Author Archives: Phil Hickey

About Phil Hickey

I am a licensed psychologist, presently retired. I have worked in clinical and managerial positions in the mental health, corrections, and addictions fields in the United States and England. My wife Nancy and I have been married since 1970 and have four grown children.

The Biological Evidence for “Mental Illness”

On January 2, 2017, I published a short post titled Carrie Fisher Dead at Age 60 on Behaviorism and Mental Health.  The article was published simultaneously on Mad in America.

On January 4, a response from Carolina Partners was entered into the comments string on both sites.

Carolina Partners in Mental Healthcare, PLLC, is a large psychiatric group practice based in North Carolina.  According to their website, they comprise 14 psychiatrists, 7 psychologists, 34 Advanced Practice Nurse Practitioners/Physicians Assistants, and 43 Therapists and Counselors.  They have 27 North Carolina locations.

Partners’ comment consists essentially of unsubstantiated assertions, non sequiturs, and appeals to psychiatric authority.  As such, it is fairly typical of the kind of “rebuttals” that psychiatry’s adherents routinely direct towards those of us on this side of the issue.  For this reason, and also because it comes from, and presumably represents the views of, an extremely large psychiatric practice, it warrants a close look.

I will discuss each paragraph in turn.

“We strongly disagree with this article, which neglects a lot of important information and uses selective hearing to distort what Carrie Fisher was about and also to distort the evidence for mental illness as a real disorder.”

My Carrie Fisher article was brief (566 words), and was intended as a counterpoint to the very widespread obituaries that lionized her as a champion of “bipolar disorder”.  The essential point of my article was that Ms. Fisher had been a victim of psychiatry, and like a great many such victims, died prematurely.  Obviously I neglected a lot of important information.  I could have gone into great length as to the recklessness of psychiatry assigning the bipolar label, with all its implications of helplessness, disempowerment, and “chemical imbalance” to a young woman who by her own account was, at the time, using any drugs she could get her hands on.  But I felt that a brief and respectful statement of the facts was all that was needed.

. . . . . . . . . . . . . . . .

“Mental illnesses have a long history of biological evidence. For example, researchers have demonstrated that people with depression have an overactive area of the brain, called Brodmann area 25. Schizophrenia has been linked to specific genes, as PTSD and autism have been linked to specific brain abnormalities. Suicide has been linked to a decreased concentration of serotonin in the brain. OCD has been linked to increased activity in the basal ganglia region of the brain.”

Brodmann area 25 (BA25)
Partners did not provide a specific reference in support of this contention, but my best guess is that the reference is Mayberg, HS, et al (1999) Reciprocal Limbic-Cortical Function and Negative Mood: Converging PET Findings in Depression and Normal Sadness (Am J Psychiatry 1999; 156:675–682).  Here’s the study’s primary conclusion:

“Reciprocal changes involving subgenual cingulate [which includes Brodmann area 25] and right prefrontal cortex occur with both transient and chronic changes in negative mood.”

What this means essentially is that negative mood, whether transient or enduring, is correlated with changes in both the subgenual cingulate (Brodmann area 25) and the right pre-frontal cortex, and that when the depression is relieved, the changes are reversed.

This, of course, is an interesting finding, but provides no evidence that depression, mild or severe, transient or enduring, is caused by a biological pathology.

The reality is that all human activity is triggered by brain activity.  Every thought, every feeling, every action has its origins in the brain.  I cannot lift a finger, blink an eye,  scratch my head, or recall my childhood home without a characteristic brain function initiating and maintaining the action in question.  Without stimuli from the brain, my heart will stop beating, my respiratory apparatus will shut down, and I will die, unless these functions are maintained by machines.

So there is absolutely no surprise in the discovery that sadness and despondency have similar neural triggers and maintainers.  It would be amazing if they didn’t.  But – and this is the critical point – this does not warrant the conclusion that sadness which crosses arbitrary and vaguely-defined thresholds of severity, duration, and frequency is best conceptualized as an illness caused by pathological or excessive activity in BA 25.

Depression is a normal state.  It is the normal human reaction to significant loss and/or living in sub-optimal conditions/circumstances.  It is also an adaptive mechanism, the purpose of which is to encourage us to take action to restore the loss and/or improve the conditions.

All consciously-felt human drives stem from unpleasant feelings.  Thirst drives us to seek water; hunger, food; hypothermia, warmth; hyperthermia, coolness; danger, safety, etc.  Sadness and despondency are no exceptions.  They drive us to seek change, and have been serving the species well since prehistoric times.

But – as is the case with all the above examples – when a drive is not acted upon, for whatever reason, the unpleasant feelings worsen.  Just as unrequited hunger and thirst increase in strength, so the depression drive when not requited deepens.

The reality is that most people deal with depression in appropriate, naturalistic, and time-honored ways.  If the source of the depression is the loss of a job, they start job-hunting.  If the source is an abusive relationship, they seek ways to exit or remediate the situation.  If the source is a shortage of money, they seek ways to budget more sensibly, or increase their earnings; etc.

Depression, either mild or severe, transient or lasting, is not a pathological condition.  It is the natural, appropriate, and adaptive response when a feeling-capable organism confronts an adverse event or circumstance.  And the only sensible and effective way to ameliorate depression is to deal appropriately and constructively with the depressing situation.  Misguided tampering with the person’s feeling apparatus is analogous to deliberately damaging a person’s hearing because he is upset by the noise pollution in his neighborhood, or damaging his eyesight because of complaints about litter in the street.

Our feeling apparatus is as valuable and adaptive as our other senses.  But psychiatry routinely numbs, and in many cases permanently damages, this apparatus to sell drugs and to promote the fiction that they are real doctors.  Their justification for this blatantly destructive activity hinges on the false notion that depression becomes a diagnosable illness when its severity crosses arbitrary and vaguely-defined thresholds.  But deep despondency is no more an illness than mild despondency.  The latter is the appropriate and adaptive response to minor losses and adversity.  The former is the appropriate and natural response to more profound or more enduring adversity.  Though, of course, what constitutes profound adversity will vary enormously from person to person.  An individual, for instance, raised to the expectation of stable and permanent employment may be truly heartbroken at the loss of a job.  Another individual, raised to the notion that there’s always another job “around the corner” will, other things being equal, be less affected.  And so on.

In this regard, it’s noteworthy that Partners’ comment refers to overactivity in BA 25.  The use of the prefix over implies pathology, but in reality there is no yardstick to determine what would be a correct amount of activity for BA 25.  All that can be said, on the basis of Mayberg et al’s findings, and subsequent BA 25 research, is that when a person is sad, there is more activity than when he is happy.  So the use of the term “overactivity” is deceptive – sneaking in the notion of pathology without any genuine or valid reasons to consider it so.  The “reasoning” here is:

–  depression is an illness
–  depression is correlated with high activity in BA 25
–  therefore high activity in BA 25 is pathological

In other words, the contention of pathology rests on the assumption that depression is an illness.  To turn around and use this falsely inferred pathology to prove that depression is an illness is obviously fallacious.  It is also typical of the kind of circular reasoning that permeates psychiatric contentions.  In reality, there is nothing in Mayberg et al or in subsequent research that warrants the conclusion that the increased activity in BA 25 is pathological or excessive.

. . . . . . . . . . . . . . . .

Schizophrenia linked to specific genes
This assertion, that schizophrenia is linked to specific genes, is frequently adduced in these debates, as evidence that “schizophrenia” is a real illness with a biological pathology.  Here again, Partners do not provide any references in support of this assertion, but there have been a number of studies in the past fifteen years or so that have found links of this kind.  However, in all cases, the correlations have been small.  In other words, there are always a great many individuals who have been assigned the “schizophrenia” label, but who do not have the gene variant in question; and there are a great many who have the gene variant, but who do not acquire the label “schizophrenia”.  To date, no genetic test has been found helpful in confirming or refuting a “diagnosis of schizophrenia”.

An additional problem arises here, in that the assertion that “schizophrenia has been linked to specific genes” is often interpreted as meaning that “schizophrenia” is a genetic disease, which it emphatically is not.  To illustrate this, let’s look briefly at a real genetic illness:  polycystic kidney disease (PKD).  This is a well established genetic illness caused by cysts in the kidneys.  The cysts progressively block the flow of blood through the kidneys, causing tissue death.

Most cases of PKD are caused by the defective gene (PKD-1).  In polycystic kidney disease, the pathology occurs because the PKD-1 gene causes the nephrons to be made from cyst wall epithelium rather than nephron epithelium.  And cyst wall epithelium produces fluid which accumulates in, and ultimately destroys, the nephrons and the kidney.

So the gene determines the structure of the nephron wall.  This is the primary genetic effect.  This structure causes the wall to produce fluid.  As the nephrons become increasingly blocked, the kidneys produce less urine.  So, reduced urination is a secondary effect of the gene PKD-1.  Symptoms of PKD don’t usually emerge until adulthood, but about 25% of children with PKD1 experience pain and other symptoms.  So a child growing up with polycystic kidney disease may feel sick much of the time.  Such a child, other things being equal, is likely to be fussier and more distressed than other children, and it is entirely possible that one could find a weak correlational link between gene PKD-1 and childhood fussiness, though, of course, any search for such a correlation will be confounded by the obvious fact that children can be habitually fussy for other reasons.  The fussiness would be a tertiary effect of the gene PKD1.

And from there the causal chain could continue in various ever-weakening directions.  For instance, the child might become somewhat sad and despondent.  Or it could be that the child received extra attention and comforting from his parents and was fairly content, and so on.  Ultimately the outcome is impossible to predict with any kind of precision, and the best we can expect from genes vs. subsequent behavior studies are weak, tenuous correlations.

Cleft palate is another example of a pathology that is caused by a gene defect; actually a gene deletion.  This condition results in a characteristically strained and nasal speech quality which can be quite stigmatizing.  The nasal speech is a secondary effect of the gene deletion.

Children with this kind of speech are sometimes mocked and bullied by their peers.  The child might react to this kind of stigmatizing by speaking as little as possible, by withdrawing socially, or in various other ways.  These reactions would be considered tertiary effects of the defect.  And so on.  As with the PKD, each step in the chain takes us further from the genetic defect, and the statistical associations grow proportionally weaker, and it would be stretching the matter to say that the lack of speech was caused by the gene deletion.  Nor would one conclude that the child’s social withdrawal was a symptom of a genetic disease.  And this is true even though the link between the deletion  and the cleft palate is clear-cut and direct.

In the same way, it is simply not tenable to claim that “schizophrenic” behaviors (e.g. disorganized speech) are symptoms of a genetic disease.  This is particularly the case in that correlations between the “diagnosis” and genetic anomalies are typically very small.  The effects of any minor genetic anomalies that might exist have had ample opportunity to be shaped by social and environmental factors, and these are more credible causal constructs.

“Schizophrenia” is not a unified condition.  Rather, it is a loose collection of vaguely defined behaviors.  For this reason, any genetic research done on this condition will inevitably result in conflicting and confusing results.  It’s like looking for genetic similarities in all the people who play bridge, or read romance novels, visit libraries, play football, or whatever.  If the sample sizes are large enough, and in genetic research sample sizes are often enormous, one could probably find small effects in all or most of these areas, but no one would conclude from this that these are genetically determined activities, much less illnesses.

A person’s ability to learn depends on two general factors:  a) the structure of his brain, as determined by his DNA, and b) his experiences since birth.

One can’t learn to play the piano, for instance, unless one has appropriate neural apparatus, and fingers, both of which require appropriate DNA.  But even a person with good genetic endowment in these regards, will never learn to play unless he is exposed to certain environmental factors.  He must, at the very least, encounter a piano.  In the same way, a person whose genetic endowment might be relatively marginal might become an excellent pianist, if he were to receive persistent environmental encouragement and support.

Similar reasoning can be applied to the behavior of not-being-“schizophrenic.”  This behavior involves navigating the pitfalls of late adolescence/early adulthood, and establishing functional habits in interpersonal, occupational, and other important life areas.  Obviously it requires appropriate neural apparatus, hence the weak correlations with genetic material, but equally clearly it calls for a nurturing childhood environment, with opportunities for emotional growth and acquisition of social, occupational, and other skills.

Given all of this, it’s not surprising that researchers are finding correlations between DNA variations and a “diagnosis” of schizophrenia, but given the number of links in the causal chain and the multiplicity of possible pathways at each link, it is also not surprising that the correlations are always found to be weak, and of little or no practical consequence.

Nor is it surprising that the correlations between being labeled “schizophrenic” and various psychosocial factors are by contrast generally strong.  Having a schizophrenia label is correlated with childhood social adversity, childhood abuse and maltreatment, poverty, and a family history of migration.

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Generally similar considerations apply to Partners contentions with regards to “PTSD”, “autism”, suicide, and “OCD”, but space precludes a detailed discussion here.

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“Eric Kandel, MD, a Nobel Prize laureate and professor of brain science at Columbia University, says, ‘All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases…The brain is the organ of the mind. Where else could [mental illness] be if not in the brain?'”

Dr. Kandel (now 87 years old) is an eminent neuroscience researcher at Columbia University.  There’s an extensive biography in Wikipedia.  His early research focused on the neurophysiology of memory.  He has received numerous awards, including the Nobel Prize in Physiology/Medicine (2000), and is widely published.  His record of research achievements is enormous, and his knowledge and expertise are vast, but in the statement quoted by Partners, and, incidentally, by other psychiatry adherents, he is simply wrong.

Let’s take a closer look.  Logically, the Kandel quote can be stated symbolically as:  A is identical to B; therefore malfunctions or aberrations in A are malfunctions or aberrations in B.

On the face of it, this seems sound, and indeed, it is a valid inference in some situations.  For instance, the furnace in a person’s home is the primary heating appliance; therefore, malfunctions in the furnace are malfunctions in the primary heating appliance.  Indeed, in a simple example of this sort, the statement is tautological.  We are simply substituting the synonyms furnace and primary heating appliance, and the inference contains no new information or insights.  But the inference is fallacious in more complex matters.

Let’s concede, for the sake of discussion, that the premise of the Kandel quote is true, i.e., that all mental processes are brain processes.  The term mental processes embraces a wide range of activities, including sensations, perceptions, thoughts, choices, positive feelings, negative feelings, hopes, beliefs, speaking, singing, general behavior, etc.

The term “disorders of mental functioning” is harder to define, but, again for the purposes of discussion, let’s accept the APA’s catalog as definitive in this regard.  Let’s accept that anything listed in the DSM is a “disorder of mental functioning”.

It’s immediately obvious that some of the DSM entries are indeed the result of brain malfunctioning.  In the text these are referred to as disorders due to a general medical condition or to the effects of a substance.  But in the great majority of DSM labels, no such biological cause is identified, and so the conclusion in the Kandel quote would appear to call for some kind of evidence or proof.  However, in the Kandel quote, the conclusion is not presented as something that has been, or even needs to be, proven.  Rather, it is presented as a logical conclusion inherent in, and stemming directly from, the premise.  And it is from this perspective that the Kandel quote needs to be evaluated.

To pursue this, let’s consider the example of “oppositional defiant disorder”.  This is a disorder of mental functioning as defined above, because it is listed in the DSM.  And according to Dr. Kandel’s “logic”, it is also therefore a “biological disease”.  The “symptoms” of oppositional defiant disorder as listed in DSM-5 are:

  1. Often loses temper.
  2. Is often touchy or easily annoyed.
  3. Is often angry and resentful.
  4. Often argues with authority figures or, for children and adolescents, with adults.
  5. Often actively defies or refuses to comply with requests from authority figures or with rules.
  6. Often deliberately annoys others.
  7. Often blames others for his or her mistakes or misbehavior.
  8. Has been spiteful or vindictive at least twice within the past 6 months. (p 462)

Obviously for any of these behaviors to occur, there has to be corresponding neural activity. But there is no necessity that the neural activity is diseased or malfunctioning in any way.  A child learning from his environment, developing his behavioral repertoire in accordance with the ordinary principles or learning, could acquire any or all of these behavioral habits without any malfunctioning in his neural apparatus.  We acquire counterproductive habits as readily, and by essentially the same processes, as we acquire productive ones.  In general, if a child discovers that he can acquire power and control in his environment by throwing temper tantrums, he will, other things being equal, acquire the habit of throwing temper tantrums.  Similarly, if arguing with parents and other authority figures yields positive results, there is a good chance that this also will become habitual.  And this is not because there is anything wrong with the child’s brain.  Rather, it’s because his brain is functioning correctly.  He is internalizing as habits those decisions and actions that pay off.  It is often observed in child-raising practice that if you’re not training your children, they’re training you.

