Tag Archives: ADHD

Thomas Insel: “Are Children Overmedicated?”

Thomas Insel, MD, is the Director of the National Institute of Mental Health.  In June of last year, he published, on the Director’s Blog, an article titled Are Children Overmedicated?  The gist of the article is that children are not being overmedicated, but rather that there is an increase in “severe psychiatric problems” in this population.

Here are some quotes, interspersed with my comments.

“The latest estimate from the National Center for Health Statistics reports that 7.5 percent of U.S. children between ages 6 and 17 were taking medication for ’emotional or behavioral difficulties’ in 2011-2012. The CDC reports a five-fold increase in the number of children under 18 on psychostimulants from 1988-1994 to 2007–2010, with the most recent rate of 4.2 percent. The same report estimates that 1.3 percent of children are on antidepressants. The rate of antipsychotic prescriptions for children has increased six-fold over this same period, according to a study of office visits within the National Ambulatory Medical Care Survey. In children under age 5, psychotropic prescription rates peaked at 1.45 percent in 2002-2005 and declined to 1.00 percent from 2006-2009.”

Dr. Insel points out that psychiatrists, parents, schools, and drug companies are often blamed for these increases. He challenges these perspectives.

“…most of the prescriptions for stimulant drugs and antidepressants are not from psychiatrists.”

This is a frequently-heard psychiatric assertion, but it is beside the point.  It is indeed the case that GP’s and various medical specialists prescribe psychiatric drugs for various problems of thinking, feeling, and/or behaving, but they can only do so because psychiatry has developed and promoted the fiction that these problems are illnesses, and the drugs are medications.  In fact, it’s even worse than that.  Psychiatry’s spurious medicalization of all human problems of thinking, feeling, and/or behaving has been so thoroughly integrated into mainstream medical care, that a physician who doesn’t prescribe psychiatric pills in certain situations could find himself legally liable for malpractice in the event of an adverse outcome.

Dr. Insel provides equally facile reasons why parents, schools, and drug companies are not to blame for the increased drugging of children. And with that whole issue out of the way, he continues:

“If psychiatrists, parents, schools, or drug companies are not the culprit, who is? The answer is potentially more complicated and more worrisome. Is it possible that the increased use of medication is not the problem but a symptom? What if more children were struggling with severe psychiatric problems and actually the problem was not over-treatment but increased need? Surely, if we discovered more children were being treated for diabetes or immune problems, we wouldn’t blame the providers or the parents. We’d be asking what drives the increase in incidence.”

Note how Dr. Insel equates psychiatric problems with real illnesses such as diabetes and immune problems.  The big difference, of course, is that real physicians don’t invent the illnesses they treat, as do psychiatrists.  Yes, more children today are “struggling with severe psychiatric problems”, but the primary reason for this is that pharma-psychiatry has been so successful in promoting the notion that virtually every problem that a child could display is an illness which needs to be “treated” with psychiatric drugs.  Former generations regarded childhood temper tantrums as a problem that needed to be addressed by parents using the normal time-honored ways.  Today these temper tantrums are a “symptom” of “disruptive mood dysregulation disorder”, a severe “psychiatric illness” warranting the attention of psychiatrists and the prescription of drugs.  There is, in fact, no difference between the temper tantrums of former years and disruptive mood dysregulation disorder of today. All that’s changed is that psychiatry has, once more, expanded its turf through the simple expedient of creating yet another “illness” by voting it into existence.  Similar observations apply to childhood inattentiveness, defiance, misconduct, boredom, etc…

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

“Skepticism regarding increased rates of emotional and behavioral difficulties as opposed to increases in other medical disorders can be attributed in part to the absence of biomarkers or laboratory tests for psychiatric diagnosis comparable to glucose tolerance tests for diabetes or anaphylactic reactions for allergies. Absent these kinds of consistent, objective measures for mental disorders, we cannot distinguish between a true increase in the number of children affected or simply changing values or trends in diagnosis. Clearly context matters. What one parent might consider hyperactivity, another parent might consider healthy exuberance.  What physicians once called attention deficit hyperactivity disorder (ADHD), often now elicits a diagnosis of childhood bipolar disorder, leading to a 40-fold increase in prevalence from 1994-1995 to 2002-2003.”

So, skepticism regarding the increased rates can be attributed partly to the absence of biomarkers.  This is true, but it is not the central issue.  The central issue is that for at least the last fifty years, organized psychiatry’s primary agenda has been the medicalization of all significant problems of thinking, feeling, and/or behaving.  They have asserted, without evidence, that these problems are illnesses and have even concocted baseless neurological pathologies as putative causes of these so-called illnesses.  By comparison, the absence of biomarkers or lab tests is a trivial issue.

And note the extraordinary dexterity with which Dr. Insel trivializes the 40-fold increase in the prevalence of “childhood bipolar disorder”.  This increase was driven largely by the efforts of Joseph Biederman, MD, and caused such a scandal that the APA created the label “disruptive mood dysregulation disorder” for the express purpose of reducing the use of the bipolar label.  This whole business was a very black chapter in a profession not noted for its moral or intellectual integrity, and resulted not only in a 40-fold increase in the “diagnosis of bipolar disorder”, but also an unprecedented increase in the prescription of neuroleptic drugs to children.  But Dr. Insel spins Dr. Biederman’s excesses as comparable to two parents holding different views as to the significance of a child’s hyperactivity.  Oh my!  What a fuss about nothing!

And incidentally, on the subject of biomarkers and lab tests, there are still vast numbers of psychiatric “patients” who have swallowed the psychiatric lie, and who believe that a scan of their brains would reveal the putative pathology.  Why is it that the Director of the NIMH will acknowledge on his blog that no biomarkers or lab tests exist to confirm a psychiatric “illness”, but has taken no steps to enlighten the general public on this matter?  Why is the NIMH not screaming this message from the rooftops, and calling for the censure of those psychiatrists and drug companies who continue to deceive their clients and the public in this way?

“No question, in a field without biomarkers, there is a risk of over-diagnosis. No question, subjective diagnosis could invite unnecessary treatment and over-medication. But what if the increased use of medication reflected more children with severe developmental problems and more families in crisis? What if the bigger problem is not over-medication but under-treatment? Hearing that 7.5 percent of children are on medication (4.2 percent on psychostimulants) seems stunning, but knowing that 11 percent of children have a diagnosis of ADHD raises a possibility of under-treatment.”

Dr. Insel concedes a “risk of over-diagnosis” and the possibility of “unnecessary treatment and over-medication”.  But his terminology is problematic.  “Over-diagnosis” or, for that matter “under-diagnosis”, inevitably implies that there is a correct level of diagnosis.  To take an analogy from general medicine, there is a rare autoimmune disease called Wegener’s granulomatosis.  It is generally acknowledged that this illness is under-diagnosed.  In other words, a certain proportion of people who really have this disease are not so diagnosed during medical examinations. But the point is that the terms under-diagnosis and over-diagnosis only have meaning in reference to something that is reliably definable, a condition which does not apply to psychiatric “illness”.  Psychiatric “illnesses” are nothing more than loose clusters of vaguely defined problems of thinking feeling, and/or behaving.  There is no accurate or real level of diagnosis against which judgments of over-, or under-, diagnosis can be made.

But Dr. Insel makes no attempt to address this question of possible “over-diagnosis” and “over-medication”.  Instead, he goes straight to the heart of psychiatry’s ever-expansionist agenda:  “What if the bigger problem is not over-medication, but under-treatment?”

This, incidentally, is the same Dr. Insel who in April 2013 wrote:

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

 So, although “symptoms alone rarely indicate the best choice of treatment”, here he comes, a year later, expressing concern that only 4.2% of America’s children are taking stimulant drugs, when 11% have “a diagnosis of ADHD.”  The clear implication being, that if a child has this invalid diagnosis, he should be taking the pills.

 “What I hear from families in crisis is lack of access, poor quality care, and a desperate need for answers. In the media reports on over-medicating children, this perspective is missing. The possibility that there is a real increase in the number of children suffering with severe emotional problems, just as there is a real increase in the number of children with diabetes and food allergies, is not even considered. Shouldn’t we be asking why so many children, at younger ages, are being seen for emotional and behavioral problems?”

To which I can only reply:  “Yes, Dr. Insel, we certainly should!”

And we should also be asking why the Director of the NIMH, the nation’s think-tank on mental health matters, is addressing these profound and controversial issues in such misleadingly simplistic terms.

Depression/ ADHD

This post was submitted by a reader.I was searching Google for effects of propaganda on the human psych, and stumbled upon this site. After reading a few stories, I felt I had to share my own. 

When I was in high school I was depressed. To the point where I was a walking text book definition. Failing grades, poor hygiene, isolation. All the signs were obvious.

I had to go to rehab for drinking too much cough syrup.

When I went to the doctor he diagnosed me with ADHD. I have never been a hyper person. always rather slow and calm.

