Tag Archives: books worth reading

A Prescription for Psychiatry, by Peter Kinderman, PhD

I recently read Peter Kinderman’s new book, A Prescription for Psychiatry, which was published on September 3 by Palgrave Macmillan.  The overall message of the work is captured nicely in the subtitle:  Why We Need a Whole New Approach to Mental Health and Wellbeing.  Dr. Kinderman is Professor of Clinical Psychology, Head of the Institute of Psychology, Health and Society at the University of Liverpool, and an honorary Consultant Clinical Psychologist with Mersey Care NHS Trust in the UK.

Dr. Kinderman manages to present a comprehensive critique of current psychiatric practices, plus a well-developed plan for reform in superb, clearly written, jargon-free prose.

The scope and direction of the book can be gathered from the table of contents:

Introduction: The Disease Model of Mental Health:  A System in Crisis

1.  Get the Message Right: A Psychosocial Model of Mental Health and Well-being
2.  Understand, Don’t Diagnose
3.  The Drugs Don’t Work … So Offer Real Solutions
4.  Promote Health and Well-being
5.  Residential Care … Not Medical Coercion
6.  Teamworking
7.  Social and Community Services in Local Authority Management
8.  Can We Afford It?
9.  A Manifesto for the Reform of Mental Health and Well-being Services

Here are some quotes from the text:

“Traditional thinking about mental health care is profoundly flawed, and radical remedies are required. Our present approach to helping people in acute emotional distress is severely hampered by old-fashioned and incorrect ideas about the nature and origins of mental health problems, and vulnerable people suffer as a result of inappropriate treatment. We must move away from the ‘disease model’, which assumes that emotional distress is merely a symptom of biological illness, and instead embrace a psychological and social approach to mental health and well-being that recognizes our essential and shared humanity.”

“We have become so used to thinking of psychological distress as a branch of medicine that we are in danger of no longer really challenging this assumption.”

“Guided by the flawed assumption that distress is best thought of as a ‘symptom’ of an ‘illness’, mental health professionals go on to assume that if a set of symptoms has a name, we know what ‘it’ is, we can talk to ‘patients’ about it easily and we have a recognised path of treatment that will ‘cure’ it.”

“People who are convinced that others mean them harm (with ‘paranoid delusions’, in psychiatric language), and who are very frightened that they are in imminent danger, will often find their fears much less preoccupying and distressing if they take chlorpromazine. That sounds a lot like the effects of opioid street drugs like heroin.”

“…‘mental health’ services simply aren’t caring and effective, the disease-model approaches don’t actually work very well, and social approaches are both most appropriate and most effective.”

“But I cannot conclude that a medical ethos adds anything positive to the experience of residential care. Ultimately, a reliance on chemical restraints is a bad thing.”

“The real change that we so badly need will only come when we move beyond the idea that mental health issues are essentially a medical problem with social aspects, and acknowledge that what we are talking about are essentially social problems. Radical change is needed to ensure that the management, leadership and practices of services reflect this.”

“The medical and psychiatric communities are powerful – with well-established and effective professional bodies, and statutory mechanisms for catching and holding the ears of policymakers. But, despite the likely opposition, this aspect of my prescription will remain – to move mental health care from medical to social management, from the health service to local authority control.”

“Evidence is also accumulating that psychiatric medication can have dangerous adverse effects (side-effects) especially when taken long term.”

“We must offer services that help people to help themselves and each other rather than disempowering them: services that facilitate personal ‘agency’ in  psychological jargon. That means involving a wide range of community workers and psychologists in multidisciplinary teams, and promoting psychosocial rather than medical solutions.”

We’ve seen a good many critiques of psychiatry in recent years, most of which focus on the notion that psychiatry has “gone too far” in the expansion of its diagnoses, and in the prescribing of psychiatric drugs.  But Dr. Kinderman’s primary thesis is much more profound and far-reaching:  that conceptualizing emotional distress as a symptom of an illness is simply incorrect, and is also destructive, and disempowering.

The reasoning and evidence for this position is presented in the first three chapters, and the proposed alternative is developed in the remainder of the book.  Dr. Kinderman challenges psychiatry’s present attempts to co-opt the recovery movement by transplanting the medical model into the community in the form of “out-patient, hospital-based” teams.  Dr. Kinderman argues forcefully that instead  “…the correct place for mental health care is within the social care system.”  Those of us who have struggled throughout our careers with trying to provide appropriate help to our clients within the context of a medically conceptualized and operated system will readily recognize how critically important this is.

Dr. Kinderman’s statement – “In many ways, the structures within which mental health care is currently located are part of the problem” – will resonate strongly with social workers, case managers, counselors, psychologists, job coaches, etc., in many parts of the world.

In the years ahead, A Prescription for Psychiatry will be seen as a cardinal work in the present debate.  I strongly encourage my readers to read it, and spread the word.

 

DISCLAIMER

I have no financial interest in Dr. Kinderman’s book, or in any books/materials promoted on this site.

