Book Review: A Profession without Reason

Image: The cover of the book is a white background with a black squiggly lined jumble that ends in an arrow pointing upwards. Below that in black letters is, "A profession without reason." Below that in red letters is, "the crisis of contemporary psychiatry untangled and solved by spinoza, freethinking, and radical enlightenment." Below that in black letters is, "Bruce E. Levine."
 

It would be impossible to review Bruce E Levine’s A Profession without Reason without acknowledging my own relevant life experiences. This is going to be a long review not as tailored to the shorter attention span of review sites and blurbs. In an attempt to keep a long and complex history at least mildly reasonable in length, I will try to be as general as I can and keep the personal history in italics in case you want to skip ahead. I am also going to analyze much more of the book in specifics, which also adds length:

I have had a personal relationship with psychiatry since age 9, an educational relationship since age 17, and a professional relationship since age 24. The latter two ended years back due to worsening disabilities, but my personal relationship remains ongoing. I am 39 years old.

Many of my friendships, most of my romantic partnerships, and both sides of my blood-related family are riddled with suffering through drug and other addictions and/or multiple mental health struggles. I have also been part of radical mental health and psychiatry-critical (a term I am using to differentiate from anti-psychiatry like that of scientology) movements in big ways due to abuses and failures I have endured off and on since childhood. In adulthood, I was forced to reexamine my views when my closest family member began suffering from severe psychosis, rife with terrifying delusions, hallucinations, and other hellish experiences, which eventually involved the authorities being called multiple times and forced hospitalization, no matter how hard I personally tried to avoid that. I was previously hard-line against these coercive methods. I was forced to reexamine those reexaminations when the coercion didn’t work either, causing even more fear and mistrust, leading that person to disappear from my life for a period of years. However, I cannot look back and see any other way things could have gone in those moments. Not long after that, unrelated to this, another immediate family member took his own life.

I eventually found the formerly mentioned family member and she is again part of my life, but still suffers today and refuses all medical treatment despite desperately needing it for physical health problems.I remain in various forms of treatment and out of work due to both physical and mental health problems. I cannot take psych meds due to lack of improvement (with every class of drug under the sun) coupled with extreme and often dangerous side effects and usually have to assertively defend this boundary with every clinician. I do not have a solution or answer to any of these problems, but there have been small improvements that have come from both inside and outside mainstream clinical psychology. There is much much more.

I am not super fond of writing all of that on the internet, though it is not the first time. The reason I am doing so is to share an account of something that is real life- not the often touted polar opposites on some ridiculous spectrum of “mainstream psychiatry is the god emperor and you are crazy and ignorant for refusing to go along with it” or “psychiatry is all horrible authoritarians who just want to poison your beautiful freedom and creativity so they can make big pharma money.”

When I first started this book of Levine’s, I worried that it was leaning too hard into the latter. Because I have seen what anti-psychiatry without other solutions in place can do, and how it can often lead to the same places as authoritarian psychiatry in the end or worse, I felt myself resisting hard against Levine’s criticisms and discussions. Because I have read that, for people suffering psychosis in particular, the longer they go without treatment, the poorer their recovery will be, I fear the criticism of psychiatry that I use to hold close and have no trouble agreeing with. While I agree that psychiatry has not made very good progress, that many larger messages about psychiatry and medication’s effectiveness are either myths or sales pitches for drug companies, and that many professionals are afraid (just like I am) to trust their patients or themselves over the system, I also worried at times that he was cherry picking data or being way too general in his claims. He has a ton of citations, but at first they seemed to only come from a few of the same books sharing his message. (This changed later in the text.) I found myself saying, “ah yes, I remember when I saw through rose colored glasses and believed this sort of thing, but what pray tell are you supposed to do when someone is truly in danger, is endangering others, is living in a persecutory hell, and who thinks all of that is real? Is that really freedom?” I dug my nails in and stuck with Levine and I would recommend that any other reader do the same if they end up feeling the same uneasiness that I was. He was pushing the buttons that I would have loved someone to push years ago before life had beaten me down this much. I am glad I held on, because honestly, he won me over by the end. I think this book should be critical reading for pretty much anyone, especially those in educational, clinical, and/or research psych* and neuro* fields. Even if you aren’t persuaded like I was, you should welcome the challenge and exercise in open-mindedness.

