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Marx, Spinoza, and the Political Implications of Contemporary Psychiatry


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Simple logic tells us that those atop a societal hierarchy will provide rewards for professionals—be they clergy or psychiatrists—who promote an ideology that maintains the status quo, and that the ruling class will do everything possible to manipulate the public to believe that the social-economic-political status quo is natural.

If a population believes that its financial and emotional suffering are caused not by social-economic-political variables but instead by individual defects—be it noncompliance with religious dogma or faulty biochemistry—this “individual-defect” belief system can be a more powerful and less expensive way of maintaining the status quo than a heavily armed police force.

That organized religion has a great deal in common with organized psychiatry would be apparent to both Karl Marx (1818-1883) and Baruch Spinoza (1632-1677), two of history’s most famous critics of the political implications of organized religion.

Karl Marx, in A Contribution to the Critique of Hegel’s Philosophy of Right (1843), famously said: “Religion is the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions. It is the opium of the people. The abolition of religion as the illusory happiness of the people is the demand for their real happiness. To call on them to give up their illusions about their condition is to call on them to give up a condition that requires illusions.”

Baruch Spinoza, in his Theological-Political Treatise (1670), somewhat less famously but perhaps more courageously given his era, said: “Granted, then, that the supreme mystery of despotism, its prop and stay, is to keep men in a state of deception, and with the specious title of religion to cloak the fear by which they must be held in check, so that they will fight for their servitude as if for salvation.”

Today, a handful of professors teach their students about Antonio Gramsci (1891-1937) and cultural hegemony, however, a century ago, the working class did not need scholars to explain to them how prevailing cultural beliefs are often social constructs implemented by the ruling class through favored institutions so as to maintain domination. Back then, workers immediately got IWW activist Joe Hill’s (1879-1915) song “The Preacher and the Slave” (1911) about how preachers from the “starvation army” attempt to get them to buy the lie: “Work and pray, live on hay. You’ll get pie in the sky when you die.”

If alive today, Hill may well write something along the lines of: “Alienate . . . Medicate. You’ll get pie in the sky with your SSRI.”

A generation ago, the political implications of biological individual-defect theories were obvious to many prominent scientists with a left perspective, for example, evolutionary geneticist R.C. Lewontin, neurobiologist Steven Rose, and psychologist Leon Kamin. In their 1984 book Not in Our Genes: Biology, Ideology, and Human Nature, Lewontin, Rose, and Kamin make clear the rightwing political ideology implicit in the individual defect theory of biochemical/genetic determinism: “Biological determinism (biologism) has been a powerful mode of explaining the observed inequalities of status, wealth, and power in contemporary industrial capitalist societies. . . . Biological determinism is a powerful and flexible form of ‘blaming the victim.’”

Marx and Spinoza highly valued science, but it would be obvious to them that simply calling oneself scientific does not make one so.

Should psychiatry be seen as a science? Or should it be seen—no different than organized religion— as simply a belief system with its own social constructs that are promoted by the ruling class to convince people that their suffering is due to individual defects, rather than a defective social-economic-political system that results in alienation from one’s own humanity, from others, and from the rest of the natural world?

The Scientific Failure of Contemporary Psychiatry

Within the highest levels of establishment psychiatry, there are today three acknowledged areas of scientific failure that contradict the myth of psychiatry’s scientific progress: (1) the jettisoning of psychiatry’s chemical imbalance theory of mental illness; (2) worsening treatment outcomes despite increased treatment; and (3) the scientific invalidity of its diagnostic system.

First, the jettisoning of psychiatry’s chemical imbalance theory of mental illness. Crucial to psychiatry’s value to the ruling class is some kind of “individual-defect theory of mental illness.” Much of the public and even many doctors remain unaware that researchers had disproven psychiatry’s chemical imbalance theory of mental illness by the 1990s, and that more recently, even establishment psychiatry has publicly acknowledged this theory’s invalidity.

In 1998, in Blaming the Brain, Elliot Valenstein, professor emeritus of psychology and neuroscience at the University of Michigan, detailed research showing that it is just as likely for people with normal serotonin levels to feel depressed as it is for people with abnormal serotonin levels, and that it is just as likely for people with abnormally high serotonin levels to feel depressed as it is for people with abnormally low serotonin levels, and he concluded, “Furthermore, there is no convincing evidence that depressed people have a serotonin or norepinephrine deficiency.”

