The Dark History and Modern Roots of Divination in Mental Health
Throughout psychiatry’s relatively brief modern history, the concept of individual degenerationism has been a central, though often implicit, doctrine. This idea holds that mental suffering is primarily rooted in some kind of individual failing- whether biological, psychological, or moral. Psychiatric theory and abnormal psychology, in both historical and contemporary contexts have tended to frame psychological distress as a deviation from a presumed norm of healthy, rational functioning.
This doctrine has taken on different forms across different schools of thought. Biological psychiatry, for example, argues that mental disorders result from neurological dysfunctions, chemical imbalances, or genetic anomalies; in other words, a failure of the body’s biological systems (nature). This model stems from pharmaceutical interventions and has underpinned the rapid expansion of psychopharmacology since the mid-20th century.
The other approach, romantic psychiatry, humanistic psychology, and some strands of psychodynamic and trauma-informed therapy argue toward a nurture based understanding. They attribute mental distress to adverse environments, developmental trauma, attachment disruptions, and existential crises. These approaches emphasise subjective meaning, lived experience, and the formative influence of relationships and culture.
Despite their differences, both camps, along with integrative or biopsychosocial models- often share an underlying premise: that persistent emotional, cognitive, or behavioural struggles are abnormal, requiring correction, treatment, or containment. The very concept of mental disorder tends to pathologise natural responses to overwhelming or chronic adversity, turning what might be better understood as a struggle for meaning or adaptation into a disease.
As historian Andrew Scull notes:
“The diagnosis of insanity, from its very inception, involved assumptions about what counts as ‘normal’ behaviour in a given society. And these assumptions are never neutral.” (Scull, 2015)
This framing subtly reinforces a narrative of fragility and deficiency, where human beings are seen as prone to breakdown under internal or external pressures- requiring expert intervention. The result is often a system where individual suffering is decontextualised and medicalised, while the social, economic, and political roots of distress are marginalised or ignored.
This degenerationist view has deep roots in psychiatry's darker chapters as well. In the 19th and early 20th centuries, theories of biological degeneracy were used to justify eugenics, institutionalisation, and forced sterilisations- based on the belief that mental illness reflected hereditary inferiority. While modern psychiatry has largely disavowed these practices, the structural logic of identifying and correcting "abnormal" individuals persists, albeit in more clinical and less overtly coercive forms.
As philosopher Michel Foucault warned:
“The birth of the asylum was also the birth of the medical gaze, which transformed the mad into objects of knowledge and control, rather than subjects of experience.” (Foucault, Madness and Civilization, 1961)
In other words, individual degenerationism serves as the underlying foundation- however thin and fragile- on which the edifice of modern psychiatric disorders is constructed, including diagnoses like depression, anxiety disorders, ADHD, and schizophrenia.
The distinction between ‘normal’ and ‘abnormal’ is not based on objective biomarkers-as it is in most branches of medicine- but on subjective judgments about behaviour, mood, and functioning, filtered through cultural norms and professional authority. For psychiatry to maintain its standing as a medical specialty, it must preserve the appearance of treating discrete, identifiable "illnesses," rather than socially or morally constructed variations of human experience.
Psychologist Philip Hickey insightfully observes:
“If psychiatry were to acknowledge that depression is not an illness, but rather a complex interaction between the individual and his environment, then the whole structure collapses. There would be no need for psychiatric diagnoses, no need for psychiatric drugs, and no need for psychiatrists. The vast power and influence that psychiatry has acquired over the past fifty years would vanish like the morning mist.”
Philip Hickey, PhD, Behaviourism and Mental Health blog
He further writes:
“Physicians are trained in the medical disease-centered model. This approach, which is extraordinarily effective in the treatment of real illness, is proportionately harmful when applied to problems of thinking, feeling, and behaving. The critical difference here is that real illnesses have a very large degree of homogeneity with regards to their origins, etiology, course, outcome, and appropriate treatment. By contrast, the kinds of life problems that psychiatry purports to address do not have this homogeneous core. Pneumonia is caused by germs in the lungs and the treatment consists essentially of eliminating those germs. The causes of depression and other forms of “psychiatric” distress, however, are as varied as the individuals who experience them. The notion that one can develop guidelines for the “treatment” of human distress analogous to those for real illnesses is a fundamental error. Shoe-horning the vast complexity of human problems into psychiatry’s invalid and unreliable “diagnoses,” and using these labels to justify widespread drugging and electric shocks, is arguably the most destructive hoax in human history. And as long as the illness thesis is retained, there is no possibility of reform. But if the central thesis is abandoned, then psychiatry loses the reason for its existence, and psychiatrists will have to find honest work. And that is the critical issue: for psychiatry this a death-struggle.”
https://www.madinamerica.com/2017/06/robert-whitaker-refutes-jeffrey-lieberman-but-is-psychiatry-reformable/
Psychiatric authority depends on the maintenance of categories that often lack empirical grounding. Critics like Hickey, Moncrieff, and Whitaker argue that many of these categories- especially depression- are labels for distress, not explanations of it. They describe the current system as one that treats the label as the cause, rather than a description of the person’s lived reality.
This circular logic "You are depressed because you have depression" is both tautological and misleading. It reduces complex psychosocial, existential, and relational experiences to biological dysfunctions, which conveniently align with pharmaceutical solutions.
This framework also obscures the sociopolitical and economic structures that often give rise to suffering. Poverty, inequality, discrimination, social isolation, trauma, and a lack of meaning are not biochemical imbalances; they are systemic conditions that demand systemic responses.
