The Danish physician Peter C. Gøtzsche has written a crushing criticism of psychiatry which should be read by all with an interest in mental health and contemporary treatment of people who struggle – Deadly Psychiatry and Organized Denial. It will be hard to find a more important and disheartening book.

Deadly Psychiatry and Organized Denial is a continuation of Gøtzsche's crushing criticism of the pharmaceutical industry, Deadly Medicines and Organized Crime (Radcliffe Publishing, 2013), which actually won first prize in the British Medical Association's book award 2014 in the category ‘Basis of Medicine’. However, in the new book it is not only the pharmaceutical industry which is in focus, but also the discipline of psychiatry. Gøtzsche does not have too much good to say about psychiatry and its treatment of patients, and he urges major revolution of this discipline. The criticism is first and foremost directed at psychiatry as a system, in the way it is governed by leading psychiatrists in close contact with the pharmaceutical industry. That psychiatry is a kind of ‘problematic discipline’ in medicine has long been clear to me; however, that the situation is actually as bad as Gøtzsche painstakingly documents that it is, you will hardly believe until you have read the book. He is obviously not critical of any psychiatrist or person working in psychiatry, and cites a number of exceptions it is emcouraging to read about.

As head of the Nordic Cochrane Centre, Gøtzsche is concerned with ‘evidence-based medicine’, and he refers to empirical grounds that the use of psychotropic drugs (psychiatric drugs) do far greater harm than benefit. He documents that psychotropic drugs kill over half a million people each year in the United States and Europe among people over 65 years. This makes psychotropic drugs to the third cause of death after heart disease and cancer. Gøtzsche explains how society can reduce its current consumption of psychotropic drugs by 98% while improving patients’ mental and physical health – and survival. Reduction of drugs should be done slowly because withdrawal symptoms can be severe, long-lasting and dangerous.

Gøtzsche presents a number of myths and misconceptions which he analyzes and refutes. Some of the erroneous perceptions that trouble him most, are:

• • psychiatric diagnoses are reliable;

• • it reduces stigmatization to give people a biological or a genetic explanation for their mental disorder;

• • the usage of psychiatric drugs reflects the number of people with mental disorders;

• • people with mental disorders have a chemical imbalance in their brain and psychiatrists can fix this imbalance with drugs, just like endocrinologists use insulin for diabetes;

• • long-term treatment with psychiatric drugs is good, as it prevents recurrence of the disease;

• • treatment with antidepressants does not lead to dependence;

• • treatment of children and adolescents with antidepressants protects against suicide;

• • depression, ADHD and schizophrenia lead to brain damage; and

• • drugs can prevent brain damage.

After having read Deadly Psychiatry and Organized Denial one is in no doubt that all these allegations are false. According to Gøtzsche the correct thing to do, is to change the content of these statements to the contrary. He shows this through an analysis of research literature.

The book consists of 18 chapters and an index. Each chapter is concluded by an endnote list of sources cited. In Chapter 1 the author presents the topics of the book, and in the next chapter he focuses on what it means to be mentally ill. Here he debates the problems with psychiatric diagnosis. The next six chapters deal in succession with depression (3), anxiety (4), ADHD (5), schizophrenia (6), bipolar disorder (7) and dementia (8).

Chapter 9 is about electroshock, which Gøtzsche believes should be banned. Chapter 10 is about two main types of measures Gøtzsche strongly supports when it comes to helping people with mental health problems: different types of psychotherapy and exercise. In chapter 11 the author discusses what happens in the brain when using psychotropic drugs. Chapter 12 is about withdrawing psychiatric drugs – why it should be done and how it can be done. In chapter 13 Gøtzsche criticizes psychiatry as a discipline and its close ties to the pharmaceutical industry. Psychotropic drugs do more harm than good, and in chapter 14, he goes through how little medication that is actually needed in psychiatry. Chapter 15 is about forced treatment and compulsory admission, which Gøtzsche believes should be banned.