Similar observations can be made about the other seven “symptoms” of oppositional defiant disorder, and indeed all the DSM labels.  A person with a perfectly normal-functioning brain can acquire the habits in question if the circumstances are conducive to this learning.

So to return to the question in the Kandel quote:  “Where else could [mental illness] be if not in the brain?”, the answer is clear:  In the self-serving and unwarranted perception of psychiatrists.  Mental illness is the distorting lens through which psychiatrists view all problems of thinking, feeling, and behaving.  It is the device they use to legitimize their drug-pushing and to maintain the fiction that they are practicing medicine.

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“You’re right that mental illness is also affected by social and environmental conditions–by a person’s disposition, or upbringing, or current environment. It’s also true that mental illness is affected by drug use (both prescribed and not prescribed). So are other medical conditions, such as heart disease and cancer.”

I’m not sure where Partners are coming from here, because I never made any such statement.  In my view, which I have stated clearly on numerous occasions, “mental illness” is a psychiatric invention, self-servingly created to promote the spurious notion that all problematic thoughts, feelings, and/or behaviors are illnesses.  And not just illnesses in some vague allegorical sense, but real illnesses “just like diabetes”, which need to be treated by medically trained psychiatrists with mood-altering drugs and high voltage electric shocks to the brain.

Partners’ vague concessions concerning environment, child-rearing, and drug effects is a fairly standard psychiatric sop, but doesn’t mitigate their earlier contentions on the “long history of biological evidence” and their uncritical endorsement of the logically spurious Kandel quote.

. . . . . . . . . . . . . . . .

“And it’s true that mental illness is often difficult to diagnose because of
1) the current limitations of the field of research. Thomas R. Insel, MD, director of the National Institute of Mental Health, for example, talks about how the diagnosis and treatment of mental illness today is where cardiology was 100 years ago, concluding that we need to continue scientific research of mental illnesses.  (There’s a longer quote on this below.)”

And (from later in the comment)

“Longer aforementioned quote:
Take cardiology, Insel says. A century ago, doctors had little knowledge of the biological basis of heart disease. They could merely observe a patient’s physical presentation and listen to the patient’s subjective complaints. Today they can measure cholesterol levels, examine the heart’s electrical impulses with EKG, and take detailed CT images of blood vessels and arteries to deliver a precise diagnosis. As a result, Insel says, mortality from heart attacks has dropped dramatically in recent decades. ‘In most areas of medicine, we now have a whole toolkit to help us know what’s going on, from the behavioral level to the molecular level. That has really led to enormous changes in most areas of medicine,’ he says.

Insel believes the diagnosis and treatment of mental illness is today where cardiology was 100 years ago. And like cardiology of yesteryear, the field is poised for dramatic transformation, he says. ‘We are really at the cusp of a revolution in the way we think about the brain and behavior, partly because of technological breakthroughs. We’re finally able to answer some of the fundamental questions.'”

It is at least forty years since I started hearing about psychiatry’s great biological breakthroughs that were just around the proverbial corner, and the promise, if my readers will pardon the pun, is getting a little old.

What’s noteworthy, however, is that in other disciplines, where there is hope or expectation of breakthroughs, the proponents of these endeavors generally wait until the evidence is in, before implementing practices based on these hopes.  In fact, to the best of my knowledge, psychiatry is the only profession whose entire work, indeed, whose entire conceptual framework, is based on “evidence” and “breakthroughs” that are not yet to hand.

Note also the truly exquisite contrast between Partners’ earlier and confident contention that “mental illnesses have a long history of biological evidence” with the assertion here that the “diagnosis” and “treatment” of “mental illness” today is where cardiology was 100 year ago.

Incidentally, Dr. Insel, former Director of the NIMH, also said:

“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’ – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.” (Transforming Diagnosis, 2013)

And let us be quite clear.  “Lack of validity” in this context means that the “diagnoses” don’t actually correspond to any disease entities in the real world.  Note also that Dr. Insel didn’t say poor validity, or low validity.  He said lack of validity – meaning none.

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Back to the Carolina Partners comment:

“2) mental illness symptoms often overlap with symptoms caused by other illnesses, for example, someone with cancer may also become depressed after diagnosis. Or someone’s fatigue may be caused by a vitamin deficiency, rather than by depression.

While considering all these factors, it is still completely inaccurate to state that there is no biological foundation for mental illnesses. They are not ‘make-believe’ diseases, but rather are caused by a variety of factors, including biological ones. As we understand more about mental illness through research we will (as we have with cardiology, for example) gain more precise vehicles for measuring and understanding the biological implications of these disorders.”

This is a little rambling, but let’s see if we can unravel it.

“… someone with cancer may also become depressed after diagnosis.”

This is true.  In fact, I would say that most people who contract serious illness become somewhat sad and despondent.  But this in no way establishes the notion that the sadness should be considered an additional illness.

“…someone’s fatigue may be caused by a vitamin deficiency, rather than by depression.”

This quote contains one of psychiatry’s core fallacies:  that the various “mental illnesses” are the causes of their respective symptoms (as is the case in real illness).  To illustrate the fallacy, consider the hypothetical conversation:

Client’s wife:  Why is my husband so tired all the time?
Psychiatrist:  Because he has an illness called major depressive disorder.
Client’s wife:  How do you know he has this illness?
Psychiatrist:  Because he is tired all the time.

Psychiatry defines major depression (the so-called illness) by the presence of five “symptoms” from a list of nine, one of which is fatigue, and then routinely adduces the “illness” to explain the symptoms.  In reality, the “symptoms” are entailed in the definition of the “illness”, and the explanation is entirely spurious.  There are many valid reasons why a person might feel fatigued, but none of these is because he “has a mental illness”.  Mental illnesses are merely labels with no explanatory significance.  And because of the inherent vagueness in the criteria, they’re not even good labels.

“…it is still completely inaccurate to state that there is no biological foundation for mental illnesses.”

As stressed above, there is a biological foundation to everything we do – every thought, every feeling, every eye blink, every action.  But – and this is the point that seems to evade psychiatry – there is no good reason to believe that the various problems catalogued in the DSM are underlain by pathological biological processes.  And there are lots of very good reasons to believe that they are not.

“They are not ‘make-believe’ diseases, but rather are caused by a variety of factors, including biological ones.”

I don’t think I’ve ever used the term “make-believe” to describe psychiatric “illnesses”, though I do routinely describe psychiatric labels as invented.  The two terms are not synonymous.  What psychiatry calls mental illnesses are actually nothing more than loose collections of vaguely-defined problems of thinking, feeling, and/or behaving.  In most cases the “diagnosis” is polythetic (five out of nine, four out of six, etc.), so the labels aren’t coherent entities of any sort, let alone illnesses.

But the problems set out in the so-called symptom lists are real problems.  That’s not the issue.  I refer to these labels as inventions, because of psychiatry’s assertion that the loose clusters of problems are real diseases.  In reality, they are not genuine diseases; they are inventions.  They are not discovered in nature, but rather are voted into existence by APA committees.

“As we understand more about mental illness through research we will (as we have with cardiology, for example) gain more precise vehicles for measuring and understanding the biological implications of these disorders.”

But meanwhile psychiatry has made up its mind.  Within psychiatric dogma, all  significant human problems of thinking, feeling, and behaving are illnesses that need to be “treated” with drugs and electric shocks.

. . . . . . . . . . . . . . . . . 

FINALLY

All of this is interesting, and I suppose it’s important to refute the more or less steady stream of unsubstantiated assertions, fallacious reasoning, and spin that flows from the psychiatric strongholds.

But meanwhile the carnage continues.  There is abundant prima facie evidence that psychiatric drugs are causally implicated in the suicide/murders that have become almost daily occurrences here in the US.  My challenge to organized psychiatry is simple:  call publicly for an independent, definitive study to explore this relationship.  And my challenge to rank and file psychiatrists is equally simple:  pressure the APA to call for such a study.  If what you are doing is unqualifiedly wholesome, safe, and effective, then what do you have to fear?

 

Carrie Fisher, Dead at Age 60

Actress Carrie Fisher died on December 27, 2016, at the early age of 60.

In a 2001 article on Healthy Place,  she was described as “Perhaps one of manic-depression’s best-known champions…”

Here’s another quote from the same article:

“I’m fine, but I’m bipolar. I’m on seven medications, and I take medication three times a day. This constantly puts me in touch with the illness I have. I’m never quite allowed to be free of that for a day. It’s like being a diabetic.”

PSYCHIATRY’S MODUS OPERANDI

First they sell you the “illness” that they’ve invented.

Then they sell you the drugs to “treat” the “illness”.

Then they sell you more drugs to counteract the adverse effects.

Then they sell you electric shocks to the brain.

Then you die prematurely.

Then they wring their hands in mock anguish, and say what a terrible illness this is, and that without their “safe and effective treatments”, you would have died a lot sooner.

PSYCHIATRY IS NOT MEDICINE

Psychiatry is irredeemably flawed and rotten.  There is truly no human problem that psychiatry does not make ten times worse.  How much longer must this carnage continue?  How many more lives will be ruined?    Where is their sense of decency?  And where is general medicine’s sense of outrage?

To what excesses of spin, venality, corruption, and destruction does psychiatry need to descend before decent doctors everywhere will speak out, and denounce this murderous hoax?  Psychiatry has long since forfeited any right it might ever have had to be considered a medical specialty.

INCIDENTALLY

In September 2011, The European Heart Journal published Honkola, J., Hookana, E., et al Psychotropic medications and the risk of sudden cardiac death during an acute coronary event.  Here’s the conclusion:

“The use of psychotropic drugs, especially combined use of antipsychotic and antidepressant drugs, is strongly associated with an increased risk of SCD at the time of an acute coronary event.”

. . . . . . . . . . . . . . . .

On April 20, 2013, the Sarasota Herald Tribune published Carrie Fisher talks about mental illness and career.  The article is an interview conducted by Elizabeth Johnson.  Here are two quotes:

“Q: Is there anything specific that causes a manic state?

A: When I was doing drugs, what caused it was stopping. I’d just get thrown off. Sleep deprivation, hurting your sleep cycle in general can be a problem. If I knew whatever it was, I would do better than I do, but I do very well.

Q: What treatment are you on now?

A: I take ECT (electroconvulsive therapy) and lots of medication.”

. . . . . . . . . . . . . . . .

“Q: What drugs were you using before that diagnosis [bipolar]?

A: Anything that you had. I smoked pot first when I was 13, but I really didn’t get heavily into that. I never could take alcohol. I always said I was allergic to alcohol, and that’s actually a definition to alcoholism — an allergy of the body and an obsession of the mind. So I didn’t do other kinds of drugs until I was about 20. Then, by the time I was 21 it was LSD. I didn’t love cocaine, but I wanted to feel any way other than the way I did, so I’d do anything.”

 

My Response to a Defender of Psychiatry

On October 13, an interesting article was published on the Huffington Post Blog.  The author is Jessica Gold, MD, a psychiatry resident at Stanford University; the post is titled Inpatient Psychiatry: Not all Needles, Drugs And Locks.

The article is a personal experience/opinion piece, the gist of which is that people who criticize or condemn psychiatry simply don’t understand the complexities and needs of psychiatry’s “patients”, particularly the need for locked wards.

The article is generally unremarkable in that the arguments adduced are well-worn by more senior psychiatrists.  But it is interesting, and indeed tragic, to see a new entrant to the field absorbing psychiatry’s defensive nonsense, and trotting it out uncritically for public consumption.

. . . . . . . . . . . . . . . .

Dr. Gold begins by describing the kinds of interactions she experiences in social settings when people learn that she is a psychiatrist.

Then:

“However, what frustrates me most are the times when after describing my day-to-day as a psychiatry resident, I am met with bewilderment, followed by misplaced sarcasm as I am asked, ‘And why would you want to do that?'”

Dr. Gold then becomes reflective:

“After reminding myself not to get defensive (as I continued to do throughout writing this piece) or just stop the conversation completely, I became intrigued. While doctors may not evoke the same respect and adoration of the days of house visits, no one asks the other doctors (non-psychiatrists) in my family with such strong negative connotation why they chose their respective specialties.

I began to wonder if it’s because the difference between a locked ward and a medical ward can seem confusing and scary to an outsider or a patient. Without knowing the safety rationale, it can feel degrading to have your clothes taken away, along with your cell phone, shoelaces, and sharp objects, only to sleep in a boring room with heavy, non-moveable (or throw-able) furniture. If you lack insight into your illness and do not understand the necessity of hospitalization, it can feel prison-like to be on a locked ward without the ability to leave it. And, without understanding the therapeutic benefit of engaging in connections with others on the unit, it can feel restrictive to have visiting hours and not be able to have a significant other or family member spend the night.”

So Dr. Gold is frustrated by the sarcasm she encounters when social acquaintances discover that she is a psychiatrist, and notes that other medical specialties do not generally attract this kind of response. She wonders if the reason for this differential response might be:

“… because the difference between a locked ward and a medical ward can seem confusing and scary to an outsider or a patient.”

This is a truly delightful piece of self-deceptive spin.  Psychiatry’s so-called patients might well feel scared of locked wards, and understandably so.  But the notion that fears of this sort underlie the general public’s negative perception of psychiatry is arrant nonsense.  The general public’s negative perception of psychiatry, as compared to genuine medical specialties, is grounded in a realistic appraisal of psychiatry’s spurious concepts and destructive “treatments”.  In particular, psychiatry is negatively perceived because:

  1. Psychiatry’s definition of a mental disorder/ illness, as set out in DSM III, IV, and 5, embraces virtually every significant problem of thinking, feeling, and/or behaving. Psychiatry uses this definition to fraudulently medicalize problems that are not medical in nature.
  1. Psychiatry routinely presents these so-called illnesses as the causes of the specific problems, when in fact they are merely labels: abbreviated rewordings of the presenting problems with no explanatory function or value.  These labels, which cause enormous damage to the individuals to whom they are assigned, serve only to legitimize the pushing of drugs, and to enable psychiatrists to bill for the services they provide.  Unlike real diagnoses, they provide no insight into the nature or essence of the presenting problems, but are nevertheless defended tenaciously by psychiatrists and their pharma funders.
  1. Psychiatry has routinely deceived, and continues to deceive, their clients, the public, the media, and government agencies, that these vaguely defined problems are in fact illnesses with known neural pathology. The classic example of this is the chemical imbalance theory of depression – a blatant hoax which was pushed so heavily by psychiatry that it has now become “common knowledge”.  And the most noteworthy aspect of this is that although the hoax has been exposed repeatedly – (most recently by Terry Lynch in his book Depression Delusion), psychiatry has taken no concerted steps to correct this misinformation, and indeed in many quarters is still promoting this fiction as established medical fact.
  1. Psychiatry has blatantly promoted drugs as corrective measures for these illnesses, when in fact it is well-known in pharmacological and psychiatric circles that no psychiatric drug corrects any neural pathology. In fact, the opposite is the case.  All psychiatric drugs exert their effect by distorting or suppressing normal brain functioning.  It is also well known that the adverse effects of these products are often devastating and permanent.
  1. Psychiatry has collaborated and conspired with pharma in the development of a vast body of fraudulent research, all designed to “demonstrate” that psycho-pharmaceutical products are safe and effective. The methods by which this fraud has been perpetrated include:  the routine suppression of negative results; the use of ridiculously short follow-up intervals; over-stating of marginal results; suppression of adverse effects; etc., etc.
  1. A great many psychiatrists have shamelessly accepted large sums of pharma money for very questionable activities. These activities include the widespread presentation of pharma infomercials in the guise of CEUs; the ghost-writing of books and papers which were actually written by pharma employees; targeting of captive and vulnerable audiences in nursing homes, group homes, and foster-care systems for prescription of psychiatric drugs; etc., etc…   Two glaring examples of this kind of venality are:

In this context, it should be noted that Dr. Biederman and Dr. Frances are among the most eminent and prestigious psychiatrists in the US.