I won’t spend much time with the parts about Spinoza in this review, even though they are a huge part of the book. This is in part, because it’s just not that interesting to me aside from saying, yes, this dude had some liberating ideas for SOME European MEN way back in the day. I left myself asking all throughout the book, “yes, but where are the women- especially non-European, white women- in Spinoza’s equation?” only to discover on the last two pages that he did not believe they deserved equality. Levine is a little critical of this glaring flaw, but is also obviously sweet on Spinoza, so he tries to save his #problematicfave by acknowledging the time period and saying that, if Spinoza were to meet his female scholars of today, perhaps he would have changed his mind. I am sorry, did smart women not exist until today? And should a man this apparently brilliant and free thinking only find himself able to see women as human when they praise his own work? Levine definitely speaks to his own blind spots in this, and it honestly irked me , but I will leave it at that because you could easily remove all of the parts about Spinoza from this book and still have an interesting piece on psychiatry and alternative ways of thinking.

Now, onto the nut-meat and potatoes of these arguments: Levine discusses several studies in which treatment outcomes were poorer in wealthier nations with higher hospitalization and psychiatric medication uses than they were in less wealthy nations with less medication use. He also talks about how, even though psychiatry has progressed in its development of many new drugs and treatments, mental illness is on the rise and the DSM continues to be expanded upon to (what I agree is) a ridiculous extent- pathologizing any deviation from the norm. Correlation does not imply causation, he acknowledges. But, this is an interesting thing I have seen brought up regularly by people critiquing psychiatry and medication. When my brain was pushing back, it was saying, “yes, and stigma may have also been reduced, healthcare access increased, and thus due to accessibility more people sought care and increased the amount of illness in statistics even though people have been struggling all along in silence. There are a number of reasons these events could have taken place this way.”

Thankfully, Levine did not make the same mistake others who cited these studies in brief passing have. He told me the same thing a (human) neuroscientist friend of mine did when I asked his thoughts about it. Said friend once worked in a schizophrenia lab and learned that in China there were better outcomes regarding schizophrenia because family and community were more important in the collectivist culture being studied and thus, people took care of their loved ones during psychotic episodes instead of being driven by fear and assuming only psychiatrists and hospitals could deal with them. This resulted in better recovery times and little to no reliance on forced hospitalization and medication.

Levine talks extensively about how community support and financial aid are far more critical in terms of recovery than medication or hospitalization. But, my mind was still pushing back when he seemed to claim that drug companies had a hand in skewing many studies, almost seeming to suggest that no studies existed showing that psych meds work. I think this may have just been poor organization, because as the book progresses, he directly addresses some studies in which antidepressants, antipsychotics, and other drugs are deemed effective. A flaw of many of them that he points out is that the effect is not much more than placebo, even if it is statistically significant. This is relevant because, as anyone who has been on a plethora of psych meds knows, the side effects can be life changing and life threatening at times. Those factors combined with the possibly long term reduction in recovery rates mean that a mildly significant result doesn’t mean much at all in the grander scheme of things. If you’re going to get 10% better from the drug but feel 65% worse physically, that’s not really a success story. When I was told- even by folks on the icarus project boards who had dealt with psychosis- that forced hospitalization and meds were all that worked for them when their symptoms were severe, I took their word for it thinking I had been stupid for trying to find other ways to help my aforementioned family member. In hindsight, was that what worked because in western countries where most of us were from, that’s often all there is aside from wandering the streets alone or ending up in prison?

