on a regular basis to children.<ref name="tburns2" />{{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.<ref name="guard 1">{{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}}</ref> Moncreiff has further argued, in the controversial and non-[[Peer review|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.<ref name="Moncrieff-2006">{{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}}</ref>
-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 under pressure from care home staff.<ref>''GPs under 'pressure' to issue neuroleptics, claims professor'', Chemist + Druggist, 15 January 2009</ref> 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.<ref>{{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}}</ref><ref>{{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}}</ref> In the US, the government has initiated legal action against the pharmaceutical company [[Johnson & Johnson]] for allegedly paying [[Kickback (bribery)|kickbacks]] to [[Omnicare]] to promote its antipsychotic [[risperidone]] (Risperdal) in nursing homes.<ref name="Hilzenrath">{{Cite news |author=Hilzenrath, David S. |date=16 January 2010 |title=Justice suit accuses Johnson & Johnson of paying kickbacks |work=The Washington Post |url=https://www.washingtonpost.com/wp-dyn/content/article/2010/01/15/AR2010011503903.html |access-date=17 January 2010}}</ref>
+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.<ref>''GPs under 'pressure' to issue neuroleptics, claims professor'', Chemist + Druggist, 15 January 2009</ref> 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.<ref>{{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}}</ref><ref>{{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}}</ref> In the US, the government has initiated legal action against the pharmaceutical company [[Johnson & Johnson]] for allegedly paying [[Kickback (bribery)|kickbacks]] to [[Omnicare]] to promote its antipsychotic [[risperidone]] (Risperdal) in nursing homes.<ref name="Hilzenrath">{{Cite news |author=Hilzenrath, David S. |date=16 January 2010 |title=Justice suit accuses Johnson & Johnson of paying kickbacks |work=The Washington Post |url=https://www.washingtonpost.com/wp-dyn/content/article/2010/01/15/AR2010011503903.html |access-date=17 January 2010}}</ref>
 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.<ref name="bied2010">{{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?_r=3&hp=&pagewanted=all}}</ref> 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]].<ref name="bied2010" /> In addition, [[Astrazeneca]] faces numerous personal-injury lawsuits from former users of [[Seroquel]] (quetiapine), amidst federal investigations of its marketing practices.<ref>{{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?_r=1 |access-date=27 July 2012}}</ref> 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&nbsp;billion and $5.4&nbsp;billion respectively.<ref name="healthcarefinancenews.com">[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).</ref>
-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&nbsp;— some of them undisclosed to Harvard&nbsp;— from companies including 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.<ref name="bied2010" />
+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.<ref name="bied2010" />
 In 2004, [[University of Minnesota]] research participant [[Death of Dan Markingson|Dan Markingson committed suicide]] while enrolled in an industry-sponsored pharmaceutical trial comparing three FDA-approved atypical antipsychotics: [[Quetiapine|Seroquel (quetiapine)]], [[Olanzapine|Zyprexa (olanzapine)]], and [[Risperidone|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 (philosopher)|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.<ref>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</ref> 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|Institutional Review Board (IRB)]] protections for research subjects.<ref>{{cite web |author=Carl |date=2012-11-23 |title=Dan Markingson Investigation |url=http://markingson.blogspot.com/ |access-date=February 14, 2016}}</ref> A 2005 FDA investigation cleared the university.  Nonetheless, controversy around the case has continued. [[Mother Jones (magazine)|''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.<ref>{{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}}</ref>
@@ Line 105: / Line 126: @@
 == Anti-psychiatry ==
-The term [[anti-psychiatry]] was coined by psychiatrist [[David Cooper (psychiatrist)|David Cooper]] in 1967 and is understood in current psychiatry to mean opposition to psychiatry's perceived role aspects of treatment.<ref name="tburns3">{{cite book |last=Burns |first=Tom |title=Psychiatry: A very short introduction |publisher=Oxford University Press |year=2006 |isbn=978-0-19-280727-4}}</ref> 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.<ref name="tburns3" /><ref name="nasral2">{{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}}</ref> Every society, including liberal Western society, permits [[compulsory treatment]] of mental patients.<ref name="tburns3" /> 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.<ref>{{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/ |url-status=dead |archive-url=https://web.archive.org/web/20140314074138/http://www.who.int/mediacentre/news/notes/2012/mental_health_20120615/en/ |archive-date=March 14, 2014 |access-date=12 June 2014 |publisher=WHO}}</ref>
+The term [[anti-psychiatry]] was coined by psychiatrist [[David Cooper (psychiatrist)|David Cooper]] in 1967 and is understood in current psychiatry to mean opposition to psychiatry's perceived role in aspects of treatment.<ref name="tburns3">{{cite book |last=Burns |first=Tom |title=Psychiatry: A very short introduction |publisher=Oxford University Press |year=2006 |isbn=978-0-19-280727-4}}</ref> 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 leaves much room for opinions and interpretations.<ref name="tburns3" /><ref name="nasral2">{{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}}</ref> Every society, including liberal Western society, permits [[compulsory treatment]] of mental patients.<ref name="tburns3" /> 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.<ref>{{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/ |url-status=dead |archive-url=https://web.archive.org/web/20140314074138/http://www.who.int/mediacentre/news/notes/2012/mental_health_20120615/en/ |archive-date=March 14, 2014 |access-date=12 June 2014 |publisher=WHO}}</ref>
-[[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.
+[[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.
