A Tale of Two Tyrannies: Psychiatry and the public health response to coronavirusFri 10:16 am +01:00, 14 Aug 2020
For the last decade, most of my writings – articles, blogpost, books – have tried to highlight the flaws in Western psychiatry’s approach to human suffering while, at the same time, striving to promote non-medical alternatives. Since the emergence of the coronavirus (SARS-CoV-2) at the start of the year, I have found it increasingly difficult to focus on mental health issues. Instead, I have observed the Government responses to this novel respiratory virus with a growing sense of disbelief, horror and – ultimately – anger. Among a raft of examples of mismanagement, I believe that the draconian lockdown will – in time – be viewed as the most self-destructive policy decision in peacetime history. (See previous blog here).
Recently, I have reflected on potential reasons why the coronavirus crisis, and the Government’s responses to it, have activated me to the point where I can think of little else. There are likely to be several factors that have contributed to the strength of my reaction, but an important one is the realisation that a number of elements responsible for my antipathy towards Western psychiatry are also being played out – on a broader scale – in the public health response to coronavirus.
In this ‘Tale of Two Tyrannies’ I will highlight five common threads evident in both psychiatry’s ‘illness like any other’ approach to emotional distress and the way the UK’s public health system has responded to SARS-CoV-2.
1. Human rights violations
It is widely acknowledged that the Mental Health Act (1983, 2007), applicable to England and Wales, constitutes a form of legalised discrimination (see here and here). Under this statutory framework, a law-abiding citizen who is unfortunate enough to be tagged as suffering a ‘mental disorder’ can be incarcerated without trial. Furthermore, a psychiatric patient held under ‘section’ immediately loses the fundamental freedom to make an informed decision as to whether or not to accept a medical intervention, often enduring the non-consensual administration of toxic psychotropic drugs.
Whereas mental health law rides roughshod over the fundamental rights of a segment of the population (those caught in the tentacles of the psychiatric system), the Government’s coronavirus legislation have ensnared us all in a totalitarian nightmare. The rushed introduction of the The Coronavirus Act (2020) and the Health Protection (Coronavirus, Restrictions)(England) Regulations (2020) (along with subsequent, hastily amended, public health regulations) have – without any parliamentary scrutiny – imposed a raft of unprecedented and draconian restrictions, depriving the whole population of a range of basic freedoms.
Over a four-month period, UK citizens have been denied the rights to: travel overseas; drive more than a few miles away from home; venture out of our houses for anything other than essential items and a brief period of exercise; meet up with friends and loved ones, including children, grandparents and partners; and to assemble in groups, for whatever purpose. Furthermore, compulsory school closures have denied our children a sizable chunk of basic education and vital peer interaction, while the shutting down of sports events, pubs, theatres, museums, leisure centres, gyms and restaurants have cast us adrift from the social activities that define a civilised country. And – as an extra nail in the coffin of a free society – we are now compelled to wear face coverings that further impede human interaction.
- Purportedly implemented for our own good
We should be especially wary of authoritarian restrictions that are supposedly implemented for our own benefit. The often-cited words of C.S. Lewis capture the threat perfectly:
‘Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive … … those who torment us for our own good will torment us without end for they do so with the approval of their own conscience’.
There are striking similarities between the attempted ‘for your own good’ justifications of Western psychiatry and the Government’s coronavirus policy.
Psychiatry excuses its coercive practices under the guise of delivering therapeutic treatments that alleviate suffering, protecting the patients from the risk of suicide or exploitation, and purportedly protecting the general public from dangerous ‘mentally ill’ patients. These paternalistic claims are difficult to substantiate. Multiple personal testimonies by patients describe the negative consequences of psychiatric coercion and there is a scarcity of research in support of its therapeutic benefits. There is little evidence that involuntary incarceration reduces suicide. And it is generally recognised that the risk that people tagged as ‘mentally disordered’ present to the public is minimal.
Likewise, the draconian, unprecedented restrictions imposed by the Government in response to SARS-CoV-2 are often justified by the claim that they are for the greater good. Mantras reinforcing this assertion abound: ‘stay safe’; ‘save lives’; ‘protect the NHS’; and ‘do your civic duty’. In more informal discourse, dissenters are typically accused of ‘killing people’, ‘throwing grandparents under a bus’ or of displaying a selfish recklessness. All this despite the accumulating evidence that the lethality of this latest coronavirus is less than a number of other common infectious agents (for example, TB and hepatitis B/C) and not appreciably greater than the infection fatality rate (IFR) of seasonal influenza (see here and here).
Furthermore, there is evidence to suggest that the countrywide lockdown – the most drastic and damaging of the Government responses – neither reduces coronavirus infections nor saves lives over and above that achieved by voluntary social distancing and hand hygiene messages (for example here and here).
- A dependence on the general public to enforce the rules
One state-sanctioned function of psychiatry in the Western world is to contain and suppress those among us who behave in ways that the majority finds troubling or troublesome (Pilgrim & Tomasini, 2013). In order to successfully perform this role, psychiatric professionals depend on laypeople to bring ‘mentally disordered’ individuals to their attention. Commonly, this social control function will be exercised by a family member, concerned by the unusual behaviour of a loved one, or by a member of the general public who witnesses someone acting extraordinarily in the street. The psychiatric system relies on this network of informers, and encourages their collusion.
