The Ongoing Movement Against Psychiatric Medications

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Demonize: “to portray (someone or something) as evil or as worthy of contempt or blame.”

–Merriam-Webster Dictionary

The following historical note recently appeared in the New York Times and immediately caught my eye¹:

“Feb 8, 1901. Six women, armed with ‘pitchforks, umbrellas, and canes,’ trashed several drugstores and attacked pharmacists in Chicago…declaring that ‘drugs were the agents of the devil’…the women were followers of John Alexander Dowie, the evangelist and ‘anti-medicine faith healer’…Mr. Dowie was leading a deadly cult…he died at 59 from complications of an illness. One doctor quoted by the Times said previous medical care might have prolonged his life 15 years.”

If this obscure bit of history seems oddly familiar, the explanation is not hard to come by. Fervent antidrug or antimedicine antipathy has been a part of Western culture from ancient times to our own day, as recent events demonstrate. John Alexander Dowie (1847-1907), for example, “…challenged the medical establishment's scientific claims to heal anything, [and argued that] the pharmaceutical industry was no better, poisoning the American public with unproven and dangerous drugs that were no better than the drug scourge of the time: opiates, especially morphine and heroin. Medicine, Dowie argued, was Satan's' way of deceiving Christians by mimicking healing and health, while offering none of the physical or spiritual benefits of divine healing.”²

Now, to be sure, there was far less regulation of the pharmacopeia in Dowie’s day. The US Food and Drug Administration was not created until a year before Dowie’s death, and there were undoubtedly dangerous drugs circulating in Dowie’s milieu. But before delving into the historical aspects of antimedication ideology, it is important to state that not every criticism of prescribed medication represents demonization. As a psychopharmacology consultant for over 20 years, I spent much of my time in nursing homes, trying to whittle down a patient’s list of psychiatric medications from 5 or 6 to 1 or 2. Indeed, I would go so far as to say that psychopharmacology is largely the science of knowing when to be critical of a drug or drug combination. Inappropriate polypharmacy is a case in point.³

So, when I speak of demonization, I am gesturing at something quite extreme—and not, say, at someone pointing out (correctly) that antipsychotic medications can cause severe weight gain; or that, in a small but significant percentage of cases—roughly 1 in 35 patients—discontinuation of antidepressants can provoke serious withdrawal symptoms.⁴ No—I am referring to claims bordering on Dowie’s “drugs [are] the agents of the devil.” Some recent examples include the bogus claim that serotonergic antidepressants induce young men to become school shooters; or that these agents (selective serotonin reuptake inhibitors [SSRIs]) have the same addictive properties as heroin.^5,6 Unfortunately, brief versions of both these false claims were recently voiced by none other than the incoming head of the Department of Health and Human Services.⁶ (It has always puzzled me that some extremist critics of antidepressants claim that these agents are little more than expensive sugar pills, while simultaneously claiming that antidepressants so powerfully affect the brain as to produce violent killers).

Although not as extreme, the baseless claim that the use of psychiatric medications has sparked an epidemic of mental illness arguably qualifies as demonization of whole classes of psychiatric medication.^7,8 All that said, my aim is not to relitigate these misleading claims, which would take an entire monograph; but rather, to place such demonization in a cultural and historical context.

First though, it is important to note that the terms medicine and drug are quite ambiguous and subject to various definitions. As Edward D. Zanders, PhD, has noted, “The terms drug and medicine are used interchangeably, although the word ‘drug’ has the connotation of an illegal substance, such as cocaine or heroin…”⁹ Not surprisingly, psychiatry’s more extreme critics almost invariably allude to psychiatric drugs (and drugging of patients) rather than to psychiatric medications. As always, language drives ideology, and vice versa. For purposes of this commentary, I will use the broad term drug to refer to any substance taken internally or injected, other than food or water, that alters the way the body functions, physically or mentally. Medications (or medicines) comprise a subset of this class, and refer to substances that help prevent, treat, or cure diseases.¹⁰

The Pharmakon in Ancient Greece: Savior or Slayer?

