Psychiatry is not a biomedical but a psychosocial discipline

But psychiatrists are expected to prescribe drugs liberally and long term

The prevailing paradigm in psychiatry is that psychiatric disorders are medical diseases in the brain that should primarily be treated with drugs that change brain functions. In the United States, for example, the Director of the National Institute of Mental Health argued that psychiatry should become a “clinical neuroscience.”¹

As another example, ADHD is called a neurodevelopmental disorder or a cerebral organ dysfunction in psychiatric textbooks even though it is merely a collection of symptoms many of us have.²

This paradigm has failed us badly. In all countries that have been investigated, the rate of disability pensions doubled in just a decade³ while the usage rates for SSRI antidepressants increased markedly,⁴ and after these drugs came on the market, a 35-fold increase in disabled mentally ill children in the US was seen in just 20 years.³

Textbooks and other authoritative texts often claim that psychiatric drugs save lives.^2,5 This has never been documented in rigorous research whereas the randomised trials and carefully controlled observational studies suggest that psychiatric drugs are the third leading cause of death.⁶

On this background, it is not surprising that the World Health Organization and the United Nations recently called for systematic mental health reform emphasising psychosocial interventions.⁷

Psychiatric diagnoses are often misleading

Another issue with the current paradigm is how psychiatric diagnoses are made. Studies have shown that the diagnostic criteria are arbitrary and rather unscientific, and that the inherent subjectivity leads to large observer variation if several psychiatrists examine the same patients and suggest a diagnosis.²

The diagnostic criteria are so vague and unspecific that many healthy people can get one or more diagnoses if examined accordingly.² The bar for making diagnoses has been lowered, which is one of the reasons why the global number of people labelled with a mental health disorder has doubled from 1990 to 2003.⁸

There is considerable overlap in the criteria for different diagnoses and the adverse effects of psychiatric drugs can be the same as those criteria. Many patients therefore quickly end up with several diagnoses and become psychiatric “career” patients losing many of their best years to psychiatry.^2,5

Psychiatrists call it comorbidity, which it rarely is. It mostly reflects the poor validity of psychiatric diagnoses. For medical diseases, this is not an issue. It is comorbidity, for example, when a patient has both hyperthyroidism and hypertension, as these are two different diseases.

Long-term randomised trials and carefully controlled observational studies have shown that the chance of being cured is greater if the patients do not take psychiatric drugs.^2,3,5 They have also shown that psychotherapy outperforms drug therapy.^2,5

However, guidelines, psychiatric textbooks, state of the art articles and similarly authoritative sources recommend long-term usage of psychiatric drugs for many conditions. They even recommend antidepressants for people at risk of suicide^2,5,9 even though these drugs double suicides.^10,11

Imagine if a cardiologist said to a patient: “You have a heart attack but we have a good drug that will double your risk of dying.” What is standard in psychiatry is unthinkable in other medical specialties.

What should we do instead?

It is very difficult for conscientious clinicians to do what would be best for their patients. Psychiatrists have been fired because they refused to use drugs equally liberally as their peers. This anecdote illustrates the issues:

An 18-year-old student was still grieving after his father hanged himself five years earlier. After he was put on sertraline (Zoloft), he tried to hang himself and a psychiatrist admitted him to a psychiatric hospital and increased the dose of sertraline. When a young psychiatrist noted that antidepressants increase the risk of suicide, the consultant replied that they were aware of this but had to treat depression. If the student committed suicide without being on an antidepressant, they would be questioned why he was not treated.

We need a new paradigm for diagnosing psychiatric patients where we focus on what happened to the patient instead of finding x “faults” with the patient out of y possible according to a diagnostic questionnaire. This way, every patient becomes unique rather than someone who gets one or more labels, chosen from among hundreds of arbitrary and overlapping psychiatric diagnoses.

We also need a new paradigm for treating psychiatric patients that should focus on psychosocial interventions, using drugs as little as possible and helping patients to come off them again.