In addition, 70% of the DSM-5 task force members had received funding from the pharmaceutical industry.

  1. Psychiatry’s labels are inherently disempowering. To tell a person, who in fact has no biological pathology, that he has an incurable illness, for which he must take psychiatric drugs for life, is an intrinsically disempowering act which robs people of hope, and encourages them to settle for a life of drug-induced dependency and mediocrity.
  1. Psychiatry’s “treatments”, whatever transient feelings of well-being or tranquilization they may induce, are always destructive and damaging in the long-term. Neuroleptic drugs cause tardive dyskinesia.  Extended use of antidepressants produces a state of chronic joylessness.  Benzodiazepines are addictive.  High-voltage electric shocks to the brain erase memories.  Psychiatry’s notion that one can solve people’s problems by tinkering irresponsibly with their brains, betrays a degree of arrogant naivety unequalled in other professional groups.
  1. Psychiatry’s spurious and self-serving medicalization of every significant problem of thinking, feeling, and/or behaving, effectively undermines human resilience, and fosters a culture of powerlessness, uncertainty, and dependence. Powerful, time-honored concepts such as the need for critical self-appraisal, and personal improvement through effort, have been systematically marginalized by psychiatry’s expanding list of “illnesses”, and ever-flowing supply of drugs.  Relabeling as illnesses, problems which previous generations accepted as matters to be addressed and worked on, and harnessing billions of pharma dollars to promote this false message, is morally and professionally repugnant.
  1. Psychiatry’s primary agenda over the past four or five decades has been the expansion of its list of “illnesses”, and the assignment of these illnesses to more and more people. It has now become routine practice to prescribe neuroleptic drugs to elderly nursing home residents who become “unmanageable”, and to young children for temper tantrums!

This is the profession that Dr. Gold chose to enter and now chooses to defend with patronizing platitudes.

. . . . . . . . . . . . . . . .

Back to Dr. Gold’s paper:

“Dear future and past patients: I. COMPLETELY. GET. IT. Nothing about being on a psychiatric ward is typical, even for a medical setting. But I (and every nurse, social worker, psychologist, occupational therapist, physical therapist, nursing assistant, and physician I have ever worked with) also really want to help you. That is why I chose a career in medicine, and even more true of the reason why I chose to specialize in psychiatry. I worry the images you have of inpatient psychiatry scare you and prevent you from seeing me as an ally. Even when I tell you that I am here to help, I can see the skepticism in your eyes and hear the fear in your voice. I am trained to observe, after all.

It is not surprising, then, that when I read descriptions or see my job portrayed as forceful or horrific, I want to take the time to correct them. I am not doing this simply because I want to protect my profession, but am actually doing this in defense of and in support of anyone who might need mental health help in the future. Stigmatizing attitudes toward psychiatric illnesses already exist; fear of psychiatry and seeking care do not need to be added to the equation.”

In recent years, the psychiatric survivor movement has grown, both in numbers and in the volume of output.  Survivors are writing about the mistreatment they have received, often for decades, at the hands of psychiatry.  But Dr. Gold dismisses these protests as erroneous and misinformed over-reactions.  Psychiatry’s so-called patients:  “lack insight” into their illnesses; do not understand “the necessity of hospitalization”; do not understand “the therapeutic benefit of engaging in conversations with others on the unit”; don’t realize that the psychiatrists who authorized the forcible injection of akathisia-inducing drugs “really” want to help; etc..

And Dr. Gold is taking the time to correct these misperceptions, not simply because she wants to protect her profession (Heavens, no!), but rather in defense and support of anyone who might need psychiatric help in the future.  How noble!

“Maybe people will always fear psychiatry, mental illness and what they do not know…But maybe those attitudes can be changed and as mental health advocates, we need to do everything we can to assuage those fears. Unfortunately, even well-meaning former patients perpetuate those fears, whether inadvertently or because of the limited lens through which they viewed their own hospitalization.”

To which I might respond:  Even well-meaning psychiatrists perpetuate these fears, whether inadvertently or because of the erroneous and destructive disease-focused lens through which they view their “patients” and their “treatments”.

The rationalizations and self-justifications continue:

“I’ve been screamed at, cursed at, rushed towards, demeaned and have seen patients and nurses get seriously injured.  Even still, I do not make these decisions lightly or lead a conversation with a needle.”

The great irony here is that the neuroleptic drugs that psychiatrists routinely use to control aggressive behavior frequently produce a condition called akathisia, which in turn is a known precipitator of suicide and violence.  Crowner, Douyon, et al, conducted a short study of this matter in 1990.  Here’s a quote from their paper:

“Akathisia is a common side effect of neuroleptic drugs that may present with behavioral disturbances. There have been preliminary reports on the association between violence and akathisia. We report the first observational study of this relationship. Patients studied were from a special unit for violent patients. A closed-circuit television camera was installed in each of the corners in its dayroom. Incidents of assault plus the 5 minutes preceding each assault were recorded on videotape. Participants and bystanders were rated for the motor component of akathisia. For each of nine incidents, we compared the akathisia scores for participants and for bystanders. Both victims and assailants were akathisic before about half of all incidents; bystanders rarely were. The classification of the movements we rated and the implications for further studies are discussed.”

It would be interesting to know how many of the individuals who screamed, cursed at, rushed towards, and demeaned Dr. Gold were experiencing akathisia as a result of neuroleptic or antidepressant drugs that she had prescribed for them.  It is also interesting that no major follow-up of the Crowner, Douyon, et al study has been undertaken by psychiatry.

. . . . . . . . . . . . . . . .

“Given the responses to our career selection in casual conversation, it is probably not shocking that I (and my peers) can sometimes hesitate to say my medical specialty, despite having no shame or regrets about my decision. Knowing now that hiding my profession only further contributes to its stigma, and without a voice or a face, psychiatrists and their patients will always just be a part of a power struggle…, I will never again shy away from it:

I am a psychiatrist-in-training. My job is complicated, weird, unique, fun, fulfilling, and challenging… but that’s what makes it beautiful.”

Well all of this is nice to know, but in my view, psychiatry is neither fun nor fulfilling for those on the receiving end, especially in the long-term..

. . . . . . . . . . . . . . . .

The reality is that psychiatry is not something good that needs some minor corrections.  Rather, it is something fundamentally flawed and rotten; a wrong turning in human history, trailing death, disability, and disempowerment in its worldwide wake.  No amount of rationalization or platitudinous exculpations can mitigate this reality.  Psychiatry kills people every day, and adamantly refuses to recognize this reality and take appropriate action.

 

Murphy Bill Being Sneaked Into House Legislation

This morning I received an email from Oldhead, who has been active in opposing the Murphy Bill.  Here are two quotes from the email:

“As succinctly as possible — the main language from MURPHY (including AOT funding) has been consolidated with another bill, the 21ST CENTURY CURES bill, which is being introduced as a House Amendment to the Senate Amendment to H.R. 34, Tsunami Warning, Education and Research Act of 2015.’  In other words, Murphy is being slipped through on another bill’s coattails, if Murphy, Jaffee & Co. have their say.”

“So there we have it, I guess.  We should be calling our congressional representatives TODAY — TUESDAY — to request that they vote AGAINST the 21ST CENTURY CURES bill being amended to H.R. 34 if it is consolidated with HR 4626 (the original Murphy bill).  You could mention that you are specifically opposed to TITLE XIV Section 14002 (AOT) [Assisted Outpatient Treatment].  I know this is a mouthful.  People with the time should focus on Democrats, but first make sure you contact your local representatives. If it’s a Republican, focus on the enormous cost and waste of taxpayer funds. Use our anti-AOT talking points as a general guide. They’re posted in the organizing forum (here) if you don’t already have them.”

On Wednesday (tomorrow), the House is expected to vote on whether to incorporate the Murphy Bill provisions into the 21st Century Cures Bill.

If there was ever a time for political lobbying, it’s now.  If you live in the US, please phone your Congressperson today, and ask him or her to oppose this amendment.  The last thing we need is any more psychiatric drugging, particularly enforced drugging.

If you don’t know how to contact your Congressman, go here.

Neuroleptic Drugs, Akathisia, and Suicide and Violence

Thirty-three years ago, in August 1983, an article titled Suicide Associated with Akathisia and Depot Fluphenazine Treatment appeared in the Journal of Clinical Psychopharmacology.  The authors were Katherine Shear, MD, Allen Frances, MD, and Peter Weiden, MD.

Here are some quotes, interspersed with my comments/observations:

“Akathisia is a common and distressing side effect of neuroleptic medication that can be difficult to recognize and treat.  Several previous reports mention maladaptive behavioral consequences, such as poor compliance with prescribed medication and aggressive or self-destructive outbursts.  We are reporting suicides in two young Hispanic men who had developed severe akathisia after treatment with depot fluphenazine.  Depression with suicidal behavior has been observed following fluphenazine injection, but suicide associated with akathisia has not been previously noted.”

Fluphenazine is a neuroleptic drug of the phenothiazine class that was introduced in 1959.  It is marketed as Prolixin and other brand names, and according to Wikipedia, is on the WHO’s “List of Essential Medicines, most important medications needed in a basic health system.”

The “treatment” used in each case was a depot injection of fluphenazine.  This is a long-lasting injection, typically 30 days, in which the drug is lodged in a dermal or muscular mass from which it is slowly drawn into the blood stream.  (Hence depot:  a place where goods are stored for later distribution.)

Depot injections have some obvious convenience value, but in psychiatry are usually used to ensure compliance.  Their major downside is that if the person has an adverse reaction to the drug, there’s no way to remove the stored chemicals from his body.

The authors may be correct in stating that this is the first published report of suicide associated with akathisia, but it is not the first report of suicide associated with fluphenazine.  Seventeen years earlier, Dorothy West, MD, had published the following letter in the British Journal of Psychiatry, 117 (1970), 718-9.

“DANGERS OF FLUPHENAZINE

Dear Sir,

A new drug is being widely used in the treatment of mental illness.  It is long-acting and used by injection – its name is fluphenazine (Moditen).  Is this the thalidomide of the 70’s?  I would like to have the opinion of other doctors.  Whilst it is still new maybe we are lulled into a false sense of security, but are we justified in using a drug, which may take up to six weeks to eradicate from the tissues, without being sure of its safety?  Its side effects alone are legion.  A study of 13 papers gives the following:
Common side-effects reported are – lethargy, drowsiness, dizziness, muscular inco-ordination, paraesthesia, hypotension, blurring of vision, dryness of mouth, malaise, feelings of tension, confusion, nausea, vomiting, and aches and pains.
Parkinsonism is extremely common.  Incidence in reports varies from 100 per cent to 24 per cent with many reports around 50 per cent.
Depression is quite common and tends to be severe – 5 suicides reported and two suicide attempts.
Other reported side-effects include psychotic relapse and glaucoma.

Dorothy West”

. . . . . . . . . . . . . . . .

Back to the Shear, Frances, and Weiden paper:

Case Reports

“Case 1

A 23-year-old single unemployed Hispanic man had been socially withdrawn, blunted in affect, and thought disordered since his early teenage years.  He was intermittently delusional with auditory hallucinations which responded to phenothiazines.  He was treated in a day hospital after one of multiple hospitalizations; depot fluphenazine was used because of medication noncompliance.  He received two injections of 25 mg of fluphenazine decanoate separated by 1 week, with noticeable improvement in his psychotic symptoms.  He also developed akathisia and was prescribed trihexyphenadyl, 2 mg twice a day, which he probably did not take.  There was no improvement in his akathisia and no anticholinergic side effects.  He soon stopped attending the day hospital and a family member called a week later to say that the man had killed himself by jumping off the roof of their building.  He had given no indication of being suicidal and his family believed the increased ‘nervousness’ had driven him to this desperate measure.  The patient had no previous history of suicidal behavior and did not drink alcohol or use drugs.”

So, we have a young man who has been socially withdrawn and joyless since his early teens.  Not surprisingly his perceptions and thinking patterns deviated from the conventional.  For reasons unknown he came within the orbit of psychiatry, and had had extensive contact with the psychiatric system.  He was given two depot injections of fluphenazine one week apart.  His “psychotic symptoms” improved, but he developed akathisia.  He was prescribed an anticholinergic agent to combat the akathisia, but apparently this was ineffective, or as the authors suggest, he didn’t take it.  In any event, a week later he killed himself by jumping from the roof of a building.

We don’t know if the fluphenazine was administered involuntarily, but we do know that he had taken phenothiazine in the past and had been noncompliant.  So it is reasonable to assume that there was some adverse effect.  Did the day hospital psychiatrists explore the reason for this “noncompliance”?  In any event, given the outcome, the phrase “depot fluphenazine was used because of medication noncompliance” is a haunting and compelling testament to psychiatric arrogance.  This anonymous young man was clearly prone to acute akathisia, and his “noncompliance” was a sensible and correct response to the neuro-poisoning he was receiving from psychiatrists.  He stopped attending the day hospital (again, understandably),but he had no way to get the drug out of his body.  The trihexyphenidyl is an anticholinergic agent and might have mitigated the akathisia.  Or perhaps he took it and it was not effective, as is frequently the case.

“Case 2

A 36-year-old non-English speaking Hispanic man was seen once in our walk-in clinic because of severe restlessness and leg cramps.  Intermittent somatic symptoms and nervousness began shortly after he arrived in the United States 8 months earlier.  When the symptoms worsened, he began a series of visits to hospital emergency rooms and private psychiatrists.  Three weeks before the walk-in visit a Spanish-speaking psychiatrist diagnosed paranoid schizophrenia and administered depot fluphenazine.  Following this injection, the patient developed a dystonic reaction and then began to complain continuously of leg cramps and restlessness.  In the ensuing weeks he received numerous drugs from emergency room or private physicians, some given by injection and some by prescription.  He brought bottles of thiothixene, chlorazepate, amitriptyline, meprobamate, and lorazepam to the clinic.  He was agitated, paced, and begged for help.  He denied symptoms of depression or suicidal ideation.  He claimed he was devoted to his wife and 9-year-old daughter, but he felt his unbearable symptoms would never go away.  He made good contact in a translated interview and showed no thought disorder, hallucinations, or delusions.  Thorough medical examination was negative except for the parkinsonian symptoms.  He had no prior history of psychiatric treatment and the family history was negative for depression, nervousness, and significant psychiatric or medical illness.  Since the diagnosis was uncertain, plans were made to discontinue all medication and a follow-up appointment was scheduled.  The next day he killed himself without warning by jumping in front of a subway train.”

The 36-year-old man had come to the US eight months earlier, and had begun to experience “somatic symptoms and nervousness”.  This seems hardly surprising in someone who is having to adapt to a new environment, but we are provided no details with regards to his psychosocial context, other than the fact that he had a wife and 9-year-old daughter, and that he didn’t speak English.  What we do know is that he visited “emergency rooms and private psychiatrists” to help with “somatic symptoms and nervousness”.  One of the psychiatrists “diagnosed paranoid schizophrenia”, and gave him a depot injection of fluphenazine.  He developed severe akathisia, and continued to visit emergency rooms and private psychiatrists in an attempt to gain some relief.  During this period he received “numerous drugs” from these sources, some by injection, some by prescription.  At this point he came to the authors’ walk-in clinic.

“He was agitated, paced, and begged for help.”

and

“He denied symptoms of depression or suicidal ideation.  He claimed he was devoted to his wife and 9-year-old daughter, but he felt his unbearable symptoms would never go away.”

Plans were made to discontinue all the drugs, which the authors euphemistically refer to as medications, but it was too little, too late.  He jumped to his death in front of a train the next day.

