Contemporary psychiatric research operates within a publication ecosystem marked by structural asymmetries of power, increasing entanglements with pharmaceutical interests, and limited tolerance for sustained methodological critique. In such contexts, critical perspectives that challenge biologically reductionist interpretations or foreground the adverse effects of widely prescribed medications may face implicit barriers, even when their arguments are scientifically sound. A recent case–control study by Magen et al. (2025) reported associations between acute urticaria and psychiatric disorders, primarily personality and anxiety disorders. While the authors speculated about biological pathways, they did not test or adequately discuss the role of psychiatric medications, despite having access to prescription data and despite urticaria being a well-documented adverse effect of several psychotropic drugs, including those commonly prescribed for anxiety. These validity concerns are compounded by the editorial handling of a letter to the editor we submitted in response. Although the critique was explicitly acknowledged as “valid,” it was rejected on the grounds that similar concerns had been raised in our previous commentaries on related studies by the same research group. Such reasoning shifts the focus away from the strength of the arguments toward the identity and persistence of the critics, effectively muting legitimate scrutiny while allowing methodological flaws to recur unchallenged. Together, these two issues—the systematic neglect of medication effects and the suppression of critical debate—threaten not only scientific progress but also public trust in mental health research, particularly in the presence of undisclosed conflicts of interest. More broadly, this case highlights the risk that the pursuit of biological explanations, when not accompanied by transparency and methodological rigor, may reinforce a narrow form of reductionism that obscures the complex reality of mind–body relations and encourages the overuse of potentially harmful medications.
Ethical standards are central to psychologists’ activities and core to the profession’s codes of ethical conduct. Intrinsic to ethics is the assumption that people are endowed with basic human rights. However, the incorporation of human rights principles in the codes of professional psychological organizations is unclear. This study investigated the codes of ethics of seven professional psychological organizations for the implementation of human rights principles through a comparative concept analysis. Most codes demonstrated some level of adoption of human rights principles, yet with vague terminology and few references to human rights documents, conventions, and treaties. Significant improvements are needed so that psychological codes of ethics foster, promote, and protect the human rights of psychologists themselves, as well as the people they serve.
The selective serotonin reuptake inhibitors act on sensory receptors in the peripheral nervous system, offering a possible therapeutic principle for the treatment of anxiety, depression, and other nervous disorders. These actions on sensory receptors give rise to a set of immediate effects whose recognition and management have the potential to help optimize the benefits of treatment or minimize the harms. In addition to contributing to patient safety, recognizing the capacity of these medicines to act on sensory systems may support the development of interoceptive exposure therapy and facilitate the contributions it can make to our understanding of peripheral nervous systems and to a set of complex medicolegal issues that arise when these systems are disturbed.
The raw material of the disciplines of psychology and psychiatry is the insubstantial and unlocalized mind, yet Western science has no means of coming to terms with anything other than material entities. Indeed, within the scientific community, the concept of an immaterial yet causally effective mind is viewed with considerable distaste. Nonetheless, repeated attempts to build a formal theory of mind within the materialist framework have achieved little beyond polemics. Panpsychism is the doctrine that mentality is constituted by the additive effects of mental properties inherent in the fundamental particles of which all matter is composed. While this appears to resolve a few of the traditional questions of the insubstantial mind, it will be argued that the concept is unnecessary.
In this article, I will introduce various philosophical assumptions and positions we can take toward so-called mental disorder. Using recurring critiques put forth in research, though also by towering figures within the psychiatric establishment, I will argue that the main reason criticisms surrounding the ontological validity of mental disorder have never been resolved is because we are all trapped in a biomedical “fly-bottle,” a powerful idea coined by the philosopher Ludwig Wittgenstein to illustrate how conceptual presumptions can lead us to recurring dead ends. Advocating for a critical analytic philosophical method, I will argue that with the help of linguistic philosophical underlaboring , we can eventually be shown the way out of the biomedical fly-bottle.
This article explores the implications of misinterpreting understandable emotional responses to life events and circumstances as “mental illnesses.” Besides stigma, fear, and pessimism about recovery, this “medical model” also leads to the widespread use of medical solutions to nonmedical problems, which are generally ineffective and often damaging. The paper supports calls by the United Nations and World Health Organization for a paradigm shift toward more humane, effective, evidence-based theory and practice.