Our terms pharmacy and pharmacology have their roots in ancient Greek myth and magic, reflecting that culture’s deep-seated ambivalence toward drugs and medicine—and perhaps toward those who held themselves out as healers. As classics scholar Todd M. Compton explains, “The pharmakos was a human embodiment of evil who was expelled from the Greek city at moments of crisis and disaster. The name is probably, but problematically, connected with pharmakon, ‘medicine, drug, poison’. Both poison and drug were originally magical; so a pharmakon is a magical dose…causing destruction or healing. Pharmakos then would be ‘magic man, wizard’ first, though the borderline between magic and religion is not easy to define; the early pharmakos might have been ‘magic man’ or he might have been ‘sacred-man’. Then, presumably, he or she was ‘healer, poisoner’, then later, expiatory sacrifice for the city and rascal…On the one hand, the pharmakos could be the medicine that heals the city…on the other, he could be the poison that had to be expelled from the system (he is often ugly or criminal). Thus, these 2 interpretations are not exclusive.”¹¹

Western culture, of course, has been heavily influenced by its ancient Greek roots—think of the impact the figure of Hippocrates has had upon the culture of Western medicine. Indeed, we can see echoes of the ancient Greek ambivalence—and animus—toward drugs and medicine in our own time, particularly in the area of psychiatric medication. On the one hand, medication for depression or anxiety is often recognized as necessary and helpful, in some cases; on the other hand, it is often falsely portrayed by extremist critics as toxic, brain damaging, and powerfully addictive.^12,13 In my view, these unsubstantiated claims have stigmatized many of our patients who rely on psychiatric medication for their emotional stability and well-being and led to the stigmatization of psychiatrists and psychiatry.¹⁴

Our Puritan Heritage: Let’s Blame the Victim

I believe that a fair portion of our modern day, antidrug animus is a vestige of our Puritan heritage, and its attitude toward disease, suffering, sin, and expiation. As historian An Vandenberghe has written¹⁵:

“Puritan preachers believed in a strong and logical connection between disease and personal sin. Proof of that lies in the advice which each minister again and again gave to the sick person and his family; namely to search their soul to try and find out what they had done to displease God. Puritans also linked certain kinds of diseases to certain kinds of sin. Bodily afflictions were mostly the consequence of sins performed with the body. Cotton Mather especially proved to be a strong believer in a correspondence between the sin and those parts of the body that were in pain. When someone was afflicted by tooth ache, for example, this person probably had sinned with his teeth ‘by Sinful, Graceless, Excessive Eating’ or ‘by Evil Speeches.’”

There was also a conviction among the early Puritan preachers that “…afflictions were spiritually beneficial in various ways; they made humans humble, aware of death and their fragile body, and, above all, aware of their past sins. The best way for the sick, their relatives and friends to profit from these advantages was to subject their will to the will of God and not to try to escape His afflictive hand.”¹⁵

I believe that our modern day culture—for all its superficial sophistication—reflects a similar ethos, albeit in an attenuated and often secularized form. This sometimes takes the form of minimizing the immense harms of clinical depression or exaggerating its dubious benefits.^16,17 Worse still, there is the hectoring, castigating, and guilt-tripping of severely depressed patients who choose to take an antidepressant. This choice is often disparaged as a failure (or refusal) to deal with the so-called “real” or “underlying” causes of the person’s depression. One self-declared expert asserts that “…each moment, you are depressing yourself from the choices you make, which are not honoring your Higher Self… The anti-depressants only cover up the symptoms of what you are feeling inside.”¹⁸ Medication is thus regarded as a cop-out or an unwillingness to confront one’s psychological or interpersonal vulnerabilities. (Of course, for some patients, those issues indeed turn out to be very important).

As Maria Yagoda wrote concerning her own experience with depression¹⁹:

“Anyone who struggles with a mental illness or mood disorder must routinely endure a litany of off-the-cuff, unsolicited feelings, ideas, and proposed solutions from people who fancy themselves doctors…One recurring theme is distaste for medication. To talk openly about your mental health struggles is to come into contact with the widespread belief that taking medication is needless or toxic or the result of some kind of personal failing — as though you are simply not trying hard enough to be happy and well-adjusted.”

The patronizing attitude Yagoda describes reminds me of the famous maxim from the French moralist, La Rochefoucauld (1630-1680): “We all have strength enough to bear the misfortunes of others.”²⁰Sometimes, even well-meaning but misinformed therapists collude in this form of drug-shaming, as psychiatrist Nathan Billig, MD, has noted²¹:

“I am aware of therapists who have accused a patient of ‘taking the easy way out’ if he took medication and failed to resolve all the issues analytically, in spite of great disability. Patients may feel ashamed, disloyal or too threatened to seek a treatment different from the one offered, particularly when it means a sharp disagreement with their ongoing therapists. And yet, patients who are depressed and anxious may become dependent on their therapists and feel trapped when the therapist advises that ‘you must suffer through this and feel the pain to reach a resolution; medication is a cop-out.’ I agree that psychotherapy is a useful, often crucial, treatment and not an easy process for either patient or therapist. Psychic pain is often inherent in the growth that results. But sometimes the pain of depression immobilizes the patient so that the work of therapy cannot be done effectively.”

