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Monday, November 6, 2023

Failed state

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Failed_state

A failed state is a state that has lost its effective ability to govern its populace. A failed state maintains legal sovereignty but experiences a breakdown in political power, law enforcement, and civil society, leading to a state of near-anarchy.

Common characteristics of a failing state include a government unable to tax and police its populace, control and maintain its territory, fill political or civil offices, or maintain its infrastructure. When this happens, widespread corruption and criminality, the intervention of state and non-state actors, the appearance of refugees and the involuntary movement of populations, sharp economic decline, and military intervention from both within and without the state are much more likely to occur.

Metrics have been developed to describe the level of governance of states. The precise level of government control required to avoid being considered a failed state varies considerably amongst authorities. Furthermore, the declaration that a state has "failed" is generally controversial and, when made authoritatively, may carry significant geopolitical consequences.

According to the political theories of Max Weber, a state is defined as maintaining a monopoly on the legitimate use of physical force within its borders. When this is broken (e.g., through the dominant presence of warlords, paramilitary groups, corrupt policing, armed gangs, or terrorism), the very existence of the state becomes dubious, and the state becomes a failed state. The difficulty of determining whether a government maintains "a monopoly on the legitimate use of force", which includes the problems of the definition of "legitimate", means it is not clear precisely when a state can be said to have "failed".

The problem of legitimacy can be solved by understanding what Weber intended by it. Weber explains that only the state has the means of production necessary for physical violence. This means that the state does not require legitimacy for achieving a monopoly on having the means of violence (de facto), but will need one if it needs to use it (de jure).

Typically, the term means that the state has been rendered ineffective and is not able to enforce its laws uniformly or provide basic goods and services to its citizens. The conclusion that a state is failing or has failed can be drawn from the observation of a variety of characteristics and combinations thereof. Examples of such characteristics include - but are not limited to - the presence of an insurgency, extreme political corruption, overwhelming crime rates suggestive of an incapacitated police force, an impenetrable and ineffective bureaucracy, judicial ineffectiveness, military interference in politics, and consolidation of power by regional actors such that it rivals or eliminates the influence of national authorities. Other factors of perception may be involved. A derived concept of "failed cities" has also been launched, based on the notion that while a state may function in general, polities at the substate level may collapse in terms of infrastructure, economy, and social policy. Certain areas or cities may even fall outside state control, becoming a de facto ungoverned part of the state.

No consistent or quantitative definition of a "failed state" exists; the subjective nature of the indicators that are used to infer state failure have led to an ambiguous understanding of the term.

Some scholars focus on the capacity and effectiveness of the government to determine whether or not a state is failed. Other indices such as the Fund for Peace's Fragile States Index employ assessments of the democratic character of a state's institutions as a means of determining its degree of failure. Finally, other scholars focus their argument on the legitimacy of the state, on the nature of the state, on the growth of criminal violence in a state, on the economic extractive institutions, or on the states' capacity to control its territory. Robert H. Bates refers to state failure as the "implosion of the state", where the state transforms "into an instrument of predation" and the state effectively loses its monopoly on the means of force.

Charles T. Call attempts to abandon the concept of state failure altogether, arguing that it promotes an unclear understanding of what state failure means. Instead, Call advances a "gap framework" as an alternative means of assessing the effectiveness of state administration. This framework builds on his previous criticism of the state failure concept as overly generalized. Call thus asserts that it is often inappropriately applied as a catch-all theory to explain the plight of states that are in fact subject to diverse national contexts and do not possess identical problems. Utilizing such an evaluation to support policy prescriptions, Call posits, is then responsible for poor policy formulation and outcomes. As such, Call's proposed framework develops the concept of state failure through the codification of three "gaps" in resource provision that the state is not able to address when it is in the process of failure: capacity, when state institutions lack the ability to effectively deliver basic goods and services to its population; security, when the state is unable to provide security to its population under the threat of armed groups; and legitimacy when a "significant portion of its political elites and society reject the rules regulating power and the accumulation and distribution of wealth."[6]

Instead of attempting to quantify the degree of failure of a state, the gap framework provides a three-dimensional scope useful to analyze the interplay between the government and the society in states in a more analytical way. Call does not necessarily suggest that states that suffer from the challenges of the three gaps should be identified as failed states but instead presents the framework as an alternative to the state failure concept as a whole. Although Call recognizes that the gap concept in itself has limits since often states face two or more of the gap challenges, his conceptual proposition presents a useful way for more precisely identifying the challenges within a society and the policy prescriptions that are more likely to be effective for external and international actors to implement.

Further critique of the ways in which the 'failed state' concept has been understood and used to inform national and international policy decisions is brought forth in research by Morten Bøås and Kathleen M. Jennings. Drawing on five case studies — Afghanistan, Somalia, Liberia, Sudan, and the Niger Delta region of Nigeria — Bøås and Jennings argue that "the use of the 'failed state' label is inherently political and based primarily on Western perceptions of Western security and interests". They go on to suggest that Western policy-makers attribute the 'failed' label to those states in which 'recession and informalisation of the state is perceived to be a threat to Western interests'. Furthermore, this suggests hypocrisy among Western policy-makers: the same forms of perceived dysfunction that lead to some states being labeled as failed are in turn met with apathy or are knowingly expedited in other states where such dysfunction is assessed to be beneficial to Western interests. In fact, "this feature of state functioning is not only accepted, but also to a certain degree facilitated, as it creates an enabling environment for business and international capital. These cases are not branded 'failed states'".

Measurement

The measurement methods of state failure are generally divided into the quantitative and qualitative approach.

Quantitative approach

Quantitative measurement of state failure means the creation of indexes and rankings are particularly important. However, a number of other indexes are generally used to describe state weakness, often focusing on the developmental level of the state (e.g. the Freedom House Index (FHI), the Human Development Index (HDI), or the World Bank Governance Indicators). Additionally, regional evaluation might give concrete details about, inter alia, the level of democracy such as the Report of Democratic Development in Latin America (Informe de desarrollo democrático de América Latina).

Fragile States Index

Countries according to the 2023 Fragile States Index
  Very high alert (111-120)
  High alert (101-110)
  Alert (91-100)
  High warning (81-90)
  Elevated warning (71-80)
  Warning (61-70)
  Less Stable (51-60)
  Stable (41-50)
  More Stable (31-40)
  Sustainable (21-30)
  Very sustainable (0-20)
  Data unavailable

However, the Fragile States Index has received comparatively much attention since its first publication in 2005. Edited by the magazine Foreign Policy, the ranking examines 178 countries based on analytical research of the Conflict Assessment System Tool (CAST) of the Fund for Peace.

