DSM Led Us Far Astray. Life Story Is the Path to Truth.

The psychological injury model uses history to guide treatment, unlike the invalid labels of the DSM.

Eric Kuelker, PhD, RPsych

Dr. Greenwood tapped his fingers on the counter three times before stopping and crossing his arms. The nurse looked at him and smiled. “Nervous about your first shift in the ER?” Dr. Greenwood nodded and smiled slightly. The nurse chuckled and said, “I’ve been doing this for 17 years, and we haven’t lost a new doctor on the first day of residency.” Dr. Greenwood did not have to respond to this old joke, as the doors swung open and ambulance attendants pushed a stretcher through. He walked over briskly and met Dr. Diastam at the stretcher. She was the senior physician on duty that night.

Dr. Diastam asked, “What do you see?” Dr. Greenwood responded, “Patient is breathing and conscious. Temperature is high, pupils are dilated, and pulse is rapid.” Dr. Diastam nodded, and said, “Sounds like Fedilrap syndrome to me.” Dr. Greenwood looked puzzled as he had never heard the term before. The senior doctor explained “Fever, dilation, rapid heartbeat syndrome. Get ice packs around the patient to bring that temperature down. Give IV morphine to reduce the dilation of the eyes. Give beta-blockers to slow that pulse.”

Dr. Greenwood stared at Dr. Diastam and swallowed. She had not asked about the patient’s history at all. She had no idea what the patient was doing an hour before they were put on a stretcher. No lab tests were run, no X-rays were completed, nothing. Dr. Diastam had also made up a syndrome, based on some symptoms. The intervention was just as weird. The patient was feverish, and she wanted ice-packs tossed on the stretcher to cool the patient down? How would that cure the patient?

Challenging the senior physician on the first day of residency is not a good career move. Yet he blurted out, “Shouldn’t we find out why the patient is sick?” Dr. Diastam looked puzzled. Dr. Greenwood continued, “We are just reducing this patient’s symptoms of fever and rapid heartbeat for a while. But we do not know why they are sick in the first place. We know nothing of their history. We don’t know if this is caused by malaria, or a drug overdose, or something else.” Dr. Diastam gave him a stern look. “Listen” she snapped, “around here we don’t waste our time looking for why people are sick. We focus on that they are sick, and we address the symptoms.”

You have watched enough episodes of “House” and “Grey’s Anatomy” to conclude that this scenario is absurd, that it never could happen. But you would be wrong. Life is not like TV. Sure, you have spent hours watching Dr. Gregory House ask questions, order lab tests, and pore through medical books to find the cause of the problem. After several missed tries, the doctor’s diagnostic brilliance shines through a crack in his spiky, scabrous personality, and he announces the obscure, correct reason why the patient is really sick. He discovers the cause, the right treatment is given, and the patient makes a nice recovery.

You may have even been in a hospital and experienced something similar.  The physician comes in, asks about your history, runs tests, and then explains why you are ill. They tell you that because you were in Kenya recently, you were infected with a parasitic flatworm, and they found the eggs in your stool. They give you a pill to swallow, and you are treated. You now believe that any medical professional follows the same process. Ask about history. Gather data to check. Find out why you are sick. Once the cause is discovered, then move to treatment.

Who Is the Real Dr. Diastam?

If only our beliefs matched reality. Dr. Diastam is not a fantasy, but the embodiment of an entire branch of medicine, that of psychiatry. Consider the Diagnostic and Statistical Manual of Mental Disorders (DSM). It was created by the American Psychiatric Association, and version 5 came out in 2013. It is the definitive statement of how modern psychiatry should conceptualize the people it interacts with, and how to think about their emotional pain, odd thoughts, and experiences.

The astonishing fact about the DSM is that the clinician who follows it is under no particular obligation to ask the person about their history. For example, they do not have to ask the interviewee whether or not they ever were sexually abused. The clinician can ignore this very troublesome topic. They will never be charged with malpractice if they turn a blind eye to the question of whether the person sobbing in front of them was severely neglected in childhood.

Instead of considering the life story of the person, the DSM only obligates the clinician to ask about recent emotions or behaviors. How often have you felt tearful in the last two weeks? Do you harm yourself through cutting or burning? The manual then clusters those symptoms into a group and attaches a label to them. Adjustment disorder, bipolar disorder, these are the words that are written in the person’s file. The backstory, the real reason why the person has cried 11 of the last 14 days, need not be noted, according to the DSM. Just record if they have this symptom or not. Clump the symptoms together and if they have two of five, then give them this diagnosis. If not, give them another.

