Tag Archives: Mad in America

Robert Spitzer’s Legacy

Robert Spitzer, MD, the architect of DSM-III (1980), died of heart disease on Christmas Day, 2015, at age 83.

Most major media outlets published obituaries in which Dr. Spitzer was praised on the grounds that he had brought scientific rigor to psychiatry by naming and defining the various psychiatric illnesses.

Here are a few illustrative quotes:

“Dr. Robert L. Spitzer, who gave psychiatry its first set of rigorous standards to describe mental disorders, providing a framework for diagnosis, research and legal judgments — as well as a lingua franca for the endless social debate over where to draw the line between normal and abnormal behavior — died on Friday in Seattle.”  (New York Times, December 26)

“Robert Spitzer, the influential American psychiatrist credited with establishing a modern classification of mental disorders, has died at the age of 83.” (BBC News, December 27)

“Dr. Robert Spitzer – a psychiatrist who played a leading role in establishing agreed-upon standards to describe mental disorders and eliminating homosexuality’s designation as a pathology – died Friday in Seattle. He was 83.” (Independent.co.uk, December 27)

“He [Dr. Spitzer] added dozens of mental disorders to the psychiatric lexicon: anorexia, bipolar disorder, panic disorder, PTSD and many other now-familiar maladies. It’s not that these ailments didn’t exist before the 1970s — but they had no agreed-upon names or definitions until Dr. Spitzer branded them in two new editions of the DSM. The book tripled in size (from a 134-page paperback to a 567-page doorstop) and at least as much in influence under his leadership.” (Washington Post, December 26)

Obviously, I don’t share the various obit writers’ enthusiasm for Dr. Spitzer’s work on the DSM-III.  In fact, I would describe the DSM-III as the turning point that steered psychiatry into the irremediably spurious, expansionist, and destructive situation in which it now finds itself.

I had been planning to write a post on this matter in the near future, but I noticed this morning that Bonnie Burstow has published an article on Mad in America that says everything I had wanted to say on the matter, with her customary skill, sensitivity, and erudition.

Here are two quotes:

“To be clear, it is always sad when someone dies — and I in no way wish to detract from the personal tragedy. Nor do I intend to make any pronouncement about Spitzer the individual. What concerns me in this article is one thing only — how to understand his ‘psychiatric contribution’ to society. Now no one denies that Spitzer was enormously influential. However, it is precisely because his legacy endures and because vulnerable people are forced to live with what was set in motion that I felt compelled to write this article.”

“…they [Dr. Spitzer and his colleagues] set psychiatric diagnosing decisively on a path where it would look scientifically rigorous; where it could claim the authority of medicine on the basis of appearance, while in point of fact being vacuous.”

You can link to Bonnie’s article here.  It’s well worth reading and passing along.

The Spurious Chemical Imbalance Theory is Still Alive and Well

On April 5, 2015, Scott Alexander, MD, a trainee psychiatrist, posted an article titled Chemical Imbalance on his website Slate Star Codex.  (The writer tells us that Scott Alexander is a blog handle and not his real name, but for convenience, I will refer to him as Dr. Alexander.)

Dr. Alexander begins by noting that there have been a number of articles recently that have criticized psychiatry for “botching the ‘chemical imbalance’ theory.”

“According to all these sources psychiatry sold the public on antidepressants by claiming depression was just a chemical imbalance (usually fleshed out as ‘a simple deficiency of serotonin’) and so it was perfectly natural to take extra chemicals to correct it.”

“This narrative is getting pushed especially hard by the antipsychiatry movement, who frame it as ‘proof’ that psychiatrists are drug company shills who were deceiving the public.”

[Actually, it’s proof that psychiatrists are either very misinformed or very deceptive.  Proving that many of them are drug company shills is a separate matter.]

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

As an example of this trend, he cites an article of mine that was published on Mad in America on June 6, 2014.  The article was titled Psychiatry DID Promote the Chemical Imbalance Theory, and was written specifically as a response to three statements made by the eminent psychiatrist Ronald Pies, MD.  Here are the three statements:

“…the ‘chemical imbalance theory’ was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.” (April 15, 2012)

“In truth, the ‘chemical imbalance’ notion was always a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists.’ (July 11, 2011)

“But I stand by my claim that no respected representatives of the profession seriously asserted a simple, ‘chemical imbalance’ theory of mental illness in general.” (September 2, 2011; response to comment on July 11, 2011 article)

My article was lengthy (6079 words), and I quoted seven prestigious psychiatrists in which a simplistic chemical imbalance theory was promoted unambiguously.

“In the last decade, neuroscience and psychiatric research has begun to unlock the brain’s secrets.  We now know that mental illnesses – such as depression or schizophrenia – are not “moral weaknesses” or “imagined” but real diseases caused by abnormalities of brain structure and imbalances of chemicals in the brain.”  Unlocking the Brain’s Secrets, by Richard Harding, MD, then President of the APA, in Family Circle magazine, November 20, 2001, p 62.

“ADHD often runs in families.  Parents of ADHD youth often have ADHD themselves.  The disorder is related to an inadequate supply of chemical messengers of the nerve cells in specific regions of the brain related to attention, activity, inhibitions, and mental operations.”  Paying Attention to ADHD, by Timothy Wilens, MD, Associate Professor of Psychiatry at Harvard Medical School, and Psychiatrist at Massachusetts General Hospital.  Op. Cit., p 65

“…the way nerves talk to each other, and communicate, is through the secretion of a chemical called a neurotransmitter, which stimulates the circuit to be activated.  And when this regulation of chemical neurotransmission is disturbed, you have the alterations in the functions that those brain areas are supposed to, to mediate.  So in a condition like depression, or mania, which occurs in bipolar disorder, you have a disturbance in the neurochemistry in the part of the brain that regulates emotion.”  Causes of Depression, a video by Jeffrey Lieberman, MD, Psychiatrist-in-Chief at NewYork Presbyterian/Columbia University Medical Center, and then President-elect of the APA.  Video made by The University Hospital of Columbia and Cornell. (June 19, 2012)

“The various forms of mental illness are due to many different types of brain abnormalities, including the loss of nerve cells and excesses and deficits in chemical transmission between neurons; sometimes the fault may be in the pattern of the wiring or circuitry, sometimes in the command centers, and sometimes in the way messages move along the wires.” (p 221) [Emphasis added] Nancy Andreasen’s book The Broken Brain: The Biological Revolution in Psychiatry (1984).  Nancy Andreasen, MD, PhD, is Chair of Psychiatry at the University of Iowa.  She served on the DSM-III and DSM-IV Task Forces, and is past president of the American Psychopathological Association and the Psychiatric Research Society.