So, we have a healthy young man, devoted to his wife and daughter, who seeks medical help for what were probably stress-related “somatic complaints and nervousness”.  Psychiatrists throw a bewildering array of drugs at him, including a depot injection of fluphenazine, which results in his death.  And the only reason we know about this forgotten victim of psychiatry is because the authors wrote up and published the case.  How many other thousands have died from the same kind of irresponsible drug-pushing; from the same arrogant conviction that for every human problem, psychiatry has a “safe and effective” pill?

. . . . . . . . . . . . . . . .

Here are some more quotes from the Shear et al article:

“Akathisia is an intensely unpleasant feeling characterized by muscle discomfort, inability to sit still, continuous agitation, restlessness, and fidgety feelings.  Sleep may be disturbed by an inability to lie down.  Some patients say they feel like jumping out of their skin”

“The estimated incidence of akathisia with neuroleptic use ranges from 20 to 45%.  Several studies using depot fluphenazine report an incidence around 35%.”

“Akathisia is a distressing  symptom which may be difficult to diagnose and treat.  Restlessness may be mistaken for anxiety and clinicians may err by raising neuroleptic dosage.”

“Sometimes the only effective treatment is withdrawal of the neuroleptic.  Although we cannot be sure that akathisia caused the deaths of our patients, akathitic symptoms seemed to be immediate precipitants of suicidal behavior.   We urge clinicians to be alert to the discomfort of akathisia and to treat it aggressively.  If treatment with anticholinergics or γ-aminobutyric acid agonists fails or symptoms are especially severe, hospitalization may be indicated.”

It is clear that the authors are leaning heavily towards the conclusion that neuroleptic-induced akathisia was the immediate precipitant of both suicides.

OTHER SIMILAR REPORTS

Several similar reports have appeared in the literature for decades.  Here are some examples, with relevant quotes:

Van Putten, T., MD, The Many Faces of Akathisia, Comprehensive Psychiatry, 1975, 16(1):

“AKATHISIA, a common side effect of neuroleptic therapy, is an emotional state and ‘refers not to any type or pattern of movement, but rather to a subjective need or desire to move.'”

“A 44-year-old woman with hebephrenic schizophrenia started to bang her head against the wall three days after an injection of 25 mg of fluphenazine enanthate.  Her only utterance was: ‘I just want to get rid of this whole body.'”

“Akathisia is often associated with strong affects of fright, terror, anger or rage, anxiety, and vague somatic complaints.”

“On this regime, she usually developed an episode of akathisia during the week following her injection.  She described several such episodes as follows: ‘I just get these attacks of tension.  I don’t feel right.  My stomach feels strange.  It’s like I’m churning inside.  I feel hostile and I hate (with intense affect) everybody.”

“Patients have described the inner restlessness and agitation of akathisia in many other ways, such as:  ‘My nerves are just jumping’ I feel like I’m wired to the ceiling; I just feel impatient and nasty.  I can’t concentrate; it’s like I got ants in my pants; my nerves are raw; I just feel on edge; I feel just nasty; I feel like jumping out of my skin; if this feeling continues, I would rather be dead.  I can’t describe the feelings; I’m quivery from the waist up; I want to climb the walls; I feel all revved up; it’s like I got diaper rash inside.'”

“Patients with severe akathisia, however, cannot sit quietly for more than a few seconds at a time, and at times the ‘impatience musculaire’ can result in running, agitated dancing, or rocking.”

“Akathisia is tolerated very poorly by hostile paranoid patients in that they tend to misinterpret the inner agitation of akathisia as further proof that they are being poisoned or controlled by outside malevolent forces.”

Note the presumably unintended irony in the word misinterpret.  In reality, they are being poisoned and controlled by outside forces!

. . . . . . . . . . . . . . . . .

Keckich, W., MD:  Neuroleptics: Violence as a Manifestation of Akathisia, JAMA, 1978, Nov 10 (240) 20, 2185:

“NEUROLEPTIC medications (eg, phenothiazines, butyrophenones) are used in medicine to control psychotic symptoms and concomitant agitated and violent behavior. They also are used to control anxiety and agitation whenever minor tranquilizers (eg, benzodiazepines) would be inappropriate. Development of akathisia as a parkinsonian side effect is confirmed in the use of these drugs.  Akathisia is a condition that gives rise to the subjective desire to be in constant motion, with a feeling of inner agitation and muscle tension. The patient cannot sit still and paces constantly”

“One week later the patient reported that he was more agitated at night.  Since it was not known at the time that akathisia was beginning, haloperidol treatment was increased to 4 mg at bedtime to decrease the agitation. Four days later, after his evening dose of 4 mg of haloperidol, he became uncontrollably agitated, could not sit still, and paced for several hours.  He complained of tightness in his muscles, rigidity, a jumpy feeling inside, and violent urges to assault anyone near him.  This culminated in an assault on his dog with an intent to kill.  He became frightened over his loss of control and came to the emergency room.  He was given 50 mg of thioridazine hydrochloride, which brought the hostility under control but did not remove it.

He subsequently discontinued the treatment with imipramine and haloperidol.  The following morning he reported that the muscle tightness, jumpy feelings, and hostility were decreased but still present.  Three days after drug treatment was discontinued all of the symptoms had ceased, and he was at his baseline of difficulty once again.  The half-life of haloperidol is approximately 24 hours, and this symptom relief coincided with expected excretion of the drug.

In retrospect it was apparent that he had experienced increasing akathitic side effects from the haloperidol medication, which accounted for his increasing night-time agitation and culminated in a stimulation of violent and aggressive activity.”

. . . . . . . . . . . . . . . .

Schulte, JL, MD, Homicide and Suicide Associated with Akathisia and Haloperidol, American Journal of Forensic Psychiatry, Jan 1985, 6(2):

“The following five cases are reported to bring attention to the potential for severe violence, as a result of akathisia, following such administration of a neuroleptic for acute psychiatric symptoms.  Particular emphasis is directed to an experience of sensory dissociation associated with the uncomfortable physical reactions, resulting in extreme acts of physical violence.”

CASE  NO. 1

“A 23-year-old married, Salvadorian-born male, with a four-day history of progressive paranoia and disorganized behavior, had been taken by the police department to a hospital at the request of his parents.  The physician insisted he receive an injection of haloperidol in the emergency room while awaiting admission to the psychiatric unit where he had previously been a patient on a number of occasions.

  He tried to resist but felt he had no option with the staff and police surrounding him.  He felt he was being unnecessarily delayed in being admitted to the inpatient unit.  In addition, he felt he had been lied to, in that apparently he had been told he was going to see his wife who had deserted him approximately 48 hours earlier.  He then escaped from the emergency room and the authorities, ran several miles to a park, tried to get a policeman to help him, escaped again and totally disrobed.  Within the next 45-minute period of time, he assaulted one woman who was walking her dog and attempted to rape her.  When pulled off by the husband, he proceeded down the street, broke down the front door of a house where an 81-year-old lady was sleeping.  He severely beat her with his fists, ‘to a pulp’, by his own description.  Following which he found knives and stabbed her repeatedly, resulting in her death.  Then, after being confronted in the street by a policeman who sprayed him with Mace, he returned through the house, exiting the back door where he ran into another woman with her child.  He repeatedly stabbed the woman in front of the child, whereupon he moved on to the next person he encountered, a woman whom he severely assaulted and stabbed to the extent that an eye was lost and an opening into the anus was created resulting in major surgery and serious residual problems, including a colostomy.  He was then finally captured and subdued by eight policemen and hospitalized.

He had ten previous psychiatric hospitalizations between 1975 and the present.  All of these hospitalizations have been only a matter of hours to several days.  He would always be placed on medication and released, following which he would stop taking the medication and go along until another upheaval would occur.

He had a history of problems with anger and acute paranoid beliefs leading to hyperactive behavior and one incident in which it was reported he tried to choke one of his brothers.

His description of his mental status at the time of his offense is quite striking.  He describes himself as feeling almost like a spectator in a movie.  He makes a point of describing how he had lost all sense of caring about anything or anyone in life.  Additionally, he describes a feeling of loss of physical sensation, including feeling nothing when maced by the police.  He felt enormous energy with a feeling of needing to rid himself of it.

He gives the history of having been picked up by the police on a traffic violation in 1979 and placed in jail for the first time in his life.  He became angry and was given a series of haloperidol injections, becoming progressively more agitated and unmanageable to the point he was rolled up in a mattress and handcuffed in order to be transported to a psychiatric inpatient unit.  In 1980, during another hospitalization, he was, despite his protests, changed from chlorpromazine to haloperidol and within hours became totally unmanageable, requiring six individuals to subdue him and place him in seclusion and restraint.” [Emphasis added]

It is noteworthy that this individual asked not to be changed from chlorpromazine to haloperidol, but his request was ignored.

Eight years later, Herrera et al confirmed in a controlled study that an increase in violent behavior was more likely with haloperidol than with chlorpromazine.  Apparently, the individual had some intuitive awareness of this from previous experience, but as is often the case, the psychiatrists discounted his protests and gave him the haloperidol anyway.

Here are two quotes from the Herrera et al study:

“We found in a controlled study that some patients have a marked increase in violence when treated with moderately high-dose haloperidol.”

“…these patients did not show an increase in violence during a placebo period, nor did they have a history of violent behavior.”

Back to the Schulte JL article:

CASE NO. 2

“A 30-year-old man with a history of mental illness dating back seven years, with hospitalizations in three other states, was admitted to the hospital on six counts of burglary. His diagnosis was paranoid schizophrenia, and he had been found not guilty by reason of insanity by the courts. The admission note by the psychiatrist stated, ‘He is somewhat paranoid, but says he has side effects from most tranquilizers.’ On the third day of hospitalization, he was referred to the psychiatrist by nurses because of difficulty getting to sleep. No evidence of aggressiveness or self-injurious behavior was charted that day in the nurses’ notes.  The psychiatrist prescribed haloperidol, 5mg. three times a day, which was begun the next day, with three doses administered with Cogentin, 2mg twice a day. Nurses’ notes that day stated, ‘He was very anxious about being in the hospital and threatened to kill himself if he gets up the nerve.’ At 10:45 p.m., notes stated, ‘He has regressed during this shift in all assessment areas. His hygiene is poor, and he is irresponsible, e.g., lying on the floor without shoes or socks.’  He refused medication initially at 5 p. m., and stated that phenothiazines, ‘fuck me up.’  He finally took the medication but then stated angrily, ‘Now I’ll  really get crazy.’  He ranted loudly and profanely for 30 minutes. He took his 9 p.m. medication and started his haranguing again, only louder and more threatening. ‘l’ll kill all of you mother-fuckers before I leave here,’  He was found in his room at 6:50 a.m., having hung himself with a bed sheet. A letter from his attorney to the hospital had stated that ‘medications caused him problems (l should perhaps state that by medications I mean psychotropic drugs).'” [Emphasis added]

CASE NO. 3

“A 52-year-old male first came to psychiatric attention eleven years earlier following an assault on his wife. He had delusions of cancer, a belief he would die and felt sexually inadequate.

He had been unsuccessfully treated with Lithium and antidepressants, as well as various tranquilizers. He had continually been an inpatient or in board and care facilities, and three and one-half months earlier, he had his medications changed to 10mg. of Haloperidol in the a.m. and 40mg. of Haloperidol at hour of sleep, with 2mg.of Artane twice daily. Each month he stated he complained to his psychiatrist of severe restlessness. He stated he had to roll over and over in bed at night and usually would be unable to get to sleep until 3 or 4 a.m. During the day, he would try to lie down but couldn’t because of his severe uncomfortableness. He described after being turned down again by the psychiatrist, he became despondent and angry, lost hope and decided if he could not ever even sleep like the rest of his boarding home mates that life wasn’t worthwhile.  He secured a knife and repeatedly stabbed himself in the abdomen, was rushed to the hospital and barely survived.  He remarked he could never even feel the knife when stabbing himself.” [Emphasis added]

. . . . . . . . . . . . . . . .

Van Putten, T. MD and Marder, SR, MD, Behavioral Toxicity of Antipsychotic Drugs, J Clin Psychiatry, September 1987, 48: 9 (Suppl):

“The subjective restlessness of akathisia is usually accompanied by telltale foot movements: rocking from foot to foot while standing or walking on the spot. Akathisia is strongly associated with depression and dysphoric responses to neuroleptics and has even been linked to suicidal and homicidal behavior in extreme cases.”

“The aforementioned case literature reads convincingly:  it is reasonable to conclude that akathisia, in the extreme case, can drive people to suicide or homicide.”

. . . . . . . . . . . . . . . .

Crowner, ML, Douyon, R, et al, Akathisia and violence Psychopharmacology Bulletin, 1990: 26(1): 115-7:

“Akathisia is a common side effect of neuroleptic drugs that may present with behavioral disturbances. There have been preliminary reports on the association between violence and akathisia. We report the first observational study of this relationship. Patients studied were from a special unit for violent patients. A closed-circuit television camera was installed in each of the corners in its dayroom. Incidents of assault plus the 5 minutes preceding each assault were recorded on videotape. Participants and bystanders were rated for the motor component of akathisia. For each of nine incidents, we compared the akathisia scores for participants and for bystanders. Both victims and assailants were akathisic before about half of all incidents; bystanders rarely were. The classification of the movements we rated and the implications for further studies are discussed.”

The extraordinary irony here is that the individuals in this study “were from a special unit for violent patients,” but in fact the drug used to control this behavior was actually precipitating more violence!

. . . . . . . . . . . . . . . .

Galynker, I, MD, PhD and Nazarian, D, MD, letter to the editor, Journal of Clinical Psychiatry, 1997, 58: 31-32:

“Case ReportMr. A, a 47-year-old white man with a diagnosis of bipolar mood disorder, was brought to the emergency room because he was screaming in the streets.  Mr. A had over 30 past psychiatric admissions associated with agitation and violence and was often discharged against medical advice.  He was nearly always noncompliant with his antipsychotic medications, claiming that they made him ‘jump and lose my temper.’  Prior to the present admission, Mr. A’s daily medications included haloperidol 20 mg, lithium carbonate 1500 mg, divalproex sodium 500 mg, and benztropine 1 mg.  At admission, the patient was grandiose, had loud and pressured speech, and admitted he was not taking haloperidol.  He was given haloperidol 15 mg q.h.s. and benztropine 1 mg q.a.m.  Within 24 hours he started pacing; became restless, agitated, and violent; complained of feeling ‘jumpy’; and attacked a staff member.  On Day 5 of his hospitalization, haloperidol and benztropine were discontinued; chlorpromazine was started, and the dose was increased to 950 mg/day.  Mr. A, although sedated, remained threatening and violent.  On Day 13, chlorpromazine was discontinued, and haloperidol was restarted at a higher dose of 15 mg p.o. b.i.d.  Mr. A again complained of ‘jumpiness’ and punched a television cabinet, causing a self-inflicted fracture.  On hospital Day 17, owing to an error, haloperidol was discontinued.  The patient became calmer, less irritable, displayed no angry outbursts, and required no further room restrictions.  After 5 days, when the error was discovered, haloperidol was restarted at a lower daily dose of 10 mg.  Within 3 days, the patient became violent and required room restriction.  Haloperidol was then discontinued, the patient’s agitation and violence resolved, and a week later he was discharged.  His daily medications were lithium carbonate 1500 mg (serum level = 0.9mEq/L; this dose had not been changed during his hospitalization), lorazepam 1 mg, and divalproex sodium 500 mg.  On these mediations, he remained well 6 months postdischarge, his longest period as an outpatient.”

In their commentary, the authors point out:

“The fact that the jumpiness occurred with haloperidol and not with chlorpromazine is another factor indicative that Mr. A has exhibited akathisia rather than nonspecific activation of mania; this is because akathisia is more common with higher potency as compared with low-potency neuroleptics.”

and, with more candor than one customarily finds in psychiatry:

“One can also speculate that Mr. A’s rocky clinical history was related to aggressive behavior perpetuated by antipsychotic administration.”

And it is worth remembering that Mr. A’s “rocky clinical history” entailed “over 30 past psychiatric admissions associated with agitation and violence”.

. . . . . . . . . . . . . . . .