This ignoring of history, this indifference to the cause of the person’s severe difficulties, is the opposite approach taken by the rest of medicine. Oncologists hunt for causes and study cancer cells under microscopes. They analyze genetic mutations. Findings are discussed and presented at conferences, and diagnostic criteria are changed accordingly. The difference between breast cancers with BCRA1 and BCRA2 mutations are noted, and intervention plans are changed, depending on which mutation is present.

Why Is a Person’s History Ignored?

A question may be forming at the back of your mind. Wait a minute, isn’t this what psychiatrists do, too? Are they not looking for the genes for depression or anorexia? You may remember reading a news story about the topic. Surely, they are seeking out all the causes for mental health issues and revising the diagnosis as the research comes in? The answer, like a Zen koan, is both yes and no.

Yes, psychiatrists earnestly seek the genetic basis for anorexia and depression and a whole host of other maladies. Blood is analyzed, and SPECT scans are carried out on people’s brains. Dozens of billions of dollars have been spent by the National Institutes of Mental Health (NIMH) and research labs around the world. Psychiatry is gripped with the concept that people cry uncontrollably at times or refuse to eat even when they are dangerously skinny because they suffer from a biological disorder.

The former head of the NIMH, Dr. Thomas Insel, proclaimed that “Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion or behavior.”1 This motif is repeated when the NIMH instructs us that, “Eating disorders are not a lifestyle choice. They are biologically-influenced medical illnesses.”2 Many psychiatrists have told the public that chemical imbalances cause their strong negative emotions or odd thoughts. Ninety-nine percent of British psychiatrists believe bad biology is the primary cause, or a major cause, of schizophrenia.3

The search for biological markers is essential for the whole DSM enterprise. The psychiatrists whose work eventuated in the DSM III hoped that each clinical syndrome would be distinct from the others, with its own genetic profile and laboratory tests for precise classification.4 This was a real leap of faith because they admitted at the time that “consistent and reliable laboratory findings have not been demonstrated among the more common psychiatric disorders.”5 The leap fell flat because 47 years later, there still is not a single laboratory test that reliably identifies a particular syndrome listed in the DSM. No single gene has ever been found to be associated with a DSM syndrome, despite dozens of studies and billions of dollars spent.

Nor will there ever be a laboratory test, or gene found. Drs. Regier and Narrow, who wrote of the conceptual basis for DSM, admit the comorbidity of disorders is rampant. They mention that more than half the people with serious levels of anxiety, depression, or somatization had one or both of the other two conditions. Thus, if most people have two or more conditions, you will never find a test or a gene that reliably identifies a single condition. You cannot find the gene for depression if most people have depression and somatization, or depression and anxiety.

Although the sound and furious energy to find a biological basis for mental disorders has come to nothing, there is an odd silence on the other side. Psychiatry ignores what it does know about the cause of a great deal of emotional distress. It excludes this knowledge from the DSM, rather than revising and updating the manual to include it. It continues to rule out the history of the person, what happened to them, as an important factor in understanding why they are in emotional pain. As a result, critically important information is lost, and effective treatments are sidelined. An excellent example of this comes from one of the largest studies ever done in American psychiatry.

The Research: The Virginia Adult Twin Study

The researchers who ran the Virginia Adult Twin study followed 4,856 people, for up to 12 years.6 They interviewed them repeatedly, up to four times each. During each interview, they were questioned about 12 different depressive symptoms they experienced in the previous year. They were asked, “During this period, did something happen to make you feel that way or did the feeling just come on you ‘out of the blue’?” If participants could think of a cause, they were asked to describe it. So far, so good. What came next was astounding.

To begin with, 88% of the time the participants identified a specific event that triggered their depression. They mentioned romantic losses, the death of a loved one, perceived failure, or a conflict with a loved one. They talked about chronic stress, poor health, and fears about the future as events that kicked off an episode of negative mood, or major depression.

This finding alone refutes the idea that biological factors, such as chemical imbalances, cause depression. Nine times out of 10, it is a psychological injury of relationship loss, grief, or significant fear that pushes a person into depression. If it were biological, then it would occur fairly randomly. Instead, depression is enormously influenced by interpersonal conflict, failure, and other painful events in the matrix of relationships.

