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”

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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!

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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.”

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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.

 

 

 

 

A Diluted Murphy Bill Clears the House and Goes to the Senate

INTRODUCTION

On Wednesday, July 6, the US House of Representatives passed a watered down version of HB 2646, the so-called Helping Families in Mental Health Crisis Act.  The bill, which is now a House Resolution, is usually referred to as the Tim Murphy bill, after its principle author, Representative Tim Murphy, PhD, who is also a clinical psychologist.

The bill passed the house with a noteworthy tally of 422-2, with nine abstentions.

On July 6, the Wall Street Journal published a helpful summary of the issues:  House Passes Mental Health Bill, authored by Louise Radnofsky.  Here are some quotes, interspersed with my comments:

“The bill passed 422-2, overwhelming support that reflected a decision by sponsors to defer debates on some of its most controversial aspects. The bill would reorganize the federal agency overseeing mental health policy, direct funding to combat serious mental illness as opposed to general mental health programs, and change Medicaid reimbursements for treating patients with illnesses like schizophrenia.”

“…as opposed to general mental health programs…” is a reference to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), which the eminent psychiatrist, Jeffrey Lieberman, MD, has described as “a proxy agency for the anti-psychiatry movement…” (here).  But here’s what Oryx Cohen wrote about the Murphy Bill and SAMHSA on November 6, 2015:

“The Murphy Bill threatens the recovery and community integration practices that current consumers of mental health services and survivors of coercive psychiatric interventions have worked so hard for over the last 40-plus years to create for those most in need. In particular, the bill would dismantle the federal Substance Abuse and Mental Health Administration (SAMHSA), which actively funds and supports important efforts to rebuild the community and family life of people dealing with mental health issues through non-medicalized institutions such as peer-run respites (short-term crisis centers managed by people living with mental health concerns and available to “self-referred” individuals seeking to avoid hospitalization through support from peers). SAMHSA also supports suicide prevention initiatives, trauma-informed practices, Emotional CPR (an educational program aimed at teaching people how to assist others through an emotional crisis), Wellness Recovery Action Planning and much more, all of which would suffer if SAMHSA were dismantled.”

And another quote from the same article:

“If the Murphy Bill is passed, psychiatric hospitals and pharmaceutical companies will reap huge financial benefits as a result of increased hospitalization and forced treatment. One way the bill will do this is by creating a financial incentive for states that implement ‘assisted outpatient treatment’: court-ordered treatment (including medication) for people whom a judge deems as living with ‘severe mental illness’ and unlikely to willingly take prescribed psychiatric medications.”

Oryx Cohen is a member of the National Coalition for Mental Health Recovery.

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

Back to the WSJ article:

“The bill’s main author, Rep. Tim Murphy (R., Pa.) has for the past few years been blunt in his assessment of mental health care in the U.S., painting a picture of federal incompetence that diverted money to frivolous and unproven programs for general mental health. He said current practices impede treatment for serious mental illness by emphasizing patients’ civil liberties ahead of their treatment.”

“Mr. Murphy, a clinical psychologist, was tapped by House leaders to investigate mental health treatment in the U.S. in the wake of the Sandy Hook shooting in 2012. He and other advocates of changing the system have cited the obstacles family members faced in caring for people with serious mental illness, including privacy laws and provider shortages.”

This theme, that the proximate cause of the mass killings is the “mental illness” of the murderers, has become a staple response from psychiatry to the charge that psychiatric drugs, particularly SSRI’s, are the primary precipitators of these incidents.  In the Sandy Hook murders, for instance, there were reports that the killer, Adam Lanza, had been receiving psychiatric “treatment” and had  been taking psychiatric pills.  But the authorities refused to divulge the nature of the pills for fear that it would “… cause a lot of people to stop taking their medications.”

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

Back to the WSJ article:

“Earlier iterations [of the bill] sought to change the privacy rules in the Health Insurance Portability and Accountability Act so that providers could share details of a patient’s diagnosis, prescriptions and appointments with a known caregiver. The earlier version would have also required states to pass laws compelling treatment for certain people as a condition of federal funding and restrict advocacy groups that receive federal health funding from helping patients bring legal challenges to their treatment.”

The bill’s sponsors have not given up on these matters, but as mentioned in the first WSJ quote above, have simply deferred them for later consideration.

The confidentiality issue is important, because client privacy has traditionally been one of the cornerstones of the mental health system.  The proposal to legitimize divulging sensitive information to a person’s family would essentially reduce the individual’s legal status to that of a child.  This is particularly critical, in that many of the individuals who would be affected by such legislation are in conflict with their families, and emphatically don’t want their confidentiality breached in this way.

Note also the proposed use of the federal purse-strings to increase the amount of forced “treatment”, and make it more difficult for “patients” to sue their psychiatrists.  Why shouldn’t an advocate help clients bring legal challenges to their “treatment”, if the “treatment” has been unhelpful and damaging?  Isn’t that what we’d expect an advocate to do?  Whose interests are being served by restricting an advocate’s activities in this way?  Certainly not the clients!  Psychiatry is extraordinarily resistant to criticism of any kind.

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

Back to the WSJ article:

“Many of Mr. Murphy’s dropped measures had drawn opposition from patient advocates such as the Bazelon Center for Mental Health Law, an organization that focuses on protecting the human rights of people with mental disabilities. The center had said that it was alarmed by the attempts to reduce the privacy and civil rights of people with mental illness, as well as a shift toward compelled treatment, which the center doesn’t believe has been proven to be effective.”

The National Coalition for Mental Health Recovery has also come out against the bill.

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

Back to the WSJ:

“The prospects for mental health legislation in the Senate are uncertain, given the compressed calendar in an election year and the fact that sponsors there have their own ideas for changes, including Bill Cassidy (R., La.) and Chris Murphy (D., Conn.) In a statement, the two senators pointed to the House’s overwhelming vote as ‘proof that there is broad, bipartisan support for fixing our broken mental health system.'”

Note the phrase “broken mental health system.”  This is actually an accurate description, in that the system is based on the spurious premise that all significant problems of thinking, feeling, and behaving are illnesses, and in practice, is destructive, disempowering, and stigmatizing.  But this is not what psychiatry proponents mean by the phrase.  Routinely in pro-psychiatry circles, the phrase is used to legitimize calls for more psychiatric “treatment”; more coercion; “early intervention” and routine integration of psychiatry’s spurious concepts and practices into schools, foster homes, nursing homes, group homes, GP’s offices, the armed services, prisons, juvenile detention centers, and, indeed, any setting where pills can be peddled.

PSYCHIATRY CAPITALIZING ON THE FEAR OF VIOLENCE

The notion that the public needs to be protected from “mentally ill” people is not new, but has enjoyed a marked revival after decades of decline.  Much of this revival can, in my view, be laid at the feet of the Treatment Advocacy Center (TAC).

J. Jaffe, a marketing executive, a founding member of TAC, and a former NAMI board member, gave an address to the Staten Island AMI in December 1994. The speech was titled “How to reduce both violence and stigma”, and was written up in the Staten Island AMI newsletter, December 1994. Here are some quotes:

“And recently adopted policies and laws won’t allow these individuals to be treated involuntarily until they become a ‘danger to self or others.'”

“We have to ‘head ’em off at the pass’.  Treat individuals with NBD [neurobiological disorders] before they become a ‘danger to self or others'”

Earlier in the address Mr. Jaffe had explained that he was using the term “NBD” as essentially synonymous with “mental illness”.

The critical point in this quote is that Mr. Jaffe is proposing that the laws be changed, so that individuals who have been given certain psychiatric labels can be committed to enforced “treatment” before there is any actual danger to self or others.  And he is absolutely clear that an individual’s refusal to take psychiatric drugs would be considered a valid reason to enforce “treatment”.