“Since the pharmacological agents that ameliorate depression and mania appear to act upon and alter the concentration and metabolism of the biogenic amines in what are presumably corrective directions, it may be inferred that in the affective disorders there exists a chemical pathology related to these compounds…positive evidence is slowly accumulating and negative evidence is thus far lacking.” [Emphasis added] opinion piece for the American Journal of Psychiatry (September, 1970, p 133), titled Affective Disorders:  Progress, But Some Unresolved Questions Remain, by Morris Lipton, PhD, MD.  The late Dr. Lipton was Chair of Psychiatry at Chapel Hill at the time of writing.

“Depression is known to be caused by a deficit of certain neurochemicals or neurotransmitters, especially norepinephrine and serotonin.” (p 47) Daniel Amen, MD, from his bestselling book Change Your Brain, Change Your Life (1998)

 I also provided the following quote from the psychiatry textbook Psychiatry (2003),  Tasman, Kay, and Lieberman (eds.)

“A final reason for studying the mechanisms of psychopathology is to inform our patients, their families, and society of the causes of mental illness.  At some time in the course of their illness, most patients and families need some explanation of what has happened and why.  Sometimes the explanation is as simplistic as ‘a chemical imbalance,’ while other patients and families may request brain imaging so that they can see the possible psychopathology or genetic analyses to calculate genetic risk.” (p 290, Vol 1)

I made the point that although this passage is not entirely clear, it does suggest that it is OK to tell clients and their families the chemical imbalance lie if they ask for an explanation.

Dr. Alexander reproduces two of my quotes – those from Drs. Harding and Lieberman – and continues:

“I have no personal skin in this game. I’ve only been a psychiatrist for two years, which means I started well after the term ‘chemical imbalance’ fell out of fashion. I get to use the excuse favored by young children everywhere: ‘It was like this when I got here’. But I still feel like the accusations in this case are unfair, and I would like to defend my profession.”

And here’s his defense: [incidentally, he confuses Mad In America with me personally, but his meaning is clear.]

“I propose that the term ‘chemical imbalance’ hides a sort of bait-and-switch going on between the following two statements:

(A): Depression is complicated, but it seems to involve disruptions to the levels of brain chemicals in some important way

(B): We understand depression perfectly now, it’s just a deficiency of serotonin.

If you equivocate between them, you can prove that psychiatrists were saying (A), and you can prove that (B) is false and stupid, and then it’s sort of like psychiatrists were saying something false and stupid!

But it isn’t too hard to prove that psychiatrists, when they talked about ‘chemical imbalance’, meant something more like (A). I mean, look at the quotes above by which Mad In America tries to prove psychiatrists guilty of pushing chemical imbalance. Both sound more like (A) than (B). Neither mentions serotonin by name. Both talk about the chemical aspect as part of a larger picture: Harding in the context of abnormalities in brain structure, Lieberman in the context of some external force disrupting neurotransmission. Neither uses the word ‘serotonin’ or ‘deficiency’. If the antipsychiatry community had quotes of APA officials saying it’s all serotonin deficiency, don’t you think they would have used them?”

In other words, he’s saying that the quotes from Drs. Harding and Lieberman were not simplistic chemical imbalance assertions, but were in fact more nuanced, and that they recognized the complicated, contextual aspects of depression.

So let’s take a look at the quotes in detail.  First, Dr. Harding:

  1. Neuroscience and psychiatric research has begun to unlock the brain’s secrets.
  2. We now know [note the unambiguous expression of certainty]
  3. that mental illnesses such as depression or schizophrenia
  4. are not ‘moral weaknesses’ or ‘imagined’,
  5. but real diseases
  6. caused by abnormalities of brain structure and imbalances of chemicals in the brain.

And Dr. Lieberman:

  1. Brain circuits are activated by neurotransmitters.
  2. Disturbances in this chemical neurotransmission lead to disturbances in function.
  3. So [implying causality],
  4. in depression or mania, there is a disturbance in brain neurochemistry.

Dr. Alexander contends that these quotes do not promote a simplistic chemical imbalance theory because:

1.  Neither mentions serotonin by name! I had never said that they mentioned serotonin by name.  Nor had there been any mention of serotonin in Dr. Pies’ original statements.  The issue was (and still is) that they promoted the chemical imbalance theory.  Dr. Alexander’s introduction of serotonin is irrelevant, and is, I suggest, an example of precisely the kind of intellectual dishonesty which he attributes to me.

2.  Both talk about the chemical aspect as part of a larger picture. This is simply false.  Dr. Harding clearly cites “imbalances of chemicals’ as a cause of mental “diseases”.  The fact that he also promotes abnormalities of brain structure does not modify or contextualize the primary contention.  And the fact that his article was embedded in a five-page “Special Advertizing Feature” for Paxil leaves little room for doubt as to his meaning. 

3.  Dr. Alexander contends that Dr. Lieberman’s statements about chemical imbalance was made in the context of  “…some external force disrupting neurotransmission.”  This, I suggest, is a very creative reading of Dr. Lieberman’s statement:

“And when this regulation of chemical neurotransmission is disturbed, you have the alterations in the functions that those brain areas are supposed to, to mediate.  So in a condition like depression, or mania, which occurs in bipolar disorder, you have a disturbance in the neurochemistry in the part of the brain that regulates emotion.”

Dr. Lieberman makes no reference to an external force disrupting neurotransmission, but even if such an external force were implied, the fundamental message is clear:  conditions like depression and mania are caused by disturbances in chemical neurotransmission, i.e. chemical imbalances!

. . . . . . . . . . . . . . . . 

It’s noteworthy that Dr. Alexander made no mention of the other quotes in my article, e.g:

Nancy Andreasen, MD, an eminent psychiatrist:

“The messages passed along these circuits are transmitted and modulated primarily through chemical processes.  Mental illnesses are due to disruptions in the normal flow of messages through this circuitry” (p 219)

Daniel Amen, MD, successful CEO and Medical Director of six psychiatric clinics, and a Distinguished Fellow of the APA:

“Depression is known to be caused by a deficit of certain neurochemicals or neurotransmitters, especially norepinephrine and serotonin.”

There’s not much ambiguity there.

And, incidentally, Dr. Alexander’s statement:  “If the antipsychiatry movement had quotes of APA officials saying it’s all serotonin deficiency, don’t you think they would have used them?” is a red herring.  In Dr. Pies’ original statements, to which I was responding, there’s no mention of APA officials.  Rather, Dr. Pies’ contentions embraced “responsible practitioners in the field of psychiatry”; “well-informed psychiatrists”; and “respected representatives of the profession”.

. . . . . . . . . . . . . . . . 

In addition, I also provided numerous unambiguous quotes promoting the chemical imbalance theory from :

  • Child and Adolescent Bipolar Foundation;
  • Depression and Bipolar Support Alliance;
  • Mental Health America; and
  • National Alliance for the Mentally Ill

and I pointed out that all of these organizations had eminent psychiatrists on their advisory boards, and that it was reasonable to infer that these advisers approved, or at least had made no objection to, the chemical imbalance messages.