 

Drugging Our Children: A Book Review

Drugging Our Children

 

The 2012 book Drugging Our Children: How Profiteers Are Pushing Antipsychotics on Our Youngest, and What We Can Do to Stop It, is edited by Sharna Olfman PhD, and Brent Dean Robbins, PhD.  It is a collection of ten articles, plus an Introduction and an Afterword by Sharna Olfman.  Here are the chapter titles, with a quote from each:

 

Introduction, by Sharna Olfman, PhD

“…they [antipsychotics] constitute such an assault to a child’s body and brain that it is hard to fathom why they are being prescribed so widely and casually, when safer and more effective and humane treatment modalities already exist.” [p xiii]

1.  Weighing the Evidence: What Science Has to Say about Prescribing Atypical Antipsychotics to Children, by Robert Whitaker

“The drugs’ disruption of normal functioning along these various neuronal pathways causes many predictable adverse events.” [p 7]

2.  From Ice Pick Lobotomies to Antipsychotics as Sleep Aids for Children: A Historical Perspective, by Brent Dean Robbins

“The era of moral treatment teaches us that successful treatment of many forms of mental illness requires neither biological explanations nor medical specialty.” [p 24]

3.  Drugging Our Children:  A culture That Has Lost Its Compass, by Sharna Olfman

“Sadly, it appears that support for families in the United States continues to deteriorate in lockstep with the rise in psychiatric disturbances.” [p 48]

4.  The Marketing of Madness and Psychotropic Drugs to Children, by Gwen Olsen

“Children are a lucrative expansion market for any drug, particularly one that requires lifelong maintenance therapy once initiated.” [p 53]

5.  Pediatric Antipsychotics:  A Call for Ethical Care, by Jacqueline A Sparks and Barry L. Duncan

“When the evidence is explored, no reasonable scientist or practitioner would come down on the side of a favorable risk/benefit profile for pediatric use of antipsychotics.” [p 87]

6.  Legal Issues Surrounding the Psychiatric Drugging of Children and Youth, by Jim Gottstein

“The horrific use of neuroleptics on defenseless children and youth cries out for legal efforts to curtail the practice.”  [p 115]

7.  Drug-Free Mental Health Care for Children and Youth:  Lessons from Residential Treatment, by Tony Stanton

“One of the first things we observed in the records sent to us was a death of curiosity.  This was due, in part, to the rush to impose a diagnostic label.  Once the diagnosis was applied, curiosity was no longer necessary.  The goal had been reached:  the child’s behaviors and symptoms were placed in their proper category.  In the records sent to us, we saw the repeated implication that there was nothing left to describe or discover.  In particular, the child’s living connections with caretakers and their history had become irrelevant.  A logical result was that clues about the origins of symptoms like those we found for Mark or Jim, didn’t need to be pursued.” [ p 129]

8.  Strategic Family Therapy as an Alternative to Antipsychotics, by George Stone

“Psychiatry assumes that a child’s psychological issues are biological events that have no meaning and sweeps the important social and contextual information that is being conveyed under the rug of genetic malfunction.” [ p 147]

9.  How Parents Can Improve Their Children’s Developmental Trajectories, by Adena B. Meyers and Laura E. Berk

“Little attention is paid to the many risk and protective factors that may influence children’s trajectories over time.  Instead, there is a tendency to reify diagnostic labels while losing sight of their hypothetical nature.  This may create the erroneous impression that a tangible disease entity with known causes,  processes, and treatment mechanisms permanently resides within each affected child.” [p 154]

 10.  Building Healthy Minds:  It Takes a Village, by Stuart Shanker

“In order for primary care physicians to play the central role that I have outlined, they will need to make a major modality shift, away from treating symptoms with psychiatric drugs to addressing the causes.” [ p 183]

Afterword, by Sharna Olfman

“Record levels of psychiatric disturbance, violence, poverty, apathy, and despair among our children speak to our current cultural crisis.” [p 187]

This is a well-written and compelling book.  It describes, in detail, psychiatry’s shameful, destructive, and widespread drugging of our children.  But it also offers a conceptual framework and practical suggestions for breaking free from the psychiatric-pharma destruction.

I highly recommend this book for parents, mental health workers, and anyone who has an interest in the welfare of our children.

 

 

 

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

************************

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.

The Bitterest Pills, by Joanna Moncrieff: Another Book Worth Reading

Dr. Joanna Moncrieff is a UK psychiatrist and a founding member of the Critical Psychiatry Network.  In 2009 she wrote The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment.

The Bitterest Pills-joanna-moncrieff

Her latest book, The Bitterest Pills, was published earlier this year, and is about neuroleptic drugs (the so-called anti-psychotics).  You can get an idea of the tenor and scope of the work from the table of contents:

  1. Curse or Cure:  What Are Antipsychotics?
  2. Chlorpromazine:  The First Wonder Drug
  3. Magic Bullets:  The Development of Ideas on Drug Action
  4. Building a House of Cards:  The Dopamine Theory of Schizophrenia and Drug Action
  5. The Phoenix Rises:  From Tardive Dyskinesia to the Introduction of ‘Atypicals’
  6. Looking Where the Light Is:  Randomised Controlled Trials of Antipsychotics
  7. The Patient’s Dilemma:  Other Evidence on the Effects of Antipsychotics
  8. Chemical Cosh:  Antipsychotics and Chemical Restraint
  9. Old and New Drug-induced Problems
  10. The First Tentacles:  The ‘Early Intervention in Psychosis’ Movement
  11. The Antipsychotic Epidemic:  Prescribing in the Twenty-first Century
  12. All is not as it Seems

There are 39 pages of references at the back.