Than he tells me that he is going to just experiment with multiple drugs to see what works, and than diagnose me with whatever that drug treats.

First drug was Vyvanse (lisdexamfetamine dimesylate)

Its a new “abuse-free” amphetamine. Due to a coating of protein, the chemical can only dissolve in your stomach acid. Injecting, Smoking, or Snorting would not activate it.

However the prescribed dose taken once a day was enough to make me a full effect of amphetamines, and I began losing alot of sleep. After having multiple panic attacks on this medication, I demanded the doctor take me off of it.

He than gave me Focalin (Dexmethylphenidate Hydrochloride)

Another new “abuse-free” drug. During my younger years I experimented with MDMA, and I would compare the feeling of Focalin with that of Extacy.

When I got into college my doctor pulled me off of it saying that college kids are more likely to sell it, and that he must change my prescription.

Next drug was Strattera (atomoxetine). I threw up every time I took it. It gave me intense piriods of happiness followed by extreme bursts of anger for no reason at all.

I stopped going to the doctor, I stopped taking medications. I no longer trust the medical system, the pharm companies, or even the government. I’d rather suffer the depression untreated than go through what I went through in high school.

On a side note, The experience made me drop out of school, and get my GED. That year, my school experienced a higher drop out rate than ever before.

 

Anonymous

 

Drugging Toddlers for Inattention, Impulsivity, and Hyperactivity

On May 16, the New York Times ran an article titled Thousands of Toddlers Are Medicated for A.D.H.D., Report Finds, Raising Worriesby Alan Schwarz.  Here is the opening sentence:

“More than 10,000 American toddlers 2 or 3 years old are being medicated for attention deficit hyperactivity disorder outside established pediatric guidelines, according to data presented on Friday by an official at the Centers for Disease Control and Prevention.”

The CDC official is Susanna Visser, MS, DrPh, Acting Associate Director of Science for the Division of Human Development and Disability, and she was speaking at the annual Rosalyn Carter Georgia Mental Health Forum.  I have not been able to find the text of Ms. Visser’s speech.  (It will probably be published later.)  Meanwhile, there is a good deal of information in Alan Schwarz’s article.  Here are some more quotes:

“The report, which found that toddlers covered by Medicaid are particularly prone to be put on medication such as Ritalin and Adderall, is among the first efforts to gauge the diagnosis of A.D.H.D. in children below age 4. Doctors at the Georgia Mental Health Forum at the Carter Center in Atlanta, where the data was presented, as well as several outside experts strongly criticized the use of medication in so many children that young.”

“The American Academy of Pediatrics standard practice guidelines for A.D.H.D. do not even address the diagnosis in children 3 and younger — let alone the use of such stimulant medications, because their safety and effectiveness have barely been explored in that age group. ‘It’s absolutely shocking, and it shouldn’t be happening,’ said Anita Zervigon-Hakes, a children’s mental health consultant to the Carter Center. ‘People are just feeling around in the dark. We obviously don’t have our act together for little children.'”

“Dr. Lawrence H. Diller, a behavioral pediatrician in Walnut Creek, Calif., said in a telephone interview: ‘People prescribing to 2-year-olds are just winging it. It is outside the standard of care, and they should be subject to malpractice if something goes wrong with a kid.'”

“Dr. Visser said that effective nonpharmacological treatments, such as teaching parents and day care workers to provide more structured environments for such children, were often ignored. ‘Families of toddlers with behavioral problems are coming to the doctor’s office for help, and the help they’re getting too often is a prescription for a Class II controlled substance, which has not been established as safe for that young of a child,’ Dr. Visser said. ‘It puts these children and their developing minds at risk, and their health is at risk.'”

But there was also some support for the practice, albeit cautiously worded:

“Keith Conners, a psychologist and professor emeritus at Duke University who since the 1960s has been one of A.D.H.D.’s most prominent figures, said that he had occasionally recommended it when nothing else would calm a toddler who was a harm to himself or others.”

“Dr. Doris Greenberg, a behavioral pediatrician in Savannah, Ga., who attended Dr. Visser’s presentation, said that methylphenidate can be a last resort for situations that have become so stressful that the family could be destroyed. She cautioned, however, that there should not be 10,000 such cases in the United States a year.”

The article finishes with quotes from Nancy Rappaport, MD:

“Dr. Nancy Rappaport, a child psychiatrist and director of school-based programs at Cambridge Health Alliance outside Boston who specializes in underprivileged youth, said that some home environments can lead to behavior often mistaken for A.D.H.D., particularly in the youngest children.”

“‘In acting out and being hard to control, they’re signaling the chaos in their environment,’ Dr. Rappaport said. ‘Of course only some homes are like this — but if you have a family with domestic violence, drug or alcohol abuse, or a parent neglecting a 2-year-old, the kid might look impulsive or aggressive. And the parent might just want a quick fix, and the easiest thing to do is medicate. It’s a travesty.'”

ADHD IN THE DSM

ADHD is listed in the DSM and is widely promoted by psychiatry as a brain illness which causes children and adults to be excessively inattentive, hyperactive, and/or impulsive.

DSM-III-R specified that the onset of this “illness” had to be prior to age seven, but set no lower age limit.  In fact, in this edition of the APA’s manual, the assignment of this “diagnosis” to preschool children is clearly endorsed.

“In preschool children, the most prominent features are generally signs of gross motor overactivity, such as excessive running or climbing.  The child is often described as being on the go and ‘always having his motor running.’  Inattention and impulsiveness are likely to be shown by frequent shifting from one activity to another.” [Emphasis added] (p 50)

and

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

DSM-IV-TR states:

“It is 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).  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.  Substantial impairment has been demonstrated in preschool-age children with Attention-Deficit/Hyperactivity Disorder.” (p 89)

DSM-5 is briefer but just as clear:

“In preschool, the main manifestation is hyperactivity.” (p 62)

So, as far as the APA is concerned, children of preschool age can, and do, “get” ADHD.

But what is ADHD?  Here again, the APA’s position, in their fact sheet titled “ADHD,” (2014) is  brief and clear:

“Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children. ADHD is a brain condition that is often first identified in school-aged children when it causes disruption in the classroom or problems with schoolwork.” [Emphasis added]

Note, incidentally, the assertion of causality.  ADHD is a brain condition that causes classroom disruption and problems with school work.  In reality, the causal connection is spurious, and is just one more example of psychiatric “logic.”  To illustrate this, imagine a conversation between a parent and a psychiatrist:

Parent:  Why is my child so disruptive in class?  Why won’t he concentrate on his schoolwork?
Psychiatrist:  Because he has ADHD.  ADHD causes these problems.
Parent:  But how do you know he has ADHD?
Psychiatrist:  Because he is so disruptive in class and doesn’t concentrate on his school work.

Psychiatry defines ADHD by the presence of an assortment of vaguely-defined behaviors and then adduces this construct as the cause of these behaviors.  In other words, a child has ADHD because he is disruptive; and he is disruptive because he has ADHD!  This particular piece of psychiatric sophistry has been identified and highlighted, at one time or another, by virtually everyone on this side of the “mental illness” debate.  But I have never seen an attempt at rebuttal from any proponent of psychiatric orthodoxy.

But back to the question: what is ADHD?  There is a document titled ADHD: Parents Medication Guide published jointly by the APA and the American Academy of Child and Adolescent Psychiatry in July 2013.  Here’s a quote:

“Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by difficulty paying attention, excessive activity, and impulsivity (acting before you think). ADHD is usually identified when children are in grade school but can be diagnosed at any time from preschool to adulthood.” [Emphases added]

This document also stresses that:

“Early identification of ADHD is advisable…”

and lists the dire consequences if “ADHD is left untreated”:

  • “Increased risk for school failure and dropout in both high school and college
  • Behavior and discipline problems
  • Social difficulties and family strife
  • Accidental injury
  • Alcohol and drug abuse
  • Depression, anxiety and other mental health disorders
  • Employment problems
  • Driving accidents
  • Unplanned pregnancy and sexually transmitted diseases
  • Delinquency, criminality, and arrest”

The NIMH document Attention Deficit Hyperactivity Disorder (2012) states:

“Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood brain disorders and can continue through adolescence and adulthood.” [Emphasis added]

So it’s pretty clear that organized psychiatry, as represented by the APA, AACAP, and NIMH, endorses the notion that preschool children can “get” ADHD, and that ADHD is a brain illness.  It is also widely promoted that ADHD should not be left “untreated.”

RESEARCH

In 2006, Greenhill L. et al. published Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD, in the Journal of the American Academy of Child and Adolescent Psychiatry.  Here’s their conclusion:

“MPH-IR [methylphenidate-instant release], delivered in 2.5-, 5-, and 7.5-mg doses t.i.d., produced significant reductions on ADHD symptom scales in preschoolers compared to placebo, although effect sizes (0.4-0.8) were smaller than those cited for school-age children on the same medication.”