The Fragile States Index published its eleventh annual report in 2015, prepared by the Fund for Peace and published by Foreign Policy Magazine. The Index categorizes states in four categories, with variations in each category. The Alert category is in dark red, Warning in orange, Stable in yellow, and Sustainable in green.

The FSI total score is out of 120, and in 2015 there were 178 states making the ranking. Initially, the FSI only ranked 75 countries in 2005. The FSI uses two criteria by which a country qualifies to be included in the list: first of all, the country must be a United Nations member state, and secondly, there must be a significant sample size of content and data available for that country to allow for meaningful analysis. There are three groupings: social, economic, and political with overall of twelve indicators.

Social indicators:

  • Demographic pressures
  • Refugees or internally displaced persons
  • Group grievance
  • Human flight and brain drain

Economic indicators:

  • Uneven economic development
  • Poverty and economic decline

Political and military indicators:

  • State legitimacy
  • Public services
  • Human rights and rule of law
  • Security apparatus
  • Factionalized elites
  • External intervention

The indicators each count for 10, adding up to a total of 120. However, in order to add up to 120, the indicator scores are rounded up-or-down to the nearest one decimal place. In the 2015 Index, South Sudan ranked number one, Somalia number two, and the Central African Republic number three. Finland is currently the most stable and sustainable country in the list.

While it is important to note that the FSI is used in many pieces of research and makes the categorization of states more pragmatic, it often receives much criticism due to several reasons. Firstly, it does not include the Human Development Index to reach the final score but instead focuses on institutions to measure what are often also considered human aspects for development. Secondly, it parallels the fragility or vulnerability of states with underdevelopment. This comparison firstly assumes that underdevelopment (economic) creates vulnerability, thus assuming that if a state is "developed" it is stable or sustainable. Thirdly, it measures the failure (or success) of a state without including the progress of other areas outside the sphere of the 12 indicators, thus excluding important measures of development such as the decline in child mortality rates, and increased access to clean water sources and medication, amongst others. Nonetheless, when discussing failed states it is important to mention the FSI not just for its use by governments, organizations, educators and analysts, but also because it provides a measure of assessment that tries to address the issues that cause threats, both domestically and internationally.

Qualitative approach

The qualitative approach embraces theoretical frameworks. Normally, this type of measurement applies stage models to allow the categorization of states. In three to five stages, researchers show state failure as a process. Notable researchers, inter alia, are Robert I. Rotberg in the Anglo-American and Ulrich Schneckener in the German sphere.

Ulrich Schneckener's (2006) stage model defines three core elements, monopoly of violence, legitimacy, and rule of law. The typology is based on the security first logic and thus, shows the relevance of the monopoly of violence in comparison to the other two while at the same time acting as the precondition for a functioning state. His four statehood types are: (1) consolidated and consolidating states, (2) weak states, (3) failing, and (4) collapsed/failed states. The first type is directed towards functioning states; all core functions of the state are functioning in the long term. In weak states, the monopoly of force is still intact, but the other two areas show serious deficits. Failing states lack the monopoly of force, while the other areas function at least partially. Finally, collapsed or failed states are dominated by parastatal structures characterized by actors trying to create a certain internal order, but the state cannot sufficiently serve the three core elements.

Both research approaches show some irregularities. While the quantitative approach lacks transparency concerning its indicators and their balancing in the evaluation process of countries, the qualitative approach shows a diversity of different foci. One of the major discrepancies is the question of whether all the stages have to be taken continuously or if a state can skip one phase. Schneckener stresses that his model should actually not be interpreted as a stage model as, in his opinion, states do not necessarily undergo every stage. Robert I. Rotberg's model underlies an ordinal logic and thus, implies that the state failure process is a chronological chain of phases.

Theoretical mechanisms for state development

State development through war-making

Charles Tilly (1985) argued that war-making was an indispensable aspect of state development in Europe through the following interdependent functions:

  • War-making—rulers eliminate external rivals (requires building military forces and supportive bureaucracies)
  • State-making—rulers eliminate internal rivals and establish control over their territories (requires building police forces and bureaucracies)
  • Protection—rulers bring about benefit to their clients by eliminating their external rivals and guaranteeing their rights (requires building courts and representative assemblies)
  • Extraction—rulers extract more tax from their subjects (requires building tax collection apparatuses and exchequers)

Tilly summarized this linkage in the famous phrase: "War made the state, and the state made war."

Similarly, Herbst (1990) added that a war might be the only chance to strengthen an extraction capability since it forced rulers to risk their political lives for extra revenue and forced subjects to consent to pay more tax. It is also important for state development in that the increased revenue would not return to its original level even after the end of wars. Contrary to European states, however, he also pointed out that most Third World states lacked external threats and had not waged interstate wars, implying that these states are unlikely to take similar steps in the future.

"Nation-building" by developed countries

Steward and Knaus (2012) tackled the question "Can intervention work?" and concluded that "we can help nations build themselves" by putting an end to war and providing "well-resourced humanitarian interventions". They criticized the overconfidence of policymakers on nation-building by contrasting what they regarded as successful interventions in Bosnia (1995) and Kosovo (1999) with the failed attempt of nation-building in Iraq (2003) and Afghanistan (2001–2021) in which the U.S. lost thousands of lives over ten years and expended more than a trillion dollars without realizing its central objective of nation-building. When a so-called failed nation-state is crushed by internal violence or disruption, and consequently is no longer able to deliver positive political goods to its inhabitants, developed states feel the obligation to intervene and assist in rebuilding them. However, intervention is not always seen positively, but due to past intervention by for instance the US government, scholars argue that the concept of a failed state is an invented rationale to impose developed states' interests on less powerful states.

The labeling of states like Somalia or Liberia , as failed states, gives Western countries the legitimization to impose the western idea of a stable nation-state. It is commonly accepted that nation-building or international response to troubled/rogue states happens too late or too quickly which is due to inadequate analysis or lack of political will. Still, it is important to highlight that developed nations and their aid institutions have had a positive impact on many failed states. Nation-building is context-specific and thus a countries' cultural-political, as well as social environment, needs to be carefully analyzed before intervening as a foreign state. The Western world has increasingly become concerned about failed states and sees them as threats to security. The concept of the failed state is thereafter often used to defend policy interventions by the West. Further, as Chesterman and Ignatieff et al. argue, regarding the duration of international action by developed states and international organizations, a central problem is that a crisis tends to be focused on time, while the most essential work of reframing and building up a state and its institutions takes years or decades. Therefore, effective state-building is a slow process and it is disingenuous to suggest otherwise to the domestic public.