So, since at least the early 80’s, individual psychiatrists have been drawing attention to the fact that neuroleptic drugs induce akathisia in many cases, and that in some cases this can precipitate suicide and/or homicide.

AKATHISIA AND ANTIDEPRESSANTS

Although it is well known that neuroleptic drugs cause akathisia, the link between antidepressants and this condition is less widely appreciated.  The Wikipedia article on akathisia contains this:

“Antidepressants can also induce the appearance of akathisia, due to increased serotonin signalling within the CNS.”

. . . . . . . . . . . . . . . .

Hamilton, MS, MD, Obler, LA, Akathisia, suicidality, and fluoxetine, J Clin Psychiatry, 1992, Nov 53(11), 401-406, write:

“The propose[d] link between fluoxetine and suicidal ideation is explained by fluoxetine-induced akathisia and other dysphoric extrapyramidal reactions.”

and

“The literature suggests that fluoxetine-induced extrapyramidal reactions may be a mediator of de novo suicidal ideation.”

Fluoxetine is an SSRI, marketed as Prozac, Sarafem, and other names.

. . . . . . . . . . . . . . . .

Wirshing, WC, MD, Van Putten, T, MD, Rosenberg, J, MD, et al, Fluoxetine, Akathisia, and Suicidality: Is There a Causal Connection?, Arch Gen Psychiatry, 1992, 49(7), 580-581, write:

“We have now had experience with five such patients.  All were women.  None had a history of significant suicidal behavior; all described their distress as an intense and novel somatic-emotional state; all reported an urge to pace that paralleled the intensity of the distress; all experienced suicidal thoughts at the peak of their restless agitation; and all experienced a remission of their agitation, restlessness, pacing urge, and suicidality after the fluoxetine was discontinued. We describe herein five cases of what we think might be fluoxetine-induced akathisia accounting for suicidal ideation.”

Eikelenboom-Schieveld, SJM, Lucire, Y, MD, Fogleman, J, PhD, The relevance of cytochrome P450 polymorphism in forensic medicine and akathisia-related violence and suicide, Journal of Forensic and legal Medicine, 2016, 41. 65-71, wrote:

“Antidepressants have been reported as causing suicide and homicide and share the class attribute of frequently producing akathisia, a state of severe restlessness associated with thoughts of death and violence.”

and

“In this paper, we report our investigation into adverse drug reactions/interactions in three persons who committed homicide, two also intending suicide, while on antidepressants prescribed for stressful life events”

and

“Three persons committed homicide, two of which intended to commit suicide. None had been aggressive or mentally ill before getting medication. None had known that they needed to take medication regularly or how to stop taking it safely. None improved on medication, and no prescriber recognized their complaints as adverse drug reactions or was aware of impending danger. Interviews elicited accounts of restlessness, akathisia, confusion, delirium, euphoria, extreme anxiety, obsessive preoccupation with aggression, and incomplete recall of events. Weird impulses to kill were acted on without warning. On recovery, all recognized their actions to be out of character, and their beliefs and behaviours horrified them.”

. . . . . . . . . . . . . . . .

Whitehead, PD, Causality and Collateral Estoppel: Process and Content of Recent SSRI Litigation, 2003, J Am Acad Psychiatry Law 31:377–82, wrote:

“In Tobin v. SmithKline Beecham Pharmaceuticals a jury in the U.S. District Court for the District of Wyoming found that the medication Paxil ‘can cause some individuals to commit homicide and/or suicide,’ and that it was a legal cause of the deaths in this case.”

. . . . . . . . . . . . . . . .

Breggin, PR, MD, Suicidality, violence and mania caused by selective serotonin reuptake inhibitors (SSRIs): A review and analysis. International Journal of Risk & Safety in Medicine, 2004, 16, 31-49, wrote:

“Evidence from many sources confirms that selective serotonin reuptake inhibitors (SSRIs) commonly cause or exacerbate a wide range of abnormal mental and behavioral conditions. These adverse drug reactions include the following overlapping clinical phenomena: a stimulant profile that ranges from mild agitation to manic psychoses, agitated depression, obsessive preoccupations that are alien or uncharacteristic of the individual, and akathisia. Each of these reactions can worsen the individual’s mental condition and can result in suicidality, violence, and other forms of extreme abnormal behavior.  Evidence for these reactions is found in clinical reports, controlled clinical trials, and epidemiological studies in children and adults. Recognition of these adverse drug reactions and withdrawal from the offending drugs can prevent misdiagnosis and the worsening of potentially severe iatrogenic disorders. These findings also have forensic application in criminal, malpractice, and product liability cases.”

and

“There are many reports and studies confirming that SSRI antidepressants can cause violence, suicide, mania and other forms of psychotic and bizarre behavior.”

. . . . . . . . . . . . . . . .

Although there is a great deal of prima facie evidence and many case reports detailing the neuroleptic/antidepressant link to suicide and violence, there has not to my knowledge been a definitive large-scale study by American psychiatry of the link between psychiatric drugs and the murder/suicides that are occurring with increased frequency.

And the great question is:  why not?  Why is this urgent, life-threatening issue not afforded the highest priority by the APA, NIMH, and university psychiatry departments?  Is their self-serving need to protect psychiatry from the consequences of its errors eclipsing their ethical integrity and their sense of responsibility?

DSM AND AKATHISIA

In this regard, it’s interesting to see how psychiatric drug-induced akathisia has been handled in the various editions of DSM.

DSM-III-R (1987) makes no specific reference to neuroleptic or antidepressant-induced akathisia.  There are, however, a number of statements in the chapter on “schizophrenia” which clearly (and deceptively) ascribe symptoms of akathisia and tardive dyskinesia to “schizophrenia” itself.  For instance:

“In addition, odd mannerisms, grimacing, or waxy flexibility may be present [in schizophrenia]. (p 190)

“Almost any symptom can occur as an associated feature [of schizophrenia].  The person may appear perplexed, disheveled, or eccentrically groomed or dressed. Abnormalities of psychomotor activity—e.g., pacing, rocking, or apathetic immobility—are common.” (p 190) [Emphasis added]

In reality, most of the pacing, grimacing, and rocking exhibited by people labeled schizophrenic is a direct result of neuroleptic drug poisoning, and not an associated feature of the so-called illness itself.

“Dysphoric mood is common [with schizophrenia], and may take the form of depression, anxiety, anger, or a mixture of these.” (p 190)

Anxiety and anger are also direct effects of neuroleptic poisoning for many people.

“Although violent acts performed by people with this disorder often attract public attention, whether their frequency is actually greater  than in the general population is not known.  What is known is that the life expectancy of people with Schizophrenia is shorter than that of the general population because of an increased suicide rate and death from a variety of other causes.” (p 191)

As is clear from the material quoted earlier, suicide is frequently a result of akathisia.  The phrase “death from a variety of other causes” is unclear.

. . . . . . . . . . . . . . . . 

DSM-IV (1994) was markedly more honest in acknowledging the existence of neuroleptic-induced akathisia.  In fact, this was included as an actual diagnosis in the fourth edition.  It was coded as 333.99, and 2½ pages (744-746) were devoted to its description.  Here are some quotes:

“In its most severe form, the individual may be unable to maintain any position for more than a few seconds.” (p 744)

“The subjective distress resulting from akathisia is significant and can lead to noncompliance with neuroleptic treatment.  Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts.  Worsening of psychotic symptoms or behavioral dyscontrol may lead to an increase in neuroleptic medication dose, which may exacerbate the problem.  Akathisia can develop very rapidly after initiating or increasing neuroleptic medication.  The development of akathisia appears to be dose dependent and to be more frequently associated with particular neuroleptic medications.  Acute akathisia tends to persist for as long as neuroleptic medications are continued, although the intensity may fluctuate over time.  The reported prevalence of akathisia among individuals receiving neuroleptic medication has varied widely (20%-75%).” (p 745) [Emphasis added]

Note the reference in the third line above to “irritability, aggression, or suicide attempts“.  In fact, as the material quoted earlier makes clear, neuroleptic-induced akathisia has been causally-linked to actual homicides and suicides.  This understatement was clearly deliberate, as Allen Frances, MD, architect of DSM-IV, was also one of the authors of the Shear et al paper quoted earlier, which linked neuroleptic-induced akathisia to actual completed suicides.

“Neuroleptic-Induced Acute Akathisia may be clinically indistinguishable from syndromes of restlessness due to certain neurological or other general medical conditions, to nonneuroleptic substances, and to agitation presenting as part of a mental disorder (e.g., a Manic Episode).” (p 745)

In other words, people who are experiencing neuroleptic-induced acute akathisia are at risk of being assigned a “diagnosis” of “bipolar disorder”!

Serotonin-specific reuptake inhibitor antidepressant medications may produce  akathisia that appears to be identical in phenomenology and treatment response to Neuroleptic-Induced Acute Akathisia.  Akathisia due to nonneuroleptic medication can be diagnosed as Medication-Induced Movement Disorder Not Otherwise Specified.” (p 745) [Bold face in original]

and

“Individuals with Depressive Episodes, Manic Episodes, Generalized Anxiety Disorder, Schizophrenia and other Psychotic Disorders, Attention-Deficit/Hyperactivity Disorder, dementia, delirium, Substance Intoxication, (e.g., with cocaine), or Substance Withdrawal (.e.g., from an opioid) may also display agitation that is difficult to distinguish from akathisia.” (p 745-746) [Bold face in original]

Which prompts one to wonder how many people who have been assigned these so-called diagnoses were actually suffering from one of the toxic effects of neuroleptic drugs or SSRI’s.  It is also entirely plausible, as DSM-IV suggests, that many of these individuals would have been “treated” with even higher doses of neuroleptics!

. . . . . . . . . . . . . . . .

The entry in DSM-IV-TR (2000) is identical to that in DSM-IV except for the following addition:

“Although the atypical [newer] neuroleptic medications are less likely to cause akathisia than the typical [older] neuroleptics, nonetheless, these medications do cause akathisia in some individuals.” (p 801)

. . . . . . . . . . . . . . . . .

DSM-5 is remarkably less frank concerning psychiatric drug-induced akathisia than was DSM-IV.  The name Neuroleptic-Induced Acute Akathisia was changed to Medication-Induced Acute Akathisia and the entry is given a total of four-and-a-half lines of text:

333.99 (G25.71)  Medication-Induced Acute Akathisia
Subjective complaints of restlessness, often accompanied by observed excessive movements (e.g., fidgety movements of the legs, rocking from foot to foot, pacing, inability to sit or stand still), developing within a few weeks of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms.” (p 711) [Bold face in original]

There is no reference to the fact that, as earlier psychiatric authors had stated, the condition can be so unbearable as to drive people to suicide and even homicide.

There is, however, an interesting admission in a separate, also brief, entry:

“333.72 (G24.09)  Tardive Dystonia
 333.99  (G25.71)  Tardive Akathisia
Tardive syndrome involving other types of movement problems, such as dystonia or akathisia, which are distinguished by their late emergence in the course of treatment and their potential persistence for months to years, even in the face of neuroleptic discontinuation or dosage reduction.” (p 712) [Bold face in original]

In other words, neuroleptic-induced akathisia can persist for years, even if the person stops taking the drugs!  But even granting this admission, it is clear that DSM-5 is markedly down-playing the significance and seriousness of neuroleptic-induced akathisia.  And it is also clear from elsewhere in the text that the agenda here is to protect the reputation of the neuroleptic drugs:

“The term neuroleptic is becoming outdated because it highlights the propensity of antipsychotic medications to cause abnormal movements, and it is being replaced with the term antipsychotic in many contexts.” (p 709)

Note the deceptive use of the passive voice (“is becoming outdated”).  In reality, psychiatrists are consciously and deliberately phasing out the term “neuroleptic” in an attempt to conceal, or at least not draw attention to, the severe and potentially life-threatening neurotoxic effects of these drugs.

But the more important question is why has the APA eliminated the DSM-IV category “neuroleptic-induced akathisia” that ran to 2 ½ pages, and replaced it with the more general “medication-induced acute akathisia”, which runs to 4 ½ lines?  Why has this dangerous and relatively widespread adverse effect been so downplayed?  On page 809 of the DSM-5 text there is a section called Highlights of Changes from DSM-IV to DSM-5, but there is no explanation for the change there.  There is a note in this section referring the reader to “An expanded description of nearly all changes…” on the APA website.  The link leads to an article titled “Highlights of Changes from DSM-IV-TR to DSM-5“.  But the article contains no reference to the change in question.

So we don’t know the APA’s justification for suppressing information about this potentially devastating adverse effect.  But we do know that neuroleptic drugs are being prescribed for an increasing range of problems, and are even being prescribed to toddlers for temper tantrums and to nursing home residents for “management problems”.  Some have even acquired “block-buster” sales status.  It is clearly in pharma’s interests to suppress this information and it is consistent with psychiatry’s hand-in-glove relationship with pharma that they should oblige their generous benefactors in this way.  Remember, 69% of the DSM-5 workforce were in the pay of pharma while working on the revision.

Despite the early, and very clear, statements from individual psychiatrists linking psychiatric drugs to murder/suicides, the psychiatric leadership has consistently failed to address this link.  Instead, they deceptively attribute these incidents to a lack of psychiatric “treatment”, and they call for legal enforcement of even more drugging.

FINALLY

On June 9, 2016, Maria Oquendo, MD, President of the APA, wrote a post in support of the Senate’s so-called Mental Health Reform Bill.  The post was standard psychiatric propaganda, including the inane 21% annual and 50% lifetime prevalence of “mental illness”.  The reality is that if one can invent illnesses at will and arbitrarily reduce the “diagnostic” thresholds of these “illnesses”, one can produce any prevalence numbers one chooses.

The post also drew attention to the fact that there were 41,000 suicides in the US in 2013, and asserted that “…we continue to fail people with mental illness every day.”

In other words, more psychiatric treatment would reduce the suicide rate.  But meanwhile, we have no data on how many of these individuals were in the throes of neuroleptic or antidepressant-induced akathisia.  And as long as psychiatry and pharma are controlling the research agenda, such information will be systematically repressed.

As I’ve stated many times, psychiatry is intellectually and morally bankrupt.  They are adamantly resistant to anything resembling critical self-appraisal, and there are no depths of deception and spin to which they will not go, to suppress the reality and the consequences of their drug-pushing depredations.  Neuroleptic and antidepressant drugs induce some individuals to take their own lives and/or the lives of others.  Neuroleptic and antidepressant drugs are almost certainly the proximate causes of many of the mass shootings that have plagued our country for almost twenty years.  How much longer can psychiatry sustain this dreadful, self-serving deception?

INCIDENTALLY

Senator John McCain and Congressman David Jolly have introduced bills in their respective chambers that if enacted will require the Veterans Administration to conduct a comprehensive study of the link between psychiatric drugs and veterans’ suicides.  It will be an enormous step forward if these bills become law.  It is also an interesting reflection that these bills were initiated by politicians, and not by psychiatrists, who present themselves as caring professionals acting in the best interests of their so-called patients.

If you live in the US, please encourage your representatives to support the McCain and Jolly bills (S 3410 and H 4640).

A Bill to Explore the Relationship Between Veteran Suicides and Prescription Medication

On September 28, US Senator John McCain (R-AZ) introduced a bill in the Senate titled Veteran Overmedication Prevention Act (S. 3410).  This is a companion bill to HR 4640, Veteran Suicide Prevention Act introduced in the House by Congressman David Jolly (R-FL) earlier this year.  The objective of both bills is to combat suicide deaths by ensuring that accurate information is available on the relationship between suicides and prescription “medication”.  At the present time, 20 US veterans a day are dying by suicide.

In a September 28 press release, Senator McCain is quoted:

“‘Combatting this [suicide] epidemic will require the best research and understanding about the key causes of veteran suicide, including whether overmedication of drugs, such as opioid pain-killers, is a contributing factor in suicide-related deaths. This legislation would authorize an independent review of veterans who died of suicide or a drug overdose over the last five years to ensure doctors develop safe and effective treatment plans for their veteran patients. We have a long way to go to eradicate veteran suicide, but this legislation builds on important efforts to end the tragedy that continues to claim far too many lives far too soon.'”

