Psychiatric Dogmatism

In November, Joanna Moncrieff, MD, a British psychiatrist who works as a Senior Lecturer in psychiatry at University College London and a practicing consultant psychiatrist, started her own blog.  What’s remarkable about this blog is that it is highly critical of psychiatry.  Dr. Moncrieff marshals important facts and arguments in this area, and it is probably safe to say that her popularity among her peers is in decline.

The facts that she adduces, however, are indisputable, and her qualities of honesty, courage, and integrity are evident in everything she writes.

So far, she has written six posts. The central theme of three of these posts is antipsychotic (or as I prefer to say, neuroleptic) drugs.

Psychiatry has its head in the sand: Royal College of Psychiatrists rejects discussion of crucial research on antipsychotics (Dec 20)  Quote:

“It seems not to be interested in discussing the serious harm its drugs can do to both physical and mental health, and in taking the steps necessary to minimise this harm. The profession appears to believe that if it keeps quiet about these inconvenient findings, and discusses them as little as possible, the fuss will blow over and nothing need change.” 

Antipsychotics and brain shrinkage: an update (Dec 13)  Quote:

“People need to know about this research because it indicates that antipsychotics are not the innocuous substances that they have frequently been portrayed as. We still have no conclusive evidence that the disorders labelled as schizophrenia or psychosis are associated with any underlying abnormalities of the brain, but we do have strong evidence that the drugs we use to treat these conditions cause brain changes. This does not mean that taking antipsychotics is not sometimes useful and worthwhile, despite these effects, but it does mean we have to be very cautious indeed about using them.”

Long-term Antipsychotics – making sense of the evidence (Dec 9)  Quote:

“This study [Wunderink et al] should fundamentally change the way antipsychotics are used. These are not innocuous drugs, and people should be given the opportunity to see if they can manage without them, both during an acute psychotic episode and after recovery from one. If psychiatrists had not forgotten the lessons of the past, and if they had been prepared to acknowledge what they saw the drugs doing with their own eyes, this would have come about long ago.”

Whilst all of Dr. Moncrieff’s writing is compelling, it was this last quote that particularly caught my attention, and caused me to articulate the following questions:

  • Why have psychiatrists not acknowledged what they saw the drugs doing with their own eyes?
  • How did it come to be that highly educated and intelligent people became so enamored of their professional dogma that they failed to recognize the damage that neuroleptic drugs were doing and continue to do?
  • And, with particular reference to the last decade or so, how have they been able  to participate, apparently with clear consciences, in the huge increase in the use of these products, even to children as young as 2 years? 

In my view the answers to these questions fall into two general categories:  self-interest and fear.

SELF-INTEREST

For the past fifty or sixty years, the prescribing of psychopharmaceutical products has brought considerable benefit to the psychiatric profession.  Firstly, it has provided them a good living ($190,000 per annum in the US) for relatively non-taxing work (15- minute med checks).  Secondly, it has boosted their perceived status in the eyes of other medical practitioners.

It’s largely forgotten now, but during the 60’s and even into the 70’s, psychiatrists were widely regarded by the medical community as a coterie of quacks who delved endlessly and pointlessly into such chimerical abstractions as unconscious impulses, Oedipus complexes, ids, etc…  Today psychiatrists prescribe drugs, have their own medical journals which often have pictures of brain scans, and conduct randomized controlled trials.  They’ve become “respectable,” or at least somewhat respectable, and they recognize that this respectability is intrinsically dependent on their symbiotic relationship with pharma.

FEAR

The kind of fear that I’m talking about here might more correctly be termed peer pressure – the fear of being ostracized or marginalized by one’s professional colleagues.  In my interactions with psychiatrists during my career, I gained the impression that in medical colleges there’s relatively little emphasis placed on discussion and opinions, and relatively high emphasis on absorbing the facts as passed down by the academics.  Other disciplines stress discourse and debate, especially at doctoral level, but medicine leans towards a traditional didactic model and conformity to orthodoxy.  I’m not saying that this is necessarily a bad thing.  Four years of medical school passes quickly, and there’s a lot of factual material to be learned.  But the inevitable result is that medical practitioners tend to be followers of orthodoxy rather than innovators.  The rationale is that the academic researchers will pursue the innovations, and the toilers in the field will follow protocol.

In and of itself this isn’t a bad model.  Similar dynamics occur in engineering.  But – and this is crucial – for the past 40 years or so academic psychiatry has been hijacked by pharma!  The only innovation that’s allowed to occur is:  more drugs for more people.

In this kind of context it’s almost impossible for a junior psychiatrist in a hospital or a mental health center to challenge the standard philosophy.  And as the years pass, it becomes even more difficult, because any challenge of this sort inevitably involves a critical review of one’s own career.

It’s almost as if there’s a macabre conspiracy of silence among psychiatrists concerning the spuriousness of their concepts and the damage they inflict on their clients.  In their “hearts” they all know that it’s there, and that it’s enormous, but no one is allowed to talk about it.  No one is allowed to wake the monster, because they intuitively know that the monster will devour them all.

 

  • Francesca Allan

    Joanna Moncrieff is a brave and valuable ally and we’re lucky to have her.

    Compare her honest and compelling research to, say, Fuller Torrey’s “Antipsychotic drugs, as a group, are one of the safest groups of drugs ….” The frightening thing about forced drugging enthusiasts is that they actually think they’re doing some good.

    Turning my back on psychiatric labeling and its associated chemical treatment was the best decision I ever made.

  • mjhoward

    This is just anexcellent article. It reminded me of a
    few years back having attended a University of Minnesota CME hosted by the two
    idiot-morons that were the PI and Co-PI of the CAFÉ’ study at the U. Being a lay person walking into the hotel where the CME was being held was like walking down the midway of our local state fair. Carnival barkers from about a dozen pharma companies lined the hallway and babes with tight dresses and padded bras seduced everyone toward their booth.
    And it went downhill from there once inside.