In 2011, establishment psychiatrist Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times, stated: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” Thomas Insel, National Institute of Mental Health (NIMH) director from 2002-2015, recently acknowledged the jettisoning of the chemical imbalance theory in his 2022 book Healing, stating: “The idea of mental illness as a ‘chemical imbalance’ has now given way to mental illnesses as ‘connectional’ or brain circuit disorders.”

With respect to this “brain circuit disorder” theory, there is as little evidence for this new individual-defect theory as there was for the now discarded chemical imbalance theory. Spinoza knew, 350 years ago, that the new and not yet unproven is useful in keeping the public hoodwinked, as he remarked: “Indeed, as the multitude remains ever at the same level of wretchedness, so it is never long contented, and is best pleased only with what is new and has not yet proved delusory.”

Second, worsening treatment outcomes despite increased treatment. Insel, as NIMH director in 2011, acknowledged: “Whatever we’ve been doing for five de­cades, it ain’t working. And when I look at the numbers—the number of sui­cides, number of disabilities, mortality data—it’s abysmal, and it’s not getting any better” (reported by Gary Greenberg in The Book of Woe, 2013).

In 2021, New York Times reporter Benedict Carey, after covering psychiatry for twenty years, concluded that psychiatry had done “little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health—rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use—went the wrong direc­tion, even as access to services expanded greatly.” In his 2022 book Healing, former NIMH director Insel, notes: “While we studied the risk factors for suicide, the death rate had climbed 33 percent.”

All of this despite increased treatment, as Insel reports, “Since 2001, prescriptions for psychiatric medications have more than doubled, with one in six American adults on a psychiatric drug.”

Third, scientific invalidity of psychiatry’s diagnostic system. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA), the guild of American psychiatrists, and it is routinely referred to as the “bible of psychiatry.” In 2010, the chair of DSM-IV task force, Allen Frances, candidly acknowledged that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” In 2013, the same year that the newly revised DSM-5 (foregoing Roman numerals) was published, Insel, as NIMH director, stated that the DSM’s diagnostic categories lack validity and announced that “NIMH will be re-orienting its research away from DSM categories.” Frances was so appalled and embarrassed by the APA’s DSM-5 revision that he published Saving Normal: An Insider’s Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (2013).

Not only is there a growing consensus among establishment psychiatry that DSM disorders are scientifically invalid, DSM diagnoses cannot be reliably assessed. To assess the reliability of the current DSM-5, the APA conducted field trials assessing the degree of agreement between clinicians diagnosing the same individuals. A standard statistic used to assess reliability is called kappa (a kappa value of 0 means zero agreement and no reliability, and a kappa of 1.00 means perfect reliability). A previous DSM task force chair, Robert Spitzer, had stated that with respect to assessing the reliability of the DSM that a kappa of less than .40 indicates “poor” agreement and .70 was “only satisfactory.” For the DSM-5 field trials, here is a sample of kappa results: .20 for generalized anxiety disorder; .32 for major depressive disorder; .41 for oppositional defiant disorder; and .46 for schizophrenia.

If a construct lacks validity and cannot be reliably measured, it has no scientific value, and so research that attempts to associate such constructs with biochemical-genetic variables is simply “garbage in, garbage out” research.

What Would Spinoza Think of the Political Implications of Psychiatry?

There have been many efforts at applying a Marxist analysis to psychiatry, most recently by psychiatrist Joanna Moncrieff, co-chair off the Critical Psychiatry Network, who references several such Marxist analyses in her 2022The Political Economy of the Mental Health System: A Marxist Analysis.” Moncrieff concludes, “The concept of mental illness has a strategic role in modern societies, therefore, enabling certain contentious social activities by obscuring their political nature, and diverting attention from the failings of the underlying economic system.”

In contrast to Marxist analyses of psychiatry, Spinozist analyses of psychiatry are uncommon. I believe that Spinoza would see both the overt and insidious political implications of contemporary psychiatry.

The overt institutional corruption of psychiatry would be immediately obvious to Spinoza. Observing the financial relationships between drug companies and psychiatry, Spinoza or any critical thinker would not take seriously psychiatry’s proclamations (or those of any institution that has a blatant disregard with respect to conflicts of interest that compromise and corrupt science).