Another important revelation was that each type of psychological injury was associated with a distinct pattern of symptoms. People who reported that a romantic loss triggered their depression experienced more sadness, appetite loss, and loss of concentration than the rest of the sample. They had less fatigue, slowed movements, restlessness, oversleeping, and appetite gain than everyone else. People who were depressed as a result of chronic stress had essentially the opposite pattern of symptoms. Meanwhile, the people whose health problems kicked off their depression had quite a different pattern of symptoms. Each psychological injury resulted in a pattern of symptoms that was markedly different from the others.

Across time, these symptom patterns were remarkably stable. Because the researchers interviewed the same people four times, some people were depressed twice over the dozen years. If the same person had two different psychological injuries during the 12 years of the study, they did not have the same symptoms as before. Instead, they had the symptoms specific to the new psychological injury. If Elizabeth was depressed in the second year of the study because her boyfriend dumped her, she had the classic “romantic loss” symptom pattern. Eight years later, when she was chronically stressed for a while, she displayed the standard “chronic stress” symptom pattern. There is no single entity of “depression.” There is “romantic loss” sadness, “chronic stress” low mood, and then there is “grief” as a form of emotional pain.

This finding also demolishes the chemical imbalance theory of depression. If it were low serotonin, then the pattern of symptoms would be the same for the person, time after time. There should only be one pattern of symptoms, “low-serotonin depression.” We see that for physical diseases; malaria produces a fever, no matter how often you get it. But each psychological injury is distinct. Each has a unique pattern of painful emotions, disturbing thoughts, and changes in behavior. “Romantic loss” sadness looks quite different from “grief.”

We see that uniqueness when we look at wounds on the skin. A cut, a burn, and a chemical spill all damage the skin. But the type of pain, the appearance of the wound, the speed of recovery, and the appearance of the scar vary distinctly between the three types of physical injury. That is why medicine does not have a diagnosis of “skin damage disorder.” It pushes deeper, and asks what was the underlying injury that caused the damage to the skin. Once a physician understands she is dealing with an abrasion, rather than a burn, she diagnoses it and treats it accordingly.

The DSM-5: Ignoring the Research

Psychiatry had the opportunity to push deeper, to ask about and understand the actual psychological injury that shows up on the surface as depression. Instead, it whiffed it. This was a massive, sophisticated longitudinal study done in the US, published in the American Journal of Psychiatry in 2007. It gave excellent evidence that nearly all “depressions” were from psychological injuries, and each had characteristic patterns of symptoms. This is a major advance in understanding what we call “depression” and how to address it. Now, clinicians could ask people about the psychological injury that they had recently. They could point out how the pattern of symptoms they reported was very similar to other people who had the same emotional wound. The clinician could explain that grief is a normal reaction to losing somebody you love deeply. If the person was chronically stressed, the clinician could discuss ways to reduce the stress and help the person recover.

None of this happened. When the DSM-5 came out six years after the study was published, it ignored the evidence that psychological injuries caused 88% of “depression” in adulthood. It wasn’t just this study that was sidelined. All the research that linked childhood trauma to later episodes of “depression” was ignored as well. I discussed this research in an earlier post on MIA available here.

There are hundreds of articles linking sexual abuse, nay, all types of abuse, neglect, and dysfunction in the household to depression and suicide later in life. None of these studies made a whisker of difference to the committee tasked with diagnosing depression in the DSM-5. They ignored every single one of them. Like Dr. Diastam (they actually are the embodiment of Dr. Diastam), they did not query what caused strong negative mood. They just clumped some symptoms together, and if you had 5 of 9, you had depression. If you had 4 of 9, you did not.

This was in complete contradiction to the rest of medicine, which puts forth huge effort to find the cause of the problem by taking a careful history and adding in blood tests and X-rays. Instead, psychiatry ignored all the research on the largest cause of depression and stuck with clusters of symptoms.

DSM—You Get What You Pay For

The more cynical and well-informed would tell us not to be too surprised. You get what you pay for, they would tell us. And they are right. Dr. Allen Frances, who headed up the whole DSM-IV revision, received hundreds of thousands of dollars from Big Pharma to promote Risperdal.7  Every single psychiatrist on the DSM-IV Committee for Mood Disorders had financial ties to the drug companies.8 Every one. For the DSM-5, that was 67% of the psychiatrists on the committee. These people had strong interests in expanding the market share of Big Pharma.

