A review of James Davies, Cracked Why Psychiatry is Doing More Harm than Good (Icon Books, 327p) Why Psychiatry is Doing More Harm than Good (Icon Books, 327p):
Editor’s note: It’s worth noting that DSM categories of mental illness are no longer accepted for official purposes in the U.S.
If you have ever spent time listening at length to a hospitalized psychiatric patient, who was completely rational, and on the same day outside the hospital listened to someone else go off on an absurd and emotional rant, you have no doubt wondered: what is the difference between “mental health” and “mental illness”? In his book, Cracked: Why Psychiatry is Doing More Harm than Good, James Davies takes on the question with skill and intensity. Davies is an Oxford Ph.D. in Social Anthropology, and a psychotherapist. His efforts have received wide attention in medicine, the academy, and the media. He wants us to know, as is obvious from his book title, that something is seriously wrong in Psychiatry. Davies’s book is one of a several recent volumes by various authors about the same crisis, including Joanna Moncrief’s The Myth of the Chemical Cure (2009), Gary Greenberg’s Manufacturing Depression (2010) and The Book of Woe (2013), Tom Burns’s Our Necessary Shadow, and Allen Frances’s Saving Normal (2013).
Davies tells us that much of psychiatry functions on a basis that is completely materialistic, that biology explains the sorrows of the soul, and thus chemicals will correct them. Although there are, what he calls, “critical psychiatrists,” who do not adhere to this doctrine, they are not in the majority.
Davies has made his case by interviewing several of the leaders in psychiatry in the US and England. He has also made liberal use of statistical studies and scientific research to back up his conclusions. An engaging writer, Davies tells us the story of the crisis in psychiatry by taking us on an excursion that progresses from bad to worse. He begins by telling how the Diagnostic and Statistical Manual of Mental Disorders (DSM) was written (originally written in 1952, with 130 pages) and improved (the latest edition has 991 pages). Many mental diseases in the manual were so determined by vote or by consensus of the committee (14-16), not research. In fact, most mental diseases in the manual have no rigorous research that helps identify them. Davies quotes Dr. Robert Spitzer, who led the writing of DSM III as saying to him, “There are only a handful of mental disorders in the DSM known to have a clear biological cause” (22). The end result of listing and describing more and more new mental illnesses, even Dr. Allen Frances, the leader of DSM IV admits, has resulted in “medicalizing” normal human problems (52-54). Fully a quarter of the people in the US are regarded as suffering from a mental illness. People are tagged as mentally unfit, when in fact they are often just having a hard time with life.
As if this isn’t aggravating enough, Davies lets us in on information that is downright depressing. Psychiatrists, followed by other doctors whom they advise, prescribe medicine to help or cure mental illnesses, including depression. When research demonstrates that the medication is ineffective, the reports are typically suppressed by pharmaceutical companies (135-148). Citing the work of Professor Irving Kirsch, Davies relates that antidepressants work little better than placebos (59-75). Antipsychotics, on the other hand help stabilize people after a psychotic episode (287-288). What psychiatric drugs typically do is alter the brain’s functioning. They do not cure (100). Davies cites a study in the British Journal of Psychiatry (2007) which confirms that for antidepressants, “psychoactive effects are neither useful nor beneficial” (106).
Many doctors would take issue with Davies, having observed instances where antidepressants have helped their patients. But Davies is not calling for their total elimination. He likewise warns about stopping, or even weaning oneself from an antidepressant without professional help. Indeed, Davies is looking at medical science and the pharmaceutical industry critically, and balance from another perspective is no doubt helpful. Tom Burns for instance, argues that psychiatry, for all its flaws helps in treating severe illnesses. Even if effects of medications on psychotic patients are placebo effects, would we want to eliminate them?
Davies interview with Joanna Moncrief is quite interesting. He quotes her on the subject of chemical solutions to mental problems, and gets to the real heart of the matter, and why antidepressants are not what they are purported to be: “The idea that there is a brain disease, or a chemical imbalance or a faulty neural network that these pills correct is completely false and unsupported.” (111). In the meantime, Moncrief has been joined in her assessment by many other psychiatrists (127-129). Davies does not let his story become morose, but injects humor from time to time. At the end of chapter 8, he writes, “if you suffer from high blood pressure, you should probably consult your physician before turning the page.”
Davies has taken his story to the public, and has written an account that anyone can understand. Change needs to come through pressure from outside.
There is money to be made in selling psychiatric drugs: proof or no proof of effectiveness. The fact that the chemical imbalance theory is not proven, “doesn’t seem to matter to these (pharmaceutical) corporations, who have made their public assertions as though they were based on scientifically established certainties” (199). Psychiatry and pharma create success for one-another. Psychiatry adheres to a myth, says Davies, “that mental suffering is caused by our biology” (216). And so doctors cure mental suffering with pills. Together, psychiatry and the pharmaceutical industry have “begun to alter the way many of us now manage, respond to and experience our emotional discontent.” (207). The most disturbing note about the pharmaceutical industry in Davies’s book is his revelation that companies not only market drugs; they also market diseases, such as “depression” as a disease. Once the people of a region or nation are convinced about the disease, it becomes easy to market the medicine (244-256).
Davies tells us that much of psychiatry functions on a basis that is completely materialistic, that biology explains the sorrows of the soul, and thus chemicals will correct them. Although there are, what he calls, “critical psychiatrists,” who do not adhere to this doctrine, they are not in the majority. He is convinced that psychiatry will not be able to extricate itself from the vicious circle of mythical diseases for which one prescribes medicine, which brings cash to pharmaceutical companies, who in turn offer grants to universities and researchers, who then influence doctors to further the chemical view. Thus, Davies has taken his story to the public, and has written an account that anyone can understand. Change needs to come through pressure from outside. The book is worth the read, and I for one hope Davies’s efforts will meet with success.
Jeff Brown is a pastor in Nuremberg, Germany, and comes from a medical family. He holds a B.S. in Biology and a Ph.D. in Systematic Theology.