Clearly in the press release there is an emphasis on opioid pain-killers, but the problem of psychiatric drugs is also addressed in the bill.  The bill mandates

“…a review of the deaths of all covered veterans who died by suicide during the five-year period ending on the date of the enactment of this Act.”

and the review shall include:

“(E) A comprehensive list of prescribed medications and legal or illegal substances as annotated on toxicology reports of covered veterans described in subparagraphs (A) through (C), specifically listing any medications that carried a black box warning, were prescribed for off-label use, were psychotropic, or carried warnings that included suicidal ideation.” [Emphasis added]

The bill clearly covers all psychiatric drugs.

On March 2, 2016, Congressman Jolly issued a press release which contained the following:

“‘It is critical that we understand whether there is any impact of certain psychiatric drugs prescribed for issues like P.T.S.D., depression or traumatic brain injuries, on the decision of a veteran to take their own life,’ Jolly said. ‘With veterans dying by suicide at a heartbreaking rate, we need to take a hard look at all possible factors in order to help prevent these tragedies.’

Specifically, the Veteran Suicide Prevention Act would require the VA to record the total number of veterans who have died by suicide during the past five years, compile a comprehensive list of the medications prescribed to and found in the systems of such veterans at the time of their deaths, and report which Veterans Health Administration facilities have disproportionately high rates of psychiatric drug prescription and suicide among veterans treated at those facilities.  The VA would then be required to submit to Congress a publicly available report on the results of their review, along with their plan of action for improving the safety and well-being of veterans.”

The wording of the House Bill is essentially similar to that of the Senate Bill.

SIGNIFICANCE

Psychiatric drugs are poisons.  They poison the brains and other organs of those who take them.  In some cases, the adverse effects are slow, often taking years, or even decades, to become obvious.  But in certain cases, the poisoning is rapid and catastrophic.  The facts of this matter have been systematically suppressed by psychiatry, and by their pharmaceutical allies, for decades.

This great lie, this monumental hoax, is the soft underbelly of psychiatry.  And it is on this great lie that their self-serving drug-pushing empire will ultimately crumble.  The bills introduced by Sen. McCain and Rep. Jolly have the potential to begin this process.

I think we can be reasonably certain that at this time, psychiatry and pharma are leaving no stone unturned in their efforts to kill these companion bills.  Skids are being greased with ill-gotten largesse; favors are being called in; lawmakers in vulnerable seats are being canvassed by pharma’s check-writers; and so on.  Every effort that money can buy is being used to kill or gut these bills.

So please, if you live in the US, write to your legislators (Senate and House), and ask them to support these bills:

Senate:             S 3410             Veteran Overmedication Prevention Act

House:             HR 4640         Veteran Suicide Prevention Act

Also, please consider writing to Senator McCain and Congressman Jolly, thanking them for this initiative and outlining its importance.

ADHD: A Destructive Psychiatric Hoax

INTRODUCTION

Earlier this year, Alan Schwarz, an investigative reporter for the New York Times, published his latest book:  ADHD Nation.

The blurb on the jacket states:

“More than 1 in 7 American children get diagnosed with ADHD—three times what experts have said is appropriate—meaning that millions of kids are misdiagnosed and taking medications such as Adderall or Concerta for a psychiatric condition they probably do not have.  The numbers rise every year.  And still, many experts and drug companies deny any cause for concern.  In fact, they say that adults and the rest of the world should embrace ADHD and that its medications will transform their lives.

In ADHD Nation, Alan Schwarz examines the roots and the rise of this cultural and medical phenomenon: The father of ADHD, Dr. Keith Conners, spends fifty years advocating drugs like Ritalin before realizing his role in what he now calls ‘a national disaster of dangerous proportions’; a troubled young girl and a studious teenage boy get entangled in the growing ADHD machine and take medications that backfire horribly; and Big Pharma egregiously over-promotes the disorder and earns billions from the mishandling of children (and now adults).”

And who could argue with any of that?  But the blurb continues:

“While demonstrating that ADHD is real and can be medicated when appropriate, Schwarz sounds a long-overdue alarm and urges America to address this growing national health crisis.”

And there, of course, is where we must part company.

When I first read the jacket blurb, I was curious as to what kinds of arguments Alan Schwarz would marshal to support the contention that ADHD is “real”, and that it sometimes warrants “medication”.  And let us be clear as to the meaning of the word “real”.  Nobody is denying that inattention, hyperactivity, and impulsivity can be real problems.  The issue at stake , however, is whether it makes any sense to conceptualize this loose cluster of vaguely-defined problems as an illness.  Usually when people say or write that ADHD is “real”, they mean that this cluster of problems listed in the APA’s catalog (DSM) is a genuine, bona fide illness – just like diabetes; and that people who “have” this so-called illness must take their “medication” in the same way that diabetics must take insulin.  So, the promise on the jacket that Mr. Schwarz would demonstrate that ADHD is a real illness seemed significant, and as I said earlier, I was particularly interested in whether he had anything new to add to this debate.

Here’s the opening page of the Introduction.

“Attention deficit hyperactivity disorder is real.  Don’t let anyone tell you otherwise.

A boy who careens frenziedly around homes and busy streets can endanger himself and others.  A girl who cannot, even for two minutes, sit and listen to her teachers will not learn.  An adult who lacks the concentration to complete a health-insurance form accurately will fail the demands of modern life.  When a person of any age has a combination of these struggles—severely enough to impair his daily functioning—with no other plausible explanation for them, then he could very well have a serious, if still somewhat mysterious, condition that medicine has decided to call ADHD.

No one quite knows what causes it.  The most commonly cited theory is that the hypractivity, lack of focus, and impulsivity of classic ADHD result from some sort of dysfunction among chemicals and synapses in the brain.  A person’s environment clearly plays a role as well: a chaotic home, an inflexible classroom, or a distracting workplace all can induce or exacerbate symptoms.  Unfortunately, as with many psychiatric illnesses, such as depression or anxiety, there is no definitive way to diagnose ADHD, no blood test or CAT scan that lets a doctor declare, ‘Okay, there it is’—all one can do is thoughtfully assess whether the severity of the behavior warrants a diagnosis.  (After all, we all are distractible or impulsive to varying degrees.)  One thing is certain, though: There is no cure for ADHD.  Someone with the disorder might learn to adapt to it, perhaps with the help of medication, but patients young and old are generally told that they will deal with their abnormal brains for the rest of their lives.” (p 1)

And there is it.  Let’s take a closer look.

“Attention deficit hyperactivity disorder is real.  Don’t let anyone tell you otherwise.”

The reality or otherwise of “ADHD” is the fundamental issue of this entire debate, and it is clear from this opening statement that Mr. Schwarz has not approached this question with anything resembling the kind of open-mindedness that one expects from an investigative journalist.

But it gets worse.

“A boy who careens frenziedly around homes and busy streets can endanger himself and others.”

Mr. Schwarz is clearly trying to create the impression that this kind of behavior is fairly typical of children who “have ADHD”, and he is also pointing out that the behaviors are serious.  What he doesn’t mention, however, and perhaps isn’t even aware of, is that physically dangerous activity – including running “into street without looking” – was one of the specific criteria for ADHD in DSM-III-R, but was diluted to “runs about or climbs excessively” in DSM-IV.  And in DSM-5, the word “excessively” was dropped.  Here are the actual items from the three editions:

DSM-III-R (1987):
“(14) often engages in physically dangerous activities without considering possible consequences (not for the purpose of thrill-seeking), e.g., runs into street without looking” (p 53)

DSM-IV (1994)
Under the sub-heading Hyperactivity:
“(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)” (p 84)

DSM-5 (2013)
Under the sub-heading Hyperactivity and impulsivity:
“c.  Often runs about or climbs in situations where it is inappropriate.  (Note: in adolescents or adults, may be limited to feeling restless.) (p 60)

So, a boy who careens frenziedly around homes and busy streets would probably meet the standard in all three editions, but – and this is the critical point – there is no requirement in the latter editions of such extreme behavior to score a “symptom” hit.  Contrary to Mr. Schwarz’s implied assertion, a child does not have to engage in such extreme or dangerous behavior to meet any of the APA’s criteria for this so-called illness. And it needs to be noted particularly that since 1994, the only requirement under this item for adults and adolescents is that they experience feelings of restlessness!

. . . . . . . . . . . . . . . .

“A girl who cannot, even for two minutes, sit and listen to her teachers will not learn.”

How can Alan Schwarz – or anyone else, for that matter – deduce that a girl who doesn’t pay attention to her teachers, can’t pay attention.  This is an invalid inference, but is standard procedure in psychiatry.

. . . . . . . . . . . . . . . .

“When a person of any age has a combination of these struggles—severely enough to impair his daily functioning—with no other plausible explanation for them, then he could very well have a serious, if still somewhat mysterious, condition that medicine has decided to call ADHD.”

This again is standard psychiatric patter:  the flaw is contained in the phrase “…with no other plausible explanation for them…”

Anyone who has had even the slightest experience working with children and families can attest to the fact that there are always alternative psychosocial explanations, if one is prepared to look for them.  The reality, however, is that within the practice of psychiatry, these alternate explanations are almost never sought.

And the reason they are not sought is because psychiatry has effectively closed the door on these kinds of deliberations.  Within the psychiatric framework, if a child (or adult) meets the arbitrary and inherently vague criteria listed in the DSM, then he has a brain illness called ADHD.  So the notion of even looking for psychosocial explanations not only doesn’t happen, but would be seen within psychiatry as ridiculous.

In real medicine, if a person has pneumonia, then that is the explanation of his persistent cough, nasty phlegm, weakness, etc..  The notion of a physician in such circumstances casting around for an alternative psychosocial explanation would be pointless.  Similarly, psychiatrists, firmly wedded as they are to their spurious illness perspective, don’t look for ordinary human explanations of the problems they encounter.  The difference, of course, between psychiatry and real medicine is that the latter’s diagnoses are indeed genuine explanations of the presenting problems.  In psychiatry, the “diagnoses” are merely labels that psychiatrists assign to the loose clusters of vague problems, and have no explanatory value whatsoever.

To demonstrate this, consider the two following hypothetical conversations.

Client’s parent:  Why is my son so distractible; why does he make so many mistakes in his schoolwork; why does he not listen to me when I speak to him; why is he so disorganized?
Psychiatrist:  Because he has an illness called attention-deficit/hyperactivity disorder.
Parent:  How do you know he has this illness?
Psychiatrist:  Because he is so distractible, makes so many mistakes in his schoolwork, doesn’t listen when you speak to him, and is so disorganized.

The critical point being that in psychiatry, the only evidence for the “illness” is the very behavior it purports to explain.  In other words:  your son is distracted because he is distracted.

Contrast this with a similar conversation in real medicine.

Patient:  Why am I so tired; why did my temperature spike; why am I spitting up such dreadful-looking phlegm?
Physician:  Because you have pneumonia.
Patient:  How do you know I have pneumonia?
Physician:  Because I can hear characteristic sounds through the stethoscope; your chest X-ray shows large quantities of fluid in both lungs; your sputum labs are positive for pneumococcus; and because everything you have told me is consistent with this diagnosis.  I can show you the X-rays if you like.

In this conversation, there is no circularity to the reasoning.  The pneumonia is the cause of the symptoms and constitutes a genuine and useful explanation.

. . . . . . . . . . . . . . . .

“No one quite knows what causes it.”

Well actually, lots of people know what prompts children to “careen frenziedly around homes and busy streets”.  It is very simply that the discipline and self-control to refrain from this kind of activity has not been instilled at an appropriate age.  And it’s not “somewhat mysterious”.  It’s something that parents and grandparents have been dealing with probably since prehistoric times.  And the same goes for the other ADHD behaviors, misleadingly called “symptoms” in the DSM.

. . . . . . . . . . . . . . . .

“The most commonly cited theory is that the hyperactivity, lack of focus, and impulsivity of classic ADHD result from some sort of dysfunction among chemicals and synapses in the brain.”

And just when we thought that the long-discredited chemical imbalance hoax was about to die!  Mr. Schwarz seems unaware that most leading psychiatrists are at the present time busy distancing themselves from this particular inanity, which was a mainstay of the psychiatric hoax for decades.  The very eminent and highly prestigious Tufts psychiatrist Ronald Pies, MD has even gone so far as to claim that psychiatry never promoted this hoax – an assertion that adds an entire new dimension to academia’s allegorical ivory tower.

Then Mr. Schwarz gets to the point:

“Unfortunately, as with many psychiatric illnesses, such as depression or anxiety, there is no definitive way to diagnose ADHD, no blood test or CAT scan that lets a doctor declare, ‘Okay, there it is’—all one can do is thoughtfully assess whether the severity of the behavior warrants a diagnosis.  (After all, we all are distractible or impulsive to varying degrees.)”

So despite the earlier vagueness, and despite Mr. Schwarz’s condemnation of what he describes as the over-diagnosis of ADHD, he is clearly a firm supporter of psychiatry’s contention that inattention, impulsivity, and general gadding about constitute an illness, if the behaviors cross some ill-defined threshold of severity.

This is another of psychiatry’s core fallacies, routinely promoted, not only in the successive editions of the DSM, but also in the defensive writings of psychiatry’s most prestigious promoters:  if a problem of thinking, feeling, or behaving crosses some arbitrary and vaguely defined thresholds, of severity, duration, or frequency, it becomes, through some alchemy known only to psychiatry, an illness.  The fact that no organic pathology has ever been identified is of no consequence.  If the problem is severe enough, then it’s an illness.

And the reason for this travesty is that within the looking-glass realm of psychiatric diagnosis, the cause of the problem is irrelevant.  This is the essential point of Robert Spitzer’s phenomenological approach as embodied in his DSM-III and in subsequent editions.  Why a person exhibits a problem is of no consequence.  If, in the case, say of “ADHD”, a child is inattentive, overly active and impulsive to the degree specified, albeit loosely, in the text, then he has the illness.  Whether he emits these behaviors because of lax parenting, inconsistent parenting, indulgent parenting, sibling rivalry, emotional abuse, or some other cause, makes no difference to the “diagnosis”.  In marked contrast to real medicine, where diagnosis and cause are virtually synonymous, in psychiatric diagnosis, the cause of the problem is immaterial.  If the child emits the behaviors in question, for any reason or cause, then he “has the illness”.  The “illness” in fact is nothing more than the presence of the vaguely-defined problem behaviors.  There is no requirement of neurological pathology, nor any evidence that the behaviors in question entail a neurological pathology.  DSM-III describes this approach as “…atheoretical with regard to etiology or pathophysiologic process except with regard to disorders for which this is well established and therefore included in the definition of the disorder.” (p xxiii), which is not the case with ADHD.

Far from acknowledging the obvious dishonesty of this “atheoretical” approach, DSM-III-R actually makes of it a virtue:

“The major justification for the generally atheoretical approach taken in DSM-III and DSM-III-R with regard to etiology is that the inclusion of etiologic theories would be an obstacle to use of the manual by clinicians of varying theoretical orientation since it would not be possible to present all reasonable etiologic theories for each disorder.” (p xxiii)

In reality, however, by ignoring etiological questions, the APA created the context in which “mental disorders” could be created at will on the basis of any human problem, and these “disorders” could be, and indeed are, morphed readily into “mental illnesses”, and, of course, as we see in Mr. Schwarz’s text, neuro-chemical imbalances.  Psychiatry has conveniently abandoned the notion that new diagnoses must be grounded on proven organic pathology.  Real doctors discover new illnesses through painstaking research and study – often taking years or even decades.  Psychiatry just makes them up and confirms their ontological validity by a committee vote.

For decades, psychiatry, confident in the knowledge that few people read the DSM,  simply lied with regards to the absence of organic pathology.  They told their clients, the public, and the media the blatant lie that the “chemical imbalances” existed and were the cause of the problems.  And – the biggest whopper of all – that the drugs corrected these non-existent imbalances.  They also routinely asserted that their “patients” would in many (or perhaps most) cases have to take the drugs for life.  And here again, Mr. Schwarz follows his psychiatric mentors, lock step.