Here are some quotes:

 “It is necessary to point out, however, that despite the claims of much official information, current evidence does not allow us to conclude that schizophrenia is a brain disease in the simple sense in which we usually understand the term ‘disease’.  No biological factor, whether it be a genetic, biochemical or anatomical deviation, has been found that is consistently and specifically related to schizophrenia, despite more than half a century of recognizably modern research efforts.  Moreover, what was thought to be one of the most reliable indications that schizophrenia arises from a defective brain, namely the finding that people with the diagnosis have smaller brains and larger brain cavities than people without, turns out, as we shall see in Chapter 10, to be at least partially a consequence of antipsychotic drug treatment.” (p 16)

“Descriptions of the neurological and physiological effects induced by antipsychotics and other psychiatric drugs such as antidepressants, disappeared from the literature …Henceforth they were referred to, if at all, only as ‘side effects’, which were regarded as an incidental nuisance, rather than an intrinsic part of the a drug’s action.” (p 51)

“In view of the considerable evidence that the only dopamine abnormalities in people with schizophrenia are caused by antipsychotic treatment, it is hard to think what evidence could convince the promoters of the dopamine theory of schizophrenia or psychosis that the theory is mistaken.” (p 74)

“Prominent psychiatrists, including David Cunningham Owens (whose research had been used to argue that tardive dyskinesia was part of schizophrenia, but who, in later years, has become more critical of drug treatments), have started to suggest that the story of atypical antipsychotics as a group of  compounds with unique therapeutic properties is a myth, largely constructed by the pharmaceutical industry, and swallowed hook, line and sinker by the psychiatric profession…” (p 90)

“People commenting on olanzapine described an altered state consisting of profound sedation accompanied by emotional flattening and indifference, in association with a markedly increased appetite for food.” (p 121)

“The use of drugs to control behaviour started to be discussed more frequently in psychiatric journals from the 1970s onwards, but articles adopted various strategies in order to emphasis the therapeutic aspects of emergency drug treatment and play down its coercive function.” (p 139)

“It seems extraordinary in the twenty-first century that people should be forced to take drugs which profoundly alter their bodily functions, their emotional life, their behaviours and personality, and that the institutions that instigate and enforce this ‘treatment’ have no interest in the range of effects the drugs produce and how they make people feel.” (p 151)

“An almost religious commitment to the disease-centred view of psychiatric drug action has created a blind spot to the serious physical consequences that long-term ingestion of toxic substances is likely to produce, and drug companies are still able to present antipsychotic drugs as innocuous and restorative agents that work by balancing the brain’s ‘natural chemicals’… (p 213)

This excellent book is for anyone who has a serious interest in the topic:  survivors, caregivers, writers, students, etc… It’s a book to read and to keep close for reference and research.

Disclosure:  I have no financial interest in this work or in any book that I promote on this website.

Another Critique of Psychiatry’s Medical Model

I have recently read De-Medicalizing Misery [palgrave macmillan, 2011].  It’s a comprehensive collection of articles, edited by Mark Rapley, Joanna Moncrieff, and Jacqui Dillon.  The table of contents provides a sense of the book’s scope.

Table of Contents

  1. Carving Nature at its Joints?  DSM and the Medicalization of Everyday Life, Mark Rapley, Joanna Moncrieff, and Jacqui Dillon
  1. Dualisms and the Myth of Mental Illness, Philip Thomas and Patrick Bracken
  1. Making the World Go Away, and How Psychology and Psychiatry Benefit, Mary Boyle
  1. Cultural Diversity and Racism: An Historical Perspective, Suman Fernando
  1. The Social Context of Paranoia, David J. Harper
  1. From Bad Character to BPD: The Medicalization of ‘Personality Disorder’, James Bourne
  1. Medicalizing Masculinity, Sami Timimi
  1. Can Traumatic Events Traumatize People?  Trauma, Madness, and Psychosis, Lucy Johnstone
  1. Children Who Witness Violence at Home, Arlene Vetere
  1. Discourses of Acceptance and Resistance:  Speaking Out about Psychiatry, Ewen Speed
  1. The Personal is The Political, Jacqui Dillon
  1. ‘I’m Just, You Know, Joe Bloggs’:  The Management of Parental Responsibility for First-episode Psychosis, Carlton Coulter and Mark Rapley
  1. The Myth of the Antidepressant:  An Historical Analysis, Joanna Moncrieff
  1. Antidepressants and the Placebo Response, Irving Kirsch
  1. Why Were Doctors So Slow to Recognize Antidepressant Discontinuation Problems? Duncan Double
  1. Toxic Psychology, Craig Newnes
  1. Psychotherapy:  Illusion with No Future? David Smail
  1. The Psychologization of Torture, Nimisha Patel
  1. What Is to Be Done? Joanna Moncrieff, Jacqui Dillon, and Mark Rapley

Each author brings to the general topic his or her unique perspectives, and the result is persuasive and inspiring.

Here’s a quote from the final chapter:

“In this volume we have attempted to show that the modern conception of madness and misery as diseases, illnesses or disorders that can only be understood within a specialist body of knowledge, fails to do justice to the range and meaning of the experiences these concepts refer to.  More seriously, by designating people’s distress as illness, we ignore the abuse that individuals may have suffered, and in a wider sense, we obscure the features of modern society that make sanity a precarious state for many people.  We enthrone a very particular, and very partisan, ‘truth’ by wreaking violence on the life experience and subjectivity of those we purport to ‘help’.  Diagnoses of schizophrenia, depression or ‘reactive attachment disorder’ are entirely inadequate descriptions of the problems and difficulties that people experience, and the unfolding life story in which those problems are set.  Such labels render people’s experiences as meaningless as if they denoted a rash, a boil, or a cough (cf Parry, 2009).  Moreover, the experiences we have come to be familiar with under the rubric of ‘psychiatric symptoms’ may be more of a signal that all is not well, a signal that something needs to change, than a problem itself.  But, as we have seen in this collection, this perspective is one that is anathema to currently hegemonic medicalized understandings.”