“For example, some individuals who become psychotic refuse treatment because they believe the medicines are poisons being administered by the CIA.  A ‘need for treatment’ standard would allow someone else to be assigned the right to decide on treatment for this individual until he/she regains the ability to reason.  The decision to administer medicines could be made before the individual becomes a danger to self or others, thus averting needless violence and another stigmatizing headline.”

Note the example Mr. Jaffe gives as to why a person might refuse psychiatric drugs:  that the drugs are being poisoned by the CIA.  But in fact most people who refuse psychiatric drugs do so for perfectly valid and rational reasons:  that they cause irreparable brain damage (e.g. tardive dyskinesia) and they produce extremely unpleasant effects (e.g. akathisia).  In 1974, forty-two years ago, Theodore Van Putten, MD, published Why Do Schizophrenic Patients Refuse to Take Theirs Drugs?  Here’s a quote:

“The reluctance to take antipsychotic medication was significantly associated with extrapyramidal symptoms—most notably a subtle akathisia.”

Mr. Jaffe outlines four proposals to promote the above agenda and then he adds:

“In addition, from a marketing perspective, it may be necessary to capitalize on the fear of violence to get the law passed.” [Bold face added]

In other words, it may be necessary to deceptively exploit isolated incidents of violence to secure the legal authority to forcibly drug many people who had never exhibited any violence, on the sole grounds that they were refusing to take neurotoxic drugs that have devastating adverse effects, including irreversible brain damage.

Mr. Jaffe continued this theme in an address he gave five years later at the 1999 NAMI Conference.  Here are some quotes:

“Laws change for a single reason, in reaction to highly publicized incidents of violence.  People care about public safety.  I am not saying it is right, I am saying this is the reality.”

“So, if you take nothing else away from what I’m saying, it’s gonna change in reaction to violence, and you gotta make this a public safety issue, and indeed it is a public safety issue.”

“We can talk to these people from their perspective, and then what we can say to them as family members, is, and this is also good for the individual.  It’s gonna prevent them from becoming homeless, psychotic, suicidal, uh, incarcerated.  We have found extraordinary…and I’m gonna show a poster in a minute…we have found extraordinary help, and again I gotta give credit to the Treatment Advocacy Center here, uh, of reaching out when there is an instance of violence.”

“We immediately call both the perpetrator and the victim.  And we say to them, ‘We understand what happened here when your sister was pushed in the subway by Andrew Goldstein.  It happened because he wasn’t getting treatment.”

“Uh, the family of Webdale, you may know Kendra Webdale was pushed in the subway, lost her life.  Somebody with untreated schizophrenia. Edgar Rivera was pushed in the subway.  He only lost his legs. But, uh…and he’s been a strong supporter.  And what happens is, the media goes and interviews these people, and because we’ve been to ’em first, they are telling our story.”

In other words, manipulate the media to inject into their reports of isolated violent incidents, the notion that people who haven’t been violent, and may never be violent, need to be forcibly drugged – just in case!  Elsewhere, Mr. Jaffe openly acknowledges that the majority of “mentally ill” people are not violent.  But he has no hesitation in infringing their rights to self-determination if they stop taking their neurotoxic pills, just in case.  In the criminal justice system this would be the equivalent of guilty unless proven innocent.  In fact, it would be worse than that.  It would be guilty, with no way to prove one’s innocence.

“Now what I’m gonna do is I’m just gonna show you very quickly, uh, the story of Kendra’s law in the media.  As I’ve said, change happens as a result of acts of violence.  And what, and so, when these acts of violence occur, the media goes out and writes stories about them, and then we start approaching the media.  We have in New York…it’s called Kendra’s Law…it’s a law we’re trying to pass.  It’s an outpatient treatment law…assisted outpatient treatment.  What a brilliant phrase.  It’s not involuntary commitment, it’s assisted outpatient treatment.  That was…came out of the Treatment Advocacy Center.”

What a “brilliant phrase”!  Almost as brilliant as “Helping Families in Mental Health Crisis”.

BACK TO THE TIM MURPHY BILL

In a House Energy and Commerce Committee press release (July 6, 2016), Fred Upton, committee chair, is quoted:

“We continue to hear tales of great loss where intervention was lacking or nonexistent.”

One can readily detect the manipulatively deceptive tones of D.J. Jaffe cited earlier.  Representative Upton made no mention of the many tales of great loss where psychiatric intervention and drugging had been present.  For instance:

Killers on psych drugs

Prior to about 1960, the status of people who were confined to mental “hospitals” for extended periods could accurately be described as pre-civil-rights.  Gradually, as the adverse effects of institutionalization and psychiatric “care” began to be exposed, their legal status improved.  The Murphy bill is, I believe, the first concerted attempt to roll back these protections.

CIVIL RIGHTS

Interestingly, Congressman Murphy was asked about this matter by CNN’s Jake Tapper in an interview on January 27, 2014.

The question came at 1:25 into the interview.

Jake Tapper:

“There was a period in the country when the civil rights and civil liberties of people with emotional and mental problems, and we obviously don’t want to stigmatize these people, however much even talking about it might do that.  But when those civil liberties became very, very important, and they had more rights, they were bestowed more rights.  Did we go too far as a society?  Did we not take into account society’s needs beyond the individual’s needs?”

This question could have produced a fruitful discussion on civil rights, but watch how Congressman Murphy neatly sidesteps the issue.

“I think we swapped the hospital bed for a jail bed, quite frankly.  Somewhere between forty and fifty percent of people in our county jails, our state prisons, our federal prisons, are mentally ill.  That is the ultimate removing of their rights.  It is…we segregate them there, we end up not treating them there.  And the same thing goes where we’ve tripled the homeless rate.  This is not the way we should be doing it.  We’re acting like a third world country quite frankly.  It is embarrassing, it is immoral, it is unethical what we have done, and so you have as one person so eloquently said, they end up dying with their rights on, because we say you have to consent to treatment.  But how do you get somebody to consent to treatment if they don’t even understand reality.  They can’t sign a contract, they can’t do anything else.  And what we need are other options.  Not just the option of you have to be adjudicated to say you must stay in a hospital, but also an outpatient treatment option like you just described the case where the guy stabbed his mom.  He could have been taking medication, he could have been doing much better.  And many of these other assaults that have taken place – Aurora, Colorado or Arizona, etc., the person later on realizes gee, if I was in treatment I wouldn’t have done this because I would not have heard those voices commanding me.”

In other words, the bill doesn’t really infringe on people’s rights, rather it protects their rights!  So we will forcibly inject large numbers of people with neurotoxic poisons to guard against the possibility that a few of them might otherwise end up in jail or prison.

The assertion that forty to fifty percent of the incarcerated population are mentally ill is routinely trotted out by psychiatrists and their adherents in these kinds of debates. But in fact this is an artifact of psychiatry’s spurious medicalization of virtually every significant problem, including criminal behavior.  According to psychiatry’s DSM, threatening or intimidating others, using weapons, being cruel to people and animals, stealing, robbing, raping, burglarizing, shoplifting etc., constitute a mental illness called conduct disorder (DSM-5, p 469).  Not surprisingly, a great number of these people end up in prison. And let us be clear, psychiatry’s contention here is not that people with other “mental illnesses” commit these crimes, but rather that the commission of these crimes, in and of itself, constitutes a “mental illness”.  So of course forty or fifty percent of the incarcerated population has a “mental illness”.  For psychiatrists, virtually all criminality is “mental illness.”

