As India liberalized its borders in the early 1990s, new desires and ways of being arrived, and with them marched in the fields of Psychology and Psychiatry in full glory. I was their foremost champion and cheerleader.
Over the next few years, if I had not seen the mental health systems fail miserably, I would have remained blind to the importance of questioning knowledge. A few years ago, Psychology was hit by a replication crisis when it was exposed that many of its experiments were faulty. The foundation of science is that an experiment done repeatedly in the same conditions should produce the same results. Psychology’s experiments were failing this test badly, and still are. By the time the replication crisis had started rolling in, I had gone through a clinical internship in Delhi where fumbling psychiatrists were practicing trial and error on their patients. Physical punishment was liberally used. Later while living in the US, I learned that sexual and physical abuse in Western psychiatric hospitals was commonplace. Everyone I knew supported access to mental health services but very few understood what being in a psychiatric ward could do to a person. Even fewer knew that these services, which they respected and posted about on social media, were deeply flawed and even dangerous.
Discarding and dismissing the voice of people who were actually undergoing psychiatric and psychological treatment (known as ‘service users’) was and is the norm. I have known people who suffered life-altering adverse effects of antidepressants and others who experienced painful akathisia caused by antipsychotic medication. At no point did the system take their concerns seriously or simply informed patients/service users about what to expect with psychiatric medication. Before service users pointed out that akathisia can be brutal and excruciating, in our clinical work we were taught it was “just restlessness”. This “just restlessness” has now come forward as one of the key reasons behind suicide and homicide for people taking psychiatric medications. Now we know, after decades of research, that antidepressants are addictive and people become physically dependent on them. Often people who think they relapsed after stopping antidepressants are instead experiencing withdrawal caused by antidepressants. In lay-man’s terms, this is addiction, but the pharmaceutical industry funded a fancier name for it: antidepressant discontinuation syndrome.
I had friends and colleagues working in American psychiatric hospitals and they complained about revolving doors – the phenomena that most people who come in for treatment never get cured. They are given a band-aid solution, made to leave, and come back in a few weeks or months – a revolving door effect. These on-ground workers, people who actually spent the most amount of time with the patients, insisted that anyone who thought clinicians had treatments or cures was deluding themselves.
Questioning prevalent knowledge, and deconstructing our most cherished ideas is central to good science, to valid research, and to helpful intervention. We must learn to reserve our judgments about people who are suffering, and our attachment to ideas about mental health that emerge from Euro-American cultures which have little in common with the rest of the world. Instead, we need to pay attention to the words and visibilities of the people experiencing distress. Without a philosophical background that encouraged me to be a good scientist, and to question the most basic assumptions around what I was taught, I would have made the same mistakes. Any time a patient said that the treatment was not working, I would have called them “treatment resistant”. I would have taken everything I heard or was taught as valid knowledge. I would not have researched whether “talking cure” (psychotherapy) actually is helpful or not. Everyone around me said it was, but there are multiple studies that show that therapy is often simply useless, and sometimes downright harmful. It can of course also be helpful and healing for some. Had mainstream Psychology and Psychiatry paid attention to philosophy, they could have been saved some embarrassment. Humiliation often follows hubris.
This was my experience but attacks on the field of Psychology and Psychiatry come from numerous sources, and are well-deserved. There is the notorious replication crisis which garnered significant media attention. Additionally, our historical failures have followed us into the present. For e.g., in the past there was a ridiculous diagnosis of Drapetomania and later homosexuality was considered a mental illness. Then there was the documented overdiagnosis of schizophrenia amongst black men who were protesting for civil rights. There are embarrassments caused by “treatments” such as removal of teeth for curing schizophrenia, or the cutting of brain parts – a treatment that now has place in torture museums, but then got Egas Moniz a Noble Prize. Moniz insisted that having fewer brain parts made his patients calm and thus this was successful treatment of mental illness; he said it was also always safe. It’s not just the past; few are aware of how clinician biases still lead to different diagnoses based on socio-economic status, even when symptoms are the same.