Building on biographic case studies presented earlier in this series, this article reviews laboratory and clinical research demonstrating that adverse environmental conditions produce behavioral, emotional, and social disturbances in animals and humans. Social isolation, confinement with reduced sensory stimulation, and limited behavioral options induce distress, fear, and stereotypic behavior while simultaneously eliminating exploratory behavior and the development of social competence. Painful stimulation disrupts ongoing productive behavior, as will neutral stimuli that signal the approach of these aversive stimuli. Under certain circumstances, pain and frustration will elicit aggressive behavior toward cage mates and inanimate objects. These aggressive responses can be replaced by another response that allows the subject to avoid or escape the aversive stimuli, can be suppressed by aversive consequences, or can be increased by positive consequences, showing how aggression is controlled by environmental contingencies. Although much of this research is decades old, these demonstrations remain credible due to independent replications, our extensive knowledge of the species’ normal behavior, and controlled experimental designs that repeatedly produced or reduced disturbances by manipulating environmental conditions. In addition to showing the importance of protecting animals and people from severe aversive stimulation and deprivation, these studies point toward preventive, supportive, and educative approaches for minimizing and ameliorating behavioral and mental disturbances.
Rhetoric has long played an important role in legitimizing the “Bible” of American psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM), particularly since its third edition. Critics have consistently alleged that the confident scientific rhetoric of DSM’s authors and advocates has often outpaced the science. In a welcome change of tone, the authors of the text’s fifth edition (DSM-5) provided a more honest and sober acknowledgment of the limitations of DSM in the document’s prefatory material. In the Introduction and Use of the Manual sections, the authors explicitly drew the reader’s attention to a host of conceptual and empirical challenges faced by the DSM classification system. Many of these statements have been removed from the DSM-5-Text Revision (2022) prefatory material. The most notable are the removal of explicit statements concerning validity (and its definition), the concerns about reification, problems with comorbidity, and conceptual and empirical issues with a categorical approach to psychiatric diagnosis. We argue these textual omissions serve the rhetorical function of implying that, in the years since DSM-5, the science has caught up to the system and validated the major DSM diagnoses. This is, unfortunately, not the case, and an increasing chorus of critics agree that the DSM system has a serious validity problem. While recognizing laudable changes, including the expanded coverage of sociocultural variables, systemic inequities, and gender diversity, we raise concerns about the rhetoric of the DSM-5-TR prefatory material. We contend that the textual changes may contribute to readers overestimating the empirical status of DSM disorders and underestimating the classification system’s many limitations. Future editions should restore and expand upon DSM-5’s more candid discussion of diagnostic limitations.
Psychologists routinely conduct psychological assessment in a wide range of contexts to inform various referral questions and decision-making processes. The results of psychological assessments can have meaningful real-world consequences on a person’s life, and psychologists therefore shoulder an important ethical responsibility to obtain informed consent (with few exceptions). Despite this, the existing professional guidelines established by governing bodies like the American Psychological Association for operationalizing and obtaining informed consent are opaque at best and at points inherently inconsistent. Given this, there is great potential for assessors to differ substantively in the depth, specificity, and quality of information that is provided to patients during this process, which raises important ethical questions. This article reviews the current heterogeneity (and inconsistencies) in informed consent standards and ethical dilemmas to consider when conducting psychological assessment. A review of concepts from the genomics literature that are relevant to these issues is also discussed as a means of informing current practices in psychological assessment contexts. The article concludes with a call for clearer guidance and specific standards for operationalizing informed consent processes within psychological assessment settings.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been a mainstay of diagnostic paradigms in psychiatry for decades. The manual has grown considerably through its evolving iterations, yet a comprehensive summary of this growth has been elusive. In its latest edition, the DSM, Fifth Edition, Text Revision (DSM-5-TR), it aspires to provide a nosology establishing clear and concise diagnoses. However, there are now more diagnostic choices than ever before, and when considering subtypes and specifiers, the number of potential diagnoses grows exponentially. A strategy was developed to tabulate the total number of diagnoses within the DSM-5-TR. This process included identifying each primary diagnosis, subtypes, and range of specifiers to determine how many diagnoses are not only within the DSM but also within each major diagnostic category. Through this analysis, there are shown to be over 37,000 potential diagnoses within the DSM-5-TR, across 21 major diagnostic categories. The vast majority of diagnoses were within the bipolar disorders, while most other categories represented less than 1% of the available diagnoses. Identifying an accurate diagnosis is essential for research and intervention protocols. The expansion of subtypes and specifiers may lead to increased specificity, but is not being sufficiently utilized in research and treatment guidelines. That is, the development of practice parameters often relies on a primary diagnosis rather than detailed intervention summaries based on subtypes and specifiers. It is argued here that increased diagnostic specificity has not effectively translated to improved treatment utilization and, thus, outcomes.