The book ends with two short chapters with advice on what mental patients can do to improve their situation (16) and what physicians can do to contribute to creating a better and more humane psychiatry (17). Finally, Gøtzsche provides an overview of useful websites for people who want to dig deeper into these topics (18).

The book is written in a clear language. Since parts are about presenting or criticizing scientific literature, there are some statistical results in the text, which is crucial when he addresses scientific scholarly readers. Much of his criticism of psychiatry is based on published studies, and necessarily the results must be included. Gøtzsche, however, is careful also to explain what the results mean in plain language, so that people who are not well-schooled in statistics can understand the importance of the results.

Gøtzsche pulls no punches! If one is to contribute to a revolution of the discipline of psychiatry the gloves must come off! I see this as both necessary and liberating. If one is to contribute to revolution of the discipline of psychiatry, one cannot take on people with verbal kid gloves!

The book is clearly written as a help to patients, especially those desperately trying to get rid of their drugs, but who have been met with hostile and arrogant reactions from their doctors. Gøtzsche has also written the book for young psychiatrists in training, in the hope that it might inspire them to revolutionize their profession, which he believes is urgently needed.

I think all health conscious people will benefit from this book, especially those who are concerned about mental health and how people with such disorders are treated. I also believe this book is important for those who are concerned about economics and how we as a society spend money to help people who are struggling mentally. Gøtzsche offers suggestions and advice that will undoubtedly reduce costs to society for treatment of mental health, while patients will get much better.

Gøtzsche is not the first to review extensive problems in psychiatry, and he stands on the shoulders of giants. There are many brave people talking against psychiatric Rome. For example, a lot of researchers and journalists have focused on similar conditions/topics, and Gøtzsche has read all of this and frequently cites them. A number of traditional psychiatrists have tried to dismiss this criticism as erroneous, and Gøtzsche presents all the usual objections in his book, to then crush them through sharp analyses. Gøtzsche is no lightweight who can be dismissed with a stroke of the pen. On the contrary, he is a recognized specialist and longstanding critic of the pharmaceutical industry.

Gøtzsche (born 1949) has a background which makes him a credible critic. He has a master's degree in biology and chemistry (1974), became a medical doctor in 1984 and is a specialist in internal medicine. He worked for the pharmaceutical industry from 1975 to 1983 as both sales representative and product manager before getting a job at a hospital in Copenhagen (1984–95). Gøtzsche helped start up the Cochrane Collaboration in 1993 and founded the Nordic Cochrane Centre in the same year. In 2010, he became professor of clinical research methods and analysis at the University of Copenhagen. Gøtzsche has written over 50 research papers in the ‘Big Five’ medical professional journals and four core textbooks. His academic work has been cited more than 10 000 times.

Gøtzsche is at home professionally when on scientific grounds he criticizes widespread problems with clinical research on psychotropic drugs. His ethical guidelines based on human rights and the patients’ point of view are both desirable and wise. It is easy to dislike everything the pharmaceutical industry is demonstrably engaged in and the political power game organized psychiatry has been involved in for far too long. That we should have only limited use of psychotropic drugs is easy to agree with, and various types of psychotherapy and exercise will be important to help people who are struggling mentally.

I find that two things are missing in the book to make the perspective complete. The first thing I miss is all other causes than psychosocial factors that may cause or contribute to people struggling mentally. It may be the diet to which we are not well adapted to or tolerate, and infections and various chemical and physical factors we are exposed to. The second is the treatment traditions that are the consequences of these causal factors, for example by changing patients’ diet, providing specific supplements (ortomolecular medicine) and trying to eliminate or reduce exposure to environmental factors that affect people adversely. Yes, more research is needed on all these issues, but there is already both research and clinical experience indicating that they can be effective. If Gøtzsche in a few pages had expanded that perspective with this research I would find the book complete. Regardless of my objections, Deadly Psychiatry and Organized Denial is exemplary in analyzing and criticizing what is its main objective, namely problems with the discipline of psychiatry and research on psychotropic drugs.