I strongly recommend this book.

Disclosure:  I have no financial ties to this book or to any publications that I recommend on this website.

 

 

 

Pharma Corruption of Healthcare

I’ve been reading another great book:  Deadly Medicines and Organised Crime: How big pharma has corrupted healthcare, by Peter C. Gotzsche [Radcliffe Publishing, 2013].

The book is an exposé of pharma’s fraudulent research and marketing.  The author is a Danish physician who has been involved in clinical trials of drugs, and in drug regulatory matters.  He is a professor at the University of Copenhagen.  He has published more than 50 papers, including papers in the BMJ, Lancet, JAMA, Annals of Internal Medicine, and the New England Journal of Medicine.

Most of the book is concerned with pharma corruption in general medicine.  But there are two chapters that deal with pharma and psychiatry: Chapters 17 and 18.

Here are the subheadings for these chapters:

17.  Psychiatry, the drug industry’s paradise

  • Are we all crazy or what?
  • Psychiatrists as drug pushers
  • The chemical imbalance hoax
  • Screening for psychiatric disorders
  • Unhappy pills
  • Prozac, a terrible Eli Lilly drug turned into a blockbuster
  • Exercise is a good intervention
  • Further lies about happy pills

18.  Pushing children into suicide with happy pills

  • Glaxo study 329
  • Concealing suicides and suicide attempts in clinical trials
  • Lundbeck’s evergreening of citalopram
  • Antipsychotic drugs
  • Zyprexa, another terrible Eli Lilly drug turned into a blockbuster
  • The bottom line of psychotropic drugs

Here are some quotes:

“Psychiatry is the drug industry’s paradise as definitions of psychiatric disorders are vague and easy to manipulate.” (p 191)

“Few psychiatrists are willing to admit that their specialty is out of control and they will continue to tell you that many patients are underdiagnosed.” (p 193)

“The psychiatrists are running amok.” (p 195)

“Leading psychiatrists are often highly effective drug pushers.” (p 197)

“…the sure way of making us all crazy is to screen for mental disorders.” (p 201)

“It is abundantly clear that suicides, suicidality and violence caused by SSRIs are grossly underestimated, and we also know the reasons.  First, there is outright fraud.  Second, many suicidal events have been coded as something else.  Third, the drug industry has taken great care to bias its trials by only recruiting people at very low risk of committing suicide.” (p 223)

“The drug companies have caused tremendous harm by their widespread illegal and aggressive promotion of the drugs for off-label use…” (p 229)

“Like for the SSRIs, there are many perverse trials supporting antipsychotics for virtually everything.” (p 230)

“I therefore estimate that 200,000 of the 20 million patients treated with Zyprexa have been killed because of the drug’s harms.” (p 232)

Anyone who has any lingering doubts as to the flawed and destructive nature of psychiatry might usefully take a look at this book.

 

Disclosure:  I have no financial interest in this book or in any books that I recommend on this website.

Cracked: The Unhappy Truth About Psychiatry, by James Davies, PhD: Book Review

This is an excellent book, published by Pegasus Books earlier this year.  The cover blurb says that it is “…scathing about every aspect of psychiatry.”

Dr. Davies, who is a practicing therapist in the UK, brings to the subject enormous energy and enthusiasm.  He has interviewed Robert Spitzer, Allen Frances, Irving Kirsch, Joanna Moncrieff, Sami Tamimi, Peter Breggin, and many, many others.

Some of the points he makes will be familiar to those of us on this side of the debate, but there is an enormous amount of fresh material and insights.  The book careens, almost literally, from one psychiatric outrage to the next, and the arguments are supported by appropriate citations.

A particularly refreshing aspect of this work is the inclusion of a great deal of input from clients.

Here are some quotes:

“Why has psychiatry become the fastest-growing medical specialism when it still has the poorest curative success?  Why are psychiatric drugs now more widely prescribed than almost any other medical drugs in history, despite their dubious efficacy?  And why does psychiatry, without solid scientific justification, keep expanding the number of mental disorders it believes to exist – from 106 in 1952 to 374 today?  What is going on?” (p x)

“And yet, as we have seen, there are forms of medicalization that are clearly unhelpful.  These are the forms that invasively spread medical authority where it was never designed to go.  For instance, ‘problems’ such as low achievement, certain kinds of truancy, or underperformance have attracted medical diagnoses and intervention in our children, as have many normal reactions to the demands of adult life that are labeled as so-called ‘stress disorders’ to be biologically explained and pharmacologically treated.” (p 33)

“An early experiment published in the Lancet explored this very question.  What the group of researchers did was gather up fifty-six medical students and hand each of them a package containing red and blue pills. All the students were told was that one color represented a tranquilizer and the other a stimulant.  After taking the pills, the students were then asked which set of pills were the stimulants and which the tranquilizers.  The majority concluded that the blue pills were the tranquilizers and the red pills the stimulants.  They reached this conclusion because when taking the blue pills they felt far less alert and much drowsier than when taking the red pills.  The researchers then told the students that, chemically, the blue and red pills were exactly the same – both sets of pills were made entirely of sugar.” (p 67)

