Conning Journalists for Psychiatric Profit
Every day, journalists who think they're being objective are parroting others' value judgments.
The prostitute resembles the journalist in that neither is expected to experience any feeling; but she differs from him in being able to experience feelings.
—Karl Kraus, Austrian satirist, 1908
One of the paradoxes of newspaper journalism is that objective reporting so often winds up as masked promotion of a particular point of view. Why? Because objectivity—the first commandment of modern-day journalism but a pie-in-the-sky ideal in the cultural milieu—has come to mean noninterpretive reporting. That means not lacing the news with the reporter's own opinions. But journalists lean on accepted authorities for information, and that information comes packaged in the experts' interpretation.
One of the results is that the views of the mainstream receive the most promotion. The problem isn't just that the writer ignores or is ignorant of minority views but that the conventional wisdom becomes the unspoken premise of all that is written. As a matter of rhetorical strategy, there is no more effective way to promote an assumption as fact than to act as if it need not be promoted—or even mentioned. When the press does this, even unwittingly, it narrows public debate on important matters, which is unfortunate for a society proud of its free marketplace of ideas.
Even if they couldn't say what "objective reporting" actually means, most reporters would agree that it doesn't include presenting moral judgments as scientific facts. Yet they do so all the time because their sources, the experts, use scientific language to express moral judgments, favorable and unfavorable.
Most language is not value-free. It is rhetorical, in the old, nonpejorative sense: its aim is to persuade or to prescribe, not simply to describe. Journalists are accessories to advocacy when they fail to realize this.
Nowhere is this more evident than in coverage drawing on the mental health field. But journalists are only the fall guys in a con perpetrated by mental health authorities, who go out of their way to couch their views in the seemingly value-free language of science. The rhetorical purpose is to gain the respect accorded the hard sciences and to have their assertions accepted by the lay audience—and government—as facts, rather than as judgments about how people should live.
"The attempt to escape from, or to deny, valuation is, for obvious reasons, especially important and dangerous in psychology, psychiatry, psychoanalysis, and the so-called social sciences," writes Dr. Thomas Szasz, long-time critic of the field. "Indeed, one could go so far as to say that the specialized languages of these disciplines serve virtually no other purpose than to conceal valuation behind an ostensibly scientific and therefore nonvaluational semantic screen."
Journalists who would never accept a politician's statement on its face fall for the same linguistic legerdemain when performed by "mental hygienists." Reporters taught in journalism school to confirm even their mother's professions of love are awed by the diagnoses of psychiatrists. Fascinated by the scientific insights they are privy to, journalists parrot them as revealed truths.
Examples are not hard to come by. In focusing on several, I draw on the work of Dr. Szasz, who for more than 20 years has argued that mental illness is a literalized metaphor for misbehavior and that the endeavors of the mental health establishment are "rhetoric, religion, and repression," not medicine. That Szasz's work is, not atypically, ignored by the writers whose work I'll review is testimony to the "mainstream effect" that results from journalists' reliance on accepted experts. For Szasz has been nearly a lone voice within the mental health field in his attempts to unmask its rhetoric.
A MELANCHOLY CASE
Under the headline "Depression—The Sickness of the '70s," Henry Allen of the Washington Post News Service recently appeared in the Wilmington (Delaware) Sunday News Journal. "Depression severe enough to require medical treatment…is a common disease, and growing commoner," Allen declares. The evidence? Estimates from a government-funded project that 15 percent of the American people have this disease and, from other sources, that one woman in six and one man in 12 will suffer a "major depression." Depression is prevalent in "economically deprived areas," he adds, and is "a cause in half to two-thirds of suicides." The article ends on an optimistic note, quoting a psychiatrist who says, "Depression is one of the only mental illnesses that can be completely cured."
What is the problem with this? It is that the writer shows no awareness of any need to explain why depression is called an illness. If that seems silly, it only shows how firm this unspoken assumption is. Yet from a commonsense view, the article itself unwittingly suggests many questions about the idea that depression is a disease requiring medical attention.
Allen begins with what is presumably a typical case. "A few years ago a certain United States senator begins to notice that he had prodigious stores of energy in the autumn weeks before Election Day. Without perceptible fatigue he could and did deliver three and four speeches a day on his own behalf and that of his political allies. He slept as little as two or three hours a night for days on end.