. . . . . . . . . . . . . . . . 

Nevertheless, Dr. Alexander concluded:

“So if you want to prove that psychiatrists were deluded or deceitful, you’re going to have to disprove not just statement (B) – which never represented a good scientific or clinical consensus – but statement (A). And that’s going to be hard, because as far as I can tell statement (A) still looks pretty plausible.”

Dr. Alexander himself concedes that statement (B) is false, but he refuses to accept the evidence I presented in the quotes – clear evidence that leading psychiatrists did promote the simplistic and false chemical imbalance theory.  And I should stress that I limited my search to psychiatrists who had achieved a measure of eminence and stature in their field (because that was the challenge presented by Dr. Pies).  If I had widened my search to include less prestigious psychiatrists, I’m sure I could have found a great many more.  The fact is that the promotion of the chemical imbalance theory is no secret.  I have personally heard dozens of psychiatrists proclaim it with total confidence, and I truly could not begin to estimate the number of clients I’ve talked to over the years who told me that their psychiatrists had told them they had a chemical imbalance in their brains, and that they needed to take the pills for life to correct this imbalance.  Even today, I regularly receive emails from readers contesting the assertions in my posts and telling me in no uncertain terms that they have chemical imbalances in their brains that cause their problems.

In addition, the simplistic chemical imbalance theory is still being promoted by some prestigious psychiatrists.  Cognitive Psychiatry at Chapel Hill (CPCH) has published 10 Common Myths About Psychiatry on their webpage.  Here are two quotes:

“Actually, the majority of patients we see have an actual illness or imbalance (much like diabetes), that with the proper treatment, the imbalance is corrected and they are no longer ill.”

“… many patients that see a Psychiatrist actually have an illness or imbalance that is causing a mental discrepancy. Once this imbalance is corrected, they are, in fact, cured of their mental illness.”

. . . . . . . . . . . . . . . . 

Dr. Alexander’s article was critiqued on Mad in America by Rob Wipond on April 15, 2015.  Rob’s article cites numerous other examples of psychiatrists promoting the chemical imbalance theory of depression.

The promotion of the chemical imbalance theory did occur, and continues to occur, and is a most shameful chapter in psychiatry’s history.  It is arguably one of the most destructive, far-reaching, and profitable hoaxes in history.

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

But, although the chemical imbalance theory has been soundly refuted, and the more astute psychiatrists, such as Dr. Pies, are actively distancing themselves from it, Dr. Alexander is clearly still a believer.  Here’s his final paragraph:

“So this is my answer to the accusation that psychiatry erred in promoting the idea of a ‘chemical imbalance’. The idea that depression is a drop-dead simple serotonin deficiency was never taken seriously by mainstream psychiatry. The idea that depression was a complicated pattern of derangement in several different brain chemicals that may well be interacting with or downstream from other causes has always been taken seriously, and continues to be pretty plausible. Whatever depression is, it’s very likely it will involve chemicals in some way, and it’s useful to emphasize that fact in order to convince people to take depression seriously as something that is beyond the intuitively-modeled ‘free will’ of the people suffering it. ‘Chemical imbalance’ is probably no longer the best phrase for that because of the baggage it’s taken on, but the best phrase will probably be one that captures a lot of the same idea.”

This paragraph is not entirely clear, but here’s my best shot at a paraphrase:

  1. Psychiatry never promoted a simple chemical imbalance theory.
  2. But psychiatry did promote a complicated chemical imbalance theory.
  3. The complicated chemical imbalance theory is plausible.
  4. There are chemicals involved in depression. [This is non-contentious.  Brain chemicals are involved in literally everything humans do, think, and feel, from the simplest eyeblink, to writing great works of art, and everything in between.]
  5. It’s useful to emphasize that brain chemicals are involved in depression, in order to convince people that depression is a serious problem that can’t be conceptualized in ordinary human terms.
  6. But we can’t use the term “chemical imbalance” any more because it’s been outed as a hoax.
  7. We need a new phrase that will mean essentially the same thing.

How about Chemical Imbalance, Version II?

And lest I be accused of putting words in Dr. Alexander’s mouth, here are some quotes from earlier in his paper:

“In other words, everything we do is caused by brain chemicals, but usually we think about them on the human terms, like ‘He went to the diner because he was hungry’ and not ‘He went to the diner because the level of dopamine in the appetite center of his hypothalamus reached a critical level which caused it to fire messages at the complex planning center which told his motor cortex to move his legs to…’ – even though both are correct. Very occasionally, some things happen that we can’t think about on the human terms, like a seizure – we can’t explain in terms of desires or emotions or goals an epileptic person is flailing their limbs, so we have to go down to the lower-level brain chemical explanation.

What ‘chemical imbalance’ does for depression is try to force it down to this lower level, tell people to stop trying to use rational and emotional explanations for why their friend or family member is acting this way. It’s not a claim that nothing caused the chemical imbalance – maybe a recent breakup did – but if you try to use your normal social intuitions to determine why your friend or family member is behaving the way they are after the breakup, you’re going to get screwy results.”

So if a person is despondent because of a marital break-up, one can’t conceptualize his despondency in ordinary human terms.  Doing so will produce “screwy results”.

“There’s still one more question, which is: are you sure that depression patients’ experience is so incommensurable with healthy people’s experiences that it’s better to model their behavior as based on mysterious brain chemicals rather than on rational choice?”  [Note the spurious implication that there are only two options.]

“And part of what I’m going on is the stated experience of depressed people themselves. As for the rest, I can only plead consistency. I think people’s political opinions are highly genetically loaded and appear to be related to the structure of the insula and amygdala. I think large-scale variations in crime rate are mostly attributable to environmental levels of lead and probably other chemicals. It would be really weird if depression were the one area where we could always count on the inside view not to lead us astray.”

And there it is – the very core of bio-psychiatry!  Political opinions (and, presumably political activity), criminal behavior, and, by implication pretty much anything else that we do think, or feel, are all best conceptualized in terms of brain structure and chemicals.

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

Twenty-five years ago an elderly friend of mine lost his wife in a car accident.  They had been married for sixty years.  I visited him, and found him understandably despondent.  His demeanor, normally active and curious, was downcast and withdrawn.  His face was haggard; his shoulders slumped; he was at times tearful; and his gait was slow and heavy.  We talked, and he told me that he felt utterly lost.  I asked him what was the worst thing about his situation.  He thought for a long while, then said:  “I have nobody to talk to.”

His words, which I’ve never forgotten, seemed to me to embody some of the essential elements of grief and despondency:  loneliness, helplessness, and isolation.  But according to Dr. Alexander, this kind of thinking is “screwy”.  Despondency is really a matter of chemicals, and we need to “convince” people to abandon their intuitive assessments of their feelings of despondency, and to recognize the psychiatric “truth” that, whatever its trigger, depression is essentially  “…a complicated pattern of derangement in several different brain chemicals…”.  And we should embrace this “truth”, despite the fact that several decades of highly motivated research has failed to identify any such “derangement” or “imbalance” or whatever similar term Dr. Alexander would choose.