“So the real question we must ask is not whether pills are leading people to change their lives, but whether they are leading people to change them in the way that is natural to them.  Are these manufactured states of mind guiding people to make the right moves or decisions?  Or are they stacking up more problems for them in the future, like many other mood-altering substances can do?  Is it right that pills should make us feel suddenly invincible, or blasé about our son’s cancer, or sexually unbridled, or indifferent to staying in a dead-end job?  Is it right that they should suddenly dry up our grief for someone we love?”  (p 91-92)

“It appears that when companies research their own products, one way or another they get – or perhaps simply choose to publish – results from which the company stands to benefit.  The financial rewards of moving the goalposts, it seems, makes the temptation of doing so perhaps too strong to resist.” (p 129)

“While many doctors are savvy about the cozening claims of ‘pharma fraudulence,’ the evidence is that they still have a significant impact on doctors’ prescribing habits as well as expanding the antidepressant market.” (p 167)

“The categories of mental disorder (rather than painful experiences themselves) are psychiatric constructions and not scientifically discovered biological entities.  As these categories have greatly proliferated in number in the DSM and ICD, psychiatry has reclassified more and more of our natural human behaviors and feelings as psychiatric disorders requiring treatment.  By doing so, psychiatry has not only expanded its jurisdiction over more of us (one in four of us apparently now suffers from a mental disorder) but has also, by inflating the number of mental disorders, created a huge market for psychiatric treatments.” (p 171-172)

“Many psychiatrists’ claims are no more substantiated than are the claims of religion.  This is because, in so many areas that they survey, psychiatrists do not prove things but decide things: they decide what is disordered and what is not, decide where to draw the threshold between normality and abnormality, decide that biological causes and treatments are most critical in understanding and managing emotional distress.” (p 181)

I strongly recommend this book.

 

Disclosure:  I have no financial interest in this work, or in any of the books/articles that I mention on this website.

 

 

 

 

 

Madness Contested: An Outstanding Book

The book Madness Contested has recently been published by PCCS Books.  It’s a collection of articles, edited by Steven Coles, Sarah Keenan, and Bob Diamond.

The book is a remarkable piece of work.  It covers just about every contentious concept in the present “mental illness” debate, and brings to bear an abundance of new insights and up-to-date research findings.

There are 21 articles plus an introduction by the editors.

Here’s the name of each article with a brief quotation from each:

Introduction:

“We believe the dominant ideology in mental health services has restricted our collective and individual conceptualization, discourse and action regarding madness.”

1.  The Persistence of Medicalisation: Is the presentation of alternatives part of the problem?  Mary Boyle

“…the more we point out the explanatory emptiness of diagnoses, the more we encourage people to ask for and expect different kinds of explanation.” (p 19)

2.  Paranoia: Contested and contextualized.  John Cromby & Dave Harper

“We have suggested that intensely distressing episodes of paranoia should be seen as habits of felt thinking and action acquired in response to events in the social world.” (p 33)

3.  Meaning, Madness and Marginalisation.  Steven Coles

“Those who are eventually considered mad by society have suffered some form of marginalization and disempowerment in their trajectory to madness, either relationally, socially, materially, or culturally.” (p 43)

4.  From Constructive Engagement to Coerced Recovery.  Alastair Morgan & Anne Felton

“Organisational culture and a fear of being blamed is recognised as a barrier for staff to supporting individuals to take therapeutic risks…creating tensions for promoting risk taking and ultimately recovery.” (p 69)

5.  Mental Disorder and the Socio-ethical Challenge of Reasonableness.  David Pilgrim & Floris Tomasini

“Thus social contingencies and specific social norms define when unreasonableness is deemed to be pathological, is sometimes ignored, and sometimes even socially valued.” (p 85)

6.  The Pharmaceutical Industry and Mental Disorder.  Joan Busfield

“Whilst it can be argued that this widening of the boundaries of mental illness helps to enable those with mental health problems to get the treatment they may need, equally it can be argued that it facilitates the pathologisation of individuals, locating the problem within them, and helping to ensure that the social and environmental factors that often give rise to their mental states and behviour are largely ignored.” (p 107)

7.  Clinical Psychology in Psychiatric Services:  The magician’s assistant?  Steven Coles, Bob Diamond & Sarah Keenan

“One way of exposing some of the iatrogenic effects of the power imbalances and problematic practices within the psychiatric system is to provide a public space to openly debate such issues.” (p 117)

8.  Manifesto for a Social Materialist Psychology of Distress.  Midlands Psychology Group

 “Distress is not the consequence of inner flaws or weaknesses.” (p 123)

9.  Soteria:  Contexts, practice and philosophy.  Philip Thomas

 “The failure of technological psychiatry to improve the outcome for people who experience psychosis, the serious harm associated with the long-term use of neuroleptic medication, and at a fundamental level, the failure of science to explain madness, have resulted in a crisis in contemporary psychiatry.” (p 154)

10.  Recovery, Discovery and Revolution:  The work of Intervoice and the Hearing Voices Movement.  Eleanor Longden, Dirk Corstens & Jacqui Dillon

“The emergence of the service user/survivor movement in the 1980s and 1990s heralded a new level of protest against prevailing medical ideologies and the dehumanizing regimes of traditional psychiatric services.” (p 167)

11.  Experiential Knowledge and the Reconception of Madness.  Peter Beresford

“What can particularly help mental health service users/survivors to challenge existing psychiatric interpretations and develop their own viewpoints and ideas is getting together and working with others with shared experience.” (p 189)