Promoting development through foreign aid

Pritchett, Woolcock, and Andrews (2013) analyzed the systematic failure of the development of failed states. They defined "state administrative capability for implementation" as the key aspect of state development, and found out the mechanism in which failed states stumbled regardless of decades of development practices tried, billions of dollars spent, and alleged "progress" boasted. These countries adopted the following techniques which led to undermining it:

  1. systemic isomorphic mimicry—disguising the dysfunction of states by simply mimicking the appearance of functional states.
  2. premature load bearing—limited-capacity states being overloaded with "unrealistic expectations".

In light of the fact that many of these countries would likely need centuries to reach the state capability of developed countries, they suggested creating "context-specific institutions", promoting "incremental reform process", and setting "realistic expectations" for attaining the goal of substantial development.

Foreign aid produces several unintended consequences when used to develop the institutional capacity of state. Donors will often delegate aid spending to recipient governments since they do not have the information or capacity to identify who is in the greatest need and how it can be best spent. The downside of this is that it can be captured by recipient governments and diverted either towards self-enrichment of incumbent elites or to establish and maintain clientelist networks to allow them to remain in power—for example, in Kenya, aid allocation is biased towards constituencies with high vote shares for the incumbent, so the geographic distribution of aid changes to their supporters following a change of regime. Furthermore, aid can also be diverted to non-state actors, and thus undermine the state's monopoly on violence, such as in Colombia during the 1990s and 2000s, where US aid to the Colombian military was diverted by the military to paramilitary groups, leading to significant increases in paramilitary violence in municipalities located near military bases. The implication is that foreign aid can undermine the state by both feeding corruption of incumbent elites, and empowering groups outside of the state.

Moss, Todd, Gunilla Pettersson, and Nicolas Van de Walle (2006) acknowledged the controversy over the effect of foreign aid that has developed in recent years. They argued that although there is a call for an increase in large aid efforts in Africa by the international community, this will actually create what they call an "aid-institutions paradox". This paradox is formed because of the large cash contributions that Western countries have given to African countries have created institutions that are "less accountable to their citizens and under less pressure to maintain popular legitimacy." They mention that the gradual decrease of aid may help foster long-lasting institutions, which is proven by the United States' efforts in Korea after the Cold War.

Berman, Eli, Felter, Shapiro, and Trolan (2013) also found similar evidence to support the paradox, stating that large US aid attempts in African agriculture have only resulted in further conflict between citizens. Notably, small investments such as grants for schools have proven to decrease violence compared to large investments, which create "incentives to capture economic rents through violence."

Furthermore, Binyavanga Wainaina (2009) likens Western aid to colonization, in which countries believe that large cash contributions to spur the African economy will lead to political development and less violence. In reality, these cash contributions do not invest in Africa's growth economically, politically and most of all, socially.

Neotrusteeship

James Fearon and David Laitin suggest in "Neotrusteeship and the Problem of Weak States" that the problem of failed states can be addressed through a system of "neotrusteeship", which they compare to "postmodern imperialism". Fearon and Laitin's idea of neotrusteeship involves a combination of international and domestic organizations which seek to rebuild states. Fearon and Laitin start with the assumption that failed states comprise a collective action problem. Failed states impose negative externalities on the rest of the international system, like refugees who are displaced by war. It would be a net good for the international system if countries worked to develop and rebuild failed states. However, intervention is very costly, and no single nation has a strong enough incentive to act to solve the problem of a failed state. Therefore, international cooperation is necessary to solve this collective action problem.

Fearon and Laitin identify four main problems to achieving collective action to intervene in failed states:

  1. Recruitment - getting countries to participate in and pay for interventions
  2. Coordination - providing good communication between all of the peacekeeping countries
  3. Accountability - ensuring that any peacekeeping countries that commit human rights abuses are held responsible
  4. Exit - having some mechanism for the peacekeeping countries to withdraw

Fearon and Laitin do propose some solutions to these problems. To solve the recruitment problem, they argue for having a powerful state with security interests in the failed state to take the lead in the peacekeeping operations and serve a point role. Having a single state lead the peacekeeping operation would also help solve the coordination problem. The empowerment of a UN body to investigate human rights abuses would solve the accountability problem. Finally, forcing the failed state to contribute funds to peacekeeping operations after several years can reduce the incentives of the peacekeepers to exit. Fearon and Laitin believe that multilateral interventions which solve the above four collective action problems will be more effective at rebuilding failed states through neotrusteeship.

Autonomous recovery

Jeremy Weinstein disagrees that peacekeeping is necessary to rebuild failed states, arguing that it is often better to allow failed states to recover on their own. Weinstein fears that international intervention may prevent a state from developing strong internal institutions and capabilities. One of Weinstein's key arguments is that war leads to peace. By this, he means that peace agreements imposed by the international community tend to freeze in place power disparities that do not reflect reality. Weinstein believes that such a situation leaves a state ripe for future war, while if the war were allowed to play out for one side to win decisively, the future war would be much less likely. Weinstein also claims that war leads to the development of strong state institutions. Weinstein borrows from Charles Tilly to make this argument, which states that wars require large expansions in state capabilities, so the states that are more stable and capable will win wars and survive in the international system through a process similar to natural selection. Weinstein uses evidence from Uganda's successful recovery following a guerilla victory in a civil war, Eritrea's forceful secession from Ethiopia, and development in Somaliland and Puntland—autonomous regions of Somalia—to support his claims. Weinstein does note that lack of external intervention can lead to mass killings and other atrocities, but he emphasizes that preventing mass killings has to be weighed against the ensuing loss of long-term state capacity.

Capability traps of failed states

Capability trap means that countries are progressing at a very slow pace in the expansion of state capability even in the contemporary world, which is also the core problem of failed states. Many countries remain stuck in conditions of low productivity that many call "poverty traps". Economic growth is only one aspect of development; another key dimension of development is the expansion of the administrative capability of the state, the capability of governments to affect the course of events by implementing policies and programs. Capability traps close the space for novelty, establishing fixed best-practice agendas as the basis of evaluating failed states. Local agents are therefore excluded from the process of building their own states, implicitly undermining the value-creating ideas of local leaders and front-line workers.