The “medical disease-centered model”- also known as the “illness thesis” of the soul- is fundamentally built upon the philosophy of individual degenerationism. This framework is not merely a scientific claim but a metaphysical assumption: that deviations in thought, emotion, or behaviour are rooted in internal defects, dysfunctions, or deficiencies within the individual. Without this belief, psychiatry- as it currently functions- would struggle to justify its authority, methods, and medicalised treatments.
This ideology is not isolated; it is interwoven with broader cultural and philosophical systems that uphold and reinforce it. Several dominant worldviews serve as the bedrock for the current psychiatric paradigm, and they all, in various ways, rest on the notion that the individual is the primary site of disorder and correction. Among these are:
Humanism, particularly in its secular, Enlightenment form, which centers the autonomous individual as the unit of reason and morality. When suffering arises, it is interpreted as a failure of self regulation, resilience, or personal growth.
Individualism, which places personal responsibility above collective or systemic understanding, often casting distress as a failure to adapt, rather than a response to untenable conditions.
Capitalism, which commodifies both wellness and illness. It reinforces productivity, efficiency, and performance as ideals, rendering any deviation from these standards as pathology. Mental health becomes a matter of keeping individuals functional within the system.
Neoliberalism, a political and economic philosophy that extends market logic into every domain of life- including healthcare and identity. Under this regime, emotions and mental states are privatised, medicalised, and monetised.
Shamanic or spiritualised ‘medical’ traditions, both ancient and modern, can also subtly perpetuate degenerationist views. While often framed more holistically, they sometimes attribute suffering to impurities, spiritual failures, or inherited curses- still locating the source of dysfunction within the individual rather than the social matrix.
In all of these systems, the individual becomes the container of the problem- whether as a malfunctioning machine (in biomedicine), a failed subject (in liberal ideology), or a spiritually impure vessel (in mystic or moral frameworks). Psychiatry, as the institutional gatekeeper of mental health, draws selectively from these traditions to uphold its medical legitimacy, while masking the deeper philosophical and political assumptions at its core.
Shamanism: The Spiritual Roots of Psychiatry and the Legacy of Degenerationism.
This short piece cannot adequately address all the philosophical and cultural worldviews that undergird modern psychiatry. For now, let us turn our attention to one particularly revealing and often overlooked origin: shamanism.
Though many today regard psychiatry as a modern, scientific discipline, its earliest precursors were spiritual and ritualistic healers-figures we now call shamans, witchdoctors, or medicine men. It may come as a shock and surprise to some, these early practitioners also operated under the assumption that mental and emotional suffering stemmed from internal flaws, whether spiritual, moral, or energetic. This, too, reflects the core of individual degenerationism0 the idea that dysfunction lies within the person and must be treated in the person.
According to Merriam-Webster’s Dictionary, shamanism is:
"A religion practiced by indigenous peoples of far northern Europe and Siberia that is characterized by belief in an unseen world of gods, demons, and ancestral spirits responsive only to the shamans."
While shamanism was embedded in cosmologies vastly different from modern biomedical psychiatry, the shaman, like the psychiatrist, served as the mediator between visible suffering and invisible causes. Shamans diagnosed afflictions not by identifying pathogens or neurotransmitters, but by discerning spiritual disharmony, ancestral curses, or demonic possession. Yet despite the metaphysical framing, the source of the problem was nearly always located in the individual- the body or soul of the afflicted person. This mirrors the psychiatric emphasis today on locating disorders within the individual’s brain, biology, or psyche.
Psychiatrist Allen Frances, former chair of the DSM 4 Task Force, highlights this continuity in an often-overlooked observation:
“Psychiatry seems like a young profession, barely two hundred years old—but you could fairly say it is the oldest. Diagnosing and ministering to the mentally ill was part of the job description of the shaman, or medicine man... The shaman got to stay home doing sick calls, using his magic to assess the causes and apply the cures for mental and physical symptoms. Doing psychiatry was always a big part of a shaman’s practice.”
Allen Frances, Saving Normal (2013)
Frances’s reflection is striking- not because it equates psychiatry with superstition, but because it shows that psychiatry, like shamanism, relies on socially sanctioned interpretations of invisible causes. In both cases, the healer assumes authority over meaning: defining what is wrong, who is ill, and what must be done to restore order.
Modern psychiatry may have replaced spirits with serotonin, and curses with chemical imbalances- but the epistemological structure remains similar: the problem is defined within the individual, the expert interprets it, and the remedy is administered from a place of hierarchical authority.
Allen Frances further emphasises the shaman’s foundational role as psychiatry’s ancestor- not just in function, but in epistemological structure and social authority. He explicitly connects the shaman’s role to the concept of individual degenerationism:
“Abnormal behavior constitutes a threat not only to the individual; it is also a clear and present danger to the future of the tribe. Psychiatric emergencies must be quickly labelled, understood, treated, and cured. The shaman had all the tools to define and deal with abnormality. He could diagnose mental disorder, explain its origin, and make it better... The shaman had great authority and healing power. Magical belief and suggestion can go a long way. But beyond the hocus-pocus, he had practical common sense, wisdom about human nature, and medicinal plants. Cures were expensive, and the shaman was the richest person in the tribe.”
Allen Frances, Saving Normal (2013)
This reflection reveals several critical continuities between the ancient shaman and the modern psychiatrist. Both assume a special insight- whether spiritual or scientific- into what constitutes normal or abnormal states of being. Both operate within a framework that interprets suffering and nonconformity as individual pathology, needing expert intervention. And both hold institutionalised power over the definition, diagnosis, and treatment of mental and spiritual distress.