Further along in the book, he discusses research that reported a favorable drug result. But, the discussion of the results (which are rarely if ever reported in mainstream media or clickbait titles with paywalls) showed a more complex reality. The people achieving success were also receiving housing and other forms of assistance. It is a no brainer (pun maybe intended?) to say that, having stable housing vs houselessness or incarceration is likely going to foster more stability in one’s mental health. Other predicting factors for good mental health outcomes are safety from abuse and violence, financial security, work or other fulfilling responsibilities, friend/family support, and so on. All of these things make perfect sense, but as Levine states, "While psychiatry claims to have a "biological-psychological-social" model, the flow of dollars dictates bio-bio-bio research and treatment. Psychological, social, cultural, and political causes...receive significantly less consideration. By paying scant attention to societal and political causes, the societal status quo is maintained, which benefits those at the top of the societal hierarchy."

Levine makes a comparison between the pathologizing of LGBQ people- homosexuality in particular- and people suffering psychosis. I found this offensive. Not because oh psychosis bad, gay good, or because there’s never any overlap, but because comparisons like these do a disservice to the unique experiences of both LGBQ people (we did not even discuss the T, yet) and people dealing with psychosis and related experiences. To be frank, someone I know believing the government is giving them brain damage by projecting microwaves into their head because of the poetry they write on their personal computer is not anything like the experience of someone being attracted to or falling in love with the same gender. The latter is pretty damned simple to figure out and, when acted on with consent of all parties, is not dangerous. The former caused the person I am referencing to be unable to drive safely, have a conversation with a stranger, or even sleep or eat. I understand the drive to make comparisons in order to draw people to one’s side or to make a point, but I can speak from experience making the same mistakes in a variety of ways: it usually obscures the real issues and turns off the reader.


The rest of Levine’s discussions about the pathologization of radical action or normal human variations of thought and behaviors were excellent, not only because they did not rely on false equivalencies. The chapter Tractatus Psychiatrico-Politicus is particularly good. I have a ton of page flags throughout the book, but ended up just flagging this entire chapter when I realized that I wanted to quote the entire thing. It is quite true that all throughout history from the beginning of any sort of attempts to understand human thought and experience, marginalized and oppressed people have been pathologized. These include but are not limited to aforementioned sexuality, “drapetomania” applied to enslaved people who escaped, the increase in diagnoses of schizophrenia among Black activists during the 1960s civil rights movements, experimentation on intellectually disabled people, Jews, and many others during the nazi era holocaust, the forced sterilization of disabled, poor, and/or people of color throughout eugenics movements, and (not mentioned in the book, but added by me,) “zoophil psychosis” applied to people who historically believed in nonhuman animal liberation. These and many other horrific histories of all forms of modern medicine- not solely psychiatry- should always be enough to cause us to keep our minds open to critiques of the system. Even today, shadows of these things remain, even inside people who find themselves horrified by these histories.

A final note: I did not realize until 90% of my way through the book that I had not had to deal with triggers regarding glorified details of nonhuman animal abuse for psych* or neuro* discovery purposes. Despite it being perfectly possible and preferable, to compose a text about human psychology without including animal abuse, many writers do so with cold detachment because they are falling in line with the norm, trying to stay on supportive terms with their colleagues, lack an understanding of human studies or the flaws with translational research, or because they just don’t care about ethics and other animals as much as they care about their citation list. We do read about horribly unethical human experimentation, but this is done in order to further support Levine’s points about how pathologization is used as a tool of oppression by governments, doctors, and scientists in supremacist cultures and movements which is very different. Levine being a “free thinking” psychologist probably served him well in these regards, though I can’t claim to know his intentions regarding a focus on human research (other than to say, because it makes the most damned sense.) I would love to be able to read more books about human (or other animals) minds without having to sit through, “wasn’t it so awesome when this brilliant science man electrocuted dogs or injected acid into rats or separated baby monkeys from their moms or induced horrifying brain injuries, etc? WHAT A GUY.”

All in all, I enjoyed this book, learned a lot, and it changed my mind about quite a few things. It also offered me a little bit of a reprieve from the guilt and pressure caused by systems expecting easy solutions to complex problems. No wonder I did not and often do not know what to do. It takes a village, and all that. I also read Levine’s previous book, Resisting Illegitimate Authority, but liked this one much better. I can see were the author has learned and grown from his last work and that is always a good thing.

This was also posted to my goodreads.