The paper lists 17 authors.  The lead author is Laurence Greenhill, MD.  Dr. Greenhill is a very eminent psychiatrist.  At present he is a professor of Psychiatry and Pediatric Psychopharmacology at Columbia University.  He is also Director of the Research Unit of Pediatric Psychopharmacology at the New York State Psychiatric Institute.  Dr. Greenhill has served as principal investigator on several NIMH studies, and on 14 pharma-funded studies.  He has also served as President of the American Academy of Child and Adolescent Psychiatry (2009-2011).

His 2008 conflict of interest statement which is on file with the AACAP, states that during the period when he was president-elect, he was spending 50% of his work time “…dedicated to the private practice treatment of toddlers, adolescents, and adults mostly with ADHD.” [Emphasis added]

Incidentally, according to the disclosure section at the end of the 2006 article, 11 of the 17 authors had ties to pharma.  (In addition, a twelfth author disclosed links in a 2009 paper that will be discussed below.)

This study was funded by the NIMH, and on October 16, 2006, NIMH issued a press release in which they described the study as:

“The first long-term, large-scale study designed to determine the safety and effectiveness of treating preschoolers who have attention deficit/hyperactivity disorder (ADHD) with methylphenidate (Ritalin) has found that overall, low doses of this medication are effective and safe.  However, the study found that children this age are more sensitive than older children to the medication’s side effects and therefore should be closely monitored.” [Emphasis added]

Thomas Insel, MD, Director of NIMH, provided a quote for the press release:

“‘The Preschool ADHD Treatment Study, or PATS, provides us with the best information to date about treating very young children diagnosed with ADHD,’ said NIMH Director Thomas R. Insel, MD. “‘The results show that preschoolers may benefit from low doses of medication when it is closely monitored, but the positive effects are less evident and side-effects are somewhat greater than previous reports in older children.'”

The press release concluded with a quote from Laurence Greenhill, MD, the lead author:

“‘The study shows that preschoolers with severe ADHD symptoms can benefit from the medication, but doctors should weigh that benefit against the potential for these very young children to be more sensitive than older children to the medication’s side effects, and monitor use closely,’ concluded Dr. Greenhill.”

MORE RESEARCH

There’s another piece of research by Abikoff, et al. published in the journal Advances in Preschool Psychopharmacology in 2009.  It’s titled Methylphenidate Effects on Functional Outcomes in the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS)  Here’s the conclusion:

“Preschoolers with ADHD treated with MPH [methylphenidate] for 4 weeks improve in some aspects of functioning.  Additional improvements might require longer treatment, higher doses, and/or intensive behavioral treatment in combination with medication.” 

This paper lists as authors most of those who are also shown in the Greenhill et al. study cited above.

So, according to the best psychiatric authorities, the condition known as ADHD

  • Is a brain illness;
  • Can and does occur in children of preschool age;
  • Causes severe problems if left untreated;
  • Can be safely and effectively treated with stimulant drugs (with the caveat that children of preschool age should be closely monitored for adverse effects).

Against this well-orchestrated and heavily promoted background, it is easy to see how the drug-prescribing is drifting into the lower age range.  In fact, if one buys the psychiatry line, wouldn’t it be tantamount to criminal to deprive these preschoolers of “treatment” for their “brain illness”?  Wouldn’t it be unconscionable to expose them to the risks outlined earlier?  Surely the risk of taking a few pills – that have been proven safe and effective anyway – is justified when weighed against the dangers of “untreated ADHD.”

Besides, in their booklet on Mental Health Medication (2008), the NIMH state unambiguously:  “Stimulant medications are safe when given under a doctor’s supervision.”  I kid you not.

DISCUSSION

The critical issue here is that the loose cluster of vaguely defined behaviors that psychiatry calls ADHD is not an illness.  Rather, it is, in the vast majority of cases, a reflection of inadequate discipline and training on the part of the parents.

In former times, parents accepted, as an intrinsic part of their role, training their children: to sit still when required; to pay attention to authority figures; to be obedient; to complete chores; to stay focused when needed; to be quiet when needed; to wait his/her turn; not to interrupt when others were speaking; to respect other children’s property; etc…

But today, psychiatry tells us that children who have not acquired these habits are ill.  This is emphatically not something that psychiatry has discovered in the normal scientific manner.  Rather, it is something that psychiatry has decided.  Psychiatry has decided that all significant problems of thinking, feeling, and/or behaving are mental illnesses.  So, children who have not been trained in the skills listed above are ill – by definition.

And because they are “ill,” they must take “medicine.”

Despite the protestations and the expressions of outrage, the expansion of the ADHD “diagnosis,” and consequent drugging, into the preschool population is an inevitable consequence of psychiatry’s spurious medicalization of every conceivable human problem, and their eagerness to prescribe drugs to “treat” these problems.

Protesting that the drugs have not been approved for children under the age of four misses the point, for two reasons.  Firstly, because the approval process is intrinsically flawed, and secondly because drugs are not an appropriate response to these problems, for preschoolers or for older children.

Debates as to whether the preschoolers in question “really” have ADHD are meaningless.  ADHD is defined by the presence of certain vaguely-defined behaviors.  If a two-year-old is engaging in these behaviors, then he “has” ADHD.  This is the travesty that the APA has created.  There is no test or reality against which the child’s presentation can be compared to confirm or refute the “diagnosis.”  All that’s needed is the subjective opinion of a mental health professional that the child displays the misbehaviors in question to a degree that is “inconsistent with [his/her] developmental level and that negatively impacts on social and academic…activities.” (DSM-5, p 59).

And there is no lower age limit for this “diagnosis.”  Well, that’s not absolutely true.  The “symptoms” must have been present for at least six months, so I suppose 6 months is effectively the lower limit!  So the babies are still safe – at least until DSM 5.1!

Psychiatry’s primary agenda for the past fifty years has been the expansion of its “diagnostic” net, and the prescribing of more and more pills to more and more people.  Psychiatry promises joy, happiness, and a trouble-free life from a pill bottle, and tragically our society and our political leadership have bought it.  Today, no group is safe from psychiatry’s depredations.  Their net embraces people of all ages, all walks of life, and all circumstances.  There is truly no human problem that cannot be “diagnosed” as a “mental illness,” and for which psychiatry doesn’t have a pill.

Ten thousand American toddlers taking stimulants for ADHD is just business as usual.  By all means, let us speak out against this psychiatric assault on our toddlers, but let’s not lose sight of the greater tragedy – that this kind of approach has become the norm.  Feeding children psychoactive drugs as a substitute for instilling age-appropriate habits of discipline, self-control, and interpersonal respect is a tragedy beyond description.  If street-dealers were promoting their products to toddlers and their parents in this way, there would be outrage – and rightly so.  But psychiatrists, dressed in nice suits, and with their image polished by an international PR firm, are accepted.

As a society, as a culture, we have truly lost our way.

Driving Under the Influence of Stimulants

On April 22, I published a post on this general topic.  In that article I pointed out that the notion of stimulant prescription drugs improving the driving of people who “have ADHD” was gaining traction.

Since than I have come across two articles on this subject from Australia.  (Thanks to Nanu Grewal for the links.)  Both articles appeared in the Sunshine Coast Daily, and you can see them here and here.

Apparently in 2009, four people, including five-year-old twin girls, died in a two-car accident.  The driver of one of the cars had been prescribed dexamphetamine for the treatment of ADHD by a local psychiatrist, and was found to have had six times the prescribed dosage of dexamphetamine in his system at the time of the crash.

In the first article, dated October 2011, two years after the accident, it was noted that the psychiatrist’s prescribing practices were under investigation.  But the general manager of the psychiatric hospital where the psychiatrist practiced is quoted as saying that none of the allegations had been substantiated.

“Not one shred of evidence against anyone has been unearthed.”

The article also quotes Michael Cleary, Queensland acting chief health officer, as saying

“An analysis of available medical evidence has found that under-medicating is potentially more dangerous than prescribing higher doses, particularly when expert physicians consider a higher dose is appropriate”

So if an “expert physician” (presumably a psychiatrist) says that it’s OK to drive stoked to the gills on speed, then it’s OK!

The second article is dated July 2013, four years after the fatal accident.  Here it is reported that the prescribing psychiatrist whose practices had

“…been the subject of complaints by colleagues and nurses for many years, has had severe restrictions placed on his right to practice.”

 It is also reported that two nurses who were fired after

“…repeatedly raising concerns” about the psychiatrist were planning to sue for reinstatement.

What’s noteworthy about all of this is that, firstly, it took four year and persistent pressure from the dead girls’ father before some kind of action was taken against this psychiatrist.  Secondly, there had evidently been multiple complaints about this psychiatrist, but they were ignored by the hospital

. . . . . . . . . 

The idea of prescribing stimulant drugs to people who drive motor vehicles has always seemed problematic to me.  I worked for five years in the chemical dependency treatment area, and I have heard more horror stories about driving under the influence of stimulants than I care to remember.  Today the notion is gaining credence that stimulant drugs improve driving performance in people who “have ADHD.”  All of the research that supports this notion was industry sponsored , and most was conducted in simulators and under artificial conditions.