The public health restrictions associated with SARS-CoV-2 also rely on layperson participation. Indeed, ‘snitching’ on the miscreants who break the rules has been encouraged, a blatant example being the recent comments of Metropolitan Police Commissioner, Cressida Dick, who expressed the hope that those not following the mandatory facemask diktat would be ‘shamed into complying … … by other members of the public’. At the height of the lockdown one sensed the twitching curtains of neighbours as indicative of their surveillance – unlikely to have been paranoia given that the police received ‘thousands of daily reports of people allegedly breaking coronavirus rules’. The mainstream media eagerly encouraged snitching by punctuating their relentless fear-inflating narrative with images of supposed rule-breakers congregating on beaches or in parks. And social media is littered with pictures of strangers on trains without masks, typically alongside a caption urging punishments (ranging from a fine to an excruciating death) to be administered to these alleged miscreants.
- The ‘cure’ is worse than the illness
For both mental health problems and the SARS-CoV-2 virus there is persuasive evidence to conclude that the mainstream responses to each of these challenges causes far more problems than they resolve.
There is growing recognition that Western psychiatry routinely delivers interventions that are of limited effectiveness and that often do more harm than good to the recipients (for a review, see Sidley, 2015). Antipsychotic drugs increase the risk of movement disorders, diabetes, heart disease, stroke and premature death (see Moncrieff, 2013, pp152-169, for a review). In addition to the long-known side effects of antidepressants (for example, nausea, headaches, sleep disturbance and sexual difficulties), recent evidence indicates that almost half of users experience ‘severe’ withdrawal symptoms when coming off the drug – a high price to pay for a medication that may not produce significant clinical benefits. And a recent evaluation of electroconvulsive therapy (ECT) – a psychiatric treatment of unknown efficacy, administered to around one million patients each year – has shown that the intervention may result in permanent memory loss for more than 1 in 3 recipients.
It is likely that the Government actions – lockdowns, inflating fear levels – in response to the threat of SARS-CoV-2 will, in due course, kill far more people than the virus itself. Initial estimates by the Office of National Statistics suggest that, as of June 2020, about 30% of excess deaths were not associated with the coronavirus, these fatalities presumably being the consequence of people’s reluctance to attend hospital with life-threatening illnesses such as stroke and cardiac problems, or parents’ hesitancy to seek emergency help for their acutely ill children. Levels of domestic violence also increased during the lockdown.
The expected medium to long-term damage of the Government’s coronavirus policy is even more sobering. Looking ahead, it is highly likely we will suffer the tragic legacy of many thousands of cancer deaths resulting from delays in screening and treatment (see here and here). And it is difficult to predict the ultimate death toll attributable to mass unemployment, poverty and reduced spending on health provision.
- The pernicious influence of the pharmaceutical industry
The symbiotic relationship between biological psychiatry and the multi-national drug companies represents one of the most malignant collusions outside of wartime (see Sidley, 2013, pp146 – 159). The pharmaceutical industry’s grubby practices in the mental health field include: disease mongering; excessive drug prescribing, particularly regarding anxiolytics, antidepressants and antipsychotics; hiding unfavourable data from drug-evaluation trials (Goldacre, 2012); and bribing stakeholders. Worryingly, the initial indications are that the ethically-compromised talons of big pharma are actively moulding the world’s response to coronavirus.
As the drug companies compete to produce a therapeutic wonder drug to counter the illness sometimes associated with SARS-Cov-2, the familiar chicanery is beginning to emerge. The expensive drug, Remdesivir, has been actively promoted on the back of research suggesting it reduces the average recovery time of very ill patients from 15 to 11 days; a modest benefit that is of questionable clinical significance, particularly when it is likely to be the product of bad science where the initial outcome measure (number of deaths) was substituted for this less impressive ‘recovery time’ measure. Meanwhile, there has been a concerted attempt to play down the effectiveness of hydroxychloroquine – a cheap, safe and widely available drug – by stooping to the depths of fabricating data for a Lancet article that later had to be retracted. The financial benefits to pharmaceutical companies of downplaying the therapeutic value of hydroxychloroquine could be vast.
And then there is the race to develop a vaccine. I’m not an anti-vaxxer nor a conspiracy theorist, but the more I discover about the financial inter-dependencies of the key players, (high-profile vaccine promoters like Bill Gates, university research departments and the pharmaceutical industry), the more wary I become.
The heightened fear levels of Governments and their people is the perfect context for turbo-charging the drive to develop a vaccine, and the woefully inaccurate overestimates of the likely death toll from SARS-CoV-2 emanating from Professor Neil Ferguson’s Imperial College team has provided this fertile ground. Could Professor Ferguson’s astrological over-predictions of coronavirus deaths have been influenced by the huge amounts of funding his academic department receives from the Bill and Melinda Gates Foundation? The fact that Professor Ferguson also has a history of receiving funds from the pharmaceutical industry suggests a potential conflict of interest.
Confidence in the integrity of the stakeholders involved in vaccine development is further shaken by the recent behaviour of the drug companies who stand to make huge profits from selling vaccines to panicked governments. Although the efficacy of a vaccine has yet to be demonstrated, the UK administration has already purchased 90 million doses from BioNTech/Pfizer and 100 million doses from AstraZeneca. Meanwhile, the negative impacts on vaccine-trial participants – that, for the large majority of recipients, is likely to mean that infection with SARS-CoV-2 is preferable to the side effects of the vaccine – are being minimised by the vaccine developers.
So there you have it. Five common threads that are evident in the actions of both Western psychiatry and the public health response to coronavirus. In light of these parallels I am surprised, and disappointed, that so few of my ‘critical’ allies in the mental health domain have spoken out against the draconian policies currently employed to counter the threat posed by SARS-CoV-2.
By Gary Sidley