Matt, Lant, and Woolcock from the Harvard Kennedy School of Government proposed an approach called the "Problem Driven Iterative Adaptation (PDIA)", to escape the capability traps. Given that many development initiatives fail to improve performance because they promote isomorphic mimicry, PDIA focuses on solving locally nominated and prioritized performance problems of failed states. It involves pursuing development interventions that engage broad sets of local agents to ensure the reforms are politically supportable and practically implementable.

While failed states are the source of numerous refugees, the chaotic emigration allowed by UN regulations and open border policies have contributed to human capital flight, or brain drain. Without sufficient professional and skilled workers, such as doctors, nurses, biologists, engineers, electricians, and so on, the severity of failed states tends to increase, leading to even more emigration. Similarly, policies that do not require third country resettlement on the same continent as failed states make eventual resettlement after the war, famine, or political collapse even less probable, as the distance, cost, and inconvenience of returning to home countries increase with distance and language change among refugee families. In Somalia, Afghanistan, and Yemen the reform movements and modernization efforts are weakened when there are no effective refugee resettlement programs.

Promoting good governance and combating further hostilities in failed states

Transnational crime and terrorism

According to U.S. Department of Justice Trial Attorney Dan E. Stigall, "the international community is confronted with an increasing level of transnational crime in which criminal conduct in one country has an impact in another or even several others. Drug trafficking, human trafficking, computer crimes, terrorism, and a host of other crimes can involve actors operating outside the borders of a country which might have a significant interest in stemming the activity in question and prosecuting the perpetrator".

A study of the Cligendael Center for Strategic Studies explains why states that are subject to failure serve as sanctuaries (used to plan, execute, support, and finance activities) for terrorist organizations. When the government does not know about the presence of the organization or if it is not able to weaken or remove the organization, the sanctuary is referred to as a "Terrorist Black Hole". However, next to governmental weakness there needs to be "Terrorist Comparative Advantages" present for a region to be considered as a "Terrorist Black Hole". According to the study, social tensions, the legacy from civil conflict, geography, corruption and policy failure, as well as external factors contribute to governmental weakness. The comparative advantages are religion and ethnicity, the legacy from civil conflict, geography, economic opportunities, economic underdevelopment, and regional stimuli. Only the combinations of the two factors (governmental weakness and Terrorist Comparative Advantages) explain what regions terrorists use as sanctuaries.

Research by James Piazza of the Pennsylvania State University finds evidence that nations affected by state failure experience and produce more terrorist attacks. Contemporary transnational crimes "take advantage of globalization, trade liberalization and exploding new technologies to perpetrate diverse crimes and to move money, goods, services and people instantaneously for purposes of perpetrating violence for political ends".

Contributing to previous research on the matter, Tiffiany Howard looks at a different dimension of the connection between state failure and terrorism, based on evidence from Sub-Saharan Africa. She argues that "citizens of failed states are attracted to political violence because of the deteriorating conditions within this type of states". Focusing on individual citizens' decision-making patterns, it is suggested that "individuals living in failed states are attracted to political violence because the system is broken—the state has failed in its duty". This finding is based on empirical evidence using barometer survey data. This individual-level approach, which differs from previous research which has focused on the attractiveness of failed states for terrorists and insurgents finds that "failed states threaten an individual's survival, which ultimately drives them to obtain tangible political and economic resources through other means, which include the use of political violence". This finding has significant implications for the international community, such as the fact that "this pattern of deprivation makes individuals in these states more susceptible to the influence of internationally sponsored terrorist groups. As a consequence, failed states are breeding grounds for terrorists, who then export their radical ideologies to other parts of the world to create terrorist threats across the globe".

The link between state failure (and its characteristics) and terrorism, however, is not unanimously accepted in the scholarly literature. Research by Alberto Abadie, which looks at determinants of terrorism at the country level, suggests that the "terrorist risk is not significantly higher for poorer countries, once the effects of other country-specific characteristics such as the level of political freedom are taken into account". In fact, as the argument goes, "political freedom is shown to explain terrorism, but it does so in a non-monotonic way: countries in some intermediate range of political freedom are shown to be more prone to terrorism than countries with high levels of political freedom or countries with highly authoritarian regimes". While poverty and low levels of political freedom are not the main characteristics of failed states, they are nevertheless important ones. For this reason, Abadie's research represents a powerful critique to the idea that there is a link between state failure and terrorism. This link is also questioned by other scholars, such as Corinne Graff, who argues that 'there is simply no robust empirical relationship between poverty and terrorist attacks'.

Moreover, "problems of weakened states and transnational crime create an unholy confluence that is uniquely challenging. When a criminal operates outside the territory of an offended state, the offended state might ordinarily appeal to the state from which the criminal is operating to take some sort of action, such as to prosecute the offender domestically or extradite the offender so that he or she may face punishment in the offended state. Nonetheless, in situations in which a government is unable (or unwilling) to cooperate in the arrest or prosecution of a criminal, the offended state has few options for recourse".

Examples

A relevant contribution to the field of failed states and its attributes was made by Jack Goldstone in his 2008 paper "Pathways to State Failure". He defines a failed state as one that has lost both its effectiveness and legitimacy. Effectiveness means the capability to carry out state functions such as providing security or levying taxes. Legitimacy means the support of important groups of the population. A state that retains one of these two aspects is not failed as such; however, it is in great danger of failing soon if nothing is done. He identifies five possible pathways to state failure:

  1. Escalation of communal group (ethnic or religious) conflicts. Examples: Rwanda, SFR Yugoslavia, Israel/Palestine.
  2. State predation (corrupt or crony corralling of resources at the expense of other groups). Examples: Nicaragua, Venezuela, and Belarus.
  3. Regional or guerrilla rebellion. Examples: Most of Latin America and Africa.
  4. Democratic collapse (leading to civil war or coup d'état). Examples: Nigeria, Nepal.
  5. Succession or reform crisis in authoritarian states. Examples: Indonesia under Suharto, the Soviet Union under Gorbachev.