So, just when we imagined that we had begun to lay this particular piece of inanity to rest, here it is surging back from a brand new psychiatrist, prescription pen poised, ready to put the world to rights, one aberrant molecule at a time.

This isn’t just faulty logic and poor science.  It is a fundamentally dehumanizing and intrinsically disrespectful way of conceptualizing human loss and suffering.

 

Polarization or Compromise

On February 2, Robert Whitaker published an article on Mad in America.  The title is Disability and Mood Disorders in the Age of Prozac.  The article echoes and updates one of the themes of his 2010 book “Anatomy of an Epidemic”:  that the steady increase in the numbers of people receiving disability benefits for depression and mania is driven largely by the corresponding increase in the use of antidepressant drugs.

Robert provides some up-to-date statistics from the US Department of Social Security, and his paper is cogent and compelling.  He ends on a sad but realistic note:

“And so the disability numbers march on.”

This general issue has received a good deal of attention in the literature, but for those not familiar with the matter, there are two essential factors.  Firstly, there is the well-established fact that some people who take antidepressants become floridly manic, which in many cases leads to a diagnosis of bipolar disorder, and a subsequent disability award.  Secondly, a great many people who take antidepressants for an extended period develop a kind of drug-induced anhedonia, and a correspondingly increased rate of being adjudged disabled.

Robert’s post generated about 120 comments, the majority of which were positive, but a few days later (February 14), Timothy Kelly put up a post, also on Mad in America, challenging the validity and/or appropriateness of Robert’s article.  Tim’s paper is titled Robert Whitaker Missed the Mark on Drugs and Disability: A Call for a Focus on Structural Violence.

Here are some quotes from Tim’s article, intermingled with my thoughts and comments:

“There’s no doubt that his writing has opened up important discussions about psychiatric medications. At the same time, my own lived experience — and reading of the literature — have led me to different conclusions on core aspects of these issues, including the putatively causal role of medication in increasing disability.
In what follows, I chart an alternative perspective on psychosocial disability that calls for the decentering of psychiatric drugs in both public discourse and advocacy. Concretely, I suggest refocusing reform efforts along two axes:
1.  The identification of areas where interests and perspectives align among advocacy groups that may otherwise strongly disagree about the role of psychiatric treatment in recovery.
2.  The intersections of psychosocial disability and poverty, the criminal justice system, and broader socioeconomic and health disparities, particularly among marginalized racial/ethnic/indigenous and/or sociopolitical minority communities.”

So essentially, what Tim is saying is that we should spend less time and energy on contentious issues like the “role of psychiatric treatment in recovery”, and focus instead on areas where we can find agreement, and on the role of poverty and injustice in the genesis of counterproductive thoughts, feelings, and/or behavior.

On the face of it, this seems a reasonable stance – put aside our differences, and pool our resources – but as is often the case, there are problems in the details.  Tim encourages us to refocus our “reform efforts” through collaboration, but what will these reform efforts look like, if the parties concerned are fundamentally divided on the validity/usefulness of psychiatric care.

The kind of compromise and accommodation that Tim advocates can only succeed if in fact there is more agreement than disagreement between the various parties, or if the areas of contention are a relatively minor part of the whole.  Neither of these conditions is true in the present context.  Psychiatry, with its spurious diseases and toxic treatments, is the proverbial elephant in the living room of the present debate.  Those who support psychiatry and those who oppose it might be able to agree on what to order for lunch, but not, I suggest, on much else.  The pretense that we can find common ground and “work with” psychiatrists has been the great error of the past fifty years, during which psychiatry, with the help of its pharma allies, has consolidated its turf, and successfully marginalized and ridiculed all opposing viewpoints.

Psychiatry’s fundamental tenet, embodied unambiguously in all editions of the DSM since DSM-III, is that every significant problem of thinking, feeling, and/or behaving is an illness, that can only be addressed successfully through medical intervention – specifically drugs and electric shocks to the brain.

Psychiatry has expended, and continues to expend, enormous sums of, mostly pharma, money in their attempts to establish the validity of this spurious tenet.  So far, all of these efforts have been in vain, and it is extremely unlikely that the core tenet will ever be validated.  Nevertheless, psychiatrists, at both leadership and rank and file levels, continue to promote this self-serving and deceptive notion with undiminished ardor and enthusiasm.

Nor is the matter academic.  Psychiatry’s application of its core tenet is damaging and destructive.  Firstly, and perhaps most profoundly, persuading people that they have a disabling illness, when in fact they don’t, is inherently disempowering, and encourages people to think of themselves as incapable of living a normal life.  Secondly, all psychiatric treatment disrupts normal brain functioning, and in many cases this disruption, especially when used for extended periods, causes permanent impairment.

The fact that psychiatric drugs produce a transient desired effect is irrelevant to the medicalization issue.  Crack cocaine produces a transient desired effect, but nobody is suggesting that street corner dealers are performing a medical function.  In fact, apart from the legality of their respective activities, there is no essential distinction between psychiatrists and street corner drug dealers.

. . . . . . . . . . . . . . . . . 

“In this discussion of disability I intentionally leave aside questions of whether the experiences classified in the DSM5 are most usefully characterized as medical problems, even if they have a biological basis. In my view, the ‘body’ and the ‘mind’ are mutually entangled, and so of course there are physiological processes involved in all human experiences, as well as considerable variability among bodies. The extent to which a biomedical approach is useful or resonant for any given person is contingent on the particularity of that person within their sociocultural surround.  How persons negotiate the meaning(s) of their (our) own experience in relation to different explanatory models is highly contextually specific.  For instance, using medication does not necessarily imply agreement with a biomedical model, just as the efficacy of yoga or mindfulness may be characterized in more biological, rather than spiritual terms depending on context. I’d like to see us shift our attention from debates about medications, loosening up polarizations that hamper our ability to work effectively on these issues, towards careful thinking and contextual grounding in fields such as mad studies, survivor research, medical anthropology, the medical humanities, and social and cultural psychiatry.”

This passage is not entirely clear, but in general what Tim seems to be saying is a variation of the old 60’s phrase:  “different strokes for different folks”.  Some people find it “useful or resonant” to conceptualize their problems as “illnesses” that call for “medication”; others don’t.  Either way it’s not that important, so let’s move on to other issues on which we can agree.

This kind of conceptual relativism is fine as far as it goes.  We have freedom of speech, so we certainly have freedom of thought.  But it is still the case that some conceptual frameworks are more valid and more accurate than others.  In the long run, comfort, or “resonance” bought at the expense of truth usually proves a bad bargain.

