Andrew Scull
British-American sociologist and historian of psychiatry, emeritus professor at UC San Diego
Andrew Scull (British-American sociologist and historian of psychiatry, emeritus professor at UC San Diego) has appeared as a guest on 1 episode in TMT. Topics they speak about most include Diagnostic and Statistical Manual of Mental Disorders, Antipsychotic, Electroconvulsive therapy.
In their words
Positions and remarks grouped by topic, each with the exact quote and where it was said.
Other remarks
Scull calls for research funding for the psychosocial dimensions of mental illness rather than only drugs, neuroscience and genetics.
“We have spent all our monies on drugs, on neuroscience, and on genetics. But there are other things we could do that would improve the lives of families and patients”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 3:33:53
Scull considers the evidence that ketamine and psychedelics cure depression to be very weak.
“I see ketamine and psychedelics being propounded as a miracle cure for depression. The evidence for that is enormously weak”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 1:44:07
Scull warns that research funding cuts and lost trust will cost roughly a decade of scientific progress.
“If you have four years with nobody being trained, you're talking about a decade being lost. And what's lost is invisible, because it's counterfactual”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 1:40:20
Diagnostic and Statistical Manual of Mental Disorders
Scull reports Allen Frances's view that rising autism diagnoses stem mainly from loosened DSM-IV criteria.
“is more driven by the fact he loosened the criteria for the diagnosis than it is because there are more actual cases”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 3:22:45
Scull describes Rosenhan's On Being Sane in Insane Places as a scientific fraud that nonetheless spurred DSM-III's reform of diagnosis.
“via a very famous study that's a scientific fraud. by David Rosenhorn called On Being Sane in Insane Places”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 14:10
Antipsychotic
Scull highlights the CATIE study finding that most patients dropped out of antipsychotic trials due to inefficacy or side effects.
“Between 67% and 82% of the patients, depending on which drug they were on, dropped out of the trial”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 3:15:17
Scull argues that current psychiatric drugs are symptomatic treatments rather than cures.
“What we have available to us are symptomatic treatments, not cures. We don't have a psychiatric penicillin for any of the conditions we're going to be talking about”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 8:45
Electroconvulsive therapy
Scull acknowledges that recent controlled trials provide enough evidence that ECT helps some severely depressed patients, though its mechanism is unknown.
“there's enough evidence now that it's hard to say, this never works, this is just one of these desperate remedies we should consign to the Dark Ages”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 2:00:56
Scull argues that in mid-century hospitals ECT functioned more as behavioral control than therapy.
“ECT was much more used as a device to control people's behavior than as a therapeutic intervention. It was quite punitive”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 1:33:12
Psychiatric hospital
Scull argues that community care following deinstitutionalization was largely illusory.
“But community care is a shell game without a P. It's like one of those confidence tricks”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 35:22
Scull says the largest inpatient psychiatric facilities in the US are now jails.
“the Los Angeles County Jail, Cook County Jail in Chicago, and Rikers Island in New York. That's shocking because by their very nature, of course, prisons aren't equipped”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 33:44
Selective serotonin reuptake inhibitors
Scull argues antidepressants beat placebo statistically but often not to a clinically meaningful degree.
“for most patients, antidepressants are marginally better. the placebo, but a lot of the effect is the placebo effect”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 3:30:08
Cognitive behavioral therapy
Scull judges CBT to work better than drugs for milder depression, consistent with NICE guidance, while its evidence is otherwise modest.
“for the milder forms of depression, I think CBT works better. than the drugs, without some of the side effects that the drugs have”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 2:53:28
Insulin shock therapy
Scull notes that insulin coma therapy failed once subjected to a controlled trial in the 1950s.
“Insulin comas weren't subjected to a randomized controlled trial until the 1950s. And when they were subjected to a controlled trial, they failed it”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 1:25:32
Focal infection theory
Scull says nearly half of Henry Cotton's abdominal surgery patients died within a year despite claims of cure.
“in reality, 45 percent of the people who get the abdominal surgery die”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 1:17:08
Aktion T4
Scull states that the gas chamber technology of the Holocaust was developed in the Nazi killing of mental patients.
“It was in the mass killing of the mentally ill, which may have been as many as a quarter million people, that the technology of the gas chamber was developed”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 48:23
National Institute of Mental Health
Scull recounts Thomas Insel conceding that $20 billion of NIMH-funded research had not improved the lives of the mentally ill.
“And after spending $20 billion, the lot of the mentally ill has improved not one bit”
Lex Fridman Podcast: #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung (Sep 17, 2026) · Listen from 17:44
Appearances
#502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & JungLex Fridman Podcast · Sep 17, 2026
Historian Andrew Scull talks with Lex Fridman about the history of psychiatry, from asylums, eugenics, lobotomy and ECT to Freud, CBT, psychiatric drugs and psychiatry's current crisis.
Often appears with
- Lex Fridman · 1 shared episode