"But once the citizens' votes were cast, the senator would collapse in a profound, paralyzing melancholy in which his life and work would seem totally devoid of worth and meaning. He would scarcely leave his house.…The Senate almost always is in adjournment between Election Day and the first of the year, and by that time the senator usually was getting back on his feet. In time the senator's mood swings grew more severe, and finally his family and staff became so concerned about his behavior that he sought psychiatric help. Dr. Frederick Goodwin, a psychiatrist now on the staff of the National Institutes of Mental Health who treated the senator and tells this story, quickly diagnosed the problem as manic depression and prescribed treatment with a lithium compound."
Goodwin tells Allen that the senator had a "beautiful response to the drug" and did not experience his "annual high." A year later, still on lithium, the senator ran for reelection. "He didn't get manic," Goodwin recalls. "And he didn't get elected."
True to his profession, the psychiatrist refuses to attribute anything but good to the drug. Allen tells us: "The psychiatrist, pointing to the strength of the senator's opponent and other political factors, doubts that his patient's recovery from manic depression caused his defeat."
Is the senator's disease evident from this Allen-cum-Goodwin account? Is this "mania" materially different from the invigoration people commonly feel when pursuing an all-consuming goal? Is this depression different from the common let-down that often follows its achievement? And, more to the point, does the psychiatric explanation shed any more light than the commonsense analysis available to everyone?
RELATIVE MISERY
From this case, Allen culls the causes and symptoms of this disease. He quotes the Comprehensive Textbook on Psychiatry, by Dr. Gerald L. Klerman: Depression is "generated not so much by the absolute levels of misery as by the relative gap between rising hopes and falling expectations. The earth's resources are limited, the human population is expanding uncontrollably and recent socio-political movements have proved themselves incapable of generating the utopian futures promised by the ideologies. These historical changes seem to be associated with an increase in the incidence of affection disorders, particularly depressive states."
Among the symptoms Allen lists are: dependency, huge expectations that inevitably lead to disappointments, disturbed sleep and appetite, loss of energy and interest, slowed thinking, self-blame and inappropriate guilt, abnormal fatigue, headaches and other pains, nausea and irritability. A manic person, on the other hand, may exhibit "extreme agitation, aggression, constant restlessness and talking, grandiosity, spending huge amounts of money."
Regarding treatments, Allen notes that psychiatrists are fond of drugs, psychotherapy (that is, in one approach: "talking in which the therapist shows the patient that his self-image as a loser is in fact inaccurate"), and electroconvulsive therapy ("the dread shock therapy" that Allen says is "regaining a bit of respectability").
Other forms of therapy include jogging and painting. Lest these imply that "home remedies" are effective, however, Allen reports that self-treatment of mental illness is itself a cause of mental illness: "Self-treatment of depression with alcohol and with illegal drugs in fact is a major causative factor of alcoholism and serious drug abuse, according to Goodwin."
The article may seem objective. But by relying on Goodwin and other psychiatrists as authorities, by reporting their judgments as facts, by failing to look for proof of their assertions, and by ignoring contrary interpretations, Allen promotes the established medical view of depression and all mental illnesses: They are diseases like pneumonia or cancer. They have verifiable symptoms and causes. They can be cured by medical specialists called psychiatrists, employing therapeutic techniques.
But a strange disease indeed! Here is a malady caused by "rising hopes and falling expectations" and "historical changes," whose symptoms are common experiences of life and clearly imply value judgments (huge expectations, abnormal fatigue, inappropriate guilt, huge amounts of money), whose cures include tranquilizers, electrically induced convulsions, and conversation about one's self-image.
HOW DOES "DISEASE" HELP?
"A person who feels sad may be said to be dejected or depressed," says Dr. Szasz aphoristically in Heresies. "A person who claims to be God may be said to be a boastful liar or a deluded schizophrenic. The difference between these descriptions is the same as the difference between calling a spade a shovel or an agricultural instrument for soil penetration.
It apparently never occurred to reporter Allen to ask: Is the concept "disease" needed to explain the experiences described? Does the diagnosis make clear a complicated matter or confuse an uncomplicated matter? As in any other departure from common sense, if disease is offered as an explanation for actions and feelings, the one proposing that approach needs to show why it should be taken. And this leads us to wonder where lie the interests of those who have built a profession around this explanation—the psychiatrists. Do they have anything to lose by our rejecting the disease explanation?