Ironically—and rather surprisingly—Vandenberghe points out that even the Puritan ministers were not adamantly opposed to the use of medicines, so long as this was understood in terms of Puritan theology. She notes that when, in 1721, “…smallpox broke out in Boston, [Puritan clergyman] Cotton Mather called on the town’s physicians to consider using inoculation to prevent further victims. All the Boston lay physicians rejected the idea, except for doctor Zabdiel Boylston (1679-1766), who performed the first inoculations in colonial America on Mather’s 6-year-old son and 2 African American servants….[Furthermore]…although one would assume that they would consider the use of medicine as disobedience against the will of God, Puritan ministers of both the late 17th and the 18th century did not see it as a sin if sick people tried to get well again. Moreover, the search for bodily healing was not only allowed, but even an obligation. God was not only the righteous Giver of disease and pain, but also the merciful Inventor of medicine on which mankind could rely in times of pain and suffering.”¹⁵

In sum: although the Puritans’ concept of disease placed considerable blame on the sick individual and the consequence of sins, the Puritans were not uniformly opposed to the use of medicinal remedies. And in at least 1 respect, the Puritan clergy may have been more enlightened than some of our modern-day antivaccine extremists.⁶

Concluding Thoughts

Antimedication myths, fears and beliefs are as old as ancient Greece and as new as recent congressional testimony.⁶ Demonizing psychiatric medications is a recurrent motif among antipsychiatry voices, along with the disparagement of psychiatry as a medical specialty. Our patients with the most severe illnesses, many of whom need medication to remain in remission from serious illness, bear the burden of this stigmatizing rhetoric. This is surely not to advocate uncritical cheerleading for psychiatric medication. Indeed, the flip-side of demonization is pseudoscientific hype. In this regard, my colleague, Nassir Ghaemi, MD, MPH, gives as an example the promotion of hallucinogens like psilocybin as “…better than sliced bread.”²² And, yes: in the 1990s and early 2000s, there was considerable hype surrounding the SSRIs, which—while moderately effective for many patients with severe, acute major depression—are assuredly not the greatest thing since sliced bread.²³ As clinicians, we have a responsibility to convey to our patients both the significant benefits of psychiatric medications and their attendant risks.^24,25 Drugs are not the agents of the devil, nor are psychiatric medications panaceas. They are, at best, a bridge between misery and recovery. It is the privilege of the psychiatrist to help the patient walk across that bridge.

Dr Pies is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and editor in chief emeritus of Psychiatric Times (2007-2010). Dr Pies is the author of several books, including several textbooks on psychopharmacology. A collection of his works can be found on Amazon.

References

1. Women wreck drug stores: faith curists start on the warpath in Chicago. New York Times. February 8, 1901. Accessed February 17, 2025. https://www.nytimes.com/1901/02/08/archives/women-wreck-drug-stores-faith-curists-start-on-the-warpath-in.html

2. Sanchez-Walsh A. Doctors, drugs and devils: pentecostalism's anti-medicine history. Religion in American History. September 28, 2013. Accessed February 17, 2025. https://usreligion.blogspot.com/2013/09/doctors-drugs-and-devils-pentecostalism.html

3. Ghaemi SN. Polypharmacy in Psychiatry (Medical Psychiatry Series). CRC Press; 2002.

4. Henssler J, Schmidt Y, Schmidt U, et al. Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. Lancet Psychiatry. 2024;11(7):526-535.

5. Knoll JL, Annas GD. Warning: antidepressants may cause messaging manslaughter. Psychiatric Times. September 19, 2017. https://www.psychiatrictimes.com/view/warning-antidepressants-may-cause-messaging-manslaughter

6. Goldberg A. RFK Jr.'s misinformation on antidepressants matters. Here's what to know. USA Today. January 30, 2025. Accessed February 17, 2025. https://www.usatoday.com/story/life/health-wellness/2025/01/30/rfk-jr-antidepressants-ssri-heroin-school-shooters-mental-health/78048367007/

7. Whitaker R. Anatomy of an epidemic: psychiatric drugs and the astonishing rise of mental illness in america. Ethical Hum Sci Serv. 2005;7(1):23-35.

8. Pies RW. The bogus “epidemic” of mental illness in the us. Psychiatric Times. June 18, 2015.https://www.psychiatrictimes.com/view/bogus-epidemic-mental-illness-us

9. Zanders ED. Introduction to drugs and drug targets. The Science and Business of Drug Discovery. 2011;11-27.

10. Definition of medicines. Australian Government Department of Health and Aged Care. July 7, 2022. Accessed Fevruary 17, 2025. https://www.health.gov.au/topics/medicines/about-medicines

11. Compton TM. Victim of the Muses: Poet as Scapegoat, Warrior and Hero in Greco-Roman and Indo-European Myth and History. Harvard University Press; 2006.