The number of diagnoses expands wildly with each edition of the DSM, from 128 in the first to 541 in the last. They even said that grief was depression, refuting all of human experience that people get very sad when someone they love dies. The psychiatrists on the drug companies’ payrolls had zero interest in telling the truth from the research that episodes of strong sad mood are very much due to psychological injuries, such as finding out your spouse is cheating on you. What would that gain them? Certainly not another lucrative promotional contract from a giant corporation.

The public might think it would be better to talk to a therapist about their feelings of betrayal, anger, and sadness than to swallow a pill. The public actually wants to get to the root of the problem, not just numb out the pain for a while and take a pill that causes weight gain.

But the public was not paying the psychiatrists on the various DSM committees. Therefore, the public did not get anything useful from them. What would have been useful was an approach like the rest of medicine. An inquiry as to the actual cause of their problems. An explanation that linked the cause to their symptoms. An intervention that flowed from the cause and helped heal the damage.

Nor did the public get anything reliable. Because the psychiatrists ignored the research that different psychological injuries produce different clusters of symptoms. They just shoved together all the symptoms associated with sad mood into a single cluster and the result was a mess.

The reliability of diagnosis is measured with a metric (kappa coefficient) that ranges from 0 to 1. If the kappa is 1, it means that two clinicians agree each time whether the person has the disease or not. If the kappa is 0, then the two clinicians never agree, and the system of diagnosis is completely unreliable. A kappa of 0.7 is considered to be good.9 The kappa for Major Depression 10 in the DSM-5 is 0.28. For Generalized Anxiety Disorder it is 0.20. For Alcohol Use Disorder it is 0.40.

That is a shocking disgrace to psychiatry. They cannot even diagnose depression with any reliability. One psychiatrist might say it is depression, another might say it is bipolar disorder.  Or adjustment disorder, or schizoaffective disorder. Who is right? No one knows. Both are equally qualified, yet both come up with different labels for the same person.

If you went to a hospital, and one physician said you had Crohn’s disease, and another said pancreatitis, and another said stomach cancer, you would be utterly confused. And if all of them came to this conclusion without doing any lab tests or blood samples or scans at all, you would think they were quacks and run away.

Yet psychiatry has no X-rays or blood samples. The labels they come up with are not grounded in reality. With stomach cancer, you can see the tumor on an ultrasound and the cells on a microscope slide. Psychiatry has no link to lab tests at all. The entire DSM is invalid. Disconnected from anything empirical. It is a bunch of unreliable labels made up by people paid vast sums by drug companies to expand their market share. That is all it is.

Exposing the intellectual bankruptcy of the DSM is necessary to help people with intense negative mood and distorted thoughts. Once they understand that the psychiatric labels pasted on them are unreliable and invalid constructs made up by drug company flunkies, they can rip them off. The stigma and helplessness inherent in the label of “schizoaffective disorder” or “borderline personality disorder” can be shed like a dolphin wriggling out of a fishing net. The fear of being denied health insurance or jobs, being shamed or bullied for the label, or being viewed as having a permanently broken brain can be left behind. Instead of being dismissed because “you’re a borderline” with the subtext that “you are a manipulator and can be ignored” these people can be listened to.

Which is not to say that these people do not have serious problems. Of course they do. They spent six hours crying yesterday and they want to kill themselves to end the pain. Their brain is whirling with vicious thoughts that they are utter failures. Just because “Fedilrap syndrome” is drivel does not mean that Dr. Greenwood should push the stretcher out the door of the emergency room and tell the person they should go home and get over it. When there is something very wrong it needs to be understood and treated accordingly.

So How Do We Treat It?

And that starts with taking a careful history. This is Diagnosis 101 and it is the step that the DSM makers skipped entirely, leading them far astray. Psychiatry can redeem itself by going back to the basics. It is breathtakingly simple. Ask the person what happened to them. When you were a child, were you ever abused in any way? Were you emotionally or physically neglected? Did your parents have substance abuse problems, violence, or other dysfunctions? Were you bullied or rejected by your peers? Did you experience trauma in adulthood? Are you working for a bully of a boss? Have you recently had a very stressful event in your life, such as a family member being diagnosed with a terminal illness?

These are the psychological injuries people commonly experience. Thousands of research articles (and untold clinical experience) show that these are the largest causes of intense negative mood, and problems with thinking and perceptions. The Psychological Injury Index is a framework for assessing these emotional wounds.  It is free at https://psychologicalinjuryindex.com/. The PII is a guide to taking the person’s history, and it gives a much richer understanding of the person.