What Frances describes is essentially a proto-psychiatric model grounded in individual degenerationism. The deviant individual is a threat to the social order- whether that order is tribal, religious, or capitalist. The response must be swift and authoritative. The healer- whether armed with rituals or prescriptions- steps in to restore ‘balance.’ The stakes are not only personal but collective; hence, the urgency to classify and treat.
This historical continuity was openly acknowledged in a 2018 article published by the Group for the Advancement of Psychiatry in Psychiatric Times, which asked:
“When did psychiatry begin? Was it with the discovery of the unconscious? Or was it the discovery of neurotransmitters? As it turns out, healers have been treating mental disorders for thousands of years. Modern psychiatry reflects some, but not all, the values and concepts held by early civilizations. Early civilizations relied on shamans, sorcerers, magicians, mystics, priests, and other approved healers to treat illnesses. Using rituals, incantations, and offerings, sickness could be prevented or healed.... Shamans entered into trances or altered states of consciousness, enabling their souls to journey into spirit worlds, sometimes into the underworld. During the journey, shamans connected to souls of the dead and to living souls that had strayed or been stolen. Interacting with demons and lost souls without losing their own souls, they brought about cures. The shaman acted as both priest and healer.”
Kenneth J. Weiss on behalf of the Group for the Advancement of Psychiatry, "Psychiatry's Ancient Origins," Psychiatric Times Online 35, no. 11 (November 29, 2018): http:// www.psychiatrictimes.com/cultural-psychiatry/ psychiatrys-ancient-origins?rememberme=1&elq_mid= 4523&elq_cid=893295.
The ‘religion of psychiatry’ operates on the same metaphysical structure as shamanism. It redefines and reinterprets the human condition through the lens of pathology, deviance, and cure, built upon the foundational assumption of internal defect- a legacy of individual degenerationism that persists even beneath layers of scientific language and clinical protocol.
The striking parallels between the societal healers of old- shamans- and the psychiatrists of today are not accidental. As several leading figures in psychiatry have openly acknowledged, modern psychiatry retains many of the ritualistic, metaphysical, and hierarchical functions of its shamanic predecessors, albeit under the cloak of scientific language and clinical authority. In this sense, psychiatry can be described not just as medicine but as neo-shamanism- a spiritualised system of soul care dressed in the garments of biomedicine and psychology.
Just like the ancient shaman, the modern psychiatrist constructs a diagnostic system of alleged abnormalities. These are not discovered through objective medical tests but defined through subjective criteria, based on their institutionalised 'wisdom about human nature.' Behaviours or emotions that are painful, disruptive, or nonconforming are reinterpreted as signs of underlying pathology- not unlike how shamans interpreted spiritual torment or curses.
Both systems have long relied on psychoactive substances as a means of achieving transcendence, healing, and insight. As one comparative study notes:
“Western psychotherapy and indigenous shamanic healing systems have both used psychoactive drugs or plants for healing and obtaining knowledge (called ‘diagnosis’ or ‘divination,’ respectively).”
Daniel Pinchbeck, Breaking Open the Head (2002)
Today’s psychiatric drugs- SSRIs, antipsychotics, stimulants, mood stabilisers- serve not only to suppress or manage symptoms but often to reconfigure identity, perception, and personality, not unlike how entheogen were once used to induce altered states or spiritual revelations. This similarity is more than historical curiosity- it raises serious questions about the metaphysical assumptions embedded in psychiatry.
If normal human experiences- grief, despair, fear, moral struggle, spiritual emptiness- can be reframed as medical “abnormalities”, especially as biological defects, then the entire framework of sorcery can be legitimised as medicine.
The neo-shamanic psychiatric model, the outward symbols have changed, but the underlying function remains. There are, of course, notable differences in form:
The metaphysical soul or psyche has been redefined in biological terms. What was once attributed to spiritual imbalance or moral impurity is now framed as chemical imbalance or neural dysfunction. The soul has been translated into the synapse.
The ‘magic potions’ of the shaman have been replaced by pharmaceuticals. These modern elixirs are manufactured not in sacred ritual, but in corporate laboratories, designed and marketed by profit-driven pharmaceutical conglomerates.
Claims of supernatural authority have given way to claims of scientific objectivity. The modern psychiatrist does not speak of ancestral spirits or stolen souls but invokes the language of receptors, brain scans, and ‘evidence based medicine’. Yet, as before, only the initiated expert is considered qualified to define, diagnose, and direct the cure.
The role of the healer has been professionalised, standardised, and institutionally empowered. The psychiatrist, much like the shaman of old, determines who belongs inside or outside the bounds of normalcy- now supported by licensing boards, diagnostic manuals, and legal authority.
Though psychiatry claims to be free of metaphysics, there remains a spiritual undercurrent, often obscured by clinical terminology. The idea that psychiatry has abandoned the realm of supernatural knowledge is, in many cases, a convenient illusion. In truth much of modern psychiatry continues to flirt with altered states and otherworldly insight- albeit under the banner of scientific exploration.
Let’s take a look at the revealing admission by Dr. Jeffrey Lieberman, former president of the American Psychiatric Association (APA) and chair of psychiatry at Columbia University. In his book Shrinks: The Untold Story of Psychiatry, Lieberman recounts his own experimentation with psychedelics, particularly LSD, and how these experiences shaped his views of psychiatry’s role:
“Along with many other psychiatrists from my generation- like Bob Spitzer- many of whom also experimented with psychedelic drugs- I became receptive to the unexpected new role of psychiatrists as psychopharmacologists, as empathic prescribers of medicine.”