Patients and family members are rarely asked about memory deficits following electroconvulsive therapy (ECT). This article reports the responses to an online survey of 858 ECT recipients and 286 family and friends from 44 countries. Four measures produced high incidence rates of memory loss resulting from ECT: spontaneous reporting of memory loss (84.5%), the Comprehensive Psychopathological Rating Scale (60.8%), a question about anterograde amnesia (ability to retain new information; 70.3%), and a question about retrograde amnesia (loss of memory of life events; 80.4%). About half (55%) reported that ECT had made their retrograde memory “much worse,” with 42% reporting the same for anterograde memory. For 65% of those experiencing anterograde amnesia, and 81% of those with retrograde amnesia, the deficit lasted 3 years or more. Family and friends reported slightly lower, but still very high, incidence, severity, and duration of memory loss. All four measures of memory deficits were correlated with the number of ECTs received (a “dose effect”) and were worse with bilateral electrode placement compared with unilateral. Most survey respondents (78%) had received bilateral ECT. There was no evidence that memory loss had reduced in recent years, as often suggested. A convenience sample risked sample bias toward those with generally negative or positive attitudes toward ECT. Another limitation is that the findings were based on self-report. It is recommended that further research be conducted into ECT’s long-term effects on memory, that evidence-based information is guaranteed to patients and families, and that effective monitoring for adverse effects be conducted, as well as appropriate assessment and rehabilitation for the many patients who feel damaged by ECT.
This brief note presents steps toward the development of peaceful cooperation and coexistence in war-torn areas of the world. The proposed peace plan is based on a revised version of the American and Canadian psychological ethics codes as published in a book by Young in 2017. The five reworked ethical principles in the revised ethics code include the following: life preservation, caring (beneficence), relational integrity, respect for the dignity and rights of persons and peoples, and promoting and acting from justice in society. The five principles were used as guides in developing a peace plan based on psychological ethics. The proposed peace plan could work ethically and psychologically when it is properly incentivized, as with the political Abraham Accords. The latter has brought together adversaries in the Middle East into a cooperative political and economic framework. Community-to-community communication and collaboration need to be promoted to organize human contact and cooperation.
Voice-hearers use various explanatory models for their experiences, often differing from health care professionals’ views. This study explores the development of these models, focusing on shared sense-making and navigating multiple models. Ten self-identified voice-hearers in the United Kingdom, all Hearing Voices Group attendees, participated in semistructured interviews. Reflexive thematic analysis led to the construction of four themes: others’ role in sense-making, independent sense-making, model evaluation, and use of multiple models. Voice-hearers assemble models from multiple sources and evaluate models by assessing costs, benefits, and evidence, including voice qualities and content. This may lead to model shifts or using distinct models for different experiences. This complex process challenges the notion that rejecting an illness model necessarily indicates a “lack of insight.”
The term “neurodiversity” was originally coined by Judy Singer to describe people diagnosed with autism. It has since expanded to include other psychiatric diagnoses and learning difficulties. This article suggests that neurodiversity is a semantic sleight of hand offering no theory or model to account for the psychiatric diagnoses it considers under its purview. Rather, it attributes behavior and personality (whether viewed positively or negatively) to mythical origins. Neurodiversity, in all its linguistic forms, can lead to wayward scientific discourse that supports the idea that psychiatric diagnoses are to be considered as primarily neurological conditions. We conclude that it is detrimental to scientific discourse to assume terms, such as “neurodiversity,” have scientific legitimacy or any explanatory capacity.