Psychiatry is not neurology; it is not a medicine of the brain; and the challenge is not a technical one but a human one; it is about relationships, meanings and values.¹

We also need a new paradigm for testing psychiatric drugs.¹² The universal use of short-term placebo-controlled trials with ineffective blinding, subjective outcomes assessed on rating scales with dubious clinical relevance, exposure of patients in the placebo group to drug withdrawal effects, and the reporting of results selectively have produced a literature plagued with misleading results that has resulted in tremendous harm for the patients.

Psychiatrists will have to be brave and resist following guidelines when this would be harmful for a concrete patient. It is allowed to deviate from guidelines if properly motivated in the patient’s file, and in the example above, it should suffice to say that the student will not be treated with an antidepressant because he is suicidal and the drugs double the risk of suicide.¹⁰

The science and the principles of medical ethics tell us that psychiatric drugs should mainly be used in acute situations and only with the patients’ fully informed consent. All laws, which allow forced treatment, violate international conventions and should be abandoned.^2,5

For further reading, some of my colleagues in the Critical Psychiatry Network¹³ and other networks have published excellent books explaining what is wrong with mainstream psychiatry and what we can do about it.¹⁴

In 2018, psychologists, leading activists and psychiatric survivors published the Power Threat Meaning Framework,¹⁵ which is an over-arching structure for identifying patterns in emotional distress, unusual experiences and troubling behaviour, as an alternative to psychiatric diagnosis and classification.

References

1 Bracken P, Thomas P, Timimi S, et al. Psychiatry beyond the current paradigm. Br J Psychiatry 2012;201:430-4.

2 Gøtzsche PC. Critical psychiatry textbook. Copenhagen: Institute for Scientific Freedom; 2022 (freely available).

3 Whitaker R. Anatomy of an epidemic, 2nd edition. New York: Broadway Paperbacks; 2015, pages 363 and 8, respectively.

4 Nielsen M, Gøtzsche P. An analysis of psychotropic drug sales. Increasing sales of selective serotonin reuptake inhibitors are closely related to number of products. Int J Risk Saf Med 2011;23:125–32.

5 Gøtzsche PC. Is psychiatry a crime against humanity? Copenhagen: Institute for Scientific Freedom 2024 (freely available).

6 Gøtzsche PC. Prescription drugs are the leading cause of death. And psychiatric drugs are the third leading cause of death. Mad in America 2024;April 16.

7 Shifting the balance towards social interventions: a call for an overhaul of the mental health system. Beyond Pills All-Party Parliamentary Group 2024;May.

8 GBD 2023 Mental Disorder Collaborators. Updated trends in the global prevalence and burden of mental disorders, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet 2026;407:2040-64.

9 Gøtzsche PC. Killing US war veterans with antidepressants. Substack 2026;May 2.

10 Hengartner MP, Plöderl M. Newer-generation antidepressants and suicide risk in randomized controlled trials: a re-analysis of the FDA database. Psychother Psychosom 2019;88:247-8 and Hengartner MP, Plöderl M. Reply to the Letter to the Editor: “Newer-Generation Antidepressants and Suicide Risk: Thoughts on Hengartner and Plöderl’s Re-Analysis.” Psychother Psychosom 2019;88:373-4.

11 Gøtzsche PC. Observational studies confirm trial results that antidepressants double suicides. Mad in America 2025;Feb 8.

12 Gøtzsche PC. A new paradigm for testing psychiatric drugs is needed. Mad in America 2023;Feb 25.

13 Critical Psychiatry Network.

14 Moncrieff J. The myth of the chemical cure: a critique of psychiatric drug treatment. Basingstoke: Palgrave Macmillan; 2007; Moncrieff J. The bitterest pills. Basingstoke: Palgrave Macmillan; 2013; Davies J. Cracked: Why psychiatry is doing more harm than good. London: Icon Books; 2013; Timimi S. Insane medicine: How the mental health industry creates damaging treatment traps and how you can escape them. Seattle: Kindle Direct Publishing; 2021; Read J. A history of madness. In: Read J, Dillon J, eds. Models of madness, 2nd ed. London: Routledge; 2013; Taylor D, Horowitz MA. The Maudsley Deprescribing Guidelines – Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs. Oxford: Wiley; 2024.

15 Johnstone L, Boyle M, Cromby J, et al. The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society; 2018.