In real-life driving, it has to be recognized that stimulants are addictive drugs.  School children sell them to their classmates for recreational use.  Adults buy them illegally on the street.  People who receive them on prescription sometimes save them up for a weekend binge.  How many traffic accidents today are stimulant-induced?  How much of the frenetic, aggressive driving that we see on our highways stems from the use of these products?

There is a movement in most western countries today to combat drunk driving, and this is having considerable success.  In this context, psychiatry’s contention that people who “have ADHD” drive better under the influence of stimulants has to be seen as a major step backwards.

Is there truly no limit to what psychiatry will do to sell drugs and enhance their own perceived importance?

Sluggish Cognitive Tempo – A New Diagnosis?

On April 11, 2014, journalist Alan Schwarz (brief bio here) published an article in the New York Times on this topic, titled Idea of New attention Disorder Spurs Research, and Debate.  Alan has written extensively on the rising rates of the condition known as ADHD, and on the abuse of the drugs that are used to “treat” this condition. He has drawn a good deal of criticism from psychiatry’s believers.

In the NY Times article Alan draws attention to the fact that sluggish cognitive tempo (SCT) is being promoted as a new disorder  “… characterized by lethargy, daydreaming and slow mental processing.”  He makes the obviously valid point, that the formalization of such an entity  “… could vastly expand the ranks of young people treated for attention problems.”

The NY Times article was prompted by the fact that the Journal of Abnormal Psychology featured this emerging “diagnosis” in its January 2014 issue.  The issue contained eleven articles on the topic.  These articles addressed questions like:

  • Is SCT a sub-domain of ADHD?
  • Is SCT a disorder in its own right?
  • What are the symptoms of SCT?
  • What are SCT’s co-morbidities?
  • In what ways does SCT differ from ADHD, inattention type?
  • How does SCT differ from depression and anxiety, etc.?

It is a central theme of this website that mental illnesses/disorders, including ADHD and SCT, have no ontological or explanatory significance, are not a helpful way to conceptualize human existence, and in fact are intrinsically disempowering and stigmatizing.  The fact that these so-called illnesses are adduced by their psychiatric inventors to legitimize toxic treatments adds to their destructiveness.  The details of these critiques need not be repeated here.

HISTORY OF SCT

Sluggish cognitive tempo is not a new concept.  ADHD has long been criticized, even by psychiatrists, as embracing two very different kinds of presentations:  inattentiveness, on the one hand, and hyperactivity/impulsivity on the other.  DSM-III-R (1987) acknowledged this problem and created the new “diagnosis” 314.00 Undifferentiated Attention-Deficit Disorder (p 95).  The manual describes this condition as follows:

“This is a residual category for disturbances in which the predominant feature is the persistence of developmentally inappropriate and marked inattention that is not a symptom of another disorder, such as Mental Retardation or Attention-deficit Hyperactivity Disorder, or of a disorganized and chaotic environment.” [Emphasis added]

DSM-IV (1994) also acknowledged this issue, and split ADHD into three distinct “diagnoses.”

  • ADHD Combined type
  • ADHD Predominantly inattentive type
  • ADHD Predominantly hyperactive-impulsive type

DSM-IV-TR (2000) created the “diagnosis” 314.9  Attention –Deficit/Hyperactivity Disorder Not Otherwise Specified

“This category is for disorders with prominent symptoms of inattention or hyperactivity-impulsivity that do not meet criteria for Attention-Deficit/Hyperactivity Disorder.  Examples include:

1.  Individuals whose symptoms and impairment meet the criteria for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type but whose age at onset is 7 years or after.

2. Individuals with clinically significant impairment who present with inattention and whose symptom pattern does not meet the full criteria of the disorder but have a behavioral pattern marked by sluggishness, daydreaming, and hypoactivity.” [Emphasis added]

DSM-5 has two residual categories in this area:

  • Other Specified ADHD (314.01)
  • Unspecified ADHD (314.01)

These “diagnoses” do not mention sluggishness, daydreaming and hypoactivity specifically, but these attributes are clearly embraced by the definitions.  This is particularly the case in that practitioners working with DSM-IV-TR would have become accustomed to conceptualizing this particular presentation as a “sub-diagnosis” of ADHD and, in addition, DSM-5 did not repudiate the SCT example given in DSM-IV-TR.  DSM-5 offers no examples of the residual diagnoses, the most reasonable interpretation of which is that the older examples are still to be considered valid as well as any others that individual practitioners encounter/invent as they go about their work.

It is noteworthy also that the DSM-5 main entry on ADHD contains the phrases: “mind seems elsewhere” and “may include unrelated thoughts.”  These phrases did not occur in the DSM-IV-TR main entry, and are clearly intended to embrace the notion of daydreaming.

So it is clear that the APA’s notion of ADHD (predominantly inattentive type) has long embraced daydreaming and lethargy, and it was probably inevitable that psychiatry, with its ever-expanding agenda, would eventually begin to conceptualize this as a distinct “illness.”  So today we have sluggish cognitive tempo emerging as a “diagnosis” in its own right, and attracting comment and attention.

CURRENT STATUS OF SCT

Earlier this year, Catherine Saxbe MD, a psychiatrist, and Russell Barkley PhD, a psychologist, wrote a paper reviewing the history of research on sluggish cognitive tempo.  The paper, The second attention disorder? Sluggish cognitive tempo vs. attention-deficit/hyperactivity disorder: update for clinicians, was published in the Journal of Psychiatric Practice.  Here’s a quote:

“Sluggish cognitive tempo (SCT) refers to an impairment of attention in hypoactive-appearing individuals that first presents in childhood. At this time, it exists only as a research entity that has yet to debut in official diagnostic taxonomies. However, it seems likely that a constellation of characteristic features of SCT may form the criteria for a newly defined childhood disorder in the foreseeable future, provided limitations in the extant findings can be addressed by future research.”

The authors expressed the belief that sluggish cognitive tempo is an unfortunate name for the disorder  “…since the term sluggish is associated with connotations of being retarded, slow-witted or just plain lazy.”  They remind us that

“More than semantics is at stake here.  The nosology reflects the way we conceptualize a disorder, view our patients, and how they understand themselves.”

They suggest that “concentration deficit disorder” or “developmental concentration disorder” or “focused attention disorder” would be better names for the problem, and appear to be entirely blind to the fact that the negative effects of referring to a child as “sluggish” pale to nothing compared with the stigma and disempowerment inherent in the notion that he is a “patient” with a “mental illness” (regardless of the name given to this illness).  In addition to which, of course, must be reckoned the destructive effects of the “treatments.”

Here are some more quotes from the Saxbe and Barkley article:

“No large-scale medication trials have examined response to stimulants specifically in SCT, but one recent investigation shows promise for the potential use of atomoxetine.”

and

“This is an exciting finding and warrants further investigation as it is the first published report to show improvement in SCT with any medication.”

and

“Given the overlap of SCT with anxiety and depression, perhaps selective serotonin reuptake inhibitors (SSRIs) might be [another] possible treatment.”

The study in question is Wietecha L. et al., titled Atomoxetine improved attention in children and adolescents with attention-deficit/hyperactivity disorder and dyslexia in a 16 week, acute, randomized, double-blind trial.  This appeared in the November 2013 issue of Journal of Child and Adolescent Psychopharmacology.  The paper is a study of the efficacy of atomoxetine in the “treatment” of various attention problems including SCT.  Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) marketed as Strattera by Eli Lilly.  The study (Wietecha et al.) found that:

“The atomoxetine-treated ADHD-only subjects significantly improved from baseline to Week 32 on…all K-SCT [Kiddie-Sluggish Cognitive Tempo Interview] subscales…”

and

“This is the first study to report significant effects of any medication on SCT.”

All of this is particularly interesting because:

  1. Ritalin, which is now off patent, and other stimulants, are reportedly ineffective in the “treatment” of SCT “symptoms.” (Saxbe and Barkley, 2014, p. 47)
  2. Atomoxetine, which is still on-patent, is now “proven” effective in this area.
  3. Linda Wietecha works as a Clinical Research Scientist for Lilly USA, LLC
  4. According to Dollars for Docs, the following co-authors on the study have also received money from Eli Lilly in the period 2009-2012: Bennett Shaywitz, MD, $963,003; Stephen Hooper, PhD, $16,540; David Dunn, MD, $56,886; and Keith McBurnett, PhD, $5,000.
  5. Russell Barkley, PhD, co-author of the article cited earlier, received $120,283 from Eli Lilly for consulting, speaking, and travel between 2009 and 2012 (Dollars for Docs), and as recently as February of this year gave a lecture tour in Japan sponsored by Eli Lilly.