Understanding the person’s psychological injuries is so crucial because diagnosis guides treatment. The diagnosis of stomach cancer leads to surgery and chemotherapy as treatments. The diagnosis of ulcerative colitis leads to completely different treatments. Get the diagnosis wrong, and you get the treatment wrong and people stay ill or die. This is the dramatic tension that powered the TV show “House.”

Once you learn that the person’s psychological injury is four years of sexual abuse by her stepfather, you interact with her in a different way than if you learn that her psychological injury is having a bully of a manager. Both may present with frequent tears, a sad mood, and hopelessness. But what I say in a therapy session to the first client is radically different from what I say to the second. Different injuries require treatment that takes those injuries into account, rather than a cookie-cutter approach of “you have depression, so you must receive this pill or that intervention.”

Exploring the person’s psychological injuries also has an important consequence. It makes them into human beings. This seems to be an odd statement; are they not always human? Sadly, no. One of the terrible consequences of labels is that they dehumanize people. “She is a borderline” is a label I have heard all too often from professionals, pasted on to keep psychological distance from people who have mood swings and suicidal thinking. Once you listen for it, the reduction of humanity in phrases like “substance abuser” or “we had a bipolar come into the emergency room last night” comes into focus.

Talking about psychological injuries is very different. Saying “Stuart has five adverse childhood experiences” puts the person first. “Stuart” is the first word in the sentence. Their humanity, their personhood is the primary element. They are not a label. They are a person with a name. The fact that they have psychological injuries comes second. It also frames that these are people who are wounded. There is a clear difference between someone who is injured (and who can recover with various forms of therapy) and someone who is diseased. Such as Typhoid Mary. Or someone with a mental illness, a sickness of the brain that whispers of permanent malfunction and warped neurons.

After the emotional wounds are mapped out with the Psychological Injury Index, the next step is to explore how the person coped with them. Have they sought out therapy in the past? Was it helpful for them, or not? Who was supportive of them in their family? Do they use substances in excess to numb out their pain? Do they try to prove they are not a failure by working all the time and chasing promotions? Do they buy self-help books, or do they find acceptance (however unhealthy it is) by being part of a neo-Nazi group? This phase is meant to explore the coping mechanisms people have used and the degree to which these strategies have either healed or perpetuated their psychological injuries.

Clearly, this process is more in-depth than the DSM. It is not about asking tightly defined questions in order to funnel people into one label or another. It is completely different. It involves learning about the person who is sitting across from the clinician. Hearing their life story. Understanding their emotional wounds, their efforts to overcome them, their goals, their defeats and their victories. It is knowing who helped them, and how it was helpful, and who hindered or abused them further.

And from that knowledge, treatment emerges. It is the same process as in medicine: understand the history, map out the cause(s), look for complicating factors, and move on to treatment. Once the psychological injuries are mapped out, treatment can address them. And only psychotherapy is specifically designed to address emotional wounds. Only therapy is focused on uncovering and refuting the negative self-talk that scrolls through the minds of people who have been emotionally abused.  Only therapy can heal the distorted images of self and body that people carry who have had their sexuality violated.

Pills may be helpful to modulate extreme distress (suicidality, active psychosis), but they can never heal the underlying psychological injury that caused the intense emotions in the first place. When people stop the pills, the underlying psychological injury causes a relapse. One only has to consider that the relapse rate after taking pills for depression is two to three times higher than with psychotherapy.11 Similar results are found for treating anxiety.12

And now the public has something that actually is helpful for them. Instead of a string of invalid and unreliable labels that seems to get longer each time they meet a doctor wielding a DSM, they get to tell their life story. They get understanding. And empathy. Once someone is seen as “Jennifer, with four childhood traumas” or “Dave, who was bullied by his boss,” they are seen as a human who is hurting, who can grow and heal. They are seen with hope.

