Letter

To the Editor: The Open Forum essay by the Rissmillers in the June issue omits the real reason for the antipsychiatry and consumer movements—the spectacularly harmful effects of biological, drug-based psychiatric treatment. That harm is reflected in the sixfold increase in the number of people receiving Social Security disability payments for psychiatric disabilities since psychopharmacology took over psychiatry 50 years ago ( 1 ). During this period, the percentage of the population said to be mentally ill has nearly tripled and the total number of inpatient care episodes for severe mental disorders, on a per capita basis, has quadrupled ( 1 ). This wave of mental illness is accelerating. The number of people disabled by mental illness has almost doubled in the past 15 years ( 1 ).

Another major omission is an account of how the replacement of psychoanalysis by psychopharmacology as the specialty's ideological basis (which the essay mentions) produced these effects. In presenting psychoanalysis and psychopharmacology as the specialty's only therapeutic alternatives, the paper omits, and thus denies, the role of counseling and psychotherapy, which has always been a major tool of physicians. The psychoanalysts maintained that their method, with its primary focus on childhood experiences and passive free association, was deeper than other methods. When its uselessness as a treatment for psychosis was finally recognized, the role of present-focused nonpsychoanalytic psychotherapy was ignored and a new emphasis on drugs took its place. However, when psychiatrists limit their therapeutic focus to medication and to its effects on symptoms, they abandon a fundamental part of their treatment armamentarium: a trusting relationship within which the psychosocial problems behind the patients' symptoms are actively addressed.

Effective treatment should be the first demand of psychiatry's critics ( 2 ). To attack what is wrong, which is the approach taken by the antipsychiatry movement, is necessary but not sufficient. The Rissmillers' focus on Foucault, Laing, and Szasz, and their omission of respected professionals, such as Loren Mosher and Peter Breggin, erroneously imply that antipsychiatry's criticisms have come almost entirely from a small, marginal, left-wing group. The authors do not, for example, mention either the International Center for the Study of Psychiatry and Psychology or its peer-reviewed journal Ethical Health and Human Services .

The Rissmillers' account makes other errors. Although the Support Coalition International became MindFreedom International in 2005, the essay lists them as separate organizations, and David Oaks, not Leonard Roy Frank, is the founder.

The consumer-survivor movement has problems not mentioned by the Open Forum authors. In objecting to psychiatric abuses, the movement ignores the importance of good psychiatric care—as though such care does not exist—and essentially denies that professionals know how to provide it ( 3 ). The movement's focus on the national and international political scene ignores where public mental health care decisions are really made—in individual states. The movements' efforts at times to place supporters on psychiatric payrolls (as "consumer advocates," for example) represent a co-optation that provides benefits to past survivors of the system while ignoring its current victims.

The Rissmillers' account raises important questions about these movements. Its answers fall short.