Does a politician have anything to lose by our discarding taxation? The answer is obvious. Just as a politician's position on taxation must be tempered with knowledge of his interests, so must a psychiatrist's position on disease explanations. The error committed by journalists is thinking that psychiatrists are fundamentally different from politicians. One look at the federal budget for the mental health establishment corrects that error.
Depression (and all disease explanation) is to psychiatrists what taxation is to politicians. In both cases, something is imposed on unwilling subjects, providing an elite with power. To mystify and sanctify the arrangement, taxpayers are told they have a "tax liability" and must turn over their wallets; patients are told they lack "insight" and must turn over their minds. To imagine what institutional psychiatry would be without disease, imagine a politician without taxation.
As if anticipating the observation that depression's symptoms are encountered by everyone, Allen writes, "In milder form, practically everyone suffers from depression sooner or later." Psychiatry, like politics, wants to make sure that no one escapes its purview. So we are told that the Sickness of the '70s exists on a continuum, from the blues ("associated with rainy days") to "unipolar depression." Apparently our mothers were only half-right when they said we'd catch cold in the rain—they never said we could also catch mental illness.
None of this is to deny that depression can be a problem that severely disrupts one's life. The kind of problem—and so the kind of solution—is the issue. If Allen followed his own evidence, he would be led to the conclusion that depression is not an illness but an outlook—or a "problem in living," as Szasz puts it. But then we have to concede that psychiatrists bring no particular expertise to the problem, that their drugs are diversions, their therapies conversions. In short, as Dr. Szasz writes, psychiatry is more akin to theology and pastoral work than to medicine and therapy.
Moreover, the view of life that is implicit in psychiatrists' disease explanations is foolishly simplistic. To hold that depression, from the blues on down, is disease is to imply that life is a simple process entailing no nonpathological prospects of unhappiness. Life isn't so simple. The need to choose and achieve values in an uncertain world holds plenty of chances for unhappiness. Yet psychiatrists promise to remove life's emotional ups and downs—without dehumanizing us—with drugs and electroshock. They're hawking snake-oil, and journalists are loyal accessories.
ONE-SIDED INVESTIGATION
When backed by force, this view easily translates into the horrors warned of by Orwell and Huxley. Of course, the alliance between psychiatry and State is clothed in beneficence, decked out as concern for the disease-ridden. A two-part article in the Philadelphia Inquirer, by Linda Lloyd and Roger Cohn, is typical. It deals with the Pennsylvania law specifying the conditions for the involuntary hospitalization of innocent, but allegedly mentally ill, persons in that state. With several tear-jerking episodes, the Inquirer in effect criticizes the State for making it too difficult to lock up nonviolent people against their will.
Again, critical assumptions are casually intoned. The writers toss out as scientific facts such allegations as: "She is a schizophrenic"; "Jennie M.…has lived for eight years with a 24-year-old son whose chronic schizophrenia at times has prompted her to 'sleep nights with locked doors'"; "…her son, a paranoid schizophrenic…"; and "His only crime was he was severely mentally ill." The writers even fail to observe the journalist's courtesies of attributing such judgments to an authority or adding "alleged" to such stigmatizing labels.
The articles discuss the formation of a new group, Families United for Mental Health Rights, which seeks changes in the law to make commitment of relatives easier. The members are unhappy with the present law because, as one organizer put it, "If we didn't have this law, there would be no court hearing, lawyers or testimony. And this wouldn't be happening." "This" is the freedom and disturbing behavior of people they would put in madhouses. The present law generally prohibits the courts from hospitalizing anyone unless he has acted violently. The group objects that nonviolent mentally ill persons are thereby denied their right to treatment.
Who are these people who ought to be committed? We don't know, because the Inquirer didn't interview them. They were given no chance to reply to the psychiatric charges. But indirectly we see that these people have one thing in common: they have bothered others, who didn't try to manage the conflict as they would have had the bothersome individuals been thought sane. Instead of cutting off relations or, if appropriate, calling the police, the "normal" parties sought involuntary psychiatric intervention against their "ill" wives or sons.
These persons were then confined and drugged until they stopped their irksome conduct. But when they resumed the conduct later, their relatives found they could not have them returned to the hospital so easily. And so the ire of these "families united for mental health rights" over a law requiring some semblance of due process before jailing the allegedly insane.
