Readers may be aware that the title is from Shakespeare’s Hamlet and means, literally, to be blown up (hoisted) by one’s own bomb (petard), and thus indicates an ironic reversal or poetic justice.

I was recently reminded of this situation when I came across a curious YouTube video:

Bible of Psychiatry
At first, I honestly thought it was a spoof of the ‘bible’ of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), published by the American Psychiatric Association. The video is based on – not to say plagiarized from – the Bee Gees’ 1977 hit, Stayin’ Alive, and features Professor Stephen Stahl prancing around in a black wig. These are some of the lyrics:

Well you can tell by the way I use my book [DSM-5] I can diagnose without a look
OCD, not anxiety, not anymore, that’s for sure
It’s alright, it’s OK, bereavement is here to stay
You will need to understand autism is a spectrum man
When you have a patient with symptoms you’re assessin’, use the DSM-5, DSM-5
Diagnosis is changing, insurance might be payin’ in the DSM-5, DSM-5
Well you can tell by your patient’s history at age 12 ADHD, DMDD is what you’ll see in all the kids who have BP

Key: OCD = Obsessive Compulsive Disorder; ADHD = Attention Deficit Hyperactivity Disorder; DMDD = Disruptive Mood Dysregulation Disorder; BP = Bipolar Disorder

It was produced in 2014 by the Neuroscience Education Institute, of which Prof Stahl is Chairman, at the University of California San Diego. From their website we learn that he has ‘written over 400 articles and chapters and more than 1,200 scientific presentations and abstracts, and is an internationally recognized clinician, researcher, and teacher in psychiatry specializing in psychopharmacology.’ (This is the study of how drugs interact with specific target sites in the nervous system to induce changes in mood, thinking, or behaviour.)

With so many publications to his name he’s been a busy man. But in how many has he made a significant contribution?

Astounding collaborative effort
Looking through a list of articles in which he’s included as an author, some of them seem quite astounding collaborative efforts. One example, taken at random, is from 2022 and appears in Physical Review, the journal of the American Physical Society. The title is ‘First Measurement of the Z→μ+μ− Angular Coefficients in the Forward Region of pp Collisions at √s=13  TeV’, and if you, dear reader, haven’t the foggiest notion of what this means or its relevance to psychiatry, neither have I. The purported authors run to well over 1,000. (I am not making this up.)

It’s all hypothetical
Back to psychiatry, here’s a taste of Prof Stahl’s approach from another video, ‘Symptoms to Circuits in Mood Disorders’:

‘If patients have psychomotor fatigue [physical fatigue originating in the mind] for example, this points to something wrong with the circuit that impinges on the motor striatum. If they have problems with interest this might be the ventral striatum. If they can’t concentrate it’s the prefrontal cortex. On and on and on. [Yes, this is how he goes.] You can deconstruct the nine symptoms of depression into specific hypothesized screwed up brain circuits. And if you have an inefficient information processing in one part of the brain, you’re going to try to restore that to efficiency in order to remove symptoms.’ (My emphasis.)

In the video we can also see a slide on which is written: ‘Match each diagnostic symptom for a manic episode to hypothetically malfunctioning brain circuits.’ (My emphasis.)

This is where it all falls down. A symptom is a symptom; a diagnosis is a diagnosis. What is a ‘diagnostic symptom’? And in particular, note ‘hypothetically malfunctioning’. It’s all hypothetical.

I am indebted to Dr Peter Gøtzsche for the following information:

‘Sixty-two psychiatrists received $1 million or more from 2014 through 2020. The top earner was Stephen Stahl. He earned $8.6 million, with $6.6 million coming from Pharmaceuticals that sells vortioxetine (a so-called antidepressant)…In 1991 the Office of Scientific Integrity at the US Department of Health and Human Services determined that Stahl had been the lead author on two papers that were ‘seriously misleading’ and that he was guilty of plagiarism in a book chapter. Stahl, then a professor of psychiatry at Stanford University, moved to a position at the University of San Diego, and the scandal was quickly forgotten. For the past 25 years, Stahl has been one of the most influential psychiatrists in the world regarding the use of psychotropic medications. His textbook, Stahl’s Essential Psychopharmacology, and his clinical manual, Essential Psychopharmacology Prescriber’s Guide, can be found on the bookshelves of many of those who prescribe psychiatric drugs. In 2000, he founded the Neuroscience Education Institute, a medical education company that produces webinars and courses on psychopharmacology. It openly promises pharmaceutical companies that it can help them sell their drugs. It also publishes CNS Spectrums, a peer-reviewed journal with Stahl as Editor-in-Chief. As new drugs are tested and earn FDA approval, he frequently writes articles about them, often in his own journal. Stahl’s lectures and scientific presentations have been distributed as more than a million CD-ROMs, internet educational programs, videotapes, audiotapes, and programmed home study texts…to hundreds of thousands of professionals in many different languages.’

Documentation of the above claims can be found here.

Orthodox psychiatry is a house of cards and Prof Stahl admits as much in his self parody.

Text © Gabriel Symonds

First published 29 May 2023