Show 12 footnotes

  1. http://www.nimh.nih.gov/about/director/index.shtml
  2. https://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml
  3. Kingdon D., Sharwa T., Hart. D., (2004). What attitudes do psychiatrists hold towards people with mental illness? Psychiatric Bulletin, vol. 28, 401-406
  4. Regier DA, Narrow WE, Kuhl EA, Kupfer DJ. (2009). The conceptual development of DSM-V. Am J Psychiatry. Jun;166(6):645-50.
  5. Feighner JP, Robins E, Guze SB, Woodruff RA Jr, Winokur G, Munoz R. (1972) Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry. Jan;26(1):57-63.
  6. Keller MC, Neale MC, Kendler KS. (2007) Association of different adverse life events with distinct patterns of depressive symptoms. Am J Psychiatry. Oct;164(10):1521-9.
  7. Caplan, PJ. (2015) Diagnosisgate: Conflict of interest at the top of the psychiatric apparatus. Aporia. Vol 7. p. 30-41.
  8. Cosgrove L, Krimsky S. (2012). A comparison of DSM-IV and DSM-5 panel members’ financial associations with industry: a pernicious problem persists. PLoS Med. 9(3):e1001190. doi: 10.1371/journal.pmed.1001190. Epub 2012 Mar 13.PMID: 22427747
  9. Spitzer, R., J. Williams. J. Endicott (2012) Standards for DSM-5 reliability. Amer J Psychiatry. 169: 537
  10. Regier DA, Narrow WE, Clarke DE, Kraemer HC, Kuramoto SJ, Kuhl EA, Kupfer DJ. (2013). DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. Am J Psychiatry. Jan;170(1):59-70.
  11. Cuijpers P, Hollon SD, van Straten A, Bockting C, Berking M, Andersson G.  (2013) Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. BMJ Open. Apr 26;3(4).
  12. Barlow DH, Gorman JM, Shear MK, Woods SW. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA. May 17;283(19):2529-36.


  1. Hi Eric,

    Its nice to see you back again.

    “…..the relapse rate after taking pills for depression is two to three times higher than with psychotherapy. Similar results are found for treating anxiety….”

    I think the “relapse rate” might be worse for anxiety: Psychologist Dr Jordan Peterson developed severe anxiety from his anti anxiety “medication”, while still on the “medication”.

    (I have suffered badly myself from the effects of psychiatric drugs, and I wouldn’t recommend them to anyone).

  2. Thanks Dr. Eric.
    Love your new spin on the old (inaccurate) trope of “What if we treated physical illnesses like ‘mental illnesses’?”

    Assume Dr. Diatram’s patient manages to recover. She’ll take all the credit and force him to spend the rest of his life surrounded by ice packs, giving himself daily morphine injections, and popping beta blockers. 🙂

  3. Critical psychiatrists can never help but make a concession to mainstream psychiatry: “Pills may be helpful to modulate extreme distress”, which illustrates that they are from the same corporation and have the same function.

    All that distinguishes a critical psychiatrist from a conventional psychiatrist is the feeling of guilt, but a critical psychiatrist will never take it upon himself to take revolutionary action: on the contrary, they always admit, according to their program, that narcotics can be useful “in some cases” and put us to sleep with promises of reform that will never come.

    Who can believe a man who works in a mental hospital? He will fill out the same psychiatric records, engage in the same drug trafficking and offer absolution to anyone who seeks in him the root cause of his misfortunes.

    After the drug trade, the intimate confession? We know that the Mafia has always been very attached to the Catholic Church. Likewise, psychiatrists are staunch defenders of psychotherapy, which is somehow their excuse and their priesthood for all the crimes they have committed.

    Corrupt priests might as well say that the Mafia can redeem itself. Narcotics, kidnappings, blackmail, corruption, extortion and exploitation: all this can be corrected as soon as you surrender your soul to God. But don’t stop the Mafia! Amen.

    • Makes sense as to why the guy (Senior Medical Officer) who coerced me to remove my clothes (you do it or we pin you down and do it) in a locked ward, knowing I had been spiked with benzos, and proceeded to insert objects into my mouth or anus when I had expressly denied my consent, was also an Ordained Minister.

      He did also sign a prescription for the benzos I had been spiked with 12 hours before he even knew of my existence, and after they had been administered. I wonder what other ‘concealments’ this person has been making in the locked ward of the mental institution he was working at? Imagine if any of the victims of childhood rape (by the likes of Fr. Gerald Ridsdale) ever turned up there, would he have declared a conflict of interest? Or would he have ensured they were never heard with a label and a fist full of drugs, like the list he wrote out to silence me with.

      Nice comment Sylvain, I’d like to hear more from you.

  4. I don’t want any more therapy. I want justice. I just don’t know how that could ever be achieved. No one can give me back the years of motherhood lost or the stigma from all directions from being a mental patient or the lost income from being shuffled onto the disability system. The mental health system piles additional harm onto already harmed individuals.