But even if we set that consideration aside, there is in fact no shortage of psychiatric “treatment” in prisons.  Here’s a quote from the Federal Bureau of Prisons Mental Health page:

“The Bureau provides a full range of mental health treatment through staff psychologists and psychiatrists. The Bureau also provides forensic services to the courts, including a range of evaluative mental health studies outlined in Federal statutes.”  [Emphasis added]

“Psychologists are available for formal counseling and treatment on an individual or group basis. In addition, staff in an inmate’s housing unit are available for informal counseling. Services available through the institution are enhanced by contract services from the community.”

And here’s a quote from California’s Department of Corrections Mental Health Program website:

“REFERRALS TO MENTAL HEALTH

Any inmate can be referred for mental health services at any time. Inmates who are not identified at Reception or upon arrival at an institution as needing mental health services, may develop such needs later. Any staff members that have concerns about an inmate’s mental stability are encouraged to refer that inmate for evaluation by a qualified mental health clinician (psychiatrist, psychologist, or clinical social worker). [Emphasis added]  Under certain circumstances, referral to mental health may be mandatory. A referral to mental health should be made whenever:

  • An inmate demonstrates possible symptoms of mental illness or a worsening of symptoms.
  • Upon return from court when an inmate has received bad news such as a new sentence that may extend their time.
  • An inmate has been identified as a possible victim per the Prison Rape Elimination Act.
  • An inmate demonstrates sexually inappropriate behavior as per the Exhibitionism policy.
  • An inmate who is written up for a disciplinary infraction was demonstrating bizarre, unusual, or uncharacteristic behavior when committing the infraction.
  • An inmate placed into Administrative Segregation indicates suicidal potential on the prescreening, or rates positive on the mental health screening, or gives staff any reason to be concerned about the inmate’s mental stability, such as displaying excessive anxiety.
  • Upon arrival to an institution when the inmate indicates prior mental health treatment and medications, especially if not previously documented.

Referrals to mental health may be made on an Emergent, Urgent, or Routine Basis. An inmate deemed to require an Emergent (immediate) referral shall be maintained under continuous staff observation until evaluated by a licensed mental health clinician. An Urgent referral is to be seen within 24 hours. A Routine referral should be seen within five working days.

Referrals are made on the CDCR-MH5, Mental Health Referral Chrono, and forwarded to the mental health office. Emergent and Urgent referrals should also be made by phone to facilitate a timely response. The referral chronos, when received at the mental health office, are logged, entered into the data tracking system, and scheduled for follow-up with the appropriate clinician.

Inmates may also self-refer for a clinical interview to discuss their mental health needs.  Inmate self-referrals shall be collected daily from each housing unit, and processed the same way as staff referrals.”

Similar programs and procedures are in place in prisons in other states, and in other countries.

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

ON TO THE SENATE

The article in the Wall Street Journal states:

“The prospects for mental health legislation in the Senate are uncertain, given the compressed calendar in an election year and the fact that sponsors there have their own ideas for changes…”

But the various vested interests are already lobbying hard.  Here’s the text of a letter sent to the Honorable Mitch McConnell, Senate Majority Leader, and the Honorable Harry Reid, Minority Leader, by the APA and other groups on July 13, 2016:

“Dear Majority Leader McConnell and Minority Leader Reid:

On behalf of the undersigned organizations, we are writing to urge you to bring S. 2680, the Mental Health Reform Act of 2016, to the Senate floor for a vote as quickly as possible. Last week, the House of Representatives voted overwhelmingly to pass H.R. 2646, the Helping Families in Mental Health Crisis Act. It is now the Senate’s turn to act.

Mental illness is widely prevalent in the United States. Over 68 million Americans have experienced mental illness in the past year which is more than 20 percent of the total population of the United States. Lifetime rates are much higher with some estimates approaching 50 percent. More striking, in 2013, over 41,000 Americans died by suicide. Many individuals with mental illness or substance use conditions are unable to access or receive the appropriate services and supports for these illnesses, and they remain constantly challenged by mental health service delivery systems that are largely fragmented and uncoordinated across the country.

The Senate Health, Education, Labor, and Pensions Committee voted unanimously to advance S. 2680 in April. Notably, this bipartisan bill strengthens federal coordination of mental health resources, increases reporting on mental health parity, advances integrated service delivery, supports the mental health workforce, and increases early access to mental health services.

We now need your leadership to pass mental health reform and bring millions of Americans and their families help and hope.

Thank you for your consideration. We stand ready to work with you to ensure this critical first step in mental health reform can be sent to the President’s desk for signature this year.

Sincerely,

American Psychiatric Association
American Academy of Child and Adolescent Psychiatry
American Association on Health and Disability
American Congress of Obstetricians and Gynecologists
American Foundation for Suicide Prevention
American Nurses Association
American Orthopsychiatric Association
American Psychological Association
Anxiety and Depression Association of America
Association for Ambulatory Behavioral Healthcare
Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD)
Clinical Social Work Guild 49
Corporation for Supportive Housing
Depression and Bipolar Support Alliance
Eating Disorders Coalition
The Jewish Federations of North America
Mental Health America
National Alliance on Mental Illness
The National Association for Rural Mental Health
The National Association of County Behavioral Health and Developmental Disability Directors
National Association of Psychiatric Health Systems
National Association of Social Workers
National Association of State Directors of Special Education
National Council for Behavioral Health
National Health Care for the Homeless Council
National League for Nursing
National Register of Health Service Psychologists
NHMH – No Health without Mental Health
Sandy Hook Promise
The Trevor Project”

Note that the first signatory is the American Psychiatric Association.

It is sad that the list includes the National Association of Social Workers, who are squandering a rare opportunity to get on the right side of this debate and sever the shackles that bind them to the psychiatric hoax.

Note also the number of self-serving clichés that the APA have managed to work into this letter:

  1. wide prevalence of “mental illness”: 20% annually and 50% lifetime, but no mention of the fact that this includes every significant problem of thinking, feeling, and/or behaving, including childhood temper tantrums, habitual disobedience, habitual delinquency, shyness, adult temper tantrums, road rage, etc.
  1. “… over 41,000 Americans died by suicide”, but no mention of the fact that in 2010, 23.8% of suicide decedents tested positive for antidepressants post-mortem. (CDC Suicide: Facts at a Glance)   Nor is there any mention of the fact that the rate of antidepressant use in the US is increasing in step with the suicide rate.  The latter has been climbing steadily since 2000.  Here are the figures/100,000:

CDC Suicide rates

[Source:  CDC]

So the national suicide rate increased by 25% between 2000 and 2014.  Note also that the curve is steepening.  The increase from 2000 to 2005 was 4.8%, but from 2010 to 2014 it was 7.4%.

The CDC also reports that between the period 1994-2002 and 2005-2008, the rate of antidepressant use in the United States among all ages increased from 6.4% to 8.9% (a 39% increase).

Of course the fact that the increase in suicide rate coincided with the increase in antidepressant use doesn’t prove that the latter caused the former.  Many factors impact suicide rates.  But it certainly suggests that the matter warrants investigation.  Yet psychiatry, the primary promoters of the drugs, have persistently failed to take on this responsibility.  Brian at AntiDepAware has been single-handedly gathering information on this matter for years.  The sheer number of incidents he has logged is persuasive and compelling.

In addition, there have been numerous first-hand accounts of this phenomenon, including an article by Katinka Blackford Newman published on August 15 in the UK’s Independent.  Here’s a quote:

“On 13 March 2016, French investigators released a report on the case of Andreas Lubitz, the German wings pilot who locked himself into the cockpit of a plane and crashed the plane carrying 150 people into the Alps. When I opened it I felt sick; just nine days before the accident, he was put on exactly the same antidepressant medication that I had been on when I became psychotic and nearly killed my kids. It was clearly stated in the toxicology report – citalopram, mirtazapine and zopiclone sleeping tablets.”

Ms. Newman’s article is detailed and graphic.  Please take a look and pass it on.