“One thing is certain, though: There is no cure for ADHD.”

Again note the dogmatic arrogance.  Children who are inattentive, unruly, disobedient, and disruptive to the inherently vague degree specified in the DSM are incapable of acquiring an age-appropriate level of discipline!  How in the world could Mr. Schwarz know this?  As early as 1973, Huessy, Marshall and Gendron (Five hundred children followed from grade 2 to grade 5 for the prevalence of behavior disorder, Acta Paedopsychiatrica, 39(11), 301-309), showed that hyperactivity is not a stable pattern across time.  There is also an abundance of research going back to the 60’s that demonstrates clearly that children who are habitually inattentive, impulsive, and hyperactive  even to an extreme degree, can be trained readily to behave in a more productive and less disruptive fashion.  In fact, prior to the mid-60’s, no such research was needed, because parents and teachers routinely and successfully trained children to control their movements, and to pay attention to their studies and to their chores.  Indeed, parents and teachers accepted that this was an intrinsic part of their responsibilities.  But in 1968, with the publication of DSM-II, psychiatry’s “top experts” decreed that these problem behaviors constituted an illness that required specialist attention.  This “illness” was labeled hyperkinetic reaction of childhood.  The description ran to four lines:

“308.0  Hyperkinetic reaction of childhood (or adolescence)*
This disorder is characterized by overactivity, restlessness, distractibility,
and short attention span, especially in young children; the
behavior usually diminishes in adolescence.” (p 50)

. . . . . . . . . . . . . . . .

“…patients young and old are generally told that they will deal with their abnormal brains for the rest of their lives.”

Despite decades of lavishly funded and highly motivated research, and despite the numerous enthusiastic, and subsequently discredited, claims to the contrary, there is not one shred of evidence that people who have been given the ADHD label have any brain pathology whatsoever.  In fact, no edition of DSM, including the present DSM-5, has ever included any kind of brain pathology as a criterion item for this so-called illness.  DSM-5 does include ADHD in the Neurodevelopmental Disorders section, but all that this entails is that the onset of the problem was in the developmental period.  There is no requirement of neurological pathology.  “The neurodevelopmental disorders are a group of conditions with onset in the developmental period.  The disorders typically manifest early in development, often before the child enters grade school, and are characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning.” (p 31)  Describing “ADHD” as a neurodevelopmental disorder strikes me as extraordinarily deceptive, in that most people would interpret the term “neurodevelopmental disorder” to entail some kind of neurological pathology.  What the APA has done here is convey the impression that there is a neurological pathology involved in “ADHD”, without having to produce evidence that this is the case.

THE “OVER-DIAGNOSIS” OF ADHD

Then Mr. Schwarz gets to the main theme of his book:  that ADHD is being grossly over-diagnosed, a theme incidentally that many psychiatrists have adopted in recent years in an attempt to rescue their crumbling profession from the criticisms of anti-psychiatry.  Watch how Mr. Schwarz does this:

“The American Psychiatric Association’s official description of ADHD, codified by the field’s top experts and used to guide doctors nationwide, says that the condition affects about 5 percent of children, primarily boys.  Most experts consider this a sensible benchmark.

But what’s happening in real-life America?

Fifteen percent of youngsters in the United States—three times the consensus estimate—are getting diagnosed with ADHD.  That’s millions of extra kids being told they have something wrong with their brains, with most of them then placed on serious medications.  The rate among boys nationwide is a stunning 20 percent.  In southern states such as Mississippi, South Carolina, and Arkansas, it’s 30 percent of all boys, almost one in three.  (Boys tend to be more hyperactive and impulsive than girls, whose ADHD can manifest itself more as an inability to concentrate.)  Some Louisiana counties are approaching half—half—of boys in third through fifth grades taking ADHD medications.

ADHD has become, by far, the most misdiagnosed condition in American medicine.

Yet, distressingly, few people in the thriving ADHD industrial complex acknowledge this reality.  Many are well-meaning—they see foundering children, either in their living rooms, classrooms, or waiting rooms, and believe the diagnosis and medication can improve their lives.  Others have motives more mixed:  Sometimes teachers prefer fewer troublesome students, parents want less clamorous homes, and doctors like the steady stream of easy business.  In the most nefarious corner stand the high-profile doctors and researchers bought off by pharmaceutical companies that have reaped billions of dollars from the unchecked and heedless march of ADHD.” (p 2-3)

But what Mr. Schwarz doesn’t mention, and perhaps isn’t even aware of, is that 69% of those “top experts” in psychiatry who “codified” the criteria for ADHD for DSM-5, and whose prevalence estimates Mr. Schwarz accepts implicitly, were also in the pay of pharma.

Nor does Mr. Schwarz seem to be aware that these same “top experts” who codified the criteria for ADHD have progressively liberalized the criteria for this so-called illness.  I have listed the DSM-IV (1994) relaxations in an earlier post.  The relaxations for DSM-5 (2013) were:

– the number of inattention “symptoms” required for adolescents and adults reduced from six to five (p 59)

–  the number of hyperactivity/impulsivity “symptoms” for adolescents and adults also reduced from six to five (p 60)

–  DSM-IV specified that some symptoms of ADHD had to have been present prior to age 7 (p 84).  DSM-5 relaxed this age-of-onset criterion to 12 (p 60).

It needs to be stressed that none of these relaxations were, or indeed could have been, based on empirical evidence or science.  There is no definition of ADHD other than that set down in successive revisions of the DSM.  The notion that the pharma-paid “top experts” compared ADHD-as-it-really-is with the description in the DSM, and found discrepancies, is simply not possible.  There is no ADHD-as-it-really-is.  There is no definition other than the one that the APA made up, and they can, and do, change it at will.  And, so far, the vast majority of the changes have been in the relaxation direction.

. . . . . . . . . . . . . . . .

And this is the central point.  To bemoan the over-diagnosis of ADHD is an empty, futile exercise.  Given the facts that:

– the criteria are impossibly vague and subjective, and
– pharma makes more money the wider the net is cast, and
– psychiatry shares in these profits through a variety of avenues, and
– the drugs are addictive, and
– schools receive additional funding for every ADHD child on their rolls,

“diagnosis” creep is inevitable.  “Diagnosis” creep is not some accident or some pharma-produced sabotage that has befallen psychiatry despite its best efforts to remain pure and undefiled.  “Diagnosis” creep is an integral component of the monster that psychiatry has consciously and deliberately created.  “Diagnosis” creep is an integral part of psychiatry’s expansionist agenda, and was facilitated enormously by Robert Spitzer’s atheoretical, phenomenological approach in DSM-III (1980).  Though, incidentally, in the case of “ADHD” it was occurring prior to 1980.  Here’s a quote from Ullmann and Krasner’s A psychological Approach to Abnormal Behavior,  Second Edition, (1975):

“The treatment of children who have received the label of ‘hyperactive’ has been a source of further controversy in both psychology and pediatrics…Drug therapy, particularly stimulants such as amphetamines, have become the popular form of treatment including up to 10% of all students in some school districts…” (p 496)

And even then, forty-one years ago, there were clear dissenting voices:

“The label plus the drug treatment brings the child into the mentally ill or sick category and the social and self-labeling that follow…The use of drugs enhances the belief in the efficacy of outside agents rather than attribution of change to one’s own efforts (an important element in the development of self control in children and responsibility in teachers).” (Op. Cit. p 497)

If should also be noted that the relaxation of criteria is not confined to “ADHD”.  DSM-5 also relaxed the APA’s definition of a mental disorder, effectively expanding the net for all their so-called diagnoses.

The definition of a mental disorder in DSM-IV (1994) was:

“… a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom.  In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one.  Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual.  Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as descried above.” (p xxi-xxii)

This definition can, I think, be accurately paraphrased as:  any significant problem of thinking, feeling, and/or behaving.  And indeed, it is extremely difficult to think of a significant problem of thinking, feeling, and/or behaving that is not listed within DSM.

The definition of a mental disorder in DSM-5 (2013) is similar to that quoted above, but contains additional verbiage, and one enormous relaxation of the definition.  To enable readers to judge this for themselves, here’s the DSM-5 definition:

“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.  Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.  An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder.  Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflicts results from a dysfunction in the individual, as described above.” (p 20) [Emphasis added]

The word usually on the fourth line expands the potential range of psychiatric “diagnosis” enormously.  One might even say that it becomes so wide as to embrace the entire population.  The point being that in DSM-IV, the problems had to reach a certain level of significance or severity.  But in DSM-5, that requirement was effectively dropped.  Admittedly, both phrases are vague, but DSM-IV’s requirement that distress or disability be present, is obviously a more stringent standard than DSM-5’s assertion that distress or disability is usually present.  In effect, the severity threshold has been abandoned, and there is a clear invitation to practitioners to assign “diagnoses” to individuals with increasingly milder presentations.  And it needs to be stressed that this change was not based on any kind of scientific information or discovery.  This change was simply a decision by the APA to expand the prevalence of their so-called illnesses to virtually everyone on the planet.  It also needs to be stressed that this is not an empty issue, but has already been implemented in the case of “ADHD”.  Compare the severity criterion for ADHD in DSM-IV with that in DSM-5:

DSM-IV:
“D.  There must be clear evidence of clinically significant impairment in social, academic or occupational functioning.” (p 84) [Emphasis added]

DSM-5:
“D.  There is clear evidence that the symptoms interfere with , or reduce the quality of, social, academic, or occupational functioning.” (p 60)

Here again, both statements are vague, but significant impairment in… is obviously a tighter standard than interfering with, or reducing the quality of….

Given all of these considerations, it’s extremely difficult to avoid the conclusion that the APA not only supports the wide expansion of this so-called diagnosis, but has actively pursued and facilitated this expansion for decades.

. . . . . . . . . . . . . . . . 

CONCLUSION

 Mr. Schwarz has done a good job of exposing pharma’s tactics and strategies.  Although much of this story is well-known and has been told before, he does present the scam in a detailed and readable form.  He also addresses the problem of parents pushing to get their children “diagnosed” and on drugs, and the undeniable fact that people do become addicted to these products.  He also exposes the link between CHADD and pharma.

Perhaps now he can take a look at the even bigger scam:  psychiatry’s spurious and destructive medicalization of literally every problem of thinking, feeling, and/or behaving, including childhood inattention, impulsivity, and general lack of discipline.

Pharma does indeed push their products using very questionable methods.  But they couldn’t sell a single prescription for methylphenidate or for any other psychiatric drug without psychiatry’s bogus and self-serving “diagnoses”.  And they couldn’t have increased their sales to the extent that they did, without the commensurate relaxation of the “diagnostic” criteria, that psychiatry knowingly and willingly provided.  Bemoaning the use of hurriedly-completed facile checklists is empty talk, unless one is also willing to turn one’s criticism against the DSM’s equally facile “symptom lists”, of which the checklists are simply mirrors.

Psychiatry is nothing more than legalized drug-pushing.  There is not one shred of intellectual or scientific validity to their so-called taxonomy.  They invent these so-called illnesses to expand their turf, and then liberalize the criteria to expand it further.

Under the guise of medical care, they routinely rob people of their sense of competence, their dignity, and in many cases, their lives.  They have radically undermined the concept of success-through-disciplined-effort, and have ensnared millions of people worldwide in their ever-expanding web of drug-induced dependency and self-doubt.  They are not the thoughtful and expert codifiers of genuine illnesses, as Mr. Schwarz contends.  Rather, they are drug-pushing charlatans and hoaxsters who have systematically and deliberately deceived their clients and the general public to enhance their own prestige and their incomes.

If there was ever a subject that called for thorough investigative journalism, psychiatry is it.

The Bonnie Burstow Scholarship in Antipsychiatry

Bonnie Burstow, PhD, is a faculty member at the University of Toronto, and an antipsychiatry activist.  She writes about topics that include institutional ruling, resistance, and social change.

On October 7, 2016, the Ontario Institute for Studies in Education (OISE) at the University of Toronto announced that they had established a scholarship for students doing theses in the area of antipsychiatry.

The scholarship committee has issued a statement providing details, and requesting donations.  Please take a look, and pass the link on to others who might have an interest.

The establishment of an antipsychiatry scholarship at a prestigious, mainstream university takes our movement to a new level of acceptance and recognition.

Dr. Burstow is also the author of Psychiatry and the Business of Madness (2015).

The Mental Health Reform Act of 2016 (SB 2680) Would Be a Huge Step Backwards

On July 6, HB 2646 (the Tim Murphy Bill) passed the US House and was sent to the Senate.

At the present time, a related bill is working its way through the Senate.  This is SB 2680, The Mental Health Reform Act 2016.  It is sponsored by Lamar Alexander (R-TN), Patty Murray (D-WA), Bill Cassidy (R-LA), Chris Murphy (D-CT), David Vitter (R-LA), and Al Franken (D-MN).  The wording of the bill was finalized in March of this year, and it passed out of committee on March 16.

There is a good measure of bi-partisan support for this bill in the Senate, and if it makes it to the floor it could pass.  If that were to happen, it would likely be reconciled with the Tim Murphy House resolution, and a reconciled version would be enacted.

SB 2680 purports to provide desperately needed help to suffering Americans but is in reality a thinly-disguised tool to expand the scope of psychiatric “care”, with all the drugging, death, damage, and destruction that this entails.

On March 16, 2016, the Committee on Health, Education, Labor, and Pensions issued a press release titled:  The Mental Health Reform Act of 2016 will help Americans suffering from mental health and substance use disorders.  Here are some quotes, interspersed with my comments and observations.

“The Senate health committee today passed legislation to help address the country’s mental health crisis and help ensure Americans suffering from mental illness and substance use disorders receive the care they need.”

Note the term “mental health crisis”.  There is indeed a crisis in the mental health business.  The crisis derives from psychiatry’s spurious and self-serving premise that all significant problems of thinking, feeling, and/or behaving are brain illnesses that are correctable by psychiatric drugs.  This false premise, avidly promoted by pharma, is the cornerstone of the psychiatric-pharmaceutical industry, and is the primary reason that psychiatric drug use in America has reached epidemic proportions.

The fact that these so-called illnesses are so vaguely defined makes it easy for pharma-psychiatry to rope in new recruits.  But the maw of greed can never be satisfied, and pharma-psychiatry continues to lobby for more.  Every undrugged person is money down the drain!

For decades, psychiatry has been inventing new “illnesses” and liberalizing the criteria for others, and it is clear that their objective in all this is to make their so-called mental illnesses as prevalent as the common cold:  everyone gets one from time to time, and psychiatry has “safe and effective treatments”.  There’s no need to suffer – just take a pill or a high-voltage electric shock to the brain.  And keep coming back!

Back to the press release:

“‘One in five adults in this country suffers from a mental illness, and nearly 60 percent aren’t receiving the treatment they need,’ said Senate health committee Chairman Lamar Alexander (R-Tenn.).”

It is a logical and mathematical axiom that one can’t quantify what one can’t define.  But even if we set aside the inanity of these oft-touted statistics, it is clear that vast numbers of Americans who could get a “diagnosis” and a prescription for pills at their local mental health center, choose, wisely, I suggest, not to avail themselves of this “service”.  To Senators Alexander, Murray, Cassidy, Murphy, Vitter, and Franken, however, all of whom, incidentally, have received campaign money from the pharmaceuticals/health products industry, this is a national tragedy – a crisis, no less, that has to be corrected through legislative action.

“‘This bill will help address this crisis by ensuring our federal programs and policies incorporate proven, scientific approaches to improve care for patients.'”

“Proven, scientific approach” means more pharma-funded psychiatric research, with ever more opportunities for over-stated conclusions and even out-and-out fraud.

Senator Murray points out that the bill, if enacted, “…would help expand access to quality care, and make sure that patients receive coordinated mental and physical health care.”

Note again the emphasis on expanding care.  Also note the promotion of co-ordination with physical (i.e. real) medicine; read:  a mental health liaison worker in every GP’s office.  The APA has been pushing this idea for years.  The idea is that one goes to see one’s GP for a bad cough, is “screened” for mental health issues, and comes away with an antibiotic for the cough and an antidepressant for some vague psychosocial concerns.