All of which raises the interesting question:  is SCT disorder being promoted at the present time by Eli Lilly’s paid hacks as a way of increasing sales of atomoxetine (Strattera) while it is still on patent?

PSYCHIATRIC CREDIBILITY

Interestingly, and sadly, most of the research and promotion of SCT has been done by psychologists rather than psychiatrists.  This fact prompted Jeffrey Lieberman, MD, President of the APA, and very eminent psychiatrist to  tweet on April 11 “no credible psychiatrist takes this [SCT] seriously” in response to Alan Schwartz’s article in the New York Times.  Dr. Lieberman seems to be unaware that in DSM-IV-TR (2000), the APA created a specific “diagnosis” for the sluggishness/daydreaming/hypoactivity presentation (using those exact words), and that this “diagnosis” has been clearly retained in DSM-5 (though without those specific words).  I’ve never been aware of any great outcry from organized psychiatry, or from individual practitioners, on this matter.  So, if we are to take Dr. Lieberman at his word (and why would we not do that?), there must be an enormous dearth of “credible psychiatrists” within the APA’s ranks.

In this context, it is also noteworthy that the Wietecha et al. article was published in the Journal of Child and Adolescent Psychopharmacology, which suggests – at least to me – that the journal takes SCT seriously.  The editor-in-chief is Harold Koplewicz, MD, psychiatrist, founding member and President of the Child Mind Institute.  Dr. Koplewicz has held many prestigious positions, and has received numerous awards, including the 2009 American Psychiatric Association McGavin Award for lifetime contributions to child psychiatry.  But alas, he must now be considered a psychiatrist with no credibility.

And

The Saxbe and Barkley article was published by the Journal of Psychiatric Practice, the editor of which is John Oldham, MD, Senior VP and Chief of Staff at the Menninger Clinic, and a psychiatry professor at Baylor College of Medicine.  Dr. Oldham is a past President of the APA (2010-2011), and of the American College of Psychiatrists (2010-2011).  He has also been President of the International Society for the Study of Personality Disorders, and was a member of the DSM-5 Personality Disorders workgroup.  But, here again, no credibility!

The general point here is that psychiatry has embraced the concept of medicalizing daydreaming. Dr. Lieberman either doesn’t realize this, or is trying to conceal the fact.

DISCUSSION

It would be easy to get distracted by this recent attempt to promote childhood daydreaming as a mental illness.  As mentioned earlier, daydreaming, or to use psychiatric terminology, “the persistence of developmentally inappropriate and marked inattention,” has been a specific “mental illness” since DSM-III-R, 1987, (p 95).

The fact is that any human presentation can be considered a mental illness.  All that is needed is the APA’s say so.  And the APA made their position absolutely clear in the foreword to DSM-II (1968).  In the paragraph where they discuss what “diagnoses” should be included in the manual, they state:

“The Committee has attempted to put down what it judges to be generally agreed upon by well-informed psychiatrists today.” (p viii)

In other words:  if we say it’s a mental illness, then it’s a mental illness!

In subsequent editions of the manual, they offer a definition of a mental disorder, which when stripped of verbiage boils down to:  any significant problem of thinking, feeling, and/or behaving.  And who decides something is a problem?  A psychiatrist, of course.

Sluggish Cognitive Tempo (or concentration deficit disorder, as Drs. Barkley and Saxbe would prefer to call it) is more psychiatric nonsense.  But that’s all it is – more of the same; another inevitable result of psychiatry’s fundamentally flawed, spurious, and destructive medicalization of human existence.  Psychiatry continues to expand its net of entrapment into all aspects of life and into every corner of the globe.

By all means let’s speak out against this latest encroachment, but let us not lose sight of the corrupt and spurious engine that has been driving this endeavor since the 1950’s, or of the trail of human suffering and destruction that it has left, and continues to leave, in its wake.

Nor let use lose sight of the fact that many of the greatest writers, scientists, and artists were chronic daydreamers.  We can only imagine how much better the world would be today if these individuals had received the benefits of modern psychiatric treatment. We can also look forward to a better future – a future where daydreaming will be routinely recognized as the illness that it is, it’s victims will be “treated” appropriately with psychiatric drugs, and this plague, that has beset humanity since pre-historic times, will finally be eradicated.

* * * * * * * * *

There is absolutely no facet of human existence that psychiatry will not pathologize in the pursuit of its own self-serving agenda.

‘ADHD’ and Dangerous Driving

In 2006, Laurence Jerome, a Canadian psychiatrist, and two colleagues wrote a paper titled What We Know About ADHD and Driving Risk: A Literature Review, Meta-Analysis and Critique.  It was published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry in August, 2006. The primary result of the meta-analysis was:

“Current data support the utility of stimulant medication in improving driving performance in younger ADHD drivers.”

The study is lengthy and well-referenced, but in keeping with standard psychiatric practice, it conceptualizes and presents ADHD as a “…common psychiatric disorder…” with symptoms of “…inattention, impulsiveness and hyperactivity…”  In other words, they present ADHD as something that a person has rather than as something that a person does. The problem with this approach is that it creates the impression that meaningful or significant correlations/effects have been found, where in fact all that has happened is an elucidation of the terms used.

For instance, the authors refer to a study by Fried et al. (2006) and state:

“Fried et al. (2006) evaluated driving behavior using the DBQ [Driving Behavior Questionnaire] and found that the ADHD group had significantly more lapses, errors and violations than controls.”

On the face of it, this looks like an interesting finding.  It purports to be an important fact that has been discovered about people who have this condition.  But in reality, lapses, errors, and violations are an integral part of the definition of ADHD.  The DSM criteria includes:  careless mistakes; difficulty remaining focused; mind seems elsewhere; easily distracted; forgetful; etc…  One doesn’t get into this group in the first place without a history of habitual lapses, errors, and violations.  The fact that these habitual lapses and errors carry over into a person’s driving behavior isn’t particularly surprising.

There are several other examples of this in Jerome et al., e.g.:

“A number of studies examined cognitive abilities associated with safe driving performance. Measures of both inattention and impulsivity were found to be higher in the ADHD groups as compared to controls.”

Here again, inattention and impulsivity are defining features of the condition labeled ADHD.  All that has actually been found here is that people who are inattentive and impulsive are inattentive and impulsive! The study reports that people who carry a “diagnosis” of ADHD are involved in more collisions, and receive more traffic citations than controls.  This is interesting, but again, hardly surprising for the reasons discussed above.  One could look at all this simply as benign, meaningless verbiage, but in reality, the constant repetition of these factoids reinforces the notion that the label ADHD refers to a real illness, and that this “illness” has real sequelae, in the same way that kidney failure, for instance, usually entails edema and anemia.

EFFECTS OF PSYCHOTROPIC DRUGS

The authors discuss several studies on the effects that stimulant and non-stimulant drugs that are used to “treat” ADHD have on driving behavior.  The results were mixed.  The authors draw attention to some methodological problems in this area and also concede that “…all currently available studies are industry sponsored.”

NEUROLOGY

Dr. Jerome et al. posit a neurological deficit as the source of the impulsivity and inattention.

“Core functional impairments in executive function related to response inhibition, working memory and flexible strategic response help explain both general ADHD pathology and its specific manifestations in problem driving in this group.”

This paper, as noted earlier, was written in 2006.  Note the cautious language in the quote above:  “…help explain…”  Today, eight years later, there’s still no definitive neural pathology known to be causally associated with these problem behaviors, and the “illness” is still being “diagnosed” by subjectively assessing, and counting, the individual’s actions.  In fact, and this is particularly compelling, the American Academy of Child and Adolescent Psychiatry in its current practice parameters for ADHD state unambiguously that unless there is a clear history of severe head injury, or other neural pathology

“…neurological studies…are not indicated for the evaluation of ADHD.” [Emphasis added]

At this point Dr. Jerome et al. make the great leap of faith:

“…it was not the knowledge base of driving skills that differentiated the driving problems in ADHD youth so much as their inability to apply these rules at the appropriate time and under the appropriate circumstances. In other words the problem is an output problem; they can ‘talk the talk but they can’t walk the walk’.” [Emphases added]

Note the words “inability” and “can’t.”  This is one of the fundamental problems in the “diagnosis” of ADHD and other psychiatric “illnesses” – the logically flawed leap from “doesn’t” to “can’t.”  And this unwarranted leap is the basis for the conclusion that the individuals in question have an illness, and, in extreme cases qualify for disability.  A person with kidney failure doesn’t and can’t produce urine.  But a person “with” ADHD can, with proper training, learn to behave in a more attentive and less impulsive manner.