Jeffrey Lieberman, Shrinks: The Untold Story of Psychiatry (2015)
Lieberman’s reflection is not incidental; it highlights the profound irony at the heart of much of modern psychiatry: while it disavows supernaturalism, it continues to seek altered states of consciousness as sources of knowledge, insight, and healing- just as the shaman did. The divinatory impulse remains, only now it is mediated by MDs, white coats, and peer-reviewed journals.
What has truly changed is not the function of the psychiatric system but its rhetoric. Instead of invoking gods or demons, psychiatrists now invoke dopamine and serotonin. Yet both are unseen forces, detectable only through their effects, interpreted only by an elite priesthood of healers.
Dr. Jeffrey Lieberman has long been one of the most powerful and outspoken advocates of the biomedical model of mental illness. As a former president of the American Psychiatric Association (APA), chair of psychiatry at Columbia University, and one of the lead figures behind the publication of the DSM-5, Lieberman holds tremendous influence in shaping how society defines and treats human suffering. He has vigorously defended psychopharmacology as a scientifically grounded and ethical form of treatment for mental disorders. However, the personal foundation for his views reveals something far less clinical- and far more mystical.
In his revealing memoir, Shrinks: The Untold Story of Psychiatry, Lieberman describes his personal experience using LSD. Far from being a neutral experiment, his account reads like a spiritual initiation- a modern-day shamanic vision quest. He writes:
“Until then, the effects of the LSD had been mostly perceptual. Now a new experience emerged that was far more intense and mind-bending — in fact, I often recall this portion of my trip when I work with psychotic patients. As I gazed upon the religious accouterments of the church, I was filled with an overwhelming spiritual awareness, as if God was communicating His secret and divine meaning to me. A cascade of insights tumbled through my consciousness, seeming to touch my soul and thrilling me with their profundity. And then in the midst of this revelatory reverie, a disembodied voice whispered, "and no one will ever know," which seemed to signify to me that this was where the real truths lie, in these secret interstices of consciousness which most human beings never accessed — or if they did, they were unable to retain these precious encounters in their memory ... We later realized that our individual experiences [on LSD] were entirely separate and often absurdly different. As my mind soared through metaphysical realms of empyrean [heavenly] knowledge, [my girlfriend) spent most of her trip reflecting on her relationship with her father.”
Jeffrey Lieberman, Shrinks: The Untold Story of Psychiatry
This is not the language of a scientist carefully observing neurochemical reactions- it is the language of divination, of ‘spiritual’ revelation acquired through chemical induction. Lieberman openly acknowledges the spiritual and metaphysical dimensions of his experience, interpreting them not as hallucinations, but as truth-bearing encounters. He continues:
“My trip did produce one lasting insight, though - one that I remain grateful for to this day. Though my LSD-fueled reverie dissipated with the light of the morning, I marveled at the fact that such an incredibly minute amount of a chemical - 50 to 100 micrograms, a fraction of a grain of salt - could so profoundly affect my perceptions and emotions. It struck me that if LSD could so dramatically alter my cognition, the chemistry of the brain must be susceptible to pharmacologic manipulation in other ways, including ways that could be therapeutic.... My psychedelic experiment opened me up to an alternative way of thinking about mental pathologies beyond psychodynamics - as something concrete and biochemical in the cellular coils of the brain.... The psychopharmacologists didn't just voice a new and radical philosophy about mental illness; they behaved in forbidden ways.”
The ‘lasting insight’ Lieberman received from his LSD experience became a guiding epistemological pillar of modern psychiatry: that the mind (or soul) could be manipulated and healed through chemical substances. This core idea- that chemical agents can bring spiritual or psychological healing- echoes the ancient practices of shamans and sorcerers, who also used mind-altering drugs to contact the spirit world and gain knowledge or perform cures.
Lieberman’s psychedelic revelation was not merely a personal epiphany- it was formative for an entire professional ideology. It helped birth and solidify what he himself calls a ‘new and radical philosophy about mental illness’: a vision of the soul, not as morally responsible or spiritually accountable, but as biochemically defective and pharmaceutically repairable.
This continuity undermines the secular pretense that psychiatry is a purely scientific or empirical discipline. The ‘new and radical philosophy’ Lieberman champions was conceived not in the lab, but in the mystical haze of a drug induced encounter with what he describes as ‘God’s secret meaning.’ That such an experience serves as a foundational moment in the development of psychiatry should deeply concern anyone who asserts scientific truth. This is the religion of scientism!
I understand that what has been shared above may raise many eyebrows. Some readers might say, ‘We already knew this,’ and then proceed to offer their own rationalisations. Others may respond defensively, perhaps even using labels or prejudicial terms to discredit the concerns raised. I recall once quoting leading figures like Dr. Allen Frances-verbatim- and the reaction among some professionals was one of shock and even disdain. Ironically, it seemed they didn’t know who these influential experts were, nor the weight of their critique of the very system they themselves defend.
I rarely offer my personal views on such topics, knowing how sensitive and emotionally charged discussions around mental health and psychiatry can be. That is why I try to let the record speak for itself- from the horse’s mouth, as the saying goes. If some of these reflections provoke discomfort or resistance, it is not out of arrogance or hostility, but out of a desire to encourage honest and informed dialogue. If anything, such strong reactions often reveal just how deeply hidden or unexplored these issues remain for many, including those within the mental health profession itself.
This is why these topics matter: because they shape ideologies, worldviews, and beliefs about what it means to suffer, to struggle, and to be human. They inform how we respond to those in pain- whether with compassion and humility, or with categorisation and control.
Understanding the roots and assumptions of modern psychiatry is not about discrediting all professionals, but about contextualising the system we have inherited.