 12.  Service User-led Research on Psychosis:  Marginalisation and the struggle for progression.  Jan Wallcraft

“The opinions and perspectives of those labeled psychotic have often been seen as globally lacking credibility and have been marginalized.” (p 198)

13.  The Patient’s Dilemma:  An analysis of users’ experiences of taking neuroleptic drugs.  Joanna Moncrieff, David Cohen & John Mason

“One respondent taking haloperidol explained that ‘I feel like a zombie.  I can’t think clear and my movement is slow’.” (p 219)

 14.  Speaking Out Against the Apartheid Approach to Our Minds.  Rufus May, Rebecca Smith, Sophie Ashton, Ivan Fontaine, Chris Rushworth & Pete Bull

“Over this time period I have discovered the process of trying to change psychiatry from within is flawed, because workers are too identified with interests of the corporate institution.” (p 235)

15.  Toxic Mental Environments and Other Psychology in the Real World Groups.  Guy Holmes

“Some come to feel that their life has been wasted.  One man who had been involved with psychiatric services for over 25 years said to me that the only point of his life seemed to be to provide work and therefore pleasure and meaning to staff who were paid to help him.” (p 259)

16.  Redressing the Balance of Power:  Psychiatric medication in Nottingham.  Nottingham Mind Medication Group

“Linking with others has helped to lift feelings of powerlessness and allowed us the opportunity to make social networks and gain social support.” (p 273)

 17.  Ordinary and Extraordinary People, Acting to Make a Difference.  Leicester Living with Psychiatric Mediation Group

“An important theme in our critical understanding of the world is power, and the structures within which it is withheld or asserted.  Language is one such structure and we want to draw attention to words that we find potentially problematic, words such as ‘patient,’ for example, are therefore put in quotation marks.” (p 278)

 18.  Peer Support.  Becky Shaw

“When I was in hospital I received all my help from the other patients and not from the staff which you might have expected.” (p 293)

 19.  A Critical Journey from Involvement to Emancipation:  A narrative account.  Theo Stickley

“There are opportunities to develop new models and approaches that go beyond involvement and that are genuinely emancipatory for people who use mental health services.” (p 313)

 20.  Rebuilding the House of Mental Health Services with Home Truths.  Bob Diamond

 “Clinical psychology must remain open to the critique that whilst it continues to work in this environment it props up the dominant oppressive psychiatric culture.” (p 329)

21.  A Beacon of Hope:  Alternative approaches to crisis – learning from Leeds Survivor Led Crisis Service.  Fiona Venner & Michelle Noad

“As an organization set up to be an alternative to psychiatric services we are fiercely opposed to the use of psychiatric diagnoses.  We pride ourselves on providing a non-medical approach to working with extreme mental distress.  Our philosophy is about being alongside people in crisis, not treating them.  We also believe passionately in the transformative and healing power of human connection.” (p 337)

 SUMMARY

I don’t normally write such lengthy book reviews.  This work, however, is simply outstanding.  If you have concerns about the mental health system, I strongly recommend that you buy it, read it, re-read it, and keep it close.  That’s what I’ll be doing.

DISCLOSURE

I have no financial ties to this book or to any of the books endorsed on this website.

 

A Survivor’s Story: The Dark Threads

I have just read The Dark Threads, by Jean Davison (Accent Press Ltd, 2009)

It’s autobiographical, and describes with great detail and insight how a young woman of 18 years, whose only problem was acute shyness coupled with a yearning for some meaning in life, made the mistake of visiting a psychiatrist.

Jean describes how she was bullied into accepting psychiatric “treatment.” She was drugged into a zombie-like stupor and given electric shock “treatment.”  She describes graphically the disempowering and humiliating aspects of “treatment,” and the endless patronizing condescension.

Here are some quotes:

“Cold, black, tunnel days. Days when I slept my time away. Days when a soul-aching darkness engulfed me and sucked me into a void. And days when I switched onto ‘automatic pilot’ behaving like a zombie that had been programmed to make ‘appropriate’ responses. There were times when I feared I might make a crash landing and break into pieces that would be scraped up from the ground, bottled, corked, and labeled and stored away in High Royds where nobody would notice that somewhere pushed down underneath a drugged haze there was a real person; somewhere there was JEAN.” (p 96)

“It had been Dr. Prior’s idea that I registered as a disabled person. It would, he said, help me get a job because the law required employers to take on a certain percentage of disabled people. So now I was the owner of a green card to show to prospective employers as proof of a registered disability. I still couldn’t take it all in. Was that really my name on this card? Who am I now? A disabled person? And mentally disabled too; a highly stigmatized form of disability. Would I always be separate, different from the world of ‘normal’ people who didn’t think or feel like me and didn’t carry a green card?” (p 125)

“I am sick and tired and weary of almost everything I think, say or do being analyzed for signs of illness. Can’t I be happy, sad, laugh, cry or do anything, without being ‘ill’? Will I ever again be able to convince others – or myself – that I am just an ‘ordinary’, ‘normal’ person? Will the scars never heal? When I was eighteen years old, I made the biggest mistake of my life. Will I have to go on paying for it forever?” (p 343)

“How quickly, how easily, and on what flimsy ‘evidence’ diagnostic labels may be affixed and lives torn apart. Yet the serious flaws in the diagnostic process are still seemingly unacknowledged by those with unswerving belief in its scientific validity.” (p 358)

Jean makes it clear that the psychiatric “treatment” she received was not only unhelpful, but made her situation a great deal worse, and essentially stole five years of her life.