JEFFREY LIEBERMAN, MD, SUPPORTS THE BILL

On June 16, 2015, the very eminent psychiatrist Jeffrey Lieberman, MD, presented testimony to the House Energy and Commerce Committee regarding the Tim Murphy bill.  Here are some quotes from his address:

“Our failure to take mental health care as an urgent public health need and national priority, has adversely affected our country in many ways, but there are several consequences which represent the tip of the iceberg of when it comes to our neglect of mental health care that are particularly disturbing. These begin with the seemingly recurrent incidents of mass violence in which the perpetrators are persons with untreated mental illness, and the shocking rates of suicide and PTSD in our military, but also includes domestic violence perpetrators and victims, the displaced mental patients who comprise 30% to 40% of the homeless and the growing rate of mentally ill prisoners. All of these would be limited or prevented by an effective mental health care system.”

Again, note the shameless regurgitation of the D. J. Jaffe marketing argument.  If you’re a Dr. Lieberman fan, as I am, do take a look at his full statement to the committee.  It’s classic Dr. Lieberman stuff, including:

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

“Stigma of mental illness is pervasive in American society and is actively perpetuated by a virulent Anti-Psychiatry Movement. Psychiatry has the dubious distinction of being the only medical specialty with a movement dedicated to its eradication.”

Of course there are very good reasons why psychiatry has this “dubious distinction”.  I’ve listed and discussed these in an earlier post.

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

“In fact I would go so far as to consider SAMHSA a proxy agency for the anti-psychiatry movement, which is to say that the agency has resisted the scientifically driven evidenced based approach to mental health care that psychiatric medicine has embraced since its scientific revolution began in the 1970’s.”

This is the “scientific revolution” that was based on the blatantly deceptive -­ and now widely debunked – premise that virtually every significant problem of thinking, feeling or behaving is caused by a chemical imbalance in the brain; a chemical imbalance which is correctible by taking psychiatric drugs, often for life.  So if that’s the revolution that SAMHSA is resisting, I’d say:  good for SAMHSA!

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

“So many painful and dispiriting elements and incidents in our society would be ameliorated by the advent of a comprehensive effective public mental health system and have a dramatically uplifting effect on public morale and quality of life.”

A dramatically uplifting effect on public morale and quality of life!  Is there just a hint of grandiosity here?

The prescribing of antidepressants and neuroleptic drugs has been increasing markedly in recent years.  We have even reached a point in the US where detectable levels of antidepressants are being found in the drinking water in many areas.  If these trends continue, perhaps “public morale” and “quality of life” will be off the charts.  Perhaps we’ll all be dancing joyously in the streets, and rival gangs will be holding choral concerts in the spill of the streetlights.  Oh Happy Day!

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

“Let me state at the outset that by mental illness I am referring to what are traditionally considered mental illnesses (e.g. schizophrenia, bipolar disorder, depression), addiction (e.g. substance use disorders) and intellectual disabilities (e.g. autism, Fragile X syndrome). The distinctions between these are arbitrary as they all are conditions affecting the same real estate in the brain and manifest by disturbances in common mental functions.”

So, the distinctions between the psychiatric labels schizophrenia, bipolar disorder, depression, addiction, autism, fragile X syndrome, etc., are arbitrary!  I’m not sure what point Dr. Lieberman is making here.  My Random House Webster’s College Dictionary (1992) defines “arbitrary” as:

“1. subject to individual will or judgment without restriction; contingent solely upon one’s discretion; an arbitrary decision2.  decided by a judge or arbiter rather than by a law or statute.  3.  having unlimited power; uncontrolled or unrestricted by law; despotic; an arbitrary government. 4.  Capricious; unreasonable; unsupported; an arbitrary demand for payment.  5.  Math undetermined; not assigned a specific value:  an arbitrary constant

So the distinction, for instance, between “schizophrenia” and “depression” is subject to individual (presumably a psychiatrist’s) will or judgment without restriction.  This sounds like there’s no essential distinction between these so-called illnesses.  Perhaps Dr. Lieberman is coming over to the anti-psychiatry side.  I’ve always said he was our greatest ally.  Or perhaps he just got a little confused in his choice of words.  Maybe he’s tired.  Laboring assiduously against “a virulent Anti-Psychiatry Movement” must take a dreadful toll.

A DISSENTING PSYCHIATRIST

Dinah Miller, MD, a psychiatrist/instructor at Johns Hopkins, pointed out on February 4, 2015, that the APA endorsed an earlier version of the bill before the full text had been published!  Here’s a quote from Dr. Miller’s post:

“Still, I heard the news and was terribly disappointed in the APA. The decision to support this sweeping legislation was made without a vote by the Assembly, with the knowledge that some of these issues are quite polarizing. In addition to the HIPAA disqualification, the issue of outpatient civil commitment, in particular, is controversial. Although proponents are quick to point to research that show its benefits – the research has been done specifically on Kendra’s Law in New York, where $125 million was placed into that state’s mental health system to shore up services – we don’t have the research to know if what helps is providing more services or strong-armed coercion. The text of the bill will be released in the coming weeks. At the very least, couldn’t the APA have waited to see exactly what it is we endorsed?”

THE LINK BETWEEN PSYCHIATRIC DRUGS AND MURDER/SUICIDE

There is an abundance of anecdotal information linking psychiatric drugs (especially neuroleptics and antidepressants) to violence, including murder, and suicide.  There are also several formal papers, most by psychiatrists, going back to at least 1978, which confirm these reports.  For instance:

Neuroleptics: Violence as a Manifestation of Akathisia, W Keckich, MD, Journal of the American Medical Association, 1978

Suicide Associated with Akathisia and Depot Fluphenazine Treatment, K Shear, MD, A Frances, MD, P Weiden, MD, Journal of Clinical Psychopharmacology, 1983

Homicide and Suicide Associated with Akathisia and Haloperidol, JL Schulte, MD, American Journal of Forensic Psychiatry, 1985

Behavioral toxicity of antipsychotic drugs, T Van Putten, MD, SR Marder, MD, Journal of Clinical Psychiatry, 1987

Fluoxetine, Akathisia, and Suicidality: Is There a Causal Connection?, W Wirshing, MD,  T. Van Putten, MD, J Rosenberg, MD, et al, Archives of General Psychiatry, 1992

Akathisia, suicidality, and fluoxetine,  MS Hamilton, MD, LA Opler, MD, Journal of Clinical Psychiatry, 1992

Akathisia as Violence, I Galynker, MD, D Nazarian, MD, Journal of Clinical Psychiatry, 1997

Causality and collateral estoppel: process and content of recent SSRI litigation,  PD Whitehead, MD, Journal of the American Academy of Psychiatry and the Law, 2003

Antidepressant-induced akathisia-related homicides associated with diminishing mutations in metabolizing genes of the CYP450 family. Y Lucire, MD, C Crotty, MD, Pharmacogenomics and Personalized Medicine, 2011

The relevance of cytochrome P450 polymorphism in forensic medicine and akathisia-related violence and suicide, SJ Eikelenboom-Schieveld, Y Lucire, MD,  JC Fogleman, PhD, Journal of Forensic Legal Medicine, 2016

Antidepressant use and violent crimes among young people: a longitudinal examination of the Finnish 1987 birth cohort., E. Hemminki, MD, M Merikukka, PhD, M Gissler, PhD, et al, Journal of Epidemiology Community Health, 2016

BRILLIANT PHRASES

Congressman Murphy is as attuned to the power of catchy slogans as D.J. Jaffe.  Here are some “brilliant phrases” that Dr. Murphy has used in an article and in speeches promoting his bill:

Mental illness is a medical emergency
Treatment before tragedy Minute 9:02
Delayed treatment is denied treatment Minute 1:22
Where there is no help, there is no hope Minute 1:26
Little has been done to get those who need help the help they need Minute 0:22

AND INCIDENTALLY

Here’s some information on the sources of Tim Murphy’s campaign finances for the past four election cycles:

Tim Murphy Campaign Finance Sources

[The source of the financial information listed above is Open Secrets.org, a “nonpartisan guide to money’s influence on US elections and public policy.”]