Financial relationships between drug companies and psychiatry institutions have—similar to other US industrial complexes—increasingly become normalized. Owing to 2008 Congressional hearings on psychiatry’s financial relationship with drug companies, psychiatry’s flagrant conflicts of interest received widespread public attention. One of many psychiatrists exposed by these Congressional hearings was Harvard psychiatrist Joseph Biederman, Director of the Johnson & Johnson Center for Pediatric Psychopathology Research at Massachusetts General Hospital. Biederman is credited with creating pediatric bipolar disorder, and due in great part to his influence, the number of American children and adolescents treated for bipolar disorder increased forty-fold from 1994 to 2003. Congressional investigations revealed that Biederman had received $1.6 million in consulting fees from drug makers from 2000 to 2007.

Federal legislation was enacted in 2013 that required pharmaceutical companies to disclose their direct payments to physicians, resulting in the creation of an Open Payments database. However, psychiatrists, similar to most US politicians, are not concerned that the transparency of their conflicts of interest will harm their careers. In 2021, utilizing this database, journalist Robert Whitaker reported: “From 2014 to 2020, pharmaceutical companies paid $340 million to U.S. psychiatrists to serve as their consultants, advisers, and speakers, or to provide free food, beverages and lodging to those attending promotional events.” Open Payments lists 31,784 psychiatrists (roughly 75 percent of the psychiatrists in the United States) who, Whitaker noted, “received something of value from the drug companies from 2014 through 2020.”

Spinoza was scrupulous about not allowing any financial conflicts of interest to interfere with his free thought and expression. In one of many examples of how he conducted his life, in 1673, Spinoza’s fame overseas garnered him an offer for a prestigious job, as he received a flattering letter from a professor at the University of Heidelberg inviting him to be a professor there; however, he turned it down, one major reason being a stipulation that could compromise his freedom of thought. Spinoza knew that it is difficult enough without conflicts of interest to discover truths; and so he would likely conclude that only the naïve and delusional would trust researchers and doctors who are financially dependent on giant pharmaceutical corporations.

More insidiously, Spinoza would see, as would Marx, Gramsci, and other critical thinkers, how organized psychiatry—similar to organized religion—serves the ruling class by having a population focus on their individual defects rather than societal ones. It would be clear to Spinoza, as a keen analyst of the political implications for belief systems, that a focus on biochemical individual defects rather than socioeconomic variables is a political win for the following factions: (1) pharmaceutical companies; (2) drug prescribers; (3) mental illness institutions whose survival is tied to biochemical causality; and (4) those atop the societal hierarchy who prefer social and economic causes for emotional difficulties and behavior disturbances be unexamined.

Moreover, given what Spinoza’s Theological-Political Treatise reveals about his thinking, it is likely that Spinoza would see another political implication of psychiatry. Spinoza cared deeply about freedom of thought and expression, and his major motivation for writing that treatise was his concern that clergy’s power over civil society threatened these freedoms; and his radical solution was to strip clergy of political power over civil society. In order to delegitimize the authority of clergy, Spinoza demonstrated that the Bible was not sacred, not revealed by God, and that instead it had numerous human authors over many years. For Spinoza, the Bible is simply a work of literature, a “faulty, mutilated, adulterated, and inconsistent” work. Spinoza knew that if the Bible is seen as God’s word, and if clergy authorities are seen as superior to others in the Bible’s interpretation, then they can exercise control over others.

Spinoza would be interested in the DSM—ironically called the “bible of psychiatry”—because of its political implications. He would see how the DSM, similar to the Bible, provides power for one group of people over others. Spinoza was troubled by how the false idea that the Bible is the word of God provides power for its professional interpreters, and he would likely be troubled by how the false idea that the DSM is scientific provides power for its professional interpreters.

Just as Spinoza saw how clergy derive their authority by positioning themselves to be the interpreters of a pseudosacred Bible, he would see how psychiatrists derive their authority by positioning themselves as the interpreters of a pseudoscientific DSM. And so, just as it was necessary for him to critique the Bible, Spinoza would see it necessary to critique the DSM. Spinoza would recognize that DSM criticism is not simply scientifically important but politically necessary.