    Many of the modern day psychiatrist are nothing more than super-sales-men..er..just like used cars. They prey on fear and cater to hope. And once
    they have you, they’ll keep you coming back for more, and more, and still more.
    Very seldom do their victims realize how often or how skillfully they are being
    cheated. I think most people assume that a rogue or quack psychiatrist would be easy to spot. Often that’s not the case as they wear or conceal themselves under the cloak of science. They use scientific terms and either quote or misquote scientific references or “peer reviewed” papers. A drug isn’t a drug…it’s a compound, and other psychiatrists are referred to as “the community,” not just other doctors.

    What sells is not the quality of their data or the drug itself, but their ability to influence their audience. To those families or individuals in pain or crisis they promise
    relief, and to the prescribers’ in the audience the message was strong and
    clear “make sure you medicate enough.” To one and all, the promise was better health and a longer life simply from attending the CME and listening to the snake charmers disseminate the pharma sponsored data. Every panel speaker introduced was some psychiatrist labeled as a scientist ahead of his time as far as mental illness
    treatment went. The message was clear, business is booming for the psychiatrist
    willing to take out his/her pen and write that script. Off-label promotion…no problem, simply make a token statement on the program that you may or may not speak about off-label usage of some atypical neuroleptic and hell, you’re free to say whatever you’re paid to say. Even the CME program publication was slanted to stimulate business for the advertisers…which just happened to be
    the manufacture’s of the drugs being discussed by the distinguished panels, and
    the gracious host. The product list was almost endless on how these wonder
    drugs could cure the gout, common cold, hang nails, fear of public speaking etc….all
    of course without almost a single side effect.

  • Phil_Hickey

    mjhoward,

    Thanks for coming in. Sounds like a tawdry spectacle!

  • mjhoward

    “Tawdry” is absolutely right on. Cheap in substance of any quality, but definitely showy. Dr’s Schulz and Olson were to speak on the results from CAFE’ and CATIE, Olson was scheduled for 45 minutes regarding CAFE’…he spoke for 12 minutes and would not take questions. Schulz stood up at the podium and thank every blessed pharma company in the world for their financial support of the CME, stated he would speak about unapproved uses of the atypicals, and proceeded to do for about 4 hours. But hey, I even was awarded my CME credits in the mail !!!!and I’m as far from being a medical professional as horses are from flying. It just proved to me that the whole charade of the pharma sponsored CME’s being hosted by the “good old boys club”, (KOL’s) was as far from real data and science as bigfoot living in my backyard.

  • cledwyn bulbs

    “Why have psychiatrists not acknowledged what they saw the drugs doing with their own eyes?”

    Woh now Phil, are you actually suggesting that psychiatrists know about the harm they are causing, after all, if they can see it, all this talk about unforeseen consequences rings hollow.

    The truth is, I would say, psychiatrists generally know exactly what they are doing. I would never deny that often many of them try to do good working within the hierarchies they are a part of, but if they know about the harm they are doing, the examples of which are often presented to their own eyes, then how can this be reconciled to the notion that they desire to do good, in anything other than a few cases perhaps?

    For example, on MIA, a woman named Sandy Steingard, regularly writes self-incriminating articles, seemingly oblivious to the fact that she is putting on exhibition how much knowledge she has of the harm that neuroleptics cause to the people she forcibly administers them to. I used to question the taken for granted nobility of her motives on this issue, partly because, at least intuitively, I understood that there can be no defence of people like her; because she simply cannot plead ignorance; she knows exactly what she is doing.

    In this example, can anyone honestly say she means well towards the person who she, with full awareness of the torment she might be inflicting on the victim, and the damage she might be causing to the most sensitive organ in the human body, attacks with a loaded needle?

    Yes, there are situations in which one adminsters to medical patients harmful drugs (such as chemotherapeutic agents) because the possible benefit justifies the harm, but involuntary psychiatrists rarely find themselves in such situations. Instead, they find themselves in situations where for legal, administrative and economic reasons, they impose damaging “treatments” upon people which they know to be harmful, but who nevertheless expect to be taken seriously when they plead that they mean well, which they no doubt do in some circumstances, but in all, such as the foregoing example?

    It’s possible that sometimes they knowingly administer the drugs because of a concern that the patient might kill himself. In that situation, maybe they are well-intentioned, but these drugs are administered in a variety of circumstances which make it much harder to believe that, in relation to the victim of this procedure, the offender is well-intentioned.

    Nevertheless, the assumption that generally these people are desperate to help is assumed as axiomatic in an age when men like to think that by ignoring the darker side of human nature, and by labelling some of us (who try to draw attention to the darkness in man because evil thrives upon ignorance, and you don’t make a problem go away by burying your head in the sand) paranoid schizophrenics and cynical, nasty misanthropes, we make these problems go away. In truth, I would say denial of evil only serves to facilitate its growth (which the sanctimonious “lovers of humanity” might want to remember), so that a refusal to face up to the facts arrayed against the notion that man is living in some sort of state of prelapsarian innocence, is in itself evil. Maybe this is why Schopenhauer considered the now all too fashionable optimism regarding human nature to be both wicked and a sinister mockery of the suffering of humans at the hands of members of their own species.

    The assumption of good intentions is even enforced on sites like MIA (ironically by someone who regularly invokes science for rhetorical purposes, yet shows little of the skepticism that animated its founding regarding the claims and beliefs of others about their own intentions), because of the prevailing spirit that values the sensitivities of supposed vulnerables over the truth, which in the current climate is regularly suppressed on the grounds that it might hurt someone!