To put these numbers in perspective, Rep. Murphy’s total campaign expenditures, again, according to Open Secrets, for the years in question were:

Tim Murphy Campaign Expenditures

So the contributions detailed above represent a sizable portion of Rep. Murphy’s campaign expenditures.

DECEPTIONS AND SLOGANS

And so, my dear and patient readers, there it is:  D.J. Jaffe’s tawdry marketing tactics and slogans from the 90’s, adopted today by an ambitious, pharma-psychiatry funded politician, and shamelessly embraced by organized psychiatry.

There are truly no depths of venality and deception to which psychiatry will not stoop to draw attention away from the link between psychiatric drugs and murder/suicide.

And to save their so-called profession, they are even willing to pass the blame for the murder-suicides onto their own clients, for whom they profess such care and concern.

Organized psychiatry, committed irrevocably and wholeheartedly to drug pushing and to their corrupt and corrupting relationship with pharma, simply will not countenance the fact that their primary product is fundamentally flawed and destructive.  So they hire a PR company; they fund and lobby politicians; they parrot slogans; and they encourage one another to ever-increasing heights of self-congratulation.  But they will not commission a definitive study to clarify and assess the scale of this problem once and for all.  And the reason for this inaction is because they know that it would be bad for business.  It would “cause a lot of people to stop taking their medications”.  So the pharma-psychiatry cartel thrives, and the dance of death goes on.

FINALLY

If you live in the US, please write to your Senators and ask them not so support this legislation.

Bad News on the Doorstep: Psychologists Prescribing Drugs

[Note:  In this post, “APA” refers to the American Psychological Association]

There is an article in the current (July/August) issue of The National Psychologist titled “Iowa becomes 4th state to approve RxP”.  The author is James Bradshaw, Associate Editor.  RxP is a commonly used abbreviation for prescription authority for psychologists.

Here are some quotes from the article, interspersed with my comments.

“Iowa Gov. Terry E. Brandstad has signed a law granting prescription authority to properly trained psychologists, making Iowa the fourth state where psychologists can prescribe drugs from a psychotropic formulary.”

The three previous states to pass this measure are New Mexico, Louisiana and Illinois.

The article quotes Neal Morris, Ed.D., president of the American Society to Advance Pharmacotherapy, a division of the American Psychological Association.

“‘I am very excited and optimistic that in the near future other states will be enacting prescribing psychologist legislation,’ he said, adding, ‘RxP is such a good idea from the public health access to quality treatment standpoint I think it should be a top priority for every thoughtful legislator concerned about providing good health care to their constituents.'”

Katherine Nordal, PhD, APA’s Director for Professional Practice was also quoted:

“‘This is a landmark decision that will improve access to a wide range of mental health services'”

and

“Increasing access to mental health care is critical given the increase of major depressive disorders among Iowa’s youth and the number of people over 65 experiencing a diagnosable mental illness.”

This is straightforward psychiatric PR, coming from a psychologist!  Note, in particular, the complete acceptance and endorsement of the spurious medical model.

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

Bethe Lonning, Psy.D., represents the Iowa Psychological Association on the APA’s Council of Representatives, and was a prime leader in Iowa’s RxP movement.  Dr. Lonning is quoted in the article:

“‘Signing this legislation into law is a great step toward increasing accessibility to mental health care for all Iowans, many of whom currently have to wait months or drive long distances to receive treatment.'”

Notice that, by implication, the word treatment is being used as synonymous with drug treatment.

The article continues:

“The dearth of psychiatrists in Iowa, particularly in rural areas, was a prime selling point to convince state legislators of the need for prescribing psychologists.  There are no psychiatrists practicing in two-thirds of the state’s counties.”

This picture – of the misfortunate “mentally ill” people languishing unserved in the psychiatry-less wasteland – is, of course, pure PR.  But I guess it was enough to convince the Iowa legislators.

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

This, of course, is sad beyond words, but it reminded me of another article published in The National Psychologist eleven years ago (September/October 2005).  The article was titled “The Decline and Fall of the American Psychological Association”.  The author was the late George Albee, PhD, then professor emeritus of psychology at The University of Vermont.  Here are some quotes:

“The decision by APA’s Council to proceed to seek prescription privileges for practicing psychologists is the final straw.  We are doomed.”

“The pharmaceutical industry became top earners.  They spread funds generously into organic psychiatry, brain research, training and public education.  They sponsored drug research, wrote the results for the researchers, funded their journals and put everyone on as paid consultants.”

“Let us not misunderstand.  Psychologists will get the legal authority to prescribe.  They have the strong support of the powerful pharmaceutical industry.  Psychologists can and will learn to be competent prescribers.  But it will finally stamp us as an integral part of the invalid, unreliable medical explanation of emotional distress.  Writing prescriptions for ‘drugs for the mind’ will cement us into a system from which there is no escape.”

“Being part of the system means supporting the system.  So we must close our eyes, hold our noses and agree that half of all Americans will have a mental illness caused by a brain defect at some time in their lives.  If judged incompetent they can be forced by law to take their pills.”

“In spite of years of seeking, no organic pathology has been found that causes mental disorders and diagnoses for these conditions are unreliable and hence invalid.  Organic (drug) treatment does not cure mental disorders.  But to work in the field it is necessary to support all these myths and dishonesties.”

“A few competent and informed journalists could expose the flimsy and invalid evidence on which the current model depends.  We need more like A. Deutsch (1948) who, in The Shame of the States, brought attention to the horrible inhumanity of the state hospitals.  R. Whitaker (2002) has made a start, but he cannot compete with the powerful citizens’ groups such as the National Alliance for the Mentally Ill (NAMI), mostly relatives of seriously disturbed people.”

Albert Deutsch (1905-1961) was an American journalist and social historian.  The Robert Whitaker book Dr. Albee references is Mad in America, and in the eleven years since George Albee wrote these words, Robert Whitaker’s work has progressed way beyond “a start”.

“NAMI fiercely defends the brain diseases model and goes ballistic to any suggestion that social conflicts could play any role in causation.  The National Alliance for Research on Schizophrenia and Depression holds formal balls to showcase its upper-class contributors but denies the clear evidence that schizophrenia is not a disease (Boyle) and that depression is unknown in many cultures.”

The Boyle reference is to Mary Boyle’s cardinal work:  Schizophrenia: A Scientific Delusion? (1990).  Dr. Boyle is a British clinical psychologist, and Professor Emeritus at University of East London.  A second edition of the book was published in 2002.

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

Also in 2005, Dr. Albee wrote this in a letter to the Independent Practitioner, an APA publication:

“To prescribe drugs as treatment changes fundamentally our orientation as a profession.  We now become part of a group that sees emotional behavioral disturbance as biological defect or glandular irregularity to be corrected with chemicals.  Our long history of research into the damage done by toxic relationships in the past, and the ways these can be mended by relearning, is abandoned.”

and

“I do indeed think we have sold our soul for money in accepting the medical model of emotional disorder.”

George Albee died on July 8, 2006, at his home in Longboat Key, Florida.  He was 84.  During his life he had written tirelessly and cogently against the medicalization of human distress.

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

Four states plus the US military now allow psychologists the authority to prescribe psychiatric drugs.  More states will certainly follow, and the profession that should be most aware of, and most outraged by, the psychiatric hoax will soon be fully integrated into the spurious, disempowering, and destructive system.