If Marx and Spinoza were alive today, it is likely they would consider the following political questions about psychiatry: (1) Is psychiatry a science based on valid and reliable empirical evidence, or is it a religion with political implications? (2) Are psychiatrists and other mental health professionals being used by societal rulers to compel individuals to adjust to a society that is unjust and dehumanizing? (3) Are biological individual-defect theories of mental illness diverting attention from societal ills that cause emotional suffering? (4) Has the ruling class’s reward of status and authority to psychiatrists and other mental health professionals undermined mutual aid, which may well be far more helpful for emotionally suffering people?

Asking these questions today makes one a heretic, but Marx and Spinoza would be unintimidated by the prospect of such a diagnosis.

Edited by PenDracoInsularis
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35 minutes ago, PenDracoInsularis said:

should [psychiatry] be seen—no different than organized religion— as simply a belief system with its own social constructs that are promoted by the ruling class to convince people that their suffering is due to individual defects, rather than a defective social-economic-political system that results in alienation from one’s own humanity, from others, and from the rest of the natural world?

No, I don't think  that incredibly narrow view of psychiatry is appropriate.

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40 minutes ago, PenDracoInsularis said:

f Marx and Spinoza were alive today, it is likely they would consider the following political questions about psychiatry:

Yes, it's likely. People who think deeply will consider difficult questions, whenever they live.

42 minutes ago, PenDracoInsularis said:

(1) Is psychiatry a science based on valid and reliable empirical evidence, or is it a religion with political implications?

It may well be both scientific and something else. There is certainly a broad scientific basis. There must also be - it's inescapable - a broad cultural basis. To what extent religion and politics imply is problematic, very difficult to determine. There are so many contributors to modern psychiatry, each with his and her own school of thought, biases, backgrounds, etc., you'd have to take that aspect case-by-case. 

46 minutes ago, PenDracoInsularis said:

2) Are psychiatrists and other mental health professionals being used by societal rulers to compel individuals to adjust to a society that is unjust and dehumanizing?

No, I don't think think so. I absolutely do not believe that health care professionals are actively attempting to 'dehumanize' their patients or clients.  I think the more valid question is: To what extent are mental health professionals influenced by the cultural norms and demands of their time and place?  To what extent are they themselves  convinced that adjustment to those norms is necessary to happiness. (You have to remember: every society demands a certain degree of conformity of its functional members.)

54 minutes ago, PenDracoInsularis said:

3) Are biological individual-defect theories of mental illness diverting attention from societal ills that cause emotional suffering?

Possibly. But the physiological aspect of emotional suffering cannot be ignored.

55 minutes ago, PenDracoInsularis said:

(4) Has the ruling class’s reward of status and authority to psychiatrists and other mental health professionals undermined mutual aid, which may well be far more helpful for emotionally suffering people?

This invariably happens when the helping professions gain social and economic status. A whole self-perpetuating system is set in motion, which is bound to influence the practice of those professions in a number of ways - most of those ways being opaque or completely invisible o the practitioners themselves, but felt by the clients and glaringly evident to the critics of the system.

Like the young man mumbled: "....it's complicated..."

There is too much material there to deal with in a forum post. In order to continue, I think it would be more productive to break down into simpler, separate questions or subject areas.

And maybe - I know it's a big ask - leave the dead philosophers out of it FTM; they tend to add unnecessary complications. 

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I have to say I'm highly suspicious when it comes to psychiatry and psychology. Not that it's all woo, but that they have a huge tendency to overstate what they know, and what they can do. 

In any other branch of science, you don't get the reversals of consensus that you do in the mental field of medicine. In the treatment of the mentally ill, you seem to constantly change and reverse what was considered best practice just a few years previously. 

And to me, the biggest pointer to the bullshit element, is that in a trial for murder or some other horrendous crime, you can have two psychiatrists on the opposing sides, giving completely contradictory opinions on the mental state of the accused. What more proof do you need that someone's bullshitting?

You wouldn't get that for a broken bone, or traces of poison, or dna signature. But psychiatry seems to be a licence to bullshit. Especially when you are being paid for giving evidence a certain way. 