Larry Diamond, in his 2006 paper "Promoting democracy in post-conflict and failed states", argues that weak and failed states pose distinctive problems for democracy promotion. In these states, the challenge is not only to pressure authoritarian state leaders to surrender power but rather to figure out how to regenerate legitimate power in the first place. There are mainly two distinct types of cases, and each of these two types of cases requires specific kinds of strategies for the promotion of good governance:

  1. The post-conflict states that are emerging from external or civil war. A number of these countries, such as Nigeria, Mozambique, Sierra Leone, and Somalia, have been in Africa, while others have been in Latin America (Nicaragua, El Salvador, and much of Central America), in Asia (e.g. Cambodia), or in the Middle East (Lebanon, Algeria, and Iraq);
  2. Countries that are in the midst of civil war or ongoing violent conflict, where central state authority has largely collapsed, as in the Democratic Republic of the Congo
  3. Countries where corruption is rampant, economy is highly depreciated and having lot of political instability. Example: Pakistan

Generally speaking, the order is the most important prerequisite for democracy promotion, which relies heavily on formal democratic mechanisms, particularly elections to promote post-conflict state-building. In the absence of an effective state, there are basically three possibilities. First, if there has been a civil war and a rebel force has ultimately triumphed, then the vacuum may be filled by the rebellious army and political movement as it establishes control over the state. Second, there may be a patchwork of warlords and armies, with either no real central state (as in Somalia) or only a very weak one. In this situation, the conflict does not really end, but may wax and wane in a decentralized fashion, as in Afghanistan today. The third possibility is that an international actor or coalition of actors steps in to constitute temporary authority politically and militarily. This may be an individual country, a coalition, an individual country under the thin veneer of a coalition, or the United Nations acting through the formal architecture of a UN post-conflict mission.

Failed states according to the Bertelsmann Transformation Index
Country '22 '20 '18 '16 '14 '12 '10 '08 '06
 Afghanistan Yes


Yes Yes Yes Yes Yes
 CAR Yes Yes Yes Yes Yes Yes Yes Yes Yes
 Chad






Yes
 DR Congo Yes Yes Yes Yes Yes Yes Yes Yes Yes
 Haiti Yes

Yes Yes Yes

Yes
 Iraq






Yes Yes
 Ivory Coast






Yes Yes
 Libya Yes Yes Yes Yes




 Pakistan Yes Yes Yes Yes




 Somalia Yes Yes Yes Yes Yes Yes Yes Yes Yes
 South Sudan Yes Yes Yes





 Sudan Yes






Yes
 Syria Yes Yes Yes Yes Yes



 Yemen Yes Yes Yes Yes




Criticisms of the concept

The term "failed state" has faced criticism along two main strands. The first argues that the term lends itself to overgeneralization, by lumping together different governance problems amongst diverse countries, and without accounting for variations of governance within states. The second is concerned with the political application of the term in order to justify military interventions and state-building based on a Western model of the state.

Olivier Nay, William Easterly, and Laura Freschi have critiqued the concept of state failure as not having a coherent definition, with indices combining various indicators of state performance arbitrarily weighted to arrive at unclear and aggregated measurements of state fragility. Charles T. Call argues that the label of "failed state" has been applied so widely that it has been effectively rendered useless. As there has been little consensus over how to define failed states, the characteristics commonly used to identify a failing state are numerous and extremely diverse, from human rights violations, poverty, corruption to demographic pressures. This means that a wide range of highly divergent states are categorized together as failed (or failing) states. This can conceal the complexity of the specific weaknesses identified within individual states and result in one size fits all approach typically focused on strengthening the state's capacity for order. Furthermore, the use of the term 'failed state' has been used by some foreign powers as a justification for invading a country or determining a specific prescriptive set of foreign policy goals. Following 2001, Call notes that the US stated that failed states were one of the greatest security threats facing the country, based on the assumption that a country with weak – or non-existent – state institutions would provide a safe haven for terrorists, and act as a breeding ground for extremism.

Call suggests that, instead of branding countries as failed states, they could be categorized in more relevant, understandable terms. For example, a "collapsed state" would refer to a country where the state apparatus completely falls apart and ceases to exist for a couple of months. This would only apply to a country where absolutely no basic functions of the state were working, and non-state actors were carrying out such tasks. A "weak state" could be used for states whereby informal institutions carry out more of the public services and channeling of goods than formal state institutions. A "war-torn" state might not be functioning because of conflict, but this does not necessarily imply it is a collapsed state. Rotberg argued that all failed states are experiencing some form of armed conflict. However, the challenges to the state can be very different depending on the type of armed conflict, and whether it encompasses the country as a whole and large territories, or is specifically focused around one regional area. Another type of state that has been traditionally put under the umbrella term "failed state" could be an "authoritarian state". While authoritarian leaders might come to power by violent means, they may ward off opposition once in power and as such ensure there is little violence within their regime. Call argues that the circumstances and challenges facing state-building in such regimes are very different from those posed in a state in civil war. These four alternative definitions highlight the many different circumstances that can lead a state to be categorized under the umbrella term of "failed state", and the danger of adopting prescriptive one-size-fits-all policy approaches to very different situations. As a result of these taxonomical difficulties, Wynand Greffrath has posited a nuanced approach to "state dysfunction" as a form of political decay, which emphasizes qualitative theoretical analysis.

Communist society

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Communist_society
 
In Marxist thought, a communist society or the communist system is the type of society and economic system postulated to emerge from technological advances in the productive forces, representing the ultimate goal of the political ideology of communism. A communist society is characterized by common ownership of the means of production with free access to the articles of consumption and is classless, stateless, and moneyless, implying the end of the exploitation of labour.

Communism is a specific stage of socioeconomic development predicated upon a superabundance of material wealth, which is postulated to arise from advances in production technology and corresponding changes in the social relations of production. This would allow for distribution based on need and social relations based on freely-associated individuals.

The term communist society should be distinguished from the Western concept of the communist state, the latter referring to a state ruled by a party which professes a variation of Marxism–Leninism.

Economic aspects

A communist economic system would be characterized by advanced productive technology that enables material abundance, which in turn would enable the free distribution of most or all economic output and the holding of the means of producing this output in common. In this respect communism is differentiated from socialism, which, out of economic necessity, restricts access to articles of consumption and services based on one's contribution.

In further contrast to previous economic systems, communism would be characterized by the holding of natural resources and the means of production in common as opposed to them being privately owned (as in the case of capitalism) or owned by public or cooperative organizations that similarly restrict their access (as in the case of socialism). In this sense, communism involves the "negation of property" insofar as there would be little economic rationale for exclusive control over production assets in an environment of material abundance.