. . . . . . . . . . . . . . . . 

“That psychiatric diagnoses do not index discreet disease processes with clearly identified etiologies has also been acknowledged by leading proponents of otherwise mainstream psychiatric treatment like Thomas Insel (Director of the National Institute of Mental Health). This is also clearly inscribed in the DSM5 which acknowledges that current psychiatric categories do not map onto discrete disease processes with homogenous ‘biomarkers,’ that knowledge is therefore provisional, and the state of the science still limited.  In this post, I have therefore opted to sidestep issues that are already relatively well-accepted across academic and activist contexts (such as the scientific and philosophical limitations of psychiatry).”

Thomas Insel, MD, has indeed stated unambiguously that the various DSM entities (which, incidentally, Dr. Insel calls “labels“) do not correspond in any systematic fashion with specific neural pathologies.  With regards to DSM-5, Tim does not provide a page number, but I’m not aware of an acknowledgement in that text that “current psychiatric categories do not map onto discrete disease processes with homogenous ‘biomarkers’.”  But in any event, the matter is moot, because the contrary notion is still very much alive and well in psychiatric circles.  Most psychiatrists are still telling their clients that they have “chemical imbalances”, though some are moving with the times and substituting the equally nebulous and equally unproven “neural circuitry anomalies”, and are promoting the impression that the various DSM labels are indeed discrete disease entities with scientifically proven etiologies.  A great many psychiatric clients actually believe, erroneously, that a brain scan would show this pathology clearly and unambiguously.

So, Tim’s statement that he decided to sidestep these controversial topics because they’re “already relatively well-accepted” is, I suggest, premature.  He is, of course, free to sidestep them if he wishes, but, in so doing, he is working with a very limited canvas.  He is focusing on some, admittedly interesting, and important, trees at the edge of the woods, but has turned his back on the dark and forbidding forest.  And in particular, he has missed the fact that the forest is literally shading and starving those trees on which he pins so much hope.

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

Then Tim takes us into really deep waters:

“On the other hand, I am deeply concerned about the degree to which the dogmatic anti-psychiatry positions of some are being leveraged at the federal level in favor of The Helping Families in Mental Health Crisis Act. So, even while advocating an emphasis on structurally and socioculturaly informed perspectives and psychosocial approaches, I also feel a duty to make the following statement explicit:
My decades of experience living with ‘severe mental illness’ and disability myself, alongside a family member with even more intense disability, my years of formal academic study and research, critically reading the literature and engaging with a wide range of other persons with lived experiences all tell me there is no question that these experiences are both real and heterogeneous, and that medication is helpful for many people. The question is: for whom, for how long, and how best to weigh the benefits against the risks. My larger point in this post, however, is that there would be a lot more space to develop psychosocial approaches and address broader systemic issues if we decentered medication in these discussions, while also challenging those who would presume to speak for ‘us’ by characterizing our experiences as not real.”

My Merriam-Webster dictionary (2000) gives the following definition of the word “dogma”:

1  a.   something held as an established opinion; esp: a definite authoritative tenet
b.  a code of such tenets
c.  a point of view or tenet put forth as authoritative without adequate grounds
2. a doctrine or body of doctrines concerning faith or morals formally stated and authoritatively proclaimed by a church

Now I am very proud to describe myself as antipsychiatry.  I am unambiguously opposed to psychiatry because it is based on false and spurious premises, and is destructive, disempowering, and stigmatizing in its practices.  But I am emphatically not dogmatic.  In fact, one of my arguments against psychiatry is that its core principles are ultimately statements of belief, vigorously and authoritatively promoted, without any kind of supportive evidence.  And I have written on many occasions that all psychiatry has to do to silence me is produce evidence in support of their tenets, at which point I will fold my tent and enjoy my retirement.

In addition, I can’t think of a single antipsychiatry advocate whose pronouncements could even remotely be described as dogma, in any ordinary sense of the term.

But Tim is taking this rhetoric even further.  He tells us that the expression of these “dogmatic anti-psychiatry positions” is actually being used “at the federal level” to promote the infamous Tim Murphy (Helping Families in Mental Health Crisis) Bill.  I’m certainly not aware of any such dynamic.  In fact, my reading of recent events is that the Tim Murphy bill has been derailed largely because of the protests from the antipsychiatry faction.

With regards to his manifesto, obviously I respect Tim’s personal convictions, but there are some matters that, in my view, warrant clarification.  Firstly, I have never encountered or read any critic of psychiatry who adopted the position that clients’ experiences or distress weren’t real.  The issue for most of us is that the various labels catalogued in the DSM are not illnesses.  In this regard, those of us on this side of the debate recognize the reality of these problems far more clearly than psychiatrists who bundle them neatly into spurious “diagnostic categories” without ever taking the time to understand or appreciate their very real human significance.

The notion that we in the anti-psychiatry camp dismiss clients’ problems as “not real” is a common ploy that adherents of psychiatry often use to discredit us, and for this reason it is particularly disappointing that Tim would come at us with this particularly facile and groundless attack.

Secondly, Tim asserts that “…medication is helpful for many people.  The question is: for whom, for how long, and how best to weigh the benefits against the risks.”  This is also a fairly standard psychiatric formula, though in practice, the pills are dished out a good deal more liberally than the formula would suggest.  But the question that comes to my mind is:  how does Tim know that “medication” is helpful for many people?  What standards are being used to assess helpfulness, and where are the randomized controlled studies that provide the evidence?  The point of Robert’s original article was that the drugs are actually doing a great deal of harm in the long run, a contention that is receiving a good deal of support from research studies in recent years.

Tim tells us that he reached the conclusion quoted above from:

  • his own personal experience;
  • the experience of others;
  • years of formal academic research

Lived experience, obviously, is the bedrock of all our knowledge and skills, and our personal assessments and reactions are generally excellent guides with regards to the costs and benefits of various activities and substances.  But there are certain substances which, through their action on brain chemistry, routinely deceive us in this regard.  Alcohol, nicotine, heroin, cocaine, etc., all have in common that, through direct action on the brain, they induce a false sense of well-being, which often blinds the ingestor to their long-term toxic effects.  It is this accident of biology that underlies and drives the phenomenon that we call chemical addiction.

Most users of nicotine find the experience pleasant and rewarding.  Many also report that this substance improves their ability to study and concentrate.  Alcohol induces a sense of well-being and relaxation.  And so on.

Pharmaceutical antidepressants are specifically designed through their action on brain chemistry, to induce a transient and false sense of well-being.  And this sense of well-being also has the effect of blinding the user to their long-term toxicity and adverse effects.

The point here is that lived experience, valuable as it is in most matters, is generally a poor guide when it comes to evaluating the efficacy or helpfulness of brain-altering chemicals.

There are also problems with regards to “formal academic study and research.”  Most of this has been conducted by pharma-psychiatry, focuses on short-term outcomes, suppresses negative results, and is an unreliable guide to long-term effects.