To state the obvious, psychology is a split profession.  On the one hand, there are those who accept the illness model, believe that the “diagnoses” have some ontological and explanatory significance, and embrace “pharmacotherapy” as a valid and ethical way to address problems of thinking, feeling, and behaving.  On the other hand, there are those of us who reject these premises as spurious and unequivocally harmful.  The split has been long evident.  For decades the two factions have worked alongside each other with a reasonable level of collaboration and a semblance of mutual respect.  But the conflicts are being exposed in sharper relief as the medicalization proponents continue to expand their prescriptive authority.  I doubt that a profession can contain this kind of internal tension indefinitely, and perhaps the day is approaching when we will have two very different kinds of psychologists:  the druggers and the non-druggers.  Though I’m sure that different terminology will  be used.

It is customary in these sorts of circumstances to lament the schism and express the hope that the two sides can “iron out” their differences.  But just as the rift between psychiatry and anti-psychiatry is irremediable, so there can never be any substantive common ground between psychologists who embrace and promote a medical model of human distress and those who do not.  To adapt Dr. Albee’s metaphor:  people can close their eyes and hold their noses for only so long.

The philosophy and practice that psychiatry has created within the mental heath system, public and private, is a spurious, destructive, self-serving travesty.  It is also a tyranny that demands of its “ancillary staff” acceptance of, and compliance with, the biological medical model.  Staff members who don’t accept the doctrine are marginalized, ridiculed, or worse.  In a recent post on Mad In America, Michael Rock, psychotherapist, vividly described his experiences in this area as he struggled with the obvious invalidity and lack of efficacy of the psychiatric system.

The reality is that as psychiatry, beleaguered as it is, doubles down on its spurious and destructive premises, routinely substituting PR and unsubstantiated assertions for logic and evidence, more and more “ancillary staff” will see through the hoax.  The emperor really and truly has no clothes.  Organized psychology and some of its members are willing to play along for the sake of the crumbs that fall from the table.  But what of the other professions:  the social workers, counselors, case managers, job coaches, etc.?  These are the people who spend the most time with the clients.  These are the people who know that there is something terribly wrong with the system, but who dare not speak out, for fear of ostracization or even loss of livelihood.

The “chemical imbalance” part of the hoax has been successfully outed.  It’s only a matter of time before the rest of the shabby enterprise follows suit.  And as psychiatrists are increasingly exposed as the destructive, self-serving, drug-pushers that they are, psychologists who pursued the primrose path of “psychopharmacotherapy” will inevitably find themselves tarred with the same brush.

Non-psychiatrists Working in the Mental Health System

I know from my own experience and from emails I receive from readers that a great many non-psychiatrists who work in the mental health system have seen through the psychiatric hoax.  These individuals, who are growing in number, realize that the problems for which clients seek help are not illnesses in any meaningful sense of the term.  They also realize that the psychiatrically-controlled mental health system, with its emphasis on drugs and electric shocks, is doing enormous harm to the people it purports to serve.

Most of these workers try to adapt.  They try to work around the meaningless “diagnoses” and the pill-for-every-problem approach, and they seek ways to be genuinely helpful to the clients.

A few days ago, through the Tell Your Story tab on my website, I received an article from one such individual.  It’s a powerful account of the author’s struggle with the inanities of psychiatric care, and his eventual exit from the system.

Please take a look, and pass it on.

“The Overdiagnosis of ADHD”

INTRODUCTION

On May 23, the very eminent psychiatrist Allen Frances, MD, published on the HuffPost blog an article titled Conclusive Proof ADHD is Overdiagnosed.

The general theme, that various “mental illnesses” are being “overdiagnosed” is gaining popularity in recent years among some psychiatrists, presumably in an effort to distance themselves from the trend of psychiatric-drugs-on-demand-for-every-conceivable-human-problem that has become an escalating and undeniable feature of American psychiatric practice.  The assertion in Dr. Frances’s title – that the label “ADHD” is being applied to too many people – is obviously true. But the implicit assumptions – that there is a correct level of such labeling, and that the label has some valid ontological significance – are emphatically false.  But Dr. Frances affords no recognition to this aspect of the matter.

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

Anyway, let’s take a look at the article.  Here’s the opening statement:

“There are 3 possible explanations for the  explosion of the ADHD diagnosis during the past 20 years — with rates that have skyrocketed from only 3-5 percent of kids to 15 percent.

1) Diagnostic enthusiasts celebrate the jump as indication of increased awareness of ADHD and better case finding.

2) Diagnostic alarmists worry that we are making our kids sicker via environmental toxins, computers, an over-stimulating world, maternal drug use, or some combination.

3) Diagnostic skeptics attribute the change to the raters, not the rated — it’s not that the kids are sicker, it’s rather that the diagnosis is being made too loosely.”

So, Dr. Frances tells us that there has been an “explosion” of ADHD diagnosis during the past 20 years – i.e. since about 1996.  Rates of “diagnosis” have gone from 3-5% to 15%.  And this may indeed be the case.  But consider this.  DSM-III-R (1987) cited a prevalence rate of “…as many as 3% of children” (p 51).  DSM-IV (1994) cited “3%-5% of school-age children” (p 82).  So, from 1987 to 1994, when DSM-III-R was the diagnostic reference, the prevalence increased modestly.  But from 1994 to the present day – a period during most of which Dr. Frances’s own DSM-IV was the reference – the rate exploded (to use Dr. Frances’s own term) from 3-5% to 15%.  Could it be that the relaxation of the criteria in DSM-IV made it easier for a person to be given the ADHD label?

“DIAGNOSTIC” RELIABILITY

“There is no gold standard or biological test to prove precisely which view is correct and what would be the ideal rate of ADHD to best balance the risks and benefits of being diagnosed. I am strongly in the skeptic school. Long experience has taught me how great is the impact on diagnostic rates of even small changes in how any disorder is defined or appraised. And this is greatly amplified when heavy drug company disease mongering aggressively sells the disorder to doctors, parents, and teachers.”

The opening sentence here represents an interesting admission.  “There is no gold standard or biological test to prove precisely which view is correct…”  In other words, it is not possible to say definitively who “has ADHD” and who does not.  But wasn’t it the purpose of successive revisions of DSM to clarify this matter once and for all?  Wasn’t it the purpose of DSM to put “diagnostic” uncertainty in the past, and to provide strict, confirmable criteria that would resolve the diagnostic reliability question?  Hasn’t this been psychiatrists’ claim since the publication of Robert Spitzer’s DSM-III?   Even Thomas Insel, MD, former Director of NIMH, while dismissing the various DSM entries as mere “labels”, clung to the notion that they were reliable.  “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.” (Transforming Diagnosis).  But now Dr. Frances tells us that at least the ADHD label doesn’t even have sufficient reliability to provide accurate prevalence rates.  Of course those of us on the anti-psychiatry side of the issue have been saying for years that the various items listed in the DSM are nothing more than loose collections of vaguely defined problems with no explanatory or ontological significance.  Whilst I don’t think there is any prospect of Dr. Frances joining the anti-psychiatry movement in the near future, it is gratifying to learn that he shares our views concerning the lack of reliability of the ADHD “diagnosis”.

Dr. Frances tells us that he is “strongly in the skeptic school”.  In other words, he believes that the increase in prevalence of this so-called illness from 5% to 15% is attributable, not to the children who are receiving the label, but rather to the labelers:  “…the diagnosis is being made too loosely.”

And to guard against any suggestion of self-incrimination or confession, Dr. Frances promptly distances himself from the perpetrators of such wanton laxness.  “Long experience”, Dr. Frances tells us, has taught him “how great is the impact on diagnostic rates of even small changes in how any disorder is defined or appraised.”  This is a particularly compelling issue, because a number of small (and some quite large) changes to the “ADHD” criteria were made by Dr. Frances and his team in the DSM-IV.