The fully developed communist economic system is postulated to develop from a preceding socialist system. Marx held the view that socialism—a system based on social ownership of the means of production—would enable progress toward the development of fully developed communism by further advancing productive technology. Under socialism, with its increasing levels of automation, an increasing proportion of goods would be distributed freely.

Social aspects

Individuality, freedom and creativity

A communist society would free individuals from long working hours by first automating production to an extent that the average length of the working day is reduced and second by eliminating the exploitation inherent in the division between workers and owners. A communist system would thus free individuals from alienation in the sense of having one's life structured around survival (making a wage or salary in a capitalist system), which Karl Marx referred to as a transition from the "realm of necessity" to the "realm of freedom". As a result, a communist society is envisioned as being composed of an intellectually-inclined population with both the time and resources to pursue its creative hobbies and genuine interests, and to contribute to creative social wealth in this manner. Marx considered "true richness" to be the amount of time one has at his disposal to pursue one's creative passions. Marx's notion of communism is in this way radically individualistic.

In fact, the realm of freedom actually begins only where labor which is determined by necessity and mundane considerations ceases; thus in the very nature of things it lies beyond the sphere of actual material production.

Capital, Volume III, 1894

Marx's concept of the "realm of freedom" goes hand-in-hand with his idea of the ending of the division of labor, which would not be required in a society with highly automated production and limited work roles. In a communist society, economic necessity and relations would cease to determine cultural and social relations. As scarcity is eliminated, alienated labor would cease and people would be free to pursue their individual goals. Additionally, it is believed that the principle of "from each according to his ability, to each according to his needs" could be fulfilled due to scarcity being non-existent.

Politics, law and governance

Marx and Engels maintained that a communist society would have no need for the state as it exists in contemporary capitalist society. The capitalist state mainly exists to enforce hierarchical economic relations, to enforce the exclusive control of property, and to regulate capitalistic economic activities—all of which would be non-applicable to a communist system.

Engels noted that in a socialist system the primary function of public institutions will shift from being about the creation of laws and the control of people into a technical role as an administrator of technical production processes, with a decrease in the scope of traditional politics as scientific administration overtakes the role of political decision-making. Communist society is characterized by democratic processes, not merely in the sense of electoral democracy, but in the broader sense of open and collaborative social and workplace environments.

Marx never clearly specified whether or not he thought a communist society would be just; other thinkers have speculated that he thought communism would transcend justice and create society without conflicts, thus, without the needs for rules of justice.

Transitional stages

Marx also wrote that between capitalist and communist society, there would be a transitory period known as the dictatorship of the proletariat. During this preceding phase of societal development, capitalist economic relationships would gradually be abolished and replaced with socialism. Natural resources would become public property, while all manufacturing centers and workplaces would become socially owned and democratically managed. Production would be organized by scientific assessment and planning, thus eliminating what Marx called the "anarchy in production". The development of the productive forces would lead to the marginalization of human labor to the highest possible extent, to be gradually replaced by automated labor.

Open-source and peer production

Many aspects of a communist economy have emerged in recent decades in the form of open-source software and hardware, where source code and thus the means of producing software is held in common and freely accessible to everyone; and to the processes of peer production where collaborative work processes produce freely available software that does not rely on monetary valuation.

Ray Kurzweil posits that the goals of communism will be realized by advanced technological developments in the 21st century, where the intersection of low manufacturing costs, material abundance and open-source design philosophies will enable the realization of the maxim "from each according to his ability, to each according to his needs".

In Soviet ideology

The communist economic system was officially enumerated as the ultimate goal of the Communist Party of the Soviet Union in its party platform. According to the 1986 Programme of the CPSU:

Communism is a classless social system with one form of public ownership of the means of production and with full social equality of all members of society. Under communism, the all-round development of people will be accompanied by the growth of the productive forces on the basis of continuous progress in science and technology, all the springs of social wealth will flow abundantly, and the great principle "From each according to his ability, to each according to his needs" will be implemented. Communism is a highly organised society of free, socially conscious working people a society in which public self-government will be established, a society in which labour for the good of society will become the prime vital requirement of everyone, a clearly recognised necessity, and the ability of each person will be employed to the greatest benefit of the people.

The material and technical foundation of communism presupposes the creation of those productive forces that open up opportunities for the full satisfaction of the reasonable requirements of society and the individual. All productive activities under communism will be based on the use of highly efficient technical facilities and technologies, and the harmonious interaction of man and nature will be ensured.

In the highest phase of communism the directly social character of labor and production will become firmly established. Through the complete elimination of the remnants of the old division of labor and the essential social differences associated with it, the process of forming a socially homogeneous society will be completed.

Communism signifies the transformation of the system of socialist self-government by the people, of socialist democracy into the highest form of organization of society: communist public self-government. With the maturation of the necessary socioeconomic and ideological preconditions and the involvement of all citizens in administration, the socialist state—given appropriate international conditions—will, as Lenin noted, increasingly become a transitional form "from a state to a non-state". The activities of state bodies will become non-political in nature, and the need for the state as a special political institution will gradually disappear.

The inalienable feature of the communist mode of life is a high level of consciousness, social activity, discipline, and self-discipline of members of society, in which observance of the uniform, generally accepted rules of communist conduct will become an inner need and habit of every person.

Communism is a social system under which the free development of each is a condition for the free development of all.

In Vladimir Lenin's political theory, a classless society would be a society controlled by the direct producers, organized to produce according to socially managed goals. Such a society, Lenin suggested, would develop habits that would gradually make political representation unnecessary, as the radically democratic nature of the Soviets would lead citizens to come to agree with the representatives' style of management. Only in this environment, Lenin suggested, could the state wither away, ushering in a period of stateless communism.

In Soviet ideology, Marx's concepts of the "lower and higher phases of communism" articulated in the Critique of the Gotha Program were reformulated as the stages of "socialism" and "communism". The Soviet state claimed to have begun the phase of "socialist construction" during the implementation of the first Five-Year Plans during the 1930s, which introduced a centrally planned, nationalized/collectivized economy. The 1962 Program of the Communist Party of the Soviet Union, published under the leadership of Nikita Khrushchev, claimed that socialism had been firmly established in the USSR, and that the state would now progress to the "full-scale construction of communism", although this may be understood to refer to the "technical foundations" of communism more so than the withering away of the state and the division of labor per se. However, even in the final edition of its program before the party's dissolution, the CPSU did not claim to have fully established communism, instead claiming that the society was undergoing a very slow and gradual process of transition.