Tim mentions the need “to weigh the benefits against the risks”, and this advice is attached to virtually every psychiatric drug in the PDR.  But in reality, it’s a hollow formula.  How can one weigh the benefits of a transient and false sense of well-being against the longer term risk of chronic, and more or less permanent, damage?  There is not, and never can be, any kind of calculus for making such comparisons.  And the issue is compounded by the fact that the risks vs. benefits question is usually presented as if the drug were the only option.  In fact, there are a great many ways to resolve feelings of depression that entail no particular risks at all – principally:  by dealing with the problems that precipitated the depression in the first place.

. . . . . . . . . . . . . . . . 

Tim tells us that “…there would be a lot more space to develop psychosocial approaches and address broader systemic issues if we decentered medication in these discussions…”.  To which I can only disagree.  Prior to about the year 2000, the antipsychiatry movement was virtually non-existent.  Those few of us who did speak out were ridiculed, marginalized, and at times vilified.  There was virtually no discussion on the downside of what Tim euphemistically calls “medication”.  By Tim’s argument, there should therefore have been lots of “space” to develop psychosocial approaches, and address broader systemic issues.  But in fact these things didn’t happen.  The spurious illness philosophy, and the ubiquitous drugs, held the field.  Other concepts and practices were effectively suppressed, and truly millions of lives were destroyed.

Today, when the antipsychiatry movement is growing in leaps and bounds, we are actually seeing a great deal more discussion of psychosocial approaches and broader issues than at any time in the past fifty years.

Today, the antipsychiatry issues are being heard, and progress is evident on all fronts.  But psychiatry, unconvinced and unrepentant, continues to resist.  There is some receptiveness, on the part of a very few psychiatrists, to alternative perspectives.  But for the most part, the leadership and the rank and file are redoubling their efforts to promote their medicalization agenda.  The APA has even engaged the services of a PR firm to improve their image and sell their philosophy.

But the facts have not changed.  Depression is not an illness.  Outbursts of temper are not an illness.  Academic inattentiveness is not an illness.  Painful memories are not an illness.  Bereavement is not an illness. 

But in the looking-glass world of psychiatry, these age-old human problems – and hundred more besides – are all illnesses that need to be “treated” with psychiatry’s so-called medication.

So for all of these reasons, I, for one, will continue to critique psychiatry and its destructive “treatments” with all the vigor at my disposal.  And I will do this because psychiatry is not something good that just needs to be expanded to embrace psychosocial and other broader issues.  Rather it is something fundamentally spurious and destructive; a wrong turning in human history.  It not only destroys individuals, but saps our cultural resilience with its self-serving insistence that virtually every significant human problem is an illness which needs a pill.  Psychiatry is not a healing force in the world.  Rather, it is a disabling force, and the pills are the most visible facet of its destructiveness.

Antipsychiatry Stigma

The current issue of Acta Psychiatrica Scandinavica is devoted to the topic of psychiatry’s poor image, and what steps might be taken to improve it.

Central to the discussion is a study Images of psychiatry and psychiatrists, by H. Stuart et al, – and seven commentaries on this study by various authors.  The Stuart et al paper describes a survey of 1057 teaching medical faculty members from 15 sites in Europe and Asia.  The overall response rate was 65%, and the results indicate clearly that general medical teaching staff have a poor opinion of psychiatry and psychiatrists.  For instance, 90% of respondents endorsed the item “Most psychiatrists are not good role models for medical students.”

“Over a third thought that their colleagues generally did not speak well of psychiatry, and almost a third thought that a bright student would not be encouraged to enter psychiatry by their mentors or teachers. As a career, psychiatry was seen as having low prestige relative to other specialties. Approximately one in five thought that students were attracted to psychiatry because of their own problems or that students chose psychiatry because they could not get in to other specialties.”

The Stuart et al findings are discussed in seven short editorial comments by various psychiatrists and one psychologist (John Read).  The primary thrust of the psychiatrists’ comments is that the poor image of psychiatry is essentially unwarranted, and that the situation calls, not for any substantive reforms, but rather for improved communication between psychiatry and other medical specialties, and for “…profession-related self-assertiveness…”  One psychiatrist, D. Wasserman, did call for  “…changed behavior on our part”, but from his text it is clear that the change he has in mind is improved sharing of the recent advances in psychiatry with other medical practitioners.

“Psychiatry needs to be proactive in providing easily readable and readily accessible scientifically grounded information to medical staff in general hospitals and in General Practitioners’ (GP) offices about modern psychiatric treatments. As we know, education generally requires repetition, and while all physicians in training are exposed to the field of psychiatry, it behoves us as psychiatrists, to continually inform our medical colleagues about the advances in our field.”

This strikes me as condescending to the point of arrogance, and, to the extent that it reflects psychiatric attitudes generally, could, in combination with psychiatry’s spurious foundations and destructive “treatments,” go a long way to explaining the negative perceptions of other medical professions.

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

I had planned to write a detailed critique of the seven editorial comments, but yesterday on Mad in America I read Psychiatry’s Poor Image: Reflecting on Psychiatrists’ “Apologias”, by Bonnie Burstow, PhD.  The article is a critique of the APS editorials.

Bonnie, in her usual measured but forthright tone, has made all the points that I had wished to make, and many more besides.  Here are some quotes:

“Before I proceed further, I would point out that there is a conspicuous void in this collection. While all authors in their own different ways address what might be done to improve psychiatry’s image, significantly, not a single psychiatrist thinks to ask what by humanistic standards would appear to be the compulsory question: Insofar as any of the bad image is deserved, exactly how are the ‘patients’ being ill served and what is owed them?”

“Most of these responses can be divided into several categories, and all entail some level of evasion. Emergent themes or claims in this regard include: 1) The evidence that psychiatry has a bad image is either not credible or is limited and as such, claims based on it are misleading; 2) Insofar as psychiatry and psychiatrists have a bad image, it is not primarily psychiatry’s fault but the fault of others; 3) The bad image is not exactly anyone’s fault—it goes with the territory; 4) While psychiatry is partially to blame, it is only one or two things psychiatry is doing wrong—none of which are substantive.”

“Ironically, what surprises most of us who are aware of psychiatry’s baselessness, is not how critical other doctors are of psychiatrists but how silent they are about the fraudulence of the medical claims—at least as a big a dynamic as the putative unfairness.”

“The primary purpose of the construction of course is to absolve psychiatry by transferring blame onto others. The various people blamed throughout this collection include: other medical teaching faculty; funders (who allegedly are not  providing sufficient resources to make psychiatry attractive to enter (see, for example Bhugra, 2015), and, finally, the media.  Note in this last regard Bhugra’s curious reference to the “antipsychiatry media coverage.” This of course is ironic given the enormous complicity of the press in furthering psychiatry (see Whitaker, 2002). Moreover, as those of us who organize against psychiatry but receive negligible coverage are well aware, if there is antipsychiatry press out there, it is keeping itself well hidden.”