I would be very wary, if I was in charge, of spending money on mental health. Not because I dismiss the torture that mental health can inflict. But because the outcomes of treatment are so shrouded in mist. In physical medicine, if an operation produces bad outcomes, you can see it, and measure it, and do something about it. In psychiatry, you can have weeks and months of expensive treatment, with a strong element of "try this" or "try that" and at the end of it you are worse than when you started.

When outcomes are not fully demonstrable, I would prefer to take that money, and spend it on hearts, and hips, and eyes and teeth, where results are more or less guaranteed beneficial to a high percentage of cases.

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One should not ignore the role of Big Pharma in promoting the  chemical imbalance paradigm.  As @Peterkin noted, the thread might work better without dead philosophers and multiple issues - perhaps just focus on the chemical imbalance paradigm and what clinical data is actually out there.   It's so easy to cherrypick data in arguing either for or against.

And blaming capitalism and its political life support systems, though an easy target, is simplistic.    

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3 hours ago, mistermack said:

You wouldn't get that for a broken bone, or traces of poison, or dna signature. But psychiatry seems to be a licence to bullshit. Especially when you are being paid for giving evidence a certain way. 

At this stage, I would not bring in the adversarial justice system, which carries its own great load of baggage, independent of the psychological issues. I think it's equally possible to get two chemists or structural engineers to testify as experts on opposite sides of a lawsuit.

And I do believe brain activity is less transparent than bone fractures, less readily quantifiable than toxins.

If the problem of mental health and illness can enter the political arena via gun ownership, I think it must be given a legitimate role in health care, as well. People do suffer from depression, anxiety, PTSD and eating disorders; those people need some help.  

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3 hours ago, Peterkin said:

those people need some help.

Absolutely. But I'm saying, prioritise help that works, and can be show to work. Not well meaning "help" that just gets you hooked on some fix, or help that only helps one percent of those 'helped'. 

All I'm saying is that if I had a million to donate, I would get far more tangible results for that money if I spent it on physical rather than mental health. Its really sad, but it's still a fact. You could blow the lot on psychiatrists and counsellors and achieve very little, whereas you could with the same money pay for hips, eyes, knees, veins or heart stents, and make a real difference to lives.

I wish it were otherwise. I would love to see more effective mental health care. But wishing doesn't make it so. The truth is that even trying your utmost, outcomes are still poor. And many mental problems actually go away on their own, without, or in spite of the treatment they get. 

My mother suffered very badly when I was young from anxiety and depression. (she was a mental nurse, so she knew a bit). What transformed her life? A hysterectomy. She was a different woman after it, and she told me years later that looking back, she couldn't believe what she put us through. 

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6 hours ago, mistermack said:

I wish it were otherwise. I would love to see more effective mental health care. But wishing doesn't make it so.

True. Neither does starving an entire field of medicine of funds. What might make it so is thoughtful, science-based research and triage-oriented application - and a lot of quite sound minds are being applied to both endeavours.  For example, suicidal teenagers need help right now, not someday, when we've fixed all the old people's hips. Disoriented, sleep-deprived, paranoid veterans need help right now, not after they've offed their family and themselves.  

 

6 hours ago, mistermack said:

And many mental problems actually go away on their own, without, or in spite of the treatment they get. 

I'm not familiar with the statistics on that. Unless you count grief counselling, which I agree is often less effective than time.  

6 hours ago, mistermack said:

My mother suffered very badly when I was young from anxiety and depression. (she was a mental nurse, so she knew a bit). What transformed her life? A hysterectomy.

So, there was a physiological basis that should have been investigated, and wasn't?

Fortunately, as long as funding for research is available, we are able to make some progress in these areas.

I'm honestly not okay with shelving 12% http://who.int/news-room/fact-sheets/detail/mental-disorders of the world's health problems until all the more obvious ones have been fixed. Partly because all the obvious ones will never be fixed. Can never be fixed. They'll all just keep coming around again, and they all keep needing attention. 

What if we divert just 50% of moneys from elective cosmetic surgery to mental health diversification?

What if we also give some creative thought to alternate - less expensive - forms of emotional help? Community support groups? Non-faith-based lay counselling? Art, music, garden and forest therapy led by experts in those fields, rather than psychiatrists?  Techniques borrowed from other cultures? 

What if we put more effort into prevention and social programs that reduce childhood harm?

Edited by Peterkin
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