The article offers an analysis of the most common ethical challenges experienced by psychologists working in wartime conditions. In addition to documenting these ethical concerns, the study highlights the results of data analysis about the experiences of Ukrainian psychologists before and after the start of a full-scale Russian invasion of Ukraine. Specifically, evidence presented in this contribution highlights the impact of war on ethical aspects of psychological care that are based on changes in psychologists’ intrapersonal resources, their capacity to carry out their work, their war-related volunteer contributions, their cognitive appraisals of war situations, their understanding of the limitations of professional competence, and other topics related to ethical concerns. The results of the study elucidate ethical dilemmas faced by psychologists practicing in war conditions, with specific focus on adaptations in practice by Ukrainian psychologists who continue to practice amid the war.
The National Institute of Mental Health (NIMH) has spent billions of dollars attempting to fulfill its mission of “transforming the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure.” In Fiscal Year 2012 and Fiscal Year 2020, the NIMH spent $1.1 billion and $1.6 billion, respectively. Over the past 15 years, the NIMH has spent increasing proportions of its research budget on studying the brain and genetics in search of mechanistic causes of mental illness and decreasing amounts on studying treatment. To estimate how much the NIMH is spending on studying methods of treatment, psychotherapy in particular, we reviewed the abstracts on the Project RePORTER database of a random sample of one-fifth of the 7,944 research studies funded by the NIMH in 2012 and 2020. In 2012 and 2020, the NIMH spent 20% and 14% of its budget, respectively, on treatment studies, including 7% and 4%, on psychotherapy. In contrast, the NIMH spent 71% of its money in 2012 and 74% in 2020 on studying the brain and genetics. Combining both years’ funding for psychotherapy, cognitive-behavioral therapy received the largest portion of money (44%), followed by behavioral therapy (18%), family therapy (11%), and solution-focused therapy (8%). In the Discussion section, we explain why the NIMH research priorities are not likely to enable it to fulfill its mission.
Ethical behavior should be evaluated on consistency and adequacy for obtaining the desired moral outcomes because the morality of a particular act is derived from general moral principles applicable to similar situations. Therefore, these ethical principles generally entail verbal–nonverbal and behavioral–behavioral consistency in all similar contexts. Morally inconsistent behavior can dilute the effects of morally consistent behaviors. Individuals act inconsistently because of self-deception, weak will, and social desirability, that is, appearing moral without the personal costs or benefits to others associated with actual moral behavior. This article specifically explores moral hypocrisy in acknowledgments and questionable research practices in psychological science.
In this article, I argue against the “scientification” and medicalization of psychology in its attempt to distinguish between defective and intact mental functioning, that is, the conventional idea of mental illness vs. mental health. My thesis is that psychology’s reliance on a medical science framework has taken it to the point of completely missing the original point. It has traded the soul, ourraison d'être, for the benefits of a medical science façade. This is particularly troublesome, as it could be argued that the soul is the most important product of human evolution, and no field of inquiry other than psychology addresses it from a critically reasoned and empirical perspective.
Project abstracts of about 20% of the National Institute of Mental Health (NIMH)-funded studies in 2012 and 2020 were analyzed to determine the proportion of funding directed toward brain, genetic, animal, human, and physiological studies. Physiological, brain, and genetic studies constituted almost three-quarters of funded studies. Funding for those increased between 2012 and 2020. Human studies were funded at a slightly higher rate than animal studies, a trend that increased in 2020. While neuroscience holds a promise for understanding the biological underpinnings of mental illness, there is a growing urgency to diversify research investments to studies that emphasize person-centered approaches, consider environmental factors and social determinants of health, and reap more immediate real-world benefits. Stakeholders should advocate for policies that mitigate those impacts and improve the likelihood of NIMH and other grantors funding clinical research.
Mental health professionals frequently face ethical dilemmas, and it is important that they become familiar with an appropriate ethical decision-making model before the need presents itself. Although there are models in use, most of them are not research-based. This article presents the author’s four-stage model developed over the last 20 years that has been implemented on ethics committees in mental health and in teaching courses on ethics. The model is innovative in that it adds two components whose content has been previously found in research to be significant in predicting clinicians’ ethical behavior, namely attitudes and morality. An illustrative example is presented.