“Finally comes the very common contention that while psychiatry is wonderful and amazingly successful (and all the psychiatrists more or less concur on this point), it is in fact doing but one or two things wrong, none of which are substantial, albeit they facilitate the “stigma”. Generally, the deficits identified relate to not having a game plan for fighting back and not properly communicating (e.g., what we are being asked to believe is that despite the enormity of the funds spent on promulgating its message—see in this regard Whitaker, 2002—psychiatry is failing to communicate how very scientific and advanced it is—hence the ‘misperceptions.'”

“That these ‘solutions’ will hardly get rid of psychiatry’s fundamental deficits is clear. How can you get rid of shortcomings by putting all your energy into attempting to persuade everyone that they don’t exist?  How can you deal with the problem of a faulty paradigm by further entrenching oneself in that paradigm? But, of course, addressing actual deficits is not the point of the exercise.”

Bonnie’s article is characterized by cogency, lucidity, and fearless honesty.  It’s a superb critique which I strongly recommend.

 

 

A Client’s Perspective on “Mental Illness”

A very important and compelling article was posted on Mad in America on June 18.  It’s by Andrew L. Yoder, and is called An Open Letter to Persons Self-Identifying as Mentally Ill.  Here are some quotes:

“My physician was not so cautious.  He was a very pleasant man that always seemed to take his time with me and did not talk down to me.  Yet as I described some of the emotional distress I was experiencing, and the ways it was affecting my life, he told me with great certainty that mine was a totally common experience.  He told me that I had a biological condition in my brain, one in which certain chemicals were ‘imbalanced.’  He told me that there should be no stigma about asking for assistance from him.  Specifically he told me, ‘Trying to not be depressed is like telling a diabetic to just make more insulin.’  He prescribed an antidepressant medication, saying that this was no different than taking medication to regulate blood pressure or manage cholesterol.  I was told of the likelihood that I would need to remain on some form of medication for an indefinite future.”

“I believe that anyone, given the right context and circumstances, can experience even the most extreme forms of cognitive and emotional distress.”

“However, I believe that treating the term ‘mental illness’ as a literal truth does more to harm that hope of recovery than it does to help it.  You see, along with the popular claim that mental illness is a literal organic brain disease ‘just like diabetes’ is a set of other dogmas unproven and unsupported by evidence.  These include, being regularly told that not only do you have a disease but that this disease also has no cure and that you will struggle with it for your entire life.  I have trouble imagining anything more hopeless than that.

It also includes being told that you must take psychiatric medications, and often many different psychiatric medications for the rest of your life, and you should never ever consider stopping them.”

“Looking back now, I wish the physician who prescribed me anti-depressants would not have told me stories of ‘chemical imbalance’ that are simply not based in science.  In truth, most psychiatric medications alter normal brain activity, and there’s no evidence of an identifiable chemical imbalance of any sort at the root of emotional suffering.  Research suggests that there are some risks associated with long-term use of antidepressants, including the possibility of decreasing benefits from the drug and something referred to as ‘treatment resistant depression.'”

“Those of us challenging the evidence-absent medical model and the objective ‘mental illness’ label that goes with it are not trying to take away something hopeful and healing from you.  Instead, we wish to counter the false-hopelessness of a system that sees you as second-class people who will never be ‘normal.'”

“We know that mental and emotional suffering is a real experience that many, many people face.  We also know that nothing good comes from convincing people that they have a biological disease when no evidence supports that.  Questioning the legitimacy of ‘mental illness’ doesn’t make the reality of the pain any different.  But it does help people avoid the pitfalls of misinformation and powerlessness in their own recovery and wellness.”

“I am not saying that you are not hurting.  I am saying that you are not broken.”

Andrew has managed to express, in candid yet empathic terms, so many of the issues that are central to this debate.  Please read and pass along.

Blame the Clients?

On June 6, I wrote a post titled Psychiatry DID Promote the Chemical Imbalance Theory.  The article was published on Mad in America, and generated a number of comments on that site, five of which were from TherapyFirst, who in his first comment identified himself as Joel Hassman, MD, a practicing psychiatrist. 

Dr. Hassman did not argue with the general notion that psychiatric practice today consists almost exclusively of the prescription of drugs.  Indeed, in one of his own blog posts on June 16, 2013, he wrote in an open letter to newly qualified psychiatrists:

“…you are now agreeing to basically just prescribe medication and give limited, selective diagnoses that serve insurer and/or bureaucratic agendas first and foremost.”

 and

“…your interest will be narrowly directed to prescribing more likely multiple medications from moment one of meeting the patient…”

And this general position – that psychiatry consists essentially of prescribing drugs – continues to be evident in his comments on the MIA post.

But then he introduces a twist that I haven’t encountered before – he blames the clients for what he aptly calls the “chemicalization” of mental health.  Here are some quotes:

“Everyone rails about psychiatrists and other prescribers just dumbing down mental health care complaints to writing scripts, but, in the last 10 years or so, people come into treatment venues just wanting drugs, and dismiss any other intervention for care, irregardless of how appropriate and indicated as a standard of care such a treatment is warranted.”

“Seems to me it fits the antipsychiatry narrative at the end of the day. It is easier to crucify the doctors, harder to attack the general public who are reinforcing ‘better living through chemistry’, eh?”

 “Sorry, but if there is going to be a valid and honest discussion/debate about who is at fault in the ‘chemicalization’ of mental health, don’t just pick on the doctors. Patients are pervasively demanding drugs, often ones of abuse potential of late, and have little to no interest in problem solving nor wanting to implement real and effective change for the better.”

 “…where are the muzzle prints on these ‘victims’ foreheads that demand they take medication?”

 “…you as a patient come to someone with an expertise and then have the gall to argue and demand interventions that do not fit as treatment A for the problem in front of the clinician, and I am to refer to him/her as ‘victim’?? Get real!”

As I noted earlier, this is an unusual and complicated  perspective.  On the one hand, there’s an element of truth in Dr. Hassman’s position.  A great many people do indeed go to psychiatrists for the specific purpose of obtaining a prescription.  And I think we can believe Dr. Hassman’s assertion that some of these individuals may become impatient and dismissive, and perhaps even demanding, when invited to explore other options.

But on the other hand, drug prescriptions are psychiatry’s stock in trade.  It’s what the vast majority of psychiatrists offer, and what their customers have, reasonably and legitimately, come to expect.  I have even heard numerous reports from clients that they were pressured by psychiatrists into taking pills.