-Three authors have come to personify the movement against psychiatry, of which two are or 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]]''. [[Michael 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 (psychiatrist)|David Cooper]] in 1967.<ref name="tburns3" /><ref name="nasral2" /> The founder of the [[Non-psychiatric approaches to psychological suffering|non-psychiatric approach]] to [[psychological suffering]] is [[Giorgio Antonucci]].<!--these are four authors-->
+Multiple authors have come to personify the movement against psychiatry, two of which are or 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]]''. [[Michael Foucault]] challenged the very basis of psychiatric practice and cast it as repressive and controlling. The founder of the [[Non-psychiatric approaches to psychological suffering|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.<ref name="tburns3" />
+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.<ref name="tburns3" />
 == Psychiatric survivors movement ==
-The [[psychiatric survivors movement]]<ref name="challenge">{{Cite book |last=Corrigan |first=Patrick W. |url=https://books.google.com/books?id=mf6MIScKn0EC&q=%22MindFreedom%22&pg=PT20 |title=Challenging the Stigma of Mental Illness: Lessons for Therapists and Advocates |author2=David Roe |author3=Hector W. H. Tsang |date=2011-05-23 |publisher=John Wiley and Sons |isbn=978-1-119-99612-5}}</ref> 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.<ref name="Oaks letter">{{cite journal |author=Oaks D |date=2006-08-01 |title=The evolution of the consumer movement |journal=Psychiatric Services |volume=57 |issue=8 |page=1212 |doi=10.1176/appi.ps.57.8.1212 |pmid=16870979}}</ref> 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''.<ref name="challenge" /><ref>{{Cite book |last=Chamberlin |first=Judi |title=On Our Own: Patient-Controlled Alternatives to the Mental Health System |publisher=Hawthorne |year=1978 |isbn=978-0-8015-5523-7 |location=New York}}</ref> Chamberlin was an ex-patient and co-founder of the Mental Patients' Liberation Front.<ref>{{cite journal |vauthors=Rissmiller DJ, Rissmiller JH |date=2006-06-01 |title=Evolution of the antipsychiatry movement into mental health consumerism |url=https://semanticscholar.org/paper/9683ccd7a611b47b53259bef91256cef625999f3 |journal=Psychiatric Services |volume=57 |issue=6 |pages=863–6 [865] |doi=10.1176/appi.ps.57.6.863 |pmid=16754765 |s2cid=19635873}}</ref> Coalescing around the ex-patient newsletter ''Dendron'',<ref>{{cite journal |last=Ludwig |first=Gregory |date=2006-08-01 |title=Letter |journal=Psychiatric Services |volume=57 |issue=8 |page=1213 |doi=10.1176/appi.ps.57.8.1213 |pmid=16870981}}</ref> 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.<ref>[http://www.mindfreedom.org/about-us About Us — MFI Portal]</ref> In 2005 the SCI changed its name to [[Mind Freedom International]] with [[David W. Oaks]] as its director.<ref name="Oaks letter" />
+The [[psychiatric survivors movement]]<ref name="challenge">{{Cite book |last=Corrigan |first=Patrick W. |url=https://books.google.com/books?id=mf6MIScKn0EC&q=%22MindFreedom%22&pg=PT20 |title=Challenging the Stigma of Mental Illness: Lessons for Therapists and Advocates |author2=David Roe |author3=Hector W. H. Tsang |date=2011-05-23 |publisher=John Wiley and Sons |isbn=978-1-119-99612-5}}</ref> arose out of the [[civil rights]] era 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.<ref name="Oaks letter">{{cite journal |author=Oaks D |date=2006-08-01 |title=The evolution of the consumer movement |journal=Psychiatric Services |volume=57 |issue=8 |page=1212 |doi=10.1176/appi.ps.57.8.1212 |pmid=16870979}}</ref> The key text in the intellectual development of the survivor movement, at least in the United States, was [[Judi Chamberlin]]'s 1978 text, ''On Our Own: Patient Controlled Alternatives to the Mental Health System''.<ref name="challenge" /><ref>{{Cite book |last=Chamberlin |first=Judi |title=On Our Own: Patient-Controlled Alternatives to the Mental Health System |publisher=Hawthorne |year=1978 |isbn=978-0-8015-5523-7 |location=New York}}</ref> Chamberlin was an ex-patient and co-founder of the Mental Patients' Liberation Front.<ref>{{cite journal |vauthors=Rissmiller DJ, Rissmiller JH |date=2006-06-01 |title=Evolution of the antipsychiatry movement into mental health consumerism |url=https://semanticscholar.org/paper/9683ccd7a611b47b53259bef91256cef625999f3 |journal=Psychiatric Services |volume=57 |issue=6 |pages=863–6 [865] |doi=10.1176/appi.ps.57.6.863 |pmid=16754765 |s2cid=19635873}}</ref> Coalescing around the ex-patient newsletter ''Dendron'',<ref>{{cite journal |last=Ludwig |first=Gregory |date=2006-08-01 |title=Letter |journal=Psychiatric Services |volume=57 |issue=8 |page=1213 |doi=10.1176/appi.ps.57.8.1213 |pmid=16870981}}</ref> 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 necessary. 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.<ref>[http://www.mindfreedom.org/about-us About Us — MFI Portal]</ref> In 2005, the SCI changed its name to [[Mind Freedom International]] with [[David W. Oaks]] as its director.<ref name="Oaks letter" />
-== History of racism ==
+== See also ==
+* [[Drapetomania]]
-=== Lead ===
+* [[The Protest Psychosis]]
-=== Article body ===
-== See also ==
 === References ===