In former times, children who were routinely inattentive and impulsive were considered to be in need of training and discipline.  By and large, school teachers and parents provided this.  In fact, the training was usually provided before the matter even became an issue.  Today these children are spuriously and arbitrarily labeled as ill, and are given pills.  The pills suppress the problem behavior, but in many, perhaps most, cases the underlying problem of self-discipline is never addressed.  So these children grow up and, not surprisingly, they become inattentive and impulsive drivers, with a reportedly 50% increased risk of negative driving outcomes.  The “diagnosis” of “illness” contains within itself the disempowering, and incidentally false, message that the individual was incapable of acquiring the level of discipline, attention, and self-control needed for successful classroom participation.  Psychiatry has given these parents, and the children themselves, the false message that their brains are malfunctioning, that the pills will correct the problem, and that attempts to teach discipline and self-control in the normal manner are futile.  With pharma-psychiatry’s successful expansion of this “diagnosis” to the adult population, the disempowerment has become a more-or-less permanent “disability.”

The role that the initial “diagnosis” and subsequent drugging played in transforming what used to be an eminently remediable problem into a permanent disability is seldom addressed or even acknowledged.  The psychiatric fiction has to be maintained:  these individuals were “sick” as children and are still “sick” as adults.  Their inattention and impulsivity are still “symptoms” of the same debilitating “illness.”  Psychiatrists for the past sixty years have insisted that they are discovering real illnesses.  They remain self-servingly blind to the fact that, firstly, they invented these illnesses, and secondly, that their active promotion of these “illnesses” has created a culture in which personal effort and self-discipline are routinely marginalized in favor of the spurious and inherently disempowering notion of pharmaceutically correctable impairments.

Jerome et al. do pay passing acknowledgement to the need for “psychological strategies,” but it is clear that they conceptualize the matter as a medical problem with a pharmaceutical remedy:

“Experimental studies indicate that stimulants and to a lesser extent non-stimulant drugs used to treat ADHD improve areas of driving performance.”

These, incidentally, are the same industry-sponsored studies mentioned earlier.

and

“In particular the question of adherence to medication regimens over time to improve driving skills is likely to be a critical question based on our knowledge of poor long-term medication adherence for young adults with ADHD.”

and

“The individual attending physician has an opportunity to reduce morbidity and mortality for the individual ADHD patient as well as contribute to improved public health for the driving population at large by making the roads safer one driver at a time.”

and

“A number of jurisdictions including Canada and UK now require physicians to report ADHD drivers thought to be at risk of problem driving to the Ministry of Transportation.”

and

“The question of medico-legal liability is in its infancy with no established case law for physicians found negligent of failing to adequately treat ADHD patients with the appropriate medications to reduce driving risk. Whilst the available literature does not yet provide clear evidence that stimulant medication should be the standard of care for problem drivers long term, it is probably only a matter of time before this question will be debated in a legal arena.”

DISCUSSION

At the present time the pharma-psychiatric system is being widely exposed as the spurious, destructive, disempowering fraud that it is.  Organized psychiatry is responding to these criticisms not by cleaning up its act, but instead by increasing its lobbying activity in the political arena.

In particular, they are actively promoting the notion of involuntary community “treatment” with coerced “medication.”  Under this system, which is established by law in more than 40 US states, a judge can order an individual to attend the local mental health center and to abide by the center’s “treatment” plan.  The plan usually entails a requirement to take psychiatric drugs, sometimes the long-lasting injectable variety.  Here’s how Jeffrey Lieberman, MD, President of the APA, describes the program:

“There’s also other forms of psycho-social treatment that are very, very helpful. Sometimes people who have schizophrenia don’t want treatment, or don’t feel they need treatment, or just plain forget about treatment. In those cases, with what’s called assertive community treatment, a case manager or somebody that’s assigned to work with that person will go out to find them, will go to their home, you know, ‘You haven’t come to the clinic, you haven’t come to the office, you haven’t shown up, what’s going on here, you need to get your medication, you need to go through your rehabilitation,’ so they’ll get after them.”

This all sounds very cozy and friendly, and you know – come on down to the mental health center, you know, we care about you, etc., etc… But within the silk glove, there’s the mailed fist of confinement and coerced drugging.  Readers can check out the other side of the story at National Coalition for Mental Health Recovery, PsychRights page on OutPatient Commitment, and by searching for assertive outpatient commitment on Mad in America.  Dr. Lieberman is talking about people labeled with schizophrenia, but it doesn’t take too much imagination to see how the concept could be adapted to a wide range of other “diagnoses,” including ADHD.

As of yet, the ominous prediction in the final Jerome et al. quote above has not come to pass.  But is the day approaching when individuals “diagnosed” with ADHD during childhood will be subjected to special screening when they apply for a driving license?  Might their licenses be made contingent on their ingestion of psychoactive drugs?  After all, impulsive, inattentive drivers constitute a danger to themselves and others.  If, as psychiatry claims, their impulsivity and inattention are the result of a “mental illness,” then doesn’t it make sense that they be committed?  Isn’t it in their own interests and the interests of the public at large that they be coerced to take their “medications”? Such a move would be consistent with psychiatry’s long-standing expansionist agenda and with pharma’s objective to sell more drugs.

And lest my concerns be considered groundless speculation, here are some interesting quotes.

From Oren Mason, MD, a blogger physician, co-owner of Attention MD, and associate professor at Michigan State University.  He specializes in the “…diagnosis and management of attention deficit disorders and related conditions” (Ritalin Saves Truckers’ Lives. Soccer Moms’, Too, February 2014):

“There is a public health issue when inattentive or impulsive behaviors occur on busy, public streets and highways.”

and

“…we could potentially prevent 100,000 injuries and deaths every year with consistent use of ADHD medications.”

Incidentally, according to Dollars for Docs, Dr. Mason received $208,459 from Eli Lilly for speaking, consulting, travel, and meals between 2009 and 2012.

And from Brian Krans, an assistant editor at HealthLine News (Could Ritalin Be the Way to Keep Truckers Safe on the Road? January 2014):

“Another new study says that undiagnosed attention-deficit hyperactivity disorder (ADHD) may be the cause of many safety issues for drivers on the road.”

Note how ADHD has become the cause of the problem behaviors, rather than just another name for them.

and

“… research shows that medications like Ritalin and Adderall may be beneficial to help them increase reaction time [presumably should read decrease], reduce accidents, and ultimately save lives.

Interestingly, Healthline.com runs a good many ads for ADHD “medications.”  They are clearly marked Advertisement, but the font is very small.

and

“So, should truckers be screened for ADHD instead of self-medicating with harder drugs?”

There is an implication here that ADHD “meds” will reduce the incidence of truckers driving under the influence of speed.  In fact, Ritalin and most other ADHD “meds” are stimulants and are widely abused.  RitalinAbuseHelp.com states that

“Ritalin is taken by recreational drug users for its cocaine-like high.”

and

“Ritalin is taken by workers such as truck drivers to stay awake for long shifts.” [Emphasis added]

Here are some more interesting quotes:

From the American Academy of Pediatrics 2011 practice guidelines on ADHD:

“Given the inherent risks of driving by adolescents with ADHD, special concern should be taken to provide medication coverage for symptom control while driving.  Longer-acting or late-afternoon, short-acting medications might be helpful in this regard.”

And from the American Academy of Child and Adolescent Psychiatry: ADHD Practice Parameters:

“Single daily dosing is associated with greater compliance for all types of medication, and long-acting MPH [methylphenidate] may improve driving performance in adolescents relative to short-acting MPH…”

And from psychologist Russell A. Barkley, PhD, Clinical Professor of Psychiatry and Pediatrics at the Medical University of South Carolina in Charleston, and author of numerous books and studies on ADHD, quoted in this New York Times article from 2012:

“Medication [for drivers who have ADHD] should not really be optional…”

And Dr. Barkley is an eminent man.  I know this because on his website it says that he is “…an internationally recognized authority on attention deficit hyperactivity disorder (ADHD or ADD) in children and adults…”  I also know that he is conscientious and caring.  His website states that he “…has dedicated his career to widely disseminating science-based information about ADHD.”  If proof is needed of his dedication to disseminating information, one need only open the “books” tab on his website.  He has 16 different titles for sale at prices ranging from $14.41 for some paperback book versions to $131.75 for his rating scale books.  One can also subscribe to his newsletter ADHD Report for $105 per year.

Dr. Barkley is well regarded by the pharmaceutical industry.  Dollars for Docs reports that between 2009 and 2012, he received $120,283 from Eli Lilly alone, for consulting, speaking and traveling.  In February of this year he conducted a five-day, multi-city lecture tour of Japan sponsored by Eli Lilly.  And according to  his CV, in 2004-2005, he was awarded a grant of $99,750 from Eli Lilly to study the “Effects of atomoxetine on driving performance in adults with ADHD.”

Dr. Barkley has also reportedly served as a consultant/speaker to Shire, Medice, Novartis, Janssen-Ortho, and Janssen-Cilag.