Ultimately, I hope this piece is read not with defensiveness, but with a discerning and open mind-a mind awake to history, philosophy, and the real-world consequences of the paradigms we adopt. Only then can we engage in meaningful reform, and offer truly humane, wise, and respectful care for those who suffer.
A. Hasan
This doctrine has taken on different forms across different schools of thought. Biological psychiatry, for example, argues that mental disorders result from neurological dysfunctions, chemical imbalances, or genetic anomalies; in other words, a failure of the body’s biological systems (nature). This model stems from pharmaceutical interventions and has underpinned the rapid expansion of psychopharmacology since the mid-20th century.
The other approach, romantic psychiatry, humanistic psychology, and some strands of psychodynamic and trauma-informed therapy argue toward a nurture based understanding. They attribute mental distress to adverse environments, developmental trauma, attachment disruptions, and existential crises. These approaches emphasise subjective meaning, lived experience, and the formative influence of relationships and culture.
Despite their differences, both camps, along with integrative or biopsychosocial models- often share an underlying premise: that persistent emotional, cognitive, or behavioural struggles are abnormal, requiring correction, treatment, or containment. The very concept of mental disorder tends to pathologise natural responses to overwhelming or chronic adversity, turning what might be better understood as a struggle for meaning or adaptation into a disease.
As historian Andrew Scull notes:
“The diagnosis of insanity, from its very inception, involved assumptions about what counts as ‘normal’ behaviour in a given society. And these assumptions are never neutral.” (Scull, 2015)
This framing subtly reinforces a narrative of fragility and deficiency, where human beings are seen as prone to breakdown under internal or external pressures- requiring expert intervention. The result is often a system where individual suffering is decontextualised and medicalised, while the social, economic, and political roots of distress are marginalised or ignored.
This degenerationist view has deep roots in psychiatry's darker chapters as well. In the 19th and early 20th centuries, theories of biological degeneracy were used to justify eugenics, institutionalisation, and forced sterilisations- based on the belief that mental illness reflected hereditary inferiority. While modern psychiatry has largely disavowed these practices, the structural logic of identifying and correcting "abnormal" individuals persists, albeit in more clinical and less overtly coercive forms.
As philosopher Michel Foucault warned:
“The birth of the asylum was also the birth of the medical gaze, which transformed the mad into objects of knowledge and control, rather than subjects of experience.” (Foucault, Madness and Civilization, 1961)
In other words, individual degenerationism serves as the underlying foundation- however thin and fragile- on which the edifice of modern psychiatric disorders is constructed, including diagnoses like depression, anxiety disorders, ADHD, and schizophrenia.
The distinction between ‘normal’ and ‘abnormal’ is not based on objective biomarkers-as it is in most branches of medicine- but on subjective judgments about behaviour, mood, and functioning, filtered through cultural norms and professional authority. For psychiatry to maintain its standing as a medical specialty, it must preserve the appearance of treating discrete, identifiable "illnesses," rather than socially or morally constructed variations of human experience.
Psychologist Philip Hickey insightfully observes:
“If psychiatry were to acknowledge that depression is not an illness, but rather a complex interaction between the individual and his environment, then the whole structure collapses. There would be no need for psychiatric diagnoses, no need for psychiatric drugs, and no need for psychiatrists. The vast power and influence that psychiatry has acquired over the past fifty years would vanish like the morning mist.”
Philip Hickey, PhD, Behaviourism and Mental Health blog
He further writes:
“Physicians are trained in the medical disease-centered model. This approach, which is extraordinarily effective in the treatment of real illness, is proportionately harmful when applied to problems of thinking, feeling, and behaving. The critical difference here is that real illnesses have a very large degree of homogeneity with regards to their origins, etiology, course, outcome, and appropriate treatment. By contrast, the kinds of life problems that psychiatry purports to address do not have this homogeneous core. Pneumonia is caused by germs in the lungs and the treatment consists essentially of eliminating those germs. The causes of depression and other forms of “psychiatric” distress, however, are as varied as the individuals who experience them. The notion that one can develop guidelines for the “treatment” of human distress analogous to those for real illnesses is a fundamental error. Shoe-horning the vast complexity of human problems into psychiatry’s invalid and unreliable “diagnoses,” and using these labels to justify widespread drugging and electric shocks, is arguably the most destructive hoax in human history. And as long as the illness thesis is retained, there is no possibility of reform. But if the central thesis is abandoned, then psychiatry loses the reason for its existence, and psychiatrists will have to find honest work. And that is the critical issue: for psychiatry this a death-struggle.”
https://www.madinamerica.com/2017/06/robert-whitaker-refutes-jeffrey-lieberman-but-is-psychiatry-reformable/
Psychiatric authority depends on the maintenance of categories that often lack empirical grounding. Critics like Hickey, Moncrieff, and Whitaker argue that many of these categories- especially depression- are labels for distress, not explanations of it. They describe the current system as one that treats the label as the cause, rather than a description of the person’s lived reality.
This circular logic "You are depressed because you have depression" is both tautological and misleading. It reduces complex psychosocial, existential, and relational experiences to biological dysfunctions, which conveniently align with pharmaceutical solutions.
This framework also obscures the sociopolitical and economic structures that often give rise to suffering. Poverty, inequality, discrimination, social isolation, trauma, and a lack of meaning are not biochemical imbalances; they are systemic conditions that demand systemic responses.
The “medical disease-centered model”- also known as the “illness thesis” of the soul- is fundamentally built upon the philosophy of individual degenerationism. This framework is not merely a scientific claim but a metaphysical assumption: that deviations in thought, emotion, or behaviour are rooted in internal defects, dysfunctions, or deficiencies within the individual. Without this belief, psychiatry- as it currently functions- would struggle to justify its authority, methods, and medicalised treatments.