The Inquirer unquestioningly accepts the assertion that the bothersome individuals are unable to know what's good for them. "She's totally out of control and I can't do anything," said a man of his wife who sometimes refuses to see him. One woman was threatened by her son. Another man's wife "couldn't speak English any longer. I had to talk to her in German." Readers are asked to believe that only a disease could make a woman refuse to see her husband, a son threaten to kill his mother, or a woman insist on speaking her native tongue. In the world of psychiatry, these are symptoms to be diagnosed.
The Inquirer doesn't wonder, doesn't investigate, what the parents or husbands might have done to provoke these actions. The reporters don't wonder if the conduct is a defense against forced drugging and confinement. Such foolish thoughts need not be examined. Psychiatry has pronounced them mad. That's all the explanation required. In 1907 Karl Kraus, a contemporary of Sigmund Freud, observed the same attitude and remarked, "The psychiatrist unfailingly recognizes the madman by his excited behavior on being incarcerated."
INDISPUTABLE RIGHTS VS. DISPUTABLE FACTS
Two unspoken assumptions pervade these articles. First, that the psychiatric diagnoses are indisputable facts. The second is that confinement of mentally ill persons has no political-ethical perspective.
When reporters call someone schizophrenic, do they realize that, as Szasz writes, "there is no agreement on what schizophrenia is, or who really is and is not a schizophrenic"? "The primary phenomenon in hospital psychiatry," he continues, "is, and has always been, social deviance, or being a nuisance to others, and its control or repression by means of psychiatric incarceration;…the notion of schizophrenia was superimposed on it and cannot be dealt with in isolation from it."
The endless stream of theories about the chemical and genetic causes of schizophrenia is bewildering. Even so, Szasz writes, "there is at present no demonstrable histopathological or pathophysiological evidence to support the claim that schizophrenia is a disease. Indeed, if there were any, the supporters of this claim would be the first to assert that schizophrenia is not a mental disease but a brain disease."
Even the psychiatric establishment backs up Szasz's charge that "schizophrenia" falls far short of being a scientifically valid concept. He quotes the Schizophrenic Bulletin, a publication of the National Institutes of Mental Health: "The fact that this diagnostic category has become widely accepted and used, even in the absence of a universally accepted definition, is remarkable.…and then of course there is the most difficult problem of all—it is not possible to validate a diagnosis of schizophrenia. There is no test which can independently confirm that the individual so designated is, in fact, schizophrenic." Said Kraus in one of his aphorisms: "Diagnosis: one of the commonest diseases." Once the diagnosis is made, however, the patient's rights fade into the background. People would like to pretend otherwise. So they adopt slogans like "mental health rights"—those being, of course, the rights of patients to have done to them what they do not themselves choose. An Inquirer headline pays nodding attention to another kind of rights: "The Mentally Ill—Trapped in Their Own Civil Liberties." But the implication is clear: freedom—real rights—is dangerous.
By reporting the issue as they do, journalists promote the dogma that "mentally ill" people can lay no claim to the Bill of Rights. It also promotes the vicious contention that there are two kinds of people, sane and insane, and that a group of experts allied with the State can tell them apart and turn them over to the State.
We should be worried that American journalism, so jealous of freedom of the press, doesn't see the moral dimension here. Would they so readily support the view that there are two kinds of journalists, responsible and irresponsible, and that a group of experts allied with the State should be empowered to tell them apart—for the good of the citizenry?
Every other day you find similar examples in newspapers everywhere. Psychiatric records are paraded in public with every sensational crime and bizarre act. And readers eagerly accept them as if to say, "He (the murderer, the rapist, etc.) is different from us. We wouldn't do such a thing. He's sick. We're healthy." And the next day they just as eagerly accept the idea that every problem in their lives can be written off as a mental illness.
Journalism that caters to this psychiatric imperialism reveals either incredible dishonesty or incredible naiveté. If objectivity or fairness is the ideal, journalism has been grossly delinquent here. And if they are not ideals, it is time the rest of us were let in on the news.
Sheldon Richman is research director of the Council for a Competitive Economy, as well as being a freelance writer His article "Who Should Pay for Nuclear Accidents?" appeared in the November 1979 REASON.