12. Ramsay W. Psychiatric drugs: cure or quackery? Law Project for Psychiatric Rights. 2015. Accessed February 18, 2025. http://www.wayneramsay.com/drugs.pdf

13. Eastgate J. Rehab fraud: psychiatry’s greatest scam. Citizens Commission on Human Rights. Accessed February 18, 2025. https://www.cchr.org/cchr-reports/rehab-fraud/introduction.html

14. Sartorius N, Gaebel W, Cleveland HR, et al. WPA guidance on how to combat stigmatization of psychiatry and psychiatrists.World Psychiatry. 2010;9(3):131-144.

15. Vandenberghe A. “We must not be pagan stoicks!”Attitudes of new england puritan ministers towards disease and medicine (late seventeenth and eighteenth century). 2001. Accessed February 18, 2025. https://www.academia.edu/5697797/We_must_not_be_pagan_stoicks_Attitudes_of_New_England_Puritan_ministers_towards_disease_and_medicine_late_17th_18th_century_

16. Pies RW. Is depression a disease?Psychiatric Times. November 9, 2020. https://www.psychiatrictimes.com/view/depression-disease

17. Pies RW. Is major depression “adaptive”?Psychiatric Times. February 10, 2011. https://www.psychiatrictimes.com/view/major-depression-adaptive

18. Sheen B. Depression: the real causes of depression and how to feel good again without medications. Accessed February 18, 2025. https://briansheen.com/dr-brian-sheen-posts-the-real-causes-of-depression/

19. Yagoda M. I need medication to treat my mental illness. Why can’t people accept that?Vice.May 10, 2018. Accessed February 17, 2025.https://www.vice.com/en/article/long-term-medication-mental-illness-stigma/

20. La Rochefoucauld F. Maxims. 1665.

21. Billig N. Medicine for depression is not a “cop-out.” Washington Post. May 29, 1989. Accessed February 17, 2025. https://www.washingtonpost.com/archive/lifestyle/wellness/1989/05/30/medicine-for-depression-is-not-a-cop-out/df5fbf87-2ac5-4c2c-a31e-64773e32bcc5/

22. Ghaemi N. Pseudoscience and hype in psychiatry. Massachusetts Psychiatric Society Bulletin. February 2025. Accessed February 18, 2025. https://maps.memberclicks.net/assets/Newsletters/2025/2502%20MPS%20February%202025%20Newsletter.pdf

23. Pies RW. Serotonin: how psychiatry got over its “high school crush.” Psychiatric Times. November 2, 2015. https://www.psychiatrictimes.com/view/serotonin-how-psychiatry-got-over-its-high-school-crush

24. Pies RW. Antidepressants, the hamilton depression rating scale conundrum, and quality of life. J Clin Psychopharmacol. 2020;40(4):339-341.

25. Ruffalo ML. A return to lithium: psychiatry's first miracle drug. Psychology Today. July 6, 2020. Accessed February 17, 2025. https://www.psychologytoday.com/us/blog/freud-fluoxetine/202007/return-lithium-psychiatrys-first-miracle-drug

For Further Reading

Morehead D. Everyone is wrong about benzodiazepines. Psychiatric Times. June 6, 2024. https://www.psychiatrictimes.com/view/everyone-is-wrong-about-benzodiazepines

Phelps J, Nguyen J, Coskey OP. Antidepressant tapering is not routine but could be. J Am Board Fam Med. 2023;36(1):145-151.

Aftab A. Medication treatment challenged in mood disorders: a discussion with Jim Phelps. Psychiatry at the Margins. February 15, 2025. Accessed February 17, 2025. https://www.psychiatrymargins.com/p/medication-treatment-challenges-in?utm_source=substack&utm_medium=email&utm_content=share

Haddad P. Do antidepressants have any potential to cause addiction? J Psychopharmacol. 1999;13(3):300-307.

Pies RW, Osser DN. Sorting out the antidepressant “withdrawal” controversy. Psychiatric Times. March 11, 2019. https://www.psychiatrictimes.com/view/sorting-out-antidepressant-withdrawal-controversy

Knoll JL, Pies RW. The ssri-violence link: myth or menace? Medscape Psychiatry. August 20, 2020. Accessed February 17, 2025. https://www.medscape.com/viewarticle/935846?form=fpf