RELAXATION OF “DIAGNOSTIC” CRITERIA IN DSM-IV

I listed and discussed these changes in an earlier post on December 8, 2015, and the details need not be repeated her.  Suffice it to say that the criteria were eased to a very considerable extent, and readers can confirm this by referring back to my earlier post and to the two DSM’s.

So, given that Dr. Frances concedes that even small changes in criteria can have a great impact on “diagnostic rates”, isn’t it reasonable to conclude that the very marked easing of criteria in Dr. Frances’s own DSM-IV, published twenty-two years ago in 1994, was the major proximate cause of the rate increase over the past twenty years?  Surely Dr. Frances is aware that within a year of the publication of DSM-IV, virtually every community mental health center and other psychiatric facility in the country had trained their staff in the new criteria, and that as a direct result of this, untold numbers of children received this label (and the almost inevitably attendant drugs) who would not have received the label under the DSM-III-R criteria.

BLAMING PHARMA

And then with po-faced innocence, Dr. Frances has the gall to complain that the problem is “amplified when heavy drug company disease mongering aggressively sells the disorder to doctors, parents, and teachers.”  One can’t monger a spurious disease until it has been invented.  It was psychiatry who invented ADHD, and it was Dr. Frances who relaxed the criteria making it possible to apply this disempowering label to more and more children.  What pharma did was what pharma always does:  they used the marketing opportunities that psychiatry had obligingly and knowingly created for them.  Did Dr. Frances imagine that they would not avail of such opportunities?

Besides, for Dr. Frances to point the finger at pharma suggests a measure of ingratitude to the hand that fed him.  Remember, this is the same Dr. Frances who in 1995, in concert with his then colleagues Drs. John Docherty and David Kahn, reportedly received grants of about $515,000 from Johnson & Johnson to write “Schizophrenia Practice Guidelines” which specifically promoted Risperdal (a Johnson & Johnson product) as the first line of treatment for schizophrenia.  On July 3, 1996, Dr. Frances and his colleagues reportedly wrote to Janssen Pharmaceutica (a Johnson & Johnson subsidiary) concerning the preparation of Schizophrenia Practice Guidelines, ‘We are also committed to helping Janssen succeed in its effort to increase its market share and visibility in the payor, provider, and consumer communities.’  For a full and compelling account of this sordid matter, see Paula Caplan’s very thorough exposé here.  This entire matter, incidentally, only came to light because Dr. Frances’s profitable and collaborative relationship with Johnson & Johnson happened to be mentioned in testimony in a Texas lawsuit against the pharmaceutical company.

And in this general context, it should also be borne in mind that 56% of the DSM-IV Task Force had financial links to pharma. (Cosgrove et al 2006)

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

But let’s not dwell on the past.  Dr. Frances was never convicted of any offense for his role in the Johnson & Johnson scandal.  Nor was his medical license ever revoked.  Nor was he ever drummed out of his professional association.  Come to think of it, what are the criteria for being drummed out of the APA?  Given the scandals and disclosures of recent years, they must be rather lax.  But I digress.

ADHD AND CHILDHOOD IMMATURITY

Dr. Frances goes on to tell us some good news:

“Fortunately, there is one ingenious and compelling indirect way to determine whether rates of ADHD are inflated. Five large studies in four different countries have compared rates of reported ADHD in the youngest vs the oldest kids in classrooms. The studies converge on the inescapable finding that we are turning immaturity into disease.”

At this point, Dr. Frances turns the article over to Joan Lipuscek, MS LMFTA.  Joan Lipuscek is a child, teen and family therapist in Houston, Texas, with over fifteen years of experience.  Ms. Lipuscek outlines the five studies, all of which indicate that, in general, children who are younger than their classroom peers are more likely to be given the ADHD label. A  2010 US study, for instance, is reported to have found that :  “Children born 1-3 months prior to the grade cutoff date were found to be 27% more likely to be diagnosed for ADHD and 24% more likely to be medicated for ADHD compared to children born 10-12 months prior to the grade cutoff date.”  This is an interesting observation, of course, but the effect size (27%) doesn’t begin to explain the increase in labeling rates from 5% to 15% that Dr. Frances cited in his opening statement.  An increase from 5% to 15% is a 300% increase.

A more important point, however, is the implication in Dr. Frances’s paper that the “diagnosis” should not have been given to these children; that their juniority in the classroom should somehow have been considered an exclusionary factor.

So let’s see what the DSM has to say on age exclusions.  Here’s the pertinent sentence from DSM-III and DSM-III-R:

“In approximately half of the cases, onset of the disorder is before age four.” (p. 51) [Emphasis added]

So, clearly, as far as Dr. Spitzer and his Task Force were concerned, all children of school age were eligible for this diagnosis.

Dr. Frances, in DSM-IV, was a little more circumspect:

“It is especially difficult to establish this diagnosis in children younger than age 4 or 5 years, because their characteristic behavior is much more variable than that of older children and may include features that are similar to symptoms of Attention-Deficit-Hyperactivity Disorder.  Furthermore, symptoms of inattention in toddlers or preschool children are often not readily observed because young children typically experience few demands for sustained attention.  However, even the attention of toddlers can be held in a variety of situations (e.g., the average 2- or 3-year-old child can typically sit with an adult looking through picture books).  In contrast, young children with Attention-Deficit/Hyperactivity Disorder move excessively and typically are difficult to contain.  Inquiring about a wide variety of behaviors in a young child may be helpful in ensuring that a full clinical picture has been obtained.” (p. 81) [Emphasis added]

But the message is still clear:  children as young as two can be assigned this “diagnosis” provided that they “move excessively and typically are difficult to contain”, and that “a full clinical picture has been obtained”.  This latter exhortation is comforting, of course, but difficult to reconcile with the reality of the 15-minute “med check”.  But the critical point is that the only age parameters in the DSM criteria lists for ADHD are:  “Onset before the age of seven” (DSM-III), and “Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years” (DSM-IV).  There is nothing in the system to even suggest that being the youngest in one’s class or being less mature than one’s peers has any bearing on the matter.  In fact, isn’t the criteria list essentially a definition of childhood immaturity?  To challenge the assignment of this “diagnosis” on the grounds that the child is merely immature misses the point.  Dr. Frances’s “discovery” that “we are turning immaturity into disease” is 48 years too late.  Turning immaturity into disease is precisely what happened in 1968 with the publication of DSM-II.  That edition of the manual contained the entry:  “308.0 Hyperkinetic reaction of childhood (or adolescence)” [p 12].  Psychiatrists then were as fond of putative brain disorders as they are today, and the children who were given the hyperkinetic “diagnosis” were also frequently described as having “minimal brain damage” (MBD), though no evidence of brain pathology was ever adduced.  By 1980, when DSM-III was published, the two concepts had fused. The Index to that edition contains the following entry:  “Minimal brain damage.  See Attention Deficit disorder” [p. 489].  And with the publication of DSM-III’s criteria list, the process of turning childhood immaturity into disease was complete.  DSM-IV’s primary contribution to this hoax, as pointed out earlier, was to liberalize the criteria, but made no attempt to reverse or even slow the process of pathologizing childhood immaturity.

In addition, all of the DSM criteria for ADHD are intrinsically vague and subjective.  As such, they are open to interpretation, and they constitute a tempting invitation to medicalize all and any problematic classroom behavior.  Is it Dr. Frances’s current contention that he and his Task Force colleagues couldn’t have foreseen that?  Dr. Frances had been a member of the DSM-III and DSM-III-R Task Forces, and had seen the effect that these documents had on psychiatric expansion and drugging.  Are we to believe that a scholar-practitioner of Dr. Frances’s caliber and experience is really that naïve?  Are we to believe that he was unaware of the controversy surrounding this issue?