The book is compelling reading, and I strongly recommend it to anyone who has an interest in these matters. As I’ve said many times, it is the survivors who manage to speak out, who ultimately will draw this sad chapter of human history to a close.

 

Shock “Treatment” Is Not Safe and Provides Little If Any Benefit

DELICATE THINGS REQUIRE DELICATE HANDLING

When I was a teenager, one of my hobbies was making small transistor radios.  It sounds complicated, but is well within the reach of an average 15-year-old.  You get some magazine articles, learn how to read a circuit, and learn how to use a soldering iron.

A transistor is a small device – about half the size of a pencil eraser – with three wires coming out of it.  In building a radio receiver, the transistors have to be soldered to other devices which are in turn soldered to other devices, etc…  The soldering iron is plugged into a wall outlet, but no mains electricity reaches the tip of the iron.  However, tiny eddy currents can circulate in the tip, and although they are only of the order of milliamps, they can burn a transistor in seconds.  What you have to do is unplug the iron from the socket, make the joint with the tip’s retained heat, and then replug the iron to have it ready for the next joint.  The point being that delicate things require delicate handling, and that electricity can be very destructive.

About the same time, an adult I knew told me that he had recently had shock “treatment.”  I had noticed that he had seemed different.  I asked him what it was like.  “Awful,” he said, shaking his head.  I didn’t ask for any details, and he didn’t elaborate.  I did some reading, and discovered that the procedure involved applying high voltage across the temples which sent a strong electric current through the brain.  I thought about my transistors, and about the delicacy and complexity of the human brain.

In college I heard a number of psychiatrists say that shock “treatment” was very effective for depression, and was perfectly safe.  They also mentioned that the therapeutic effect occurred because the electric current caused a seizure.  They talked vaguely about the current “breaking up” dysfunctional neural circuits and allowing them to “reconnect” in more functional ways, and conceded that for many individuals, repeated “treatments” were needed, sometimes for years, to maintain the benefits.

I had seen a young girl (let’s call her June) have a seizure once in her front yard.  I was about four.  June was lying on the ground and being cared for by her mother and another adult.  I was walking past on the sidewalk with my mother, whom I noticed was in tears.  I had but the vaguest understanding of what was going on, but I definitely got the impression that seizures (or “fits” as we called them then) were not good.  In later years I learned that real doctors go to extraordinary lengths to prevent seizures, precisely because they are so damaging to the brain.

In the early years of my career I often heard that shock “treatment” was both effective and safe.  But I never shook the lessons from the transistors and from June.  It seemed to me that shock “treatment” was a bit like using a jack-hammer to fine-tune a piece of electronic equipment.  The likelihood of improvement seemed low; the likelihood of serious damage seemed high.  I looked for studies that demonstrated efficacy and safety but found very little.

THE TRUTH ABOUT SHOCK “TREATMENT:” DANGEROUS AND INEFFECTIVE

I recently came across a book called Doctors of Deception by Linda Andre.  It’s very compelling reading, and I strongly recommend it to anyone who has an interest in the topic.  Linda received shock “treatment” (now called electroconvulsive therapy) in her mid-twenties.  Prior to that she had been a successful photojournalist with an IQ of 156.  After the shock “treatment” her IQ had dropped to 118, and she had:

“Deficits in executive functioning, cognitive flexibility, abstract thinking, planning… Difficulties with higher level cognitive processes…Significant decrease in her attentional and organizational abilities…severe enough to undermine her ability to work…Results clearly indicative of brain injury secondary to ECT… (p. 9)

Prior to the “treatment” Linda had apparently not been informed of any of these risks.  Most of the book is devoted to her subsequent attempts to highlight the risks (and minimal benefits) of shock “treatment” and to have truly informed consent made mandatory.  She decries in detail the collusive relationship between the shock doctors, the FDA, and the machine manufacturers, and the entire scenario is strikingly similar to the corrupt and corrupting pharma-psychiatry alliance with which we are all familiar.  The PR job that the shock faction have done makes the tobacco industry look like a bunch of ham-fisted schoolchildren.  The shock doctors’ message, fully bought by the media, is – we’re doctors, we know what we’re doing; these other people are crazy – you can’t believe what they say.

But the message that “they” communicate clearly from the pages of Linda’s book is consistent:  gains from shock “treatment” are minimal and transient; damage is severe and lasting.

There’s other reading on the topic.  Peter Breggin, MD, of course, has been an ardent foe for years.  You can read one of his articles here.

John Breeding, PhD, a Texas psychologist, has been an active opponent of ECT for the past 20 years.  You can find his website here.

Fred Baughman, MD, an eminent neurologist, writing in 2011, had this to say about ECT:

“Throughout the more than 3 decades of my neurological practice I have encountered patients treated with ECT who had permanent erasures of parts of their memory.  Think of the extent of memory loss not immediately evident in these and in all patients.  For their own selfish reasons, psychiatrists may wish to call ECT and such end-results ‘therapeutic’ but they never achieve anything but to diminish adaptability in the broadest sense and cannot be called ‘therapeutic or medically justifiable.”

Probably the definitive work on shock “treatment” from the scientific perspective is a 2010 article by John Read and Richard Bentall:  The effectiveness of electroconvulsive therapy: A literature review.  The study is a systematic review of the research on ECT from the ’40s through the present.  Their conclusion is startlingly frank:

“Given the strong evidence … of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.”