Fictional portrayals

Several works of utopian fiction have portrayed versions of a communist society. Some examples include: Assemblywomen (391 BC) by Aristophanes, an early piece of utopian satire which mocks Athenian democracy's excesses through the story of the Athenian women taking control of the government and instituting a proto-communist utopia; The Law of Freedom in a Platform (1652) by Gerrard Winstanley, a radical communist vision of an ideal state; News from Nowhere (1892) by William Morris, describing a future society based on common ownership and democratic control of the means of production; Red Star (1908, Russian: Красная звезда), Alexander Bogdanov's 1908 science fiction novel about a communist society on Mars; and The Dispossessed: An Ambiguous Utopia (1974) by Ursula K. Le Guin, set between a pair of planets: one that like Earth today is dominated by private property, nation states, gender hierarchy, and war, and the other an anarchist society without private property.

The economy and society of the United Federation of Planets in the Star Trek franchise has been described as a communist society where material scarcity has been eliminated due to the wide availability of replicator technology that enables free distribution of output, where there is no need for money.

The Culture novels by Iain M Banks are centered on a communist post-scarcity economy where technology is advanced to such a degree that all production is automated, and there is no use for money or property (aside from personal possessions with sentimental value). Humans in the Culture are free to pursue their own interests in an open and socially-permissive society. The society has been described by some commentators as "communist-bloc" or "anarcho-communist". Banks' close friend and fellow science fiction writer Ken MacLeod has said that The Culture can be seen as a realization of Marx's communism, but adds that "however friendly he was to the radical left, Iain had little interest in relating the long-range possibility of utopia to radical politics in the here and now. As he saw it, what mattered was to keep the utopian possibility open by continuing technological progress, especially space development, and in the meantime to support whatever policies and politics in the real world were rational and humane."

Mad in America

From Wikipedia, the free encyclopedia
Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill
Cover of the first edition
AuthorRobert Whitaker
CountryUnited States
LanguageEnglish
SubjectPsychiatry
PublisherPerseus Publishing
Publication date
2002
Media typePrint (Hardcover and Paperback)
ISBN978-0-465-02014-0
OCLC48779542

Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill is a 2002 book by medical journalist Robert Whitaker, in which the author examines and questions the efficacy, safety, and ethics of past and present psychiatric interventions for severe mental illnesses, particularly antipsychotics. The book is organized as a historical timeline of treatment development in the United States.

Mad in America received positive reviews from the general public and mixed reviews from the medical community, which criticized some bias in sourcing but nonetheless acknowledged the need to address the critical questions raised by the book regarding modern psychiatry.

Synopsis

Part One: The Original Bedlam (1750–1900)

Part One describes early treatments like a spinning chair which could reach 100 revolutions per minute, the Tranquilizer Chair which immobilized patients, and water therapies. Whitaker then describes moral treatment, dating back to 1793 and the French Revolution and established in the U.S. by Quakers in 1817, in which lay superintendents treated the mentally ill in small homes with great kindness and had good outcomes: About 35 to 80 percent of patients were discharged within a year, the majority of them cured. Pennsylvania Hospital reported that about 45 percent of patients were discharged as cured and 25 percent discharged as improved. In Worcester State Hospital, 35 percent were chronically ill or had died while mentally ill. Dr. George Wood, a visitor, reported in 1851:

"...you encounter persons walking, conversing, reading or variously occupied, neatly and often handsomely dressed, to whom as you pass you receive an introduction as in ordinary social life; and you find yourself not unfrequently quite at a loss to determine whether the persons met with are really the insane, or whether they may not be visitors or officials in the establishment."

Part Two: The Darkest Era (1900–1950)

Part Two describes the rise of eugenics, which did away with moral treatment in favor of forced sterilization of the mentally ill, and led to newly invigorated fields of psychiatry and neuroscience whose experts practiced insulin coma, metrazol convulsion, forced electroshock, and lobotomy.

Part Three: Back to Bedlam (1950–1990s)

Chlorpromazine, marketed in the U.S. as Thorazine, was first synthesized by Rhône-Poulenc in 1950.

Part Three describes the discovery of phenothiazines and the advent of the neuroleptic drugs that were derived from them, such as chlorpromazine (Thorazine) by Rhône-Poulenc in France, and its purchase by Smith, Kline & French (today known as GlaxoSmithKline). The drug "produced an effect similar to frontal lobotomy", according to early reports by the company's lead investigator. Whitaker says that pharmaceutical advertising, articles published in the scientific literature, and stories in the media of "miracle drugs" transformed Thorazine into a healing drug.

Whitaker says that marketing money from pharmaceutical companies began to flow to the American Medical Association in 1951, a year after Thorazine was synthesized, because of the Durham-Humphrey Amendment to the Federal Food, Drug, and Cosmetic Act which "greatly expanded the list of medications that could only be obtained with a doctor's prescription".

In Part Three, Whitaker also describes the American (but not for example British) propensity to classify patients as "schizophrenic", as well as the error (confusion of schizophrenia with the yet-to-be-discovered encephalitis lethargica) in the original classification by Emil Kraepelin, which psychiatry chose to not revisit and fix. Whitaker then describes three pathways that dopamine may take in the human brain, and quotes first-person accounts of the effects of antipsychotic drugs on individuals.

He calls a 1996 New York Times advertisement by a consortium of pharmaceutical companies a "bald-faced lie": the group sought to say that the cause of psychosis and schizophrenia is an abnormal dopamine level and that their drugs worked by altering the level of dopamine. Whitaker then criticizes some American studies, and points out the work of George Crane at the National Institute of Mental Health to get tardive dyskinesia recognized, which up to that point had largely been touted as a symptom of schizophrenia, and he contrasts the dosages that British doctors were comfortable in prescribing (300 milligrams per day of Thorazine) with what American psychiatrists prescribed (1,500 up to perhaps 5,000 milligrams per day).

He sees irony in the fact that The New York Times reported on Soviet forced use of neuroleptic drugs (which Florida Senator Edward Gurney called "chemicals which convert human beings into vegetables") in "psychiatric jails", but called the same drugs "widely acknowledged to be effective" when reporting on American schizophrenic patients.