This controversy is not new.  Here are three quotes from Ullmann and Krasner’s psychology text book A Psychological Approach to Abnormal Behavior, 2nd edition.

“This general type of hyperactivity is called ‘hyperkinetic reaction’ in DSM-II, in contrast to no mention in DSM-I.  Does this mention in DSM-II indicate the development of a new disease, the awareness and greater alertness of the professional to a disorder not previously of major concern, or the advent of a treatment method (drugs) for which practitioners sought more and more behaviors as being applicable?” [p. 496]

And:

“The treatment of children who have received the label of ‘hyperactive’ has been a source of further controversy in both psychology and pediatrics (Sroufe and Stewart, 1973).  Drug therapy, particularly stimulants such as the amphetamines, have become the popular form of treatment including up to 10 percent of all students in some school districts (Sroufe, 1972).

Investigators (Freedman et al, 1971; Wender, 1971; Fish, 1971) report that the stimulant drugs have been ‘beneficial’ in one-half to two-thirds of the cases in which they have been used.  However, the use of drugs with children brings up questions as to the conditions, goals, and effects of such treatment.  Critics of drug usage contend that diagnostic categories such as minimal brain dysfunctions are so vague and unspecific that many children who receive the label are actually reacting to specific environmental stimuli (uninspiring curriculum, ghetto schools, crowded classrooms, etc.)  (Battle and Lacey, 1972).  Thus the drugs are used (in much the same way as tranquilizers in mental hospitals) for management in the classroom or home.” [p. 496]

And:

“The label plus the drug treatment brings the child into the mentally ill or sick category and the social and self-labeling that follow (see Chapters 2 and 10).  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). [p. 497]

This was written in 1975:  forty-one years ago!

PSYCHIATRY’S BIO-BIO-BIO MODEL

Psychiatry, throughout its modern history (with the exception of its brief and circumscribed fling with psychoanalysis), has adopted and promoted a consistently bio-bio-bio approach to human problems.  Robert Spitzer, MD, architect of DSM-III and DSM-III-R, is often identified as the individual who codified this approach and embedded it solidly into psychiatric theory, research, and practice.  But here’s a little-known quote from the Introduction to DSM-III and DSM-III-R that lends at least a measure of doubt to that conclusion:

“The approach taken in DSM-III-R is atheorectical with regards 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.  Undoubtedly, over time, some of the disorders of unknown etiology will be found to have specific biological etiologies; others, to have specific psychological causes; and still others, to result mainly from an interplay of psychological, social, and biological factors.” (p. xxiii) [Emphasis added]

In the Introduction to DSM-IV, here’s what Dr. Frances wrote on the same topic:

Nothing.

That’s right – nothing!  The compellingly obvious notion that some of the problems listed in the APA’s catalog might actually stem from psychological factors was simply dropped from DSM-IV without explanation.  In my view, the most reasonable interpretation of this omission is that Dr. Spitzer’s earlier statement posed a threat to what has consistently been psychiatry’s primary agenda:  the medicalization of all problems of thinking, feeling, and behaving.

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

And here’s another interesting difference between III and IV.  Under the heading “The Distinction between ‘Mental Disorder’ and ‘Physical Disorder'”, DSM-III-R states:

“Throughout this manual there is reference to the terms mental disorder and physical disorder.  The term mental disorder is explained above. As used in this manual, it refers to the categories that are contained in the mental disorders chapter of the International Classification of Diseases (ICD).  The term physical disorder is used merely as a shorthand way of referring to all those conditions and disorders that are listed outside the mental disorders section of the ICD.  The use of these terms by no means implies that mental disorders are unrelated to physical or biological factors or processes.” (p. xxv)

DSM-IV’s statement, under the same heading, is similar, but with an important addition:

“The terms mental disorder and general medical condition are used throughout this manual.  The term mental disorder is explained above.  The term general medical condition is used merely as a convenient shorthand to refer to conditions and disorders that are listed outside the “Mental and Behavioural Disorders” chapter of ICD.  It should be recognized that these are merely terms of convenience and should not be taken to imply that there is any fundamental distinction between mental disorders and general medical conditions, that mental disorders are unrelated to physical or biological factors or processes, or that general medical conditions are unrelated to behavioral or psychosocial factors or processes.” (p. xxv) [Bold face added]

Note the assertion:  “It should be recognized that these are merely terms of convenience and should not be taken to imply that there is any fundamental distinction between mental disorders and general medical conditions…”

This is arguably the strongest and clearest endorsement of the bio-bio-bio approach that one could find in the psychiatric literature:  there is no fundamental distinction between mental disorders and ordinary physical illness.  This is the foundation for the mantra:  depression is a real illness, just like diabetes:  that unredeemed falsehood that psychiatrists have been telling their customers for decades.

PHARMA’S MARKETING IS BASED ON PSYCHIATRY’S HOAX

In his present article, Dr. Frances laments what he calls the overdiagnosis of ADHD.  And, indeed, the extent to which this fabricated disease is being foisted on our children for the sake of psychiatric prestige and profit is nothing short of a national scandal. But it pales into insignificance in comparison with the Great Psychiatric Hoax:  that all significant problems of thinking, feeling, and behaving, including childhood distractibility, are illnesses, requiring expert medical intervention and drugs.  And this perverse notion – that all significant problems of thinking, feeling, and behaving are biological illnesses – is the cornerstone of all pharma-psychiatric marketing:  you need our products because your brain is sick; your child needs our products because his/her brain is sick; your aging parents need our products because their brains are sick; etc.

And, as his own words clearly show, Dr. Frances has been a major player in the design, maintenance, and promotion of this hoax.  But now that the hoax is exposed, and even the mainstream media have come to recognize psychiatry’s venality, corruption, and spurious concepts, Dr. Frances is striving to distance himself from his former positions, and is re-inventing himself as the tireless champion of the “mentally ill” who has fought long and hard against the expanding tentacles of pharma and the slovenly prescribing practices of GP’s.

WHY PICK ON DR. FRANCES?

As my regular readers know, I have, in the past year or so, critiqued a number of Dr. Frances’s papers.  Some of my readers have written to me and asked why I bother to do this; that his excuses and self-promotions are unconvincing; and that there are more pressing matters to tackle.  And, or course, these are valid points.

But there is for me an over-riding issue:  that Dr. Frances isn’t just trying to exculpate himself.  He is also trying to exculpate psychiatry.  Dr. Frances’s consistent stance across several recent articles is that psychiatry is fundamentally good and sound, but that its concepts have been distorted and its “diagnoses” and “treatments” misused by others.  In my view, psychiatry is not something good and sound.  Rather, it is something fundamentally flawed and rotten.  And the fundamental flaw – the great lie – is that all significant problems of thinking, feeling, and behaving are illnesses. This is the very basis of psychiatry – the fundamental justification for medical intervention.  And it is a lie.  And it is irremediable.  Apart from those entries that are clearly identified as due to a general medical condition, illness is neither a valid nor a useful way to conceptualize the problems catalogued in the various editions of the DSM.  And when this hoax is thoroughly exposed, psychiatry will have lost its basis for existing.

By focusing on what are, by comparison, relatively minor and remediable matters, Dr. Frances is deflecting attention from the major and irremediable matter:  that psychiatry is a hoax.

Psychiatry is a destroyer of people, both individually and in terms of our cultural resilience.  They have replaced the success-through-collaboration-and-personal-effort ethos of Western society with their intrinsically disempowering broken-brains-need-pills philosophy that has infected every facet of modern life.