This ideology is not isolated; it is interwoven with broader cultural and philosophical systems that uphold and reinforce it. Several dominant worldviews serve as the bedrock for the current psychiatric paradigm, and they all, in various ways, rest on the notion that the individual is the primary site of disorder and correction. Among these are:
Humanism, particularly in its secular, Enlightenment form, which centers the autonomous individual as the unit of reason and morality. When suffering arises, it is interpreted as a failure of self regulation, resilience, or personal growth.
Individualism, which places personal responsibility above collective or systemic understanding, often casting distress as a failure to adapt, rather than a response to untenable conditions.
Capitalism, which commodifies both wellness and illness. It reinforces productivity, efficiency, and performance as ideals, rendering any deviation from these standards as pathology. Mental health becomes a matter of keeping individuals functional within the system.
Neoliberalism, a political and economic philosophy that extends market logic into every domain of life- including healthcare and identity. Under this regime, emotions and mental states are privatised, medicalised, and monetised.
Shamanic or spiritualised ‘medical’ traditions, both ancient and modern, can also subtly perpetuate degenerationist views. While often framed more holistically, they sometimes attribute suffering to impurities, spiritual failures, or inherited curses- still locating the source of dysfunction within the individual rather than the social matrix.
In all of these systems, the individual becomes the container of the problem- whether as a malfunctioning machine (in biomedicine), a failed subject (in liberal ideology), or a spiritually impure vessel (in mystic or moral frameworks). Psychiatry, as the institutional gatekeeper of mental health, draws selectively from these traditions to uphold its medical legitimacy, while masking the deeper philosophical and political assumptions at its core.
Shamanism: The Spiritual Roots of Psychiatry and the Legacy of Degenerationism.
This short piece cannot adequately address all the philosophical and cultural worldviews that undergird modern psychiatry. For now, let us turn our attention to one particularly revealing and often overlooked origin: shamanism.
Though many today regard psychiatry as a modern, scientific discipline, its earliest precursors were spiritual and ritualistic healers-figures we now call shamans, witchdoctors, or medicine men. It may come as a shock and surprise to some, these early practitioners also operated under the assumption that mental and emotional suffering stemmed from internal flaws, whether spiritual, moral, or energetic. This, too, reflects the core of individual degenerationism0 the idea that dysfunction lies within the person and must be treated in the person.
According to Merriam-Webster’s Dictionary, shamanism is:
"A religion practiced by indigenous peoples of far northern Europe and Siberia that is characterized by belief in an unseen world of gods, demons, and ancestral spirits responsive only to the shamans."
While shamanism was embedded in cosmologies vastly different from modern biomedical psychiatry, the shaman, like the psychiatrist, served as the mediator between visible suffering and invisible causes. Shamans diagnosed afflictions not by identifying pathogens or neurotransmitters, but by discerning spiritual disharmony, ancestral curses, or demonic possession. Yet despite the metaphysical framing, the source of the problem was nearly always located in the individual- the body or soul of the afflicted person. This mirrors the psychiatric emphasis today on locating disorders within the individual’s brain, biology, or psyche.
Psychiatrist Allen Frances, former chair of the DSM 4 Task Force, highlights this continuity in an often-overlooked observation:
“Psychiatry seems like a young profession, barely two hundred years old—but you could fairly say it is the oldest. Diagnosing and ministering to the mentally ill was part of the job description of the shaman, or medicine man... The shaman got to stay home doing sick calls, using his magic to assess the causes and apply the cures for mental and physical symptoms. Doing psychiatry was always a big part of a shaman’s practice.”
Allen Frances, Saving Normal (2013)
Frances’s reflection is striking- not because it equates psychiatry with superstition, but because it shows that psychiatry, like shamanism, relies on socially sanctioned interpretations of invisible causes. In both cases, the healer assumes authority over meaning: defining what is wrong, who is ill, and what must be done to restore order.
Modern psychiatry may have replaced spirits with serotonin, and curses with chemical imbalances- but the epistemological structure remains similar: the problem is defined within the individual, the expert interprets it, and the remedy is administered from a place of hierarchical authority.
Allen Frances further emphasises the shaman’s foundational role as psychiatry’s ancestor- not just in function, but in epistemological structure and social authority. He explicitly connects the shaman’s role to the concept of individual degenerationism:
“Abnormal behavior constitutes a threat not only to the individual; it is also a clear and present danger to the future of the tribe. Psychiatric emergencies must be quickly labelled, understood, treated, and cured. The shaman had all the tools to define and deal with abnormality. He could diagnose mental disorder, explain its origin, and make it better... The shaman had great authority and healing power. Magical belief and suggestion can go a long way. But beyond the hocus-pocus, he had practical common sense, wisdom about human nature, and medicinal plants. Cures were expensive, and the shaman was the richest person in the tribe.”
Allen Frances, Saving Normal (2013)
This reflection reveals several critical continuities between the ancient shaman and the modern psychiatrist. Both assume a special insight- whether spiritual or scientific- into what constitutes normal or abnormal states of being. Both operate within a framework that interprets suffering and nonconformity as individual pathology, needing expert intervention. And both hold institutionalised power over the definition, diagnosis, and treatment of mental and spiritual distress.
What Frances describes is essentially a proto-psychiatric model grounded in individual degenerationism. The deviant individual is a threat to the social order- whether that order is tribal, religious, or capitalist. The response must be swift and authoritative. The healer- whether armed with rituals or prescriptions- steps in to restore ‘balance.’ The stakes are not only personal but collective; hence, the urgency to classify and treat.