The press release continues in the same vein.  All the old chestnuts are there, e.g.:

“This bill is an important step in the road to recovery for the 44 million Americans who suffer from a serious mental illness.”

“…our broken mental health care system…”

“…we allow those with mental illness to fall through the cracks.”

“…families struggling to get a loved one the help they need.”

“…prevent suicide…”

“…provide mental health awareness for teachers and others…”

“…evidence-based approaches…”

etc.

DISCUSSION

SB 2680 is littered with platitudes, and for this reason, there is a danger that many of its provisions might be seen as benign, and even desirable.

For instance, the bill calls for the identification of

“…strategic priorities, goals, and measurable objectives for mental and substance use disorder activities and programs operated and supported by the Administration, including priorities to prevent or eliminate the burden of mental illness and substance use disorders;”

and

“…to improve services for individuals with a mental or substance use disorder…”

and

“…ensure that programs provide, as appropriate, access to effective and evidence-based prevention, diagnosis, intervention, treatment, and recovery services…”

etc.

All of these proposals seem positive and helpful, but the bill is solidly rooted in psychiatry’s spurious medical model.  Psychiatric concepts and language permeate the text.  The term “mental illness” is routinely used as if it had the same ontological significance as real illness.

To convey the general tone and thrust of the bill, here’s the full text of Sec 502, which pertains to child psychiatry:

SEC. 502. TELEHEALTH CHILD PSYCHIATRY ACCESS GRANTS.

(a) In General.—The Secretary of Health and Human Services (referred to in this section as the “Secretary”), acting through the Administrator of the Health Resources and Services Administration and in coordination with other relevant Federal agencies, may award grants through existing health programs that promote mental or child health, including programs under section 330I, 330K, or 330L of the Public Health Service Act (42 U.S.C. 254c-14, 254c-16, 254c-18), to States, political subdivisions of States, and Indian tribes and tribal organizations (for purposes of this section, as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b)) to promote behavioral health integration in pediatric primary care by—”

Translation:  The Federal Government may award grants to promote the embedding of psychiatric concepts and practices into pediatric primary care by:

“(1) supporting the development of statewide or regional child psychiatry access programs; and

 (2) supporting the improvement of existing statewide or regional child psychiatry access programs

(b) Program Requirements.—

(1) IN GENERAL.—To be eligible for funding under subsection (a), a child psychiatry access program shall—

(A) be a statewide or regional network of pediatric mental health teams that provide support to pediatric primary care sites as an integrated team;

(B) support and further develop organized State or regional networks of child and adolescent psychiatrists to provide consultative support to pediatric primary care sites;”

Note:  “networks” of psychiatrists advising and supporting pediatricians!  What kind of advice do you think these networks of psychiatrists will provide?

“(C) conduct an assessment of critical behavioral consultation needs among pediatric providers and such providers’ preferred mechanisms for receiving consultation and training and technical assistance;

(D) develop an online database and communication mechanisms, including telehealth, to facilitate consultation support to pediatric practices;

(E) provide rapid statewide or regional clinical telephone consultations when requested between the pediatric mental health teams and pediatric primary care providers;

(F) conduct training and provide technical assistance to pediatric primary care providers to support the early identification, diagnosis, treatment, and referral of children with behavioral health conditions and co-occurring intellectual and other developmental disabilities;”

What kind of training do you think these access programs will be providing to pediatricians?  Facile “diagnostic” checklists?  Treatment guidelines that recommend neuroleptic drugs for 3-year-olds who display temper tantrums?  The thinly-hidden agenda here is to erode whatever resistance remains among pediatricians to psychiatric orthodoxy, and bring them on board the great psychiatric drugging bonanza.

“(G) inform and assist pediatric providers in accessing child psychiatry consultations and in scheduling and conducting technical assistance;

(H) assist with referrals to specialty care and community and behavioral health resources; and

(I) establish mechanisms for measuring and monitoring increased access to child and adolescent psychiatric services by pediatric primary care providers and expanded capacity of pediatric primary care providers to identify, treat, and refer children with mental health problems.”

In other words, the Feds will be checking to make sure that they’re getting value for their money in the form of more children drugged.

“(2) PEDIATRIC MENTAL HEALTH TEAMS.—In this subsection, the term “pediatric mental health team” means a team of case coordinators, child and adolescent psychiatrists, and a licensed clinical mental health professional, such as a psychologist, social worker, or mental health counselor. Such a team may be regionally based.

(c) Applications.—A State, political subdivision of a State, Indian tribe, or tribal organization that desires a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a plan for the comprehensive evaluation and the performance and outcome evaluation described in subsection (d).

(d) Evaluation.—A State, political subdivision of a State, Indian tribe, or tribal organization that receives a grant under this section shall prepare and submit an evaluation to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require, including a comprehensive evaluation of activities carried out with funds received through such grant and a performance and outcome evaluation of such activities.

(e) Access To Broadband.—In administering grants under this section, the Secretary may coordinate with other agencies to ensure that funding opportunities are available to support access to reliable, high-speed Internet for providers.

(f) Matching Requirement.—The Secretary may not award a grant under this section unless the State, political subdivision of a State, Indian tribe, or tribal organization involved agrees, with respect to the costs to be incurred by the State, political subdivision of a State, Indian tribe, or tribal organization in carrying out the purpose described in this section, to make available non-Federal contributions (in cash or in kind) toward such costs in an amount that is not less than 20 percent of Federal funds provided in the grant.

The meaning and intent of Sec 502 is absolutely clear:  if this legislation passes, Congress is going to pour money and resources into providing more psychiatric care to children.

And how do psychiatrists provide care for children?  They drug them.

THE EMPIRE IS FIGHTING BACK

In the past ten years or so, opposition to psychiatry’s medicalization of virtually every human problem has been growing.  As the venerable and prestigious psychiatric leader Jeffrey Lieberman, MD, has lamented on more than one occasion, psychiatry is the only medical speciality that has its own anti group.  And of course, as we all know, there are very good reasons for this.

We also know that American psychiatry as a whole has been extraordinarily unreceptive to any kind of criticism.  Indeed, their response has been to double down – to assert with increasing vigor that their concepts are sound, their research valid, and their practices helpful and benign.

They have also hired a renowned PR firm and have been lobbying hard in political circles.  SB 2680 and the Tim Murphy House bill are the result of these endeavors.

This is the hidden face of psychiatry, using the legal machinery to push its pernicious concepts and practices deeper and deeper into the lives and institutions of the American people, with increasingly disastrous results.

Incidentally, the sponsors of SB 2680 received the following sums of money from the pharmaceutical/health products industry during the current election cycle (source: OpenSecrets.org):

            Lamar Alexander        $452,548

            Patty Murray               $542,778

            Bill Cassidy                 $234,502

            Chris Murphy              $121,876

            Al Franken                  $131,088

            David Vitter                   $7,850

If you live in the US, please ask your Senators to oppose SB 2680.  Tell them that we don’t need any more psychiatric drugging, particularly of our children!

Psychiatric Ethics

On June 9, 2016, the very eminent psychiatrist Allen Frances, MD, published an article on the Huffington Post Blog.  The piece was titled Trump Is Breaking Bad, Not Clinically Mad.

The gist of the article was that, although the Republican presidential candidate has many flaws, he does not have a mental disorder.

Here are some quotes:

“Trump obviously does have an outsize, obnoxious personality, but most certainly does not have a Personality Disorder (and there is no evidence that he has now, or ever has had, any other mental disorder).”

“This does not make Trump fit to be president, not by any means. He must be by far the least suitable person ever to run for high office in the US — completely disqualified by habitual dishonesty, bullying bravado, bloviating ignorance, blustery braggadocio, angry vengefulness, petty pique, impulsive unpredictability, tyrannical temper, fiscal irresponsibility, imperial ambitions, constitutional indifference, racism, sexism, minority hatred, divisiveness etc.”

“People who dislike Trump’s outrageous behavior should call him on it, but need not and should not, add to their critique a gratuitous and inaccurate diagnosis of mental disorder.”

Dr. Frances adduces some arguments in support of his contention.  For instance:

“Personality Disorder requires that the individual’s personality characteristics cause clinically significant distress or impairment. Trump’s behavior causes a great deal of significant distress and impairment in others, but he seems singularly undistressed and his obnoxiousness has been richly rewarded, not a source of impairment.”

and

“Most people with mental illness are nice, polite, well mannered, well meaning, decent people. They suffer, but don’t cause suffering.”

. . . . . . . . . . . . . . . .

I saw Dr. Frances’s article when it first appeared, and I considered writing a response.  My response would have been along the lines:  if “psychiatric diagnosing” is, as psychiatrists claim, a complex, detailed, painstaking, highly skilled activity involving close observation, discussion, and gathering of accurate collateral information, how can Dr. Frances legitimately conclude a status of “no diagnosis” in someone he has never met using information derived primarily from media reports?

In the event, there were other priorities, and I didn’t write the article, but on August 3, 2016, Maria Oquendo, MD, President of the APA, wrote The Goldwater Rule: Why breaking it is Unethical and Irresponsible.

The Goldwater Rule, or, more formally, Section 7.3 of the APA’s  Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry 2013 Edition, states:

“On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

Incidentally, Section 7.3 is called the Goldwater Rule because in the 1964 presidential election campaign, many psychiatrists publicly assigned “psychiatric diagnoses” to Barry Goldwater and declared him unfit for the presidency.  Here’s Dr. Oquendo’s take on this matter:

“This large, very public ethical misstep by a significant number of psychiatrists violated the spirit of the ethical code that we live by as physicians, and could very well have eroded public confidence in psychiatry.”

Note that Dr. Oquendo condemns the activity in question because of potential erosion of public confidence in psychiatry, but makes no mention of the damage done to Senator Goldwater.

But Dr. Oquendo is clear on one thing:

“Simply put, breaking the Goldwater Rule is irresponsible, potentially stigmatizing, and definitely unethical.”

Dr. Oquendo doesn’t actually mention Dr. Frances, or his psychiatric delving into the media-reported thoughts, feelings, and actions of Mr. Trump, but it seems clear that her article was an oblique response to Dr. Frances, and a blunt warning to other psychiatrists who might be tempted to engage in this kind of activity.

. . . . . . . . . . . . . . . .

The highly esteemed and prestigious psychiatrist Ronald Pies, MD, also weighed in on this issue.  On August 25, he published on Psychiatric Times Deconstructing and Reconstructing the “Goldwater Rule”.

Dr. Pies expresses agreement with Dr. Oquendo’s general principle, but argues that Section 7.3 is in need of “substantial revision”, and he outlines the changes he would like to see.  He then concludes:

“For a mental health professional—or any physician—to publicly offer a diagnosis at a distance of a non-patient not only invites public distrust of these professionals, but also is intellectually dishonest and is damaging to the profession.”

Again, there’s no mention of Dr. Frances’s article in the text, but Dr. Frances’s article is listed under “Further Reading”, and is clearly the target of Dr. Pies’ criticism.

Note here also that with regards to the psychiatric evaluation of public figures on the basis of media reports, Dr. Pies’ concerns are:

– it invites public distrust of the psychiatrist(s) concerned
– it is intellectually dishonest
– it is damaging to the profession

As in Dr. Oquendo’s paper, the emphasis is on the damage done to the psychiatrist and to the profession, but there’s no mention of the potential damage to the individual who is subjected publicly, presumably without any invitation on his part, to psychiatric scrutiny and assessment.

Dr. Pies’ characterization of this kind of activity as “intellectually dishonest”, coming as it does from an ardent promoter of a profession that is intellectually bankrupt, strikes me as ironic.  Indeed, for any psychiatrist to discuss the ethical or intellectual merits of publicly evaluating the “mental health” of prominent figures represents a high point in hypocrisy.

I’m certainly not condoning Dr. Frances’s activity, but in the context of psychiatry’s general lack of even a semblance of ethical behavior, his lapse strikes me as relatively minor.

Here are some of the major ethical transgressions that have constituted an integral part of psychiatric practice for decades.

  1. They have created the bogus concept of mental disorder/mental illness, and have relentlessly and shamelessly expanded this concept to embrace virtually every significant problem of thinking, feeling, and/or behaving, even childhood temper tantrums (disruptive mood dysregulation disorder)
  1. They have used this concept to formally and deceptively medicalize problems that are not even remotely medical in nature, including childhood disobedience (oppositional defiant disorder) and road rage (intermittent explosive disorder).
  1. They routinely present these labels as the causes of the problems in question, when in reality they are mere labels with no explanatory significance.
  1. They routinely deceive their clients and the general public that these illnesses have known neural pathologies: the infamous “chemical imbalances” that have been avidly promoted by psychiatry for decades.
  1. They have shamelessly peddled neurotoxic drugs as corrective measures for these so-called illnesses, although it is well known that no psychiatric drugs correct any neural pathology.
  1. They routinely administer these neurotoxic drugs and high voltage electric shocks to the brain coercively.
  1. They have conspired with the pharmaceutical industry in the creation of a large body of questionable – and in many cases outrightly fraudulent – research all designed to “prove” the efficacy and safety of psychiatric drugs.
  1. They have shamelessly accepted large sums of pharma money for very questionable activities, e.g., the ghost writing of books and papers which were actually written by pharma staff; the substitution of pharma infomercials for CEU’s; the acceptance of pharma money by paid “thought leaders” to promote new drugs and “diagnoses”; the targeting of captive and vulnerable audiences in nursing homes, group homes, foster care systems, juvenile detention centers, etc., for prescriptions of psychiatric drugs.
  1. They have routinely disempowered millions of people by telling them falsely that they have incurable illnesses for which they must take psychiatric drugs for life.
  1. By falsely convincing people that their problems are illnesses which are essentially out of their control, they have undermined ordinary human fortitude and resilience, and have fostered a culture of powerless and drug-induced dependency.
  1. They accept no limits to their expansionist agenda, insisting that there are still vast numbers of “untreated patients” who need to be brought into their “care”, including children as young as three years, and elderly people in their final years.

. . . . . . . . . . . . . . . . 

In this general context of rampant institutionalized corruption and deception, a discussion of Dr. Frances’s ethical lapse in publicizing his psychiatric assessment of Mr. Trump strikes me as absurdly irrelevant.

THE REAL ISSUE

Interesting as these matters are, the real issue here is that Dr. Frances has let the proverbial cat out of the bag with regards to psychiatric “diagnoses”.  He has told us, indeed, he has demonstrated, that psychiatric “diagnosis” is nothing more than a facile sorting activity – a trite and simplistic algorithm – which has as much validity and intellectual rigor as astrology.  The point is that Dr. Frances conducted a psychiatric “diagnostic” assessment on Mr. Trump based entirely on media reports, and concluded unambiguously that the latter “… most certainly does not have a Personality Disorder”.  And to make matters even more glaring, in his preamble to this conclusion, Dr. Frances presents himself as highly qualified to make this judgment:

“I know something about Personality Disorders, having written the final versions in DSM III, DSM IV, and DSM 5 and also having been Founding Editor of the Journal Of Personality Disorders.”

And this is the problem that Dr. Oquendo and Dr. Pies seek to address:  when psychiatrists conduct “diagnostic” assessments on public figures in this way, they are drawing attention to the fact that psychiatry’s “diagnostic” system is more like a children’s matching test than a genuine medical nosology.  They are drawing attention to the fact that the Emperor has no clothes, and we all know where that leads.

Those of us who are members of what the most eminent psychiatrist Jeffrey Lieberman, MD, describes as the “virulent Anti-Psychiatry Movement” have been drawing attention to the invalidity and triteness of psychiatric diagnoses for decades.  But when the architect of DSM-IV demonstrates these realities in a public statement, it constitutes a major blow to psychiatry, which no amount of APA damage control can offset.  If psychiatric “diagnoses” can be performed on the basis of sensationalized media reports without ever meeting the individual or checking the accuracy of the reported information, then psychiatric “diagnoses” can’t lay much claim to validity, reliability, or usefulness.