Dr. Barkley played a significant role in the relaxing of the age-of-onset criterion from 7 to 12 in DSM-5.  As early as 1997, he and the equally eminent Joseph Biederman, MD co-authored Toward a Broader Definition of the Age-of-Onset Criterion for Attention-Deficit Hyperactivity Disorder (Journal of the American Academy of Child and Adolescent Psychiatry, September 1997).  In this article they state, apparently without the slightest hint of irony:

“We can see no positive benefits of the recommended AOC [age of onset criterion] except that it would certainly limit the number of children (and probably adults) with diagnosed ADHD.  Some special education districts or managed health care companies who might wish to restrict the access of those with ADHD to their services could conceivably see such a restriction as advantageous, but this is purely financial self-interest.”

So, all things considered, when Dr. Barkley tells a New York Times reporter that medication for drivers with ADHD “should not really be optional,” perhaps we should be concerned.

Over the past 60 years, pharma-psychiatry has demonstrated, time and again, that there is no human problem that they can’t exploit for their own benefit and, in the process, make ten times worse.  I will be watching this latest foray into road safety with trepidation.

ADHD: Are We Helping Or Harming?

In November 2013, the British Medical Journal published Attention-deficit/hyperactivity disorder: are we helping or harming? by Rae Thomas, PhD, Psychologist, Australia; Geoffrey K. Mitchell, MB BS, FRACGP, PhD, Professor of General Practice, Australia; and Laura Batstra, PhD, Psychologist, Netherlands.  The article is part of a series on the dangers of overdiagnosis.

Here are some quotes:

“Prevalence and prescribing rates for attention-deficit/hyperactivity disorder (ADHD) have risen steeply over the past decade, partly in response to concerns about underdiagnosis and undertreatment.”

“…prescribing rates for commonly used drugs such as dexamfetamine, methylphenidate, and atomoxetine for children diagnosed with ADHD have increased.”

“DSM-5 widens the definition of ADHD by expanding behavioural descriptions to include more examples and increasing the maximum age of symptom onset from 7 to 12 years.”

“Among the work group advisers of DSM-5 for ADHD and disruptive behaviour disorders, 78% disclosed links to drug companies as a potential financial conflict of interest.”

“The main medications for ADHD are methylphenidates and amfetamines, which can cause adverse reactions such as weight loss, hepatotoxicity, and suicide ideation, and in the short term may suppress pubertal growth.”

“A diagnostic label is value laden and has the potential to cause harm and, paradoxically, increase mental health problems.”

SUMMARY

This is an interesting and important article.  The authors emphasize the factors that are driving the increased “prevalence” and the consequent potential damage, particularly in what they call mild and moderate cases.

Unfortunately, although they don’t describe ADHD as an illness, they do appear to accept a medical perspective, or at least a need for medical intervention, in severe cases.  If the problems persist after “minimal intervention” with parents and some “brief …counselling,” they recommend that the child be referred to “a developmental pediatrician or psychiatrist for definite diagnosis and treatment”.

This general theme – that the condition known as ADHD is a valid medical entity that is simply being overused – is becoming quite common.  It was the primary thread in Dr. Lieberman’s latest article, and is being widely promoted in an attempt to rescue the illness concept from collapsing under its own weight.

But in reality, there is no more reason to conceptualize severe inattention/impulsivity as an illness, than mild inattention/impulsivity. 

Nevertheless, the article is useful.  It is certainly a step in the right direction, and provides a long list of references.  With regards to the illness concept, my guess is that the wording of the article represents a compromise.  Dr. Batstra is quoted elsewhere as saying that “It is a fallacy to regard ADHD as an illness.”  Dr. Thomas in Moving the diagnostic goalposts: medicalizing ADHD, states:  “I believe that attention deficit hyperactivity disorder is a real disorder; I also believe it’s too frequently diagnosed and over-treated.”  Dr. Mitchell’s position is harder to assess, but from the wording of some articles of which he was a co-author, it seems possible that he conceptualizes ADHD as an illness.

For the record, and to guard against misunderstanding, it is my position that the condition known as ADHD is a loose cluster of vaguely-defined problem behaviors, most of which can be conceptualized as a failure on the part of the child to acquire age-appropriate habits in the areas of discipline, self-control, and social interaction.  It is not an illness in any meaningful sense of the term.

 

 

 

Dr. Lieberman Still Passing the Buck: Psychiatry Is Blameless

Jeffrey Lieberman, MD, President of the APA, has expressed concern about the rise in the number of people being assigned a “diagnosis” of ADHD.  He has put up a video on Medscape, Explaining the Rise in ADHDThere is a transcript with the video.

Dr. Lieberman is responding to a December 14, 2013, New York Times article The Selling of Attention Deficit Disorderby Alan Schwarz, and a December 18 editorial in the same paper titled An Epidemic of Attention Deficit Disorder.

The article had pointed out that 15% of all high school students in the US carry a diagnosis of ADHD, and that the number of children being treated for ADHD rose from 600,000 in 1990 to 3.5 million in 2013.

Dr. Lieberman points out that Alan Schwarz had blamed the increase on drug company marketing to doctors and consumers, and on doctors’ susceptibility to this marketing.

But Dr. Lieberman, our intrepid champion of honesty and integrity, isn’t buying that entirely.  He tells us that he has been reading the “scientific medical literature” as well as “the lay literature,” and it is apparent to him that there is:

“…increased pressure from parents and schools, which influences doctors when they see patients and attempt to determine whether a child has a diagnosable condition or whether a specific treatment should be used.”

There is also, he tells us:

“…a readiness to refer children for evaluation, either for neuropsychological testing or to be seen by a pediatric neurologist or psychiatrist. In our competitive society, we know that people desire a competitive edge to improve their chances of doing well in school, getting into the best colleges, and so forth. If having a diagnosis and taking stimulant medications can enhance performance in addition to procuring for the student extra time on tests, this is seen as desirable, and doctors may be subject to the pleas or requests of parents to see their children in ways that encourage the diagnosis and treatment of ADHD.”

He also mentions:

“Public schools can receive financial incentives to have students in special education or remedial education programs, and families with lower incomes can receive subsidies and disability support if their children have diagnoses of cognitive problems, whether it is a learning disability or ADHD, that result in the need for special education.”

So there we have it.  Once again, psychiatry is blameless – it’s the mean ol’ drug companies with their high-power marketing, and the overly-ambitious parents seeking that extra edge for their children in this highly competitive world.  And, of course, the schools, who covet the extra funding that comes their way for every student who carries an ADHD “diagnosis.”

But – in classic Dr. Lieberman style – he ignores the fact that it was psychiatrists who invented this non-illness in the first place.  It was psychiatrists who set out criteria for this “illness” that were so vague that virtually any child could be pathologized. It was psychiatrists, in their long-standing, corrupt relationship with pharma, who promoted the notion of popping pills as the correct and appropriate “treatment” for this “under-diagnosed” condition.  And it was psychiatrists who, spurred by their success in the pediatric market, launched this so-called illness at the adult population, and turned dangerous stimulant drugs into the blockbusters they are today.

No.  Dr. Lieberman doesn’t address those issues.

He does, however, concede that

“…it ultimately comes back to the doctors, who are the gatekeepers or arbiters of diagnosis and treatment.”

And he insists that

“…clinicians must resist marketing pressures, as well as parental pressures, to ensure that diagnoses are made in a rigorous way and that treatments are prescribed judiciously.”

So, diagnoses are to be made in a rigorous way.  Could anyone explain to me how the criterion item

“Often runs or climbs about in situations where it is inappropriate (Note: in adolescents or adults may be limited to feeling restless)”

can be applied in a rigorous way?  How often is “often”?  How would one even begin to assess the frequency with which a child runs or climbs about?  How do we define appropriate?  A strict, uptight nanny might say that running and climbing about is never appropriate.  A parent or teacher might feel that running and climbing about were OK for boys but not for girls, etc…  And apparently adolescents and adults score yes on this item if they often feel restless!  I would guess that during the winter, half the adult population of the northern United States feel restless.  We call it cabin fever!  And aren’t adolescents supposed to feel restless?  Isn’t it the time of the great awakening – when young people look to the horizon and dream their dreams?

Or how about:

“Often unable to play or engage in leisure activities quietly.”

How are we to interpret the word “unable”?  How do we define “quietly”?  Should be have a decibel meter?

Or:

“Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).”

How do we define “extraneous”?  Would this item embrace a gifted child who is finding the class lesson boring and facile, and looking out the window watching a magpie building a nest?  And how can we assess “unrelated thoughts”?

Psychiatrist (to adolescent): Are you distracted by unrelated thoughts?
Adolescent (who wants diagnosis):  Yes – all the time.
Adolescent (who doesn’t want diagnosis):  No – not much.

I suggest that of the 18 criteria that underpin this so-called diagnosis, there isn’t one that could by any stretch of the imagination, be rigorously applied.  The wording in each item is colloquial, and no attempt is made to define the terms.  The word “often,” which occurs in every item, is clearly open to interpretation.