This historical continuity was openly acknowledged in a 2018 article published by the Group for the Advancement of Psychiatry in Psychiatric Times, which asked:
“When did psychiatry begin? Was it with the discovery of the unconscious? Or was it the discovery of neurotransmitters? As it turns out, healers have been treating mental disorders for thousands of years. Modern psychiatry reflects some, but not all, the values and concepts held by early civilizations. Early civilizations relied on shamans, sorcerers, magicians, mystics, priests, and other approved healers to treat illnesses. Using rituals, incantations, and offerings, sickness could be prevented or healed.... Shamans entered into trances or altered states of consciousness, enabling their souls to journey into spirit worlds, sometimes into the underworld. During the journey, shamans connected to souls of the dead and to living souls that had strayed or been stolen. Interacting with demons and lost souls without losing their own souls, they brought about cures. The shaman acted as both priest and healer.”
Kenneth J. Weiss on behalf of the Group for the Advancement of Psychiatry, "Psychiatry's Ancient Origins," Psychiatric Times Online 35, no. 11 (November 29, 2018): http:// www.psychiatrictimes.com/cultural-psychiatry/ psychiatrys-ancient-origins?rememberme=1&elq_mid= 4523&elq_cid=893295.
The ‘religion of psychiatry’ operates on the same metaphysical structure as shamanism. It redefines and reinterprets the human condition through the lens of pathology, deviance, and cure, built upon the foundational assumption of internal defect- a legacy of individual degenerationism that persists even beneath layers of scientific language and clinical protocol.
The striking parallels between the societal healers of old- shamans- and the psychiatrists of today are not accidental. As several leading figures in psychiatry have openly acknowledged, modern psychiatry retains many of the ritualistic, metaphysical, and hierarchical functions of its shamanic predecessors, albeit under the cloak of scientific language and clinical authority. In this sense, psychiatry can be described not just as medicine but as neo-shamanism- a spiritualised system of soul care dressed in the garments of biomedicine and psychology.
Just like the ancient shaman, the modern psychiatrist constructs a diagnostic system of alleged abnormalities. These are not discovered through objective medical tests but defined through subjective criteria, based on their institutionalised 'wisdom about human nature.' Behaviours or emotions that are painful, disruptive, or nonconforming are reinterpreted as signs of underlying pathology- not unlike how shamans interpreted spiritual torment or curses.
Both systems have long relied on psychoactive substances as a means of achieving transcendence, healing, and insight. As one comparative study notes:
“Western psychotherapy and indigenous shamanic healing systems have both used psychoactive drugs or plants for healing and obtaining knowledge (called ‘diagnosis’ or ‘divination,’ respectively).”
Daniel Pinchbeck, Breaking Open the Head (2002)
Today’s psychiatric drugs- SSRIs, antipsychotics, stimulants, mood stabilisers- serve not only to suppress or manage symptoms but often to reconfigure identity, perception, and personality, not unlike how entheogen were once used to induce altered states or spiritual revelations. This similarity is more than historical curiosity- it raises serious questions about the metaphysical assumptions embedded in psychiatry.
If normal human experiences- grief, despair, fear, moral struggle, spiritual emptiness- can be reframed as medical “abnormalities”, especially as biological defects, then the entire framework of sorcery can be legitimised as medicine.
The neo-shamanic psychiatric model, the outward symbols have changed, but the underlying function remains. There are, of course, notable differences in form:
The metaphysical soul or psyche has been redefined in biological terms. What was once attributed to spiritual imbalance or moral impurity is now framed as chemical imbalance or neural dysfunction. The soul has been translated into the synapse.
The ‘magic potions’ of the shaman have been replaced by pharmaceuticals. These modern elixirs are manufactured not in sacred ritual, but in corporate laboratories, designed and marketed by profit-driven pharmaceutical conglomerates.
Claims of supernatural authority have given way to claims of scientific objectivity. The modern psychiatrist does not speak of ancestral spirits or stolen souls but invokes the language of receptors, brain scans, and ‘evidence based medicine’. Yet, as before, only the initiated expert is considered qualified to define, diagnose, and direct the cure.
The role of the healer has been professionalised, standardised, and institutionally empowered. The psychiatrist, much like the shaman of old, determines who belongs inside or outside the bounds of normalcy- now supported by licensing boards, diagnostic manuals, and legal authority.
Though psychiatry claims to be free of metaphysics, there remains a spiritual undercurrent, often obscured by clinical terminology. The idea that psychiatry has abandoned the realm of supernatural knowledge is, in many cases, a convenient illusion. In truth much of modern psychiatry continues to flirt with altered states and otherworldly insight- albeit under the banner of scientific exploration.
Let’s take a look at the revealing admission by Dr. Jeffrey Lieberman, former president of the American Psychiatric Association (APA) and chair of psychiatry at Columbia University. In his book Shrinks: The Untold Story of Psychiatry, Lieberman recounts his own experimentation with psychedelics, particularly LSD, and how these experiences shaped his views of psychiatry’s role:
“Along with many other psychiatrists from my generation- like Bob Spitzer- many of whom also experimented with psychedelic drugs- I became receptive to the unexpected new role of psychiatrists as psychopharmacologists, as empathic prescribers of medicine.”
Jeffrey Lieberman, Shrinks: The Untold Story of Psychiatry (2015)
Lieberman’s reflection is not incidental; it highlights the profound irony at the heart of much of modern psychiatry: while it disavows supernaturalism, it continues to seek altered states of consciousness as sources of knowledge, insight, and healing- just as the shaman did. The divinatory impulse remains, only now it is mediated by MDs, white coats, and peer-reviewed journals.