    This can’t be repaired by changing how we feel about it or being heard and validated. How do we get justice? That’s all I care about now.

    • I doubt we can get rid of the bible, so it stands to reason that we get rid of psychiatry.
      I still do not understand how in a world where people consider themselves to be a society based on “justice”, on “freedoms”, that same justice system treats ALL persons who have seen a shrink, as suspicious and not worth of the same rights, or standards of care as anyone else.

      So psychiatry and politicians use each other, to actually attack people who have done absolutely nothing wrong.
      It seems to me that psychiatry is a reflection of a delusional world. The dangerous people NEVER see a shrink, because they share the same traits… so it would be impossible to keep society running smoothly.

      • “I still do not understand how in a world where people consider themselves to be a society based on “justice”, on “freedoms”, that same justice system treats ALL persons who have seen a shrink, as suspicious and not worth of the same rights, or standards of care as anyone else.”

        Consider how the German people saw themselves during the 1940s sam, and that in that “free” and “just” society the consequences of ticking the box marked “Juden” on your National identity record? All that justice and freedom just went out the window.

        I am not a fan of book burning so I don’t want to see it destroyed. I think some years down the track it will stand a bit like the book I read about how National Socialist administrators were struggling to get good seats made for their trucks as a result of the delousing program in the camps (many of the finest truck seats made by people of Jewish backgrounds). The matter of fact manner they spoke about their crimes against humanity seems obvious to us now, though at the time I’m sure it was written in ‘good faith’ as seeing that soldiers were comfortable in their work delivering free labour to those areas that required it.

        Actually theres a good documentary called “The Act of Killing” that covers the Suharto death squads (Hi to the doctor in the Emergency Dept assisting my State with whistleblowers) and how they come to a realisation of what they actually did. At first they sit bragging to one another about how vicious they were in their torturing and killing of communists, and then realised it was all being recorded and they saw themselves from ‘outside’. Like Michael Douglas in Falling Down, “you mean I’m the bad guy?” lol

  5. It is always helpful for people to be clear about the DSM and the pills it inevitably leads to BUT please can we have some humility and honesty about psychotherapy and its equally limited ability to help people.

    This is just massive and shameful overselling -makes me cringe – i’m just imagining a drug company style video that goes along with this sort of waffle.

    ‘Once the psychological injuries are mapped out, treatment can address them. And only psychotherapy is specifically designed to address emotional wounds. Only therapy is focused on uncovering and refuting the negative self-talk that scrolls through the minds of people who have been emotionally abused. Only therapy can heal the distorted images of self and body that people carry who have had their sexuality violated’.

  6. (Okay. Inside voice.) If you see a string of “removed for moderation” comments above, it is because I have failed thus far at finding a way to say my truth without “questioning” the integrity of the author. (that’s the polite way to say: without letting my own pain take over my linguistic better judgement.) Forgive me. Language is not my first language. (Insert smiley faces to help convey a desire to play nice!) 🙂

    I will try one last time. (Maybe it is best to start with an opening greeting.)

    Thank you, Dr. K, for an informative essay. I really appreciate a life story first point of view. You are admirably well informed!

    Speaking from my own life story, this article left me “bothered” not because of the specific content, but because of an inner sense that something about the intention of it was concealed. (maybe my transference is just acting up again.) First I reacted (quite a few times) and then I researched.

    I really value the research you presented in this article! 🙂

    Speaking from my own research, I have concerns that MIA may be being used as a marketing platform, so I have sent a letter to the author asking for clarification. If my intuition is right, we can go from there. Consultation may be necessary to find a way forward, but I am worth every penny. Even smiley face has to earn a thriving. 🙂

    I did learn something very helpful in (following my heart to) the Primacy of Therapy website founded by Dr. K. As people with credentials that we have paid dearly for, (credentials that could only be earned by going inside forced treatment and surviving to tell about it), we can use our “preeminence” as survivors to get our voices heard and more. Too many survivors (maybe like the therapists Dr. K coaches) have had the self-esteem beaten out of them, but there is hope! Thank you for the practical actionable suggestions on how to get ahead in a tough market! 🙂

    I am ready to apply one thing I’ve learned from this article and the ensuing research. We can quickly establish ourselves as experts by teaching. As a trauma (at the hands of credentialed professionals with good intentions and the backing of research) survivor, the first skill I want to teach is the courage to question all authority, research for yourself, and respond proactively when something doesn’t feel right. QUESTION-RESEARCH-RESPOND. Stand up straight and say it three times with me… Q-R-R Q-R-R Q-R-R

    Protect your truth even if finding the appropriate words never happens! Even if it ends up being a private practice with God and your cat as your only clients. Even if the first dozen attempts come across sarcastic and passive-aggressive! Say it anyway. Your heart will thank you and mine will too. 🙂

    You are a survival expert so own your pride of place and paycheck by schooling professionals who have not had the privilege of seeing reality from ground zero! You are not less. You are more! Pick the gravel out of your road rash face and get back out there people! There is a market for your wisdom, the world just doesn’t know how much they need you!