Whitaker describes the demise of modern-day moral treatment in a short history of Loren Mosher's Soteria Project, funded by the U.S. while Mosher was chief of schizophrenia at NIMH. He attributes the results in a World Health Organization 1979 study of outcomes for schizophrenia patients (which found better outcomes in undeveloped countries like India, Nigeria and Colombia than in developed countries like the United States, England, Denmark, Ireland, Russia, Czechoslovakia and Japan) to doctors in the developed world who maintained their patients on medications.

He then describes 50 years of American scientists doing experiments on schizophrenia patients: to intentionally exacerbate their symptoms and study the results. He compares the doctors' behavior, unfavorably, to 1947 after American trials of Nazi doctors ended in the Nuremberg Code for ethics in human experimentation.

Part Four: Mad Medicine Today (1990s–Present)

Part Four is Whitaker's description of drug trials for the newer atypical antipsychotics. He says that many of these trials were stacked in favor of the drug being proposed by eliminating the placebo, or by comparing multiple doses of the new drug against a single, very high dose of the old one. He says that the pharmaceutical companies and the press used their influence to make claims for these drugs (some claims that the Food and Drug Administration had explicitly asked them not to make). Risperidone and olanzapine, for example, were both claimed to have fewer side effects than the first generation of antipsychotics. Whitaker also tells the stories of patients whose deaths were caused by drug trials, but were not mentioned to the public.

Epilogue

Whitaker calls it a type of medical fraud that schizophrenics are told that they suffer from too much dopamine or serotonin activity and that drugs put these brain chemicals back in "balance". And suggests that it would not be tolerated to mislead patients with verified pathological disease such as cancer and heart disease. He writes, "Little is known about what causes schizophrenia. Antipsychotic drugs do not fix any known brain abnormality, nor do they put brain chemistry back into balance. What they do is alter brain function in a manner that diminishes certain characteristic symptoms...." . Which in various parts of the book he claims or alludes to the drugs having this effect on all other fundamental aspects of personality and behaviors, including the ability to take care of oneself, a notion he later explores more critically in Anatomy of an Epidemic.

Reception

Recognizing Whitaker for marshalling evidence, a reviewer writing for the Chicago Tribune thought his hopes for moral treatment were admirable but inadequate. Writers for The Baltimore Sun and In These Times both liked the book but wondered why the author did not mention Thomas Szasz, a critic of psychiatry.

Scholarly journal reviews

Clinical psychologist Claudia Bukszpan Rutherford acknowledged that though the author holds an extreme position, the book's insight into many of the problems of clinical psychiatry over the years has good points: "While at times his lack of editorial restraint actually distracts from his message, and one may not agree with all of his arguments, his topic is a vital one that has needed to be raised for quite some time, and one which will hopefully be a catalyst for further discussion."

The book was also reviewed in JAMA, where reviewer Daniel J. Luchins, MD, of the University of Chicago observed the review of scientific literature to be biased at times. Despite this, Luchins concluded the book was of value in highlighting social aspects of treatment in psychiatry.

Physician J. van Gijn, reviewing the book for the New England Journal of Medicine, writes that "the book is more of an indictment than a historical account", and starts by pointing out that Whitaker "virtually equates mental illness with schizophrenia; depression and other psychiatric disorders are mentioned only parenthetically." Van Gijn summarizes the pre-1950 coverage of the book without much commentary, but then criticizes the rest of the book. Specifically, he questions Whitaker's assertion that Kraepelin's schizophrenia patients in fact suffered from encephalitis lethargica. With regard to antipsychotic medication, van Gijn notes that "Although there may be truth in the notion that dosages of antipsychotic drugs in the United States are higher than necessary, the author weakens his position by issuing continuous and unrelenting condemnations (for instance, “The Nuremberg Code doesn't apply here”), despite a dearth of evidence to support them." Van Gijn then describes Whitaker's attack on the dopamine hypothesis of schizophrenia as "simplistic reasoning", and concludes that "Although [Whitaker] is widely read on the subject, the facts are largely arranged to suit his prejudice, especially in the chapters on drug treatment. American psychiatric institutions may have their failings in the current management of patients with schizophrenia, but they deserve better critics."

Psychologist Clare Mundell, PhD, writing for the Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry said Mad in America "should be required reading not only for mental health professionals, but also for those who still question whether profit has eclipsed patient care as the primary force in medicine in this country."

Online reviews

David Pilgrim, writing "News of scandal is a few decades too late" for Times Higher Education, focuses on the book's shortcomings, saying, "The semi-academic froth he generates distracts the reader from a legitimate outrage, which is not his alone. It was shared by many others well before 1998" (the year Whitaker began writing on mental health).

Physician Larry S. Goldman wrote a critical review of the book in WebMD's Medscape Today, claiming that Whitaker "is ready to throw the baby out with the bath water" because Mad in America fails to acknowledge any biological abnormalities in schizophrenia, while at the same conceding that Whitaker's argument is correct in the sense that the true causes of schizophrenia are not known. Goldman concludes that the "overheated style" of the book "tends to undermine some of its more important points, such as the unhealthy symbiosis between the US pharmaceutical industry and much of the psychiatric research community and the ever-present miserliness of public mental healthcare systems."

In a rejoinder to Goldman's review, physician Nathaniel S. Lehrman disagrees with Goldman, and writes that "Whitaker is right", and goes on to agree with the main points in the book, namely that antipsychotic drugs cause brain damage, that despite "psychiatrically produced misconceptions", they "do not fix any known brain abnormality nor do they put brain chemistry back into balance. What they do is alter brain functions in a manner that diminishes certain characteristic symptoms." Lehrman then writes that all the data accumulated on the neurobiology of schizophrenia "has hardly helped patient care."

Lehrman later wrote in the official journal of the conservative political organization the Association of American Physicians and Surgeons, the Journal of American Physicians and Surgeons that Mad in America is "perhaps the most important psychiatric book of the 21st century."

Christian Perring, editor of Metapsychology Online Review and who was impressed by the book, wrote, "Even though Whitaker himself could be accused of being overly critical of psychiatry, his argument against schizophrenia medication is cogent enough to urgently require an answer."

E. Fuller Torrey writing for the Treatment Advocacy Center called it "histrionic" and "deeply disappointing."

Physician Marcia Angell, MD, writing a two-part review for The New York Review of Books called this and similar books "powerful indictments of the way psychiatry is now practiced", documenting "the 'frenzy' of diagnosis, the overuse of drugs with sometimes devastating side effects, and widespread conflicts of interest."

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