This vagueness in the criteria items has been a feature of virtually every “diagnosis” in the DSM since its inception.  Psychiatrists have made no attempt to sharpen these defining features, and it is difficult to avoid the impression that they like them just the way they are.  And the reason they like them is because it enables psychiatry to expand its scope more or less indefinitely.  This is in line with their unspoken but clearly evident philosophy:  every problem is an illness, for every illness there’s a pill, and every undrugged person is money down the drain.

For the past 60 years, organized psychiatry never raised the slightest objection to this implied philosophy, and never expressed the slightest alarm or misgiving about the increasing “prevalence of mental illness.”  Indeed, it was commonplace to hear leading psychiatrists assuring us that “mental illness” was under diagnosed.  Remember the much-lamented statistic:  only 40% of people with “mental illness” are receiving treatment!

Now, with the controversy surrounding the publication of DSM-5 and the emergence of the survivor movement as a force to be reckoned with, organized psychiatry is trying to backpedal.  Dr. Lieberman wants diagnoses to be made “in a rigorous way” and treatments to be prescribed “judiciously.”  But a runaway train is a hard thing to stop.  And if psychiatry had really wanted this, they would have taken appropriate steps decades ago.  In fact, they wouldn’t have embarked on this travesty in the first place.

Certainly, pharma poured money into the promotion of ADHD, but it was psychiatric “thought leaders,” unashamedly embracing their roles as pharma shills, who presented the seminars and the CEU sessions in every conceivable venue, including the APA’s own conferences.

Dr. Lieberman is well aware that all across America the “diagnosis” of ADHD, for children and adults, is being made in five-minute interviews, and that stimulant drugs are being distributed readily and with little regard for their adverse effects.

He also knows that it was organized psychiatry that created this situation, and that they did so consciously and deliberately.  This was not some minor transient error into which psychiatry briefly drifted and from which it will promptly extricate itself.  This state of affairs is the end result of 60 years of focused and dedicated work on the part of psychiatry’s leaders to create a culture in which all human problems would be seen as psychiatric illnesses to be treated by pills.  The American Journal of Psychiatry, the APA’s own official journal is still running ADHD drug ads in its online version.

In addition, it is disingenuous of Dr. Lieberman to imply that it is only now, thanks to Alan Schwarz’s article, that he is discovering the excesses to which his profession has reached.  In the relentless pursuit of their disempowering but self-serving agenda, psychiatry has systematically silenced and marginalized its critics – those from within its own ranks and those from outside.  As recently as last May, Thomas Insel, MD, Director of NIMH, who had declared psychiatric diagnoses to be invalid, was quickly brought to heel, and even issued a press statement – jointly with Dr. Lieberman – to the effect that DSM-5 was the best option.

The notion that every problem is an illness to be treated by a pill has been nurtured and promoted by successive generations of psychiatrists to the point where it is now an article of faith – an essential tenet of psychiatric orthodoxy to which all new recruits must subscribe, and on whose altar ever-increasing numbers of children and adults are being sacrificed every day.

There are dissenting psychiatrists, of course, and they are to be commended for their courage and their outspokenness.  But from the great majority of psychiatrists there’s not a word – just lockstep compliance and overworked prescription pads.  And from their great leader, a hollow and belated call for “rigorous” psychiatric diagnosis and “judicious” prescription, both of which, I suggest, are contradictions in terms.

The psychiatric ship has long been unseaworthy.  It’s on the rocks, holed and taking water.  But the psychiatrists on board are joined together in a self-destructive conspiracy of complacent self-deception, ever ready to blame others for their plight, but adamantly refusing to recognize that the ship in which they sail is a vessel of their own making, and that the course to disaster was charted by their own hands.

 

The Sandcastle Continues to Crumble: ADHD Does Not Exist

BOOK PREVIEW

Richard C. Saul, MD
ADHD Does Not Exist:  The Truth About Attention Deficit and Hyperactivity Disorder
Publication date:  February 18, 2014

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Those of us on this side of the psychiatry debate have been saying for decades that the condition known as ADHD is not an illness, but is rather an arbitrarily delineated cluster of vaguely defined problems that children have acquired in various ways.  We have also pointed out that psychiatry’s labeling of this condition as an illness is simply another instance of their inexorable turf expansion, and that their widespread drugging of the individuals so labeled is destructive and disempowering.

And, also for decades, psychiatry has been marginalizing us as unscientific mental illness deniers, who seek to put the clock back and deprive people suffering from this “illness” of the vital “treatment” that they so desperately need.

In recent years, we have seen some fracturing in psychiatry’s defenses.   Individual psychiatrists have been dissenting – sometimes very forcibly – against psychiatry’s philosophy that every problem is an illness and for every illness there’s a pill.

And now their voices are joined by Richard C. Saul, MD, an experienced and highly regarded neurologist who practices in the Chicago area.  He has written a book, ADHD Does Not Exist:  The Truth About Attention Deficit and Hyperactivity Disorder, which is due out next month.  The book is sure to present a formidable challenge to the orthodoxy and practices of organized psychiatry, with regards to this particular “diagnosis,” that has seen an almost four-fold increase in prevalence from 1987 to the present day.

Kyle Smith, a journalist who writes for the New York Post, has written a promotional article on the book for the Post (January 4).  Here are some quotes from the article:

“After a long career treating patients complaining of such problems as short attention spans and an inability to focus, Saul is convinced that ADHD is a collection of symptoms…”

“Treating ADHD as a disease is a huge mistake, according to Saul. Imagine walking into a doctor’s office with severe abdominal pains and simply being prescribed painkillers. Then you walk away, pain-free. Later you die of appendicitis.”

“Adderall and Ritalin are stimulants, though, and the more you take them the more you develop a tolerance for them, which can lead to a dangerous addiction spiral.”

“The explosion in ADHD diagnoses and related prescriptions of stimulants is not without substantial costs. Potentially addictive drugs are not to be given out like Skittles.”

“‘I know of far too many colleagues,’ Saul writes, ‘who are willing to write a prescription for a stimulant with only a cursory examination of the patient, such as the ‘two-minute checklist,’ for ADHD.'”

“Two minutes to jot down a prescription may lead to years of consequences: short-term side effects of stimulants include loss of sleep, increased anxiety, irritability and mood problems. Over the long term, use of these drugs can lead to unhealthy weight loss, poor concentration and memory, even reduced life expectancy or self-destructive behaviors not excluding suicide.”

Dr. Saul’s debunking of ADHD as a disease entity should come as no surprise.  There was never a shred of evidence or valid reason for considering it an illness in the first place.  It became an illness the same way other psychiatric conditions became illnesses – by APA fiat:  Let there be illness, said the APA, and illness appeared everywhere.

It will be interesting to see how the APA leadership spin this.  I imagine that today they’re just reaching for the acetaminophen, but we can be sure that their ever-resourceful Office of Communications and Public Affairs will be all over it soon, and that our esteemed Dr. Lieberman’s fluent pen will be generating persuasive prose to reassure us that psychiatric diagnoses reflect real illnesses, and that there are vast unmet needs in this area.

The DSM’s so-called nosology is like a sandcastle on the foreshore.  The tide of scrutiny, particularly from survivors, is rising, and as the APA’s cherished edifice crumbles, organized psychiatry’s hold on reality becomes increasingly tenuous.

Never Mind The Facts; Just Sell More Pills

There’s an interesting article, recently published in Journal of Contemporary Psychotherapy, on Springer Link.  It’s titled Shooting the Messenger: The Case of ADHD,  and it was written by Gretchen LeFever Watson, PhD, et al.

Apparently some of the authors had noted in 1995 a marked increase in the “diagnosis” and “treatment” of the condition known as ADHD in southeastern Virginia.  This is a large urban conglomeration of six different cities, including Norfolk, Portsmouth, and Virginia Beach.

Psychologists in the area formed a school health coalition “…to implement and evaluate interventions to address the problem.”

They soon found themselves under attack by “other professionals with strong ties to the pharmaceutical industry…,” and in 2005, the work of the coalition was terminated.

One of the attacks consisted of an anonymous allegation that Dr. LeFever was falsely reporting high rates of ADHD in order to promote an anti-drugging agenda.

As a result of the termination of the work, the coalition was disbanded, and promising behavioral and public health interventions were discontinued.  Meanwhile, the drugging of the children “diagnosed” with this condition continued to escalate.

The article cites that today, 14% of American children are receiving this “diagnosis” before the age of 18.

One of Dr. LeFever’s most outspoken critics is Russell Barkley, PhD – a psychologist who has written and spoken extensively on the condition known as ADHD.  He also has strong financial ties to pharma ($91,167 in 2009-2011 according to Pro Publica’s Dollars for Docs), and is considered a key opinion leader in the ADHD field.

The Shooting the Messenger article runs to 16 pages, discusses the issues in considerable depth, and is well worth reading.  The general message is that if one takes on pharma-psychiatry and starts having a significant impact, one will come under attack.  In bio-psychiatry, truth is routinely subordinated to the central task of medicalizing an ever-widening range of human problems, and selling drugs to “treat” these fictitious illnesses.