    I hear you! (Tell me about that. hmmm. hmmm.) Sorry. I couldn’t help my prickly self!

    I’m here all week. Try the faux-veal.

    Keep your stick on the ice!

      • I was TOTALLY “triggered” by this essay. I “dissociated” and everything. Sheesh even the old “bipolar mania” fight for justice “symptom” and my “schizophrenic” “suspicion” that there was a “capitalist conspiracy” motivating it came back! I got all “manipulative” and “rescue seeking” and worse! “threatening” Ham good thing this site has a “patient” moderator. I “reality tested” by googling and “praise-be” it only “consumed” a few hundred to “forget” that my intuition was right all along “strap down” and get “straight” again. In the end I remembered my “shock” and all the “life skills conditioning” I learned in “psycho therapy” like smiling no matter what. 🙂 not creepy at all.

  7. “Ninety-nine percent of British psychiatrists believe bad biology is the primary cause, or a major cause, of schizophrenia.”

    Someone needs to remind those psychiatrists of what they were taught in med school. Which is that the antidepressants and/or antipsychotics can create psychosis and hallucinations, two of the positive symptoms of “schizophrenia,” via anticholinergic toxidrome. And the antipsychotics/neuroleptics can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome. So most so called “schizophrenia” is likely primarily an iatrogenic illness, not an illness with a genetic/biologic etiology.

    “Psychiatry ignores what it does know about the cause of a great deal of emotional distress. It excludes this knowledge from the DSM, rather than revising and updating the manual to include it.” So true, like after Whitaker pointed out the iatrogenic etiology of “bipolar;” the symptoms of “bipolar” can be created with the antidepressants and/or ADHD drugs. Likely out of spite, the DSM5 psychiatrists took this common sense disclaimer out of the DSM5.

    “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

    And, given the reality that the vast majority of those labeled with the DSM disorders are survivors of adverse childhood experiences.


    It’s quite inappropriate that NO “mental health” worker today, may EVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER. Unless they first misdiagnose all ACEs survivors with one, or more, of the billable DSM disorders.


    Thank you, Eric, for pointing out the systemic, and worsening, fraud and other problems with the psychiatric DSM “bible.” Absolutely, taking away hope is a goal of the psychiatric, and the DSM “bible” believing psychological, industries. Despite the fact hope is mandatory.

    “Life Story Is the Path to Truth.” And the truth shall set you free.

  8. Perhaps “talk” “therapy” has it’s place.
    Talk without play is useless to a child or teenager and adults are mostly physically declining children.
    The brain has memory stored, it stands to reason that it can’t be talked away, and it can also not be drugged away, not even in complete stupor of drugs.

    We all know of beneficial environments. “environmentally, emotionally stimulating, satisfying”. To counteract the past or present drudgery, to enrich the present and future, so that the past is not as important.

    If therapists did their “therapy” in settings like a canoe trip, or cooking classes, or the person’s work or homelife setting, perhaps it would be of benefit.
    But therapy that really helps is not cost-efficient.

    • I think the biggest problem with even quality therapy is that it is not really the proper mode to deal with current or ongoing abuse or oppression. It can be valuable for a person to discuss the pain of living with a dead-end job, and may even help motivate a person to seek a better one, but it can’t take care of the question of why so many jobs are dull and lifeless and why so many people are forced to work in them for inadequate pay in order to merely survive to face another day. Therapy can be valuable, but it is limited and can’t really handle the bigger social issues with which our current Western society is riddled.

      • Therapy has been used to reinforce internalizing reactions to trauma and oppresion by promoting coping skills in leui of concrete personal and political action to change oppressive systems. Mutual aid between equals removes the disempowering professional/client dynamic so that folks can focus their energy on effective action to create change.

        Therapy is less than useless in this context.