Formal studies, randomized control trials, and meta-analyses are, of course, the yardstick for truth in any science, including the human sciences.  But the human sciences are unique in that the object of the study is not rocks or electricity or light – but human beings – people.  And although I’ve always been, and still am, a big believer in the need for and the value of research, I also think it’s critical in our work to recognize and listen to the input of individual people.

ASK THE VICTIMS

In this context, I have come across a truly remarkable article by Lucy Johnstone, PhD.  It’s called Adverse psychological effects of ECT, and was published in the Journal of Mental Health in 1999.  Here’s the abstract.

“Although it is known that a proportion of people find ECT distressing to receive, these adverse psychological reactions are little understood. Twenty people who reported having found ECT upsetting were interviewed about their experiences in detail. A variety of themes emerged, including feelings of fear, shame and humiliation, worthlessness and helplessness, and a sense of having been abused and assaulted. This had reinforced existing problems and led to distrust of psychiatric staff. Few had felt able to tell professionals of the strength of their reactions, implying a possible hidden pool of trauma. Implications for the practice of ECT are discussed.”

But the paper also reports verbatim what the “treated” individuals said.  Here are some quotes:

“They asked me if I would agree to it, but they did say if I refused they’d go ahead with it anyway…being forced to stay there is bad enough but being forced to have something that you don’t want is ten times worse, so I did agree, yes.”

“I thought maybe second time around it’ll be much easier and I won’t feel so scared and terrified, but it was just the same, if not a bit more.”

“Afterwards I felt as if I’d been battered…I was just incapacitated, body and mind, like a heap of scrunched-up bones.”

“It was the whole treatment, being carted off I felt like a slave, taken away to this little room and put on a bed. No control, it was awful.”

“It was like I was a non-person and it didn’t matter what anybody did to me.”

“It felt like I had been got at, yes, bashed, abused, as if my brain had been abused. It did feel like an assault.”

“People would come up to me in the street that knew me and would tell me how they knew me and I had no recollection of them at all…very frightening.”

“In a very bizarre sort of way, because the treatment and the abuse was so terrible, it made me come to my senses. I’ve got to get my act together, I’ve got to help myself.”

“Well, it deadens your brain, doesn’t it? That’s what it does.”

There are pages more; a tragic and heart-rending catalog of abuse.

THE “THERAPEUTIC” EFFECT

After shock “treatment,” many individuals present fewer management problems and also say that they feel better.  These benefits are usually short-lived, but they constitute the basis for the fiction that ECT is a safe and effective “treatment” for severe depression.

In the early days of shock “treatment” the proponents were more honest about the brain damage, and in fact stated very clearly that it was this very damage that produced the “beneficial” effect.  Here are some quotes:

“I believe there have to be organic changes or organic disturbances in the physiology of the brain for the cure [with electric convulsive therapy] to take place. I think the disturbance in memory is probably an integral part of the recovery process. I think it may be true that these people have for the time being at any rate more intelligence than they can handle and that the reduction of intelligence is an important factor in the curative process. I say this without cynicism. The fact is that some of the very best cures that one gets are in those individuals whom one reduces almost to amentia.” Abraham Myerson (U.S. electroshock psychiatrist), June 1942 [The Electroshock Quotationary]

 “This brings us for a moment to a discussion of the brain damage produced by electroshock…. Is a certain amount of brain damage not necessary in this type of treatment? Frontal lobotomy indicates that improvement takes place by a definite damage of certain parts of the brain.”  Paul H. Hoch (Hungarian-born U.S. electroshock psychiatrist), “Discussion and Concluding Remarks,” Journal of Personality, vol. 17, 1948.  [The Electroshock Quotationary]

“From the data available, it is probable that the biochemical basis of convulsive therapy is similar to that of craniocerebral trauma…” Max Fink, MD, psychiatrist, in 1958 (quoted in Doctors of Deception by Linda Andre, p 49)

“After a few sessions of ECT the symptoms are those of moderate cerebral contusion, and further enthusiastic use of ECT may result in the patient functioning at a subhuman level…. In all cases the ECT “response” is due to the concussion-type, or more serious, effect of ECT. The patient “forgets” his symptoms because the brain damage destroys memory traces in the brain, and the patient has to pay for this by a reduction in mental capacity of varying degree.  Sidney Sament (U.S. neurologist), letter to Clinical Psychiatry News, March 1983. [The Electroshock Quotationary]

In addition, it is very well known in neurology circles that one of the side effects of severe brain injury is a short-lived sense of euphoria!

As is the case with psychoactive drugs, the putative therapeutic effect is identical to the toxic effect.  In the immediate aftermath of shock “treatment” people don’t feel depressed because they have lost the ability to feel much of anything.  They don’t present management problems, because they are rendered almost incapable of any kind of executive action; they don’t remember past traumatic events, because their memories have been obliterated.  Sometimes these deficits remit somewhat over time, sometimes not.  But with repeated “maintenance” exposure, the damage becomes extensive and more or less permanent.

Imagine if rheumatologists amputated people’s legs to cure knee joint deterioration.  It would definitely work!

In his wonderful novel Galapagos, Kurt Vonnegut, with tongue firmly in cheek, laments the fact that the human brain is simply too big.  He attributes all our woes, all our counter-productive fretting, all our dysfunctional behavior, to this simple anatomical fact, and looks forward to the day when the inexorable adjustments of natural selection will have corrected this aberration.

But you don’t have to wait for evolution.  We have shock “treatment”!!   It’s in a “hospital” near you – right now.

Isn’t it time that this “treatment” went the way of spinning chairs and insulin coma “therapy”?