What has truly changed is not the function of the psychiatric system but its rhetoric. Instead of invoking gods or demons, psychiatrists now invoke dopamine and serotonin. Yet both are unseen forces, detectable only through their effects, interpreted only by an elite priesthood of healers.
Dr. Jeffrey Lieberman has long been one of the most powerful and outspoken advocates of the biomedical model of mental illness. As a former president of the American Psychiatric Association (APA), chair of psychiatry at Columbia University, and one of the lead figures behind the publication of the DSM-5, Lieberman holds tremendous influence in shaping how society defines and treats human suffering. He has vigorously defended psychopharmacology as a scientifically grounded and ethical form of treatment for mental disorders. However, the personal foundation for his views reveals something far less clinical- and far more mystical.
In his revealing memoir, Shrinks: The Untold Story of Psychiatry, Lieberman describes his personal experience using LSD. Far from being a neutral experiment, his account reads like a spiritual initiation- a modern-day shamanic vision quest. He writes:
“Until then, the effects of the LSD had been mostly perceptual. Now a new experience emerged that was far more intense and mind-bending — in fact, I often recall this portion of my trip when I work with psychotic patients. As I gazed upon the religious accouterments of the church, I was filled with an overwhelming spiritual awareness, as if God was communicating His secret and divine meaning to me. A cascade of insights tumbled through my consciousness, seeming to touch my soul and thrilling me with their profundity. And then in the midst of this revelatory reverie, a disembodied voice whispered, "and no one will ever know," which seemed to signify to me that this was where the real truths lie, in these secret interstices of consciousness which most human beings never accessed — or if they did, they were unable to retain these precious encounters in their memory ... We later realized that our individual experiences [on LSD] were entirely separate and often absurdly different. As my mind soared through metaphysical realms of empyrean [heavenly] knowledge, [my girlfriend) spent most of her trip reflecting on her relationship with her father.”
Jeffrey Lieberman, Shrinks: The Untold Story of Psychiatry
This is not the language of a scientist carefully observing neurochemical reactions- it is the language of divination, of ‘spiritual’ revelation acquired through chemical induction. Lieberman openly acknowledges the spiritual and metaphysical dimensions of his experience, interpreting them not as hallucinations, but as truth-bearing encounters. He continues:
“My trip did produce one lasting insight, though - one that I remain grateful for to this day. Though my LSD-fueled reverie dissipated with the light of the morning, I marveled at the fact that such an incredibly minute amount of a chemical - 50 to 100 micrograms, a fraction of a grain of salt - could so profoundly affect my perceptions and emotions. It struck me that if LSD could so dramatically alter my cognition, the chemistry of the brain must be susceptible to pharmacologic manipulation in other ways, including ways that could be therapeutic.... My psychedelic experiment opened me up to an alternative way of thinking about mental pathologies beyond psychodynamics - as something concrete and biochemical in the cellular coils of the brain.... The psychopharmacologists didn't just voice a new and radical philosophy about mental illness; they behaved in forbidden ways.”
The ‘lasting insight’ Lieberman received from his LSD experience became a guiding epistemological pillar of modern psychiatry: that the mind (or soul) could be manipulated and healed through chemical substances. This core idea- that chemical agents can bring spiritual or psychological healing- echoes the ancient practices of shamans and sorcerers, who also used mind-altering drugs to contact the spirit world and gain knowledge or perform cures.
Lieberman’s psychedelic revelation was not merely a personal epiphany- it was formative for an entire professional ideology. It helped birth and solidify what he himself calls a ‘new and radical philosophy about mental illness’: a vision of the soul, not as morally responsible or spiritually accountable, but as biochemically defective and pharmaceutically repairable.
This continuity undermines the secular pretense that psychiatry is a purely scientific or empirical discipline. The ‘new and radical philosophy’ Lieberman champions was conceived not in the lab, but in the mystical haze of a drug induced encounter with what he describes as ‘God’s secret meaning.’ That such an experience serves as a foundational moment in the development of psychiatry should deeply concern anyone who asserts scientific truth. This is the religion of scientism!
I understand that what has been shared above may raise many eyebrows. Some readers might say, ‘We already knew this,’ and then proceed to offer their own rationalisations. Others may respond defensively, perhaps even using labels or prejudicial terms to discredit the concerns raised. I recall once quoting leading figures like Dr. Allen Frances-verbatim- and the reaction among some professionals was one of shock and even disdain. Ironically, it seemed they didn’t know who these influential experts were, nor the weight of their critique of the very system they themselves defend.
I rarely offer my personal views on such topics, knowing how sensitive and emotionally charged discussions around mental health and psychiatry can be. That is why I try to let the record speak for itself- from the horse’s mouth, as the saying goes. If some of these reflections provoke discomfort or resistance, it is not out of arrogance or hostility, but out of a desire to encourage honest and informed dialogue. If anything, such strong reactions often reveal just how deeply hidden or unexplored these issues remain for many, including those within the mental health profession itself.
This is why these topics matter: because they shape ideologies, worldviews, and beliefs about what it means to suffer, to struggle, and to be human. They inform how we respond to those in pain- whether with compassion and humility, or with categorisation and control.
Understanding the roots and assumptions of modern psychiatry is not about discrediting all professionals, but about contextualising the system we have inherited.
Ultimately, I hope this piece is read not with defensiveness, but with a discerning and open mind-a mind awake to history, philosophy, and the real-world consequences of the paradigms we adopt. Only then can we engage in meaningful reform, and offer truly humane, wise, and respectful care for those who suffer.
A. Hasan
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