The scandal around American Psychological Associations’ (APA) collusion with Bush-era torture is well-known but the links between warm and fuzzy positive psychology with American military programs are less popular. More recently, even the highly respected Empirically Supported Treatments — treatments that APA says have evidence that they work, came under scrutiny as researchers found only mixed results; many of these treatments showed questionable power and replicability.
Historical blunders aside, current criticisms come from within and outside the disciplines of Psychology and Psychiatry. Cross-cultural and especially indigenous practitioners from across the world have criticized our field’s understanding of what is mentally ill or healthy, the priority we give to feelings and talking about feelings, and how we de-prioritize the body. They noted that this division Psychology creates between the mind and body is artificial, and thus this tendency to think that expressing feelings verbally is healthy (“the only way to heal is to talk about it”) and expressing feeling via the body is unhealthy (“a stress headache means you are repressing feelings”) is inaccurate and biased. Academics, researchers, theoreticians, and physicians from across the global south scrutinized how the DSM’s (the American Psychiatric Association’s manual that tells us which symptoms are a mental disorder) criteria of trauma and grief are do not apply to the native populations even in America, let alone the rest of the world. Most of all, they challenged Psychology’s portrayal of people around the world as damaged, intellectually inferior, incapable of understanding their own suffering, and needing to be rescued by the Global North. Academics pointed to how Psychology, by calling oppressed groups of people traumatized and needing therapy, has actually helped oppressors stay powerful. This helps oppressors by focusing on mental health issues while ignoring people’s actual demands for self-governance, land rights, water rights etc.
Psychology’s toxic effects in other countries ranged from misdiagnosing and drugging of street children, and even guilting and financially penalizing young girls when they didn’t live up to our standards of psychological mental health. Cultural psychology has revealed that fundamental attribution error is anything but fundamental, that universal perceptual illusions such as the Muller-Lyer are not universal at all, and that most of our studies are studies of Psychology undergraduates which we then liberally apply to people across the world. We have found our research, evidence, and even abstracts in papers to be riddled with bias. Pharmaceutical industry corruption is rampant and new evidence shows that people’s emotional experiences like depression are not a chemical imbalance.
Over the years it is the service user movement which has courageously fought to be heard. Recently it made great strides and brought about policy-level change as professionals admitted that antidepressant withdrawal was devastating and could last for more than a year. Earlier we told patients that it lasts a few weeks and is mild. This led to necessary changes to the UK’s NICE guidelines and the Royal College of Psychiatry released resources for antidepressant withdrawal. Noted figures on the inside wrote about our past errors and critiqued our current ways, often at great personal cost.
The list of failures, blunders, corruption, greed, and incompetence is unending. So, where are we going to go from here? Will these cracks in the Psy-Disciplines lead to a revolution? My worry is that this movement will get destroyed as we fashionably talk about systemic issues (gender, caste, and class violence causing mental distress) while looking for individual interventions (give people a pill).
When I read the contributions coming from other disciplines such as anthropology, literature, sociology, social work, linguistics, philosophy and more, I have hope. The possibility of change, of an actual paradigm shift, is slim if criticism is superficial. We must examine our most basic ideas around mental health, illness, suffering, and healing. Most importantly, we must listen to those experiencing mental distress and use the feedback of people using mental health services, whether these are medications, therapy, group support or anything else.
We must hold to light Psychology’s and Psychiatry’s crimes, and make no mistake they are crimes.
This piece is similar to another authored by Ayurdhi Dhar for American Psychological Associations’ Division 24 Newsletter.
Dr. Ayurdhi Dhar is a spotlight interviewer for Mad in America and the founder of Mad in South Asia. She does some professoring (Assistant Professor at the University of West Georgia) and academic writing (author of Madness and Subjectivity: A Cross-Cultural Examination of Psychosis in the West and India), but mostly likes to be known for her love for food, animals, friends, and family. She struggles daily with her desire to pet every dog she sees.