I’m old enough to remember a time when outpatient psychiatry was almost entirely a talking and listening profession.  Depression was considered a fairly ordinary and understandable phenomenon – part of the human lot, so to speak – and remediation was conceptualized as being largely a matter of seeking support and solace from friends and loved ones, and of making positive changes in one’s circumstances and lifestyle.  In extreme cases, people did consult psychiatrists, but the purpose of these visits was to discuss issues and problems – not to obtain drugs.

I imagine that psychiatrists in those days felt that their years of medical training were somewhat wasted.  The problems that they were helping people address were not considered medical in nature, except perhaps in very extreme cases, and there was nothing particularly medical about the “treatments.”  And, of course, there were fewer psychiatrists.

Obviously things are very different today, and I think the fundamental questions here are:  how did these changes come about? and, who’s to blame?

There is an obvious parallel between the growth of psychiatric prescribing and the growth of the illegal drug trade over the past fifty or sixty years.  It is also obvious, and generally accepted, that the illegal trade is driven by demand, and would collapse overnight if that demand were to dry up.

So the question arises:  is what Dr. Hassman calls the chemicalization of psychiatry essentially a product of consumer demand for drugs?  And, of course, the answer, at least to some extent, is yes.  If people stopped going to psychiatrists for prescriptions, then psychiatrists would have to either disband as a profession or find something else to do.

But there is another side to this coin.  People who deal in illegal drugs make no pretense that their products are medications.  For psychiatrists, however, this is their primary marketing tool.  For decades, they and their pharmaceutical allies have promoted this fiction using every means at their disposal.  Very few psychiatrists have distanced themselves to a significant degree from this position.

They have spread the seductive deception that virtually all significant problems of thinking, feeling, and/or behaving are caused by neurochemical imbalances which can be corrected only by ingesting their products.  They have issued, and continue to issue, dire warnings as to the consequences of not taking these pills.  They have persuaded parents that their children’s brains are impaired, and that even toddlers need to take the pills.  And so on.  The whole sordid tale has been exposed many times, but psychiatry, without a hint of shame or compunction, continues to spread this self-serving and destructive deception.  In fact, at the present time, psychiatry, as represented by the World Psychiatric Association and the American Psychiatric Association, is actively working to improve its tarnished image with a view to expanding its market even further.

So, Dr. Hassman is probably correct when he writes that some clients do come to psychiatrists to obtain drugs, and are resistant to alternative suggestions.  But I think there’s a bigger issue:

A steady stream of individuals, of all ages and from all walks of life, coming to psychiatrists for drugs is precisely the objective towards which the psychiatric leadership and vast majority of the rank and file have worked diligently for the past fifty years. 

It wasn’t the customers who invented and disseminated the term “a chemical imbalance, just like diabetes.”  And, it wasn’t the customers who wrote and expanded the DSM to provide an impression of legitimacy for the drug-pushing activity.  That was psychiatry!

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

This article has also be posted at the Mad in America site.

 

 

‘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.

Robert Whitaker: Looking Back and Looking Ahead

On March 5, Bruce Levine, PhD, published an interesting article on Mad in America  titled Psychiatry Now Admits It’s Been Wrong in Big Ways – But Can It Change?

Bruce had interviewed Robert Whitaker, and most of the article is the transcript of this interview.

Bruce begins by noting that Robert, in his book Mad in America, had challenged some fundamental tenets of psychiatry, including the validity of its “diagnoses” and the efficacy (especially the long-term efficacy) of its treatments.

Bruce reminds us that Robert initially incurred a good deal of psychiatric wrath in this regard, but also points out that some members of the psychiatric establishment are beginning to express a measure of agreement with these deviations from long-held psychiatric orthodoxy.

Robert was asked if these kinds of developments have rendered him optimistic with regards to the future of psychiatry, and his response is particularly interesting.  He points out that it is obviously a hopeful sign that psychiatry is beginning to recognize at least some of its shortcomings.  But he continues:

“Even as the intellectual foundation for our drug-based paradigm of care is collapsing, starting with the diagnostics, our society’s use of these medications is increasing; the percentage of children and youth being medicated is increasing; and states are expanding their authority to forcibly treat people in outpatient settings with antipsychotics drugs. Disability numbers due to mental illness go up and up, and we don’t see that as reason to change either. History does show that paradigms of psychiatric care can change, but, in a big-picture sense, I don’t know how much is really changing here in the United States.”

And in this regard, Robert is absolutely correct.  He has also pointed us to the very crux of the matter:  psychiatry has never had even the slightest interest in the validity of its concepts.  Psychiatry needed illnesses to establish its dominance of the helping professions arena, and to legitimatize the prescribing of drugs.  So illnesses it created.

Dissent (and there has been a great deal of it over the past 60 years) was routinely stifled, marginalized, and even ridiculed with the help of pharma money.  What Robert has done – and for this he deserves a Pulitzer Prize – is spell out the shortcomings of psychiatry so clearly and so vigorously that the psychiatric leadership can no longer pretend not to hear.  But there is, I suggest, nothing in the attitude of organized psychiatry to indicate any interest in fundamental change.

Jeffrey Lieberman, MD, President of the APA, in his fortnightly article in Psychiatric News, continues to insist that psychiatric diagnoses reflect real illness and that psychiatry should not only maintain its present level of activity, but should actually widen its net to embrace those populations that are “underserved,” as well as those who are “at risk.”

DSM-5 (May 2013) actually contains the phrase

“…DSM, like other medical disease classifications…” (p 5) [Emphasis added]

The psychiatric leadership may well have decided to stop bashing Robert.  But this in my view does not reflect any kind of honest re-appraisal of their philosophy or their practices.  For psychiatry, today, as for the past 60 years, all significant problems of thinking, feeling, and/or behaving are illnesses, best treated by psychiatrists using neurotoxic drugs and electrically-induced seizures.  The only difference at this time is that they’re keeping their heads down, hoping, in politician style, that the present hue and cry will die down, that the pharma companies will re-start the pseudo-research gravy train, and that they can continue with their mission of drugging and disempowering an ever-increasing number of people.

There are, it has to be acknowledged, a very small number of psychiatrists who recognize the truth about psychiatry, and they are speaking out courageously and honestly.  But the great majority of psychiatrists, including the leadership, are still marching in lock-step to the biological illness drum. They no longer have the gall to say “just like diabetes,” but the general idea is still the same.  The protests, including those from the survivors, are being ignored, the drugs are still flowing like candy, and politicians are being lobbied for legislative and financial support.

We still have a lot of work to do.

Benzodiazepines – Adverse Effects

On November 25, Mad in America posted a link to an article in the Journal of Neurological Sciences.  The article is by Harnod et al, and is titled An Association between Benzodiazepine Use and Occurrence of Benign Brain Tumors.  The authors studied the records of  62,186 individuals in Taiwan  who had been prescribed a benzodiazepine for at least 2 months between 2000 and 2009.  They compared the incidence of brain tumors in these patients with the incidence in patients in a matched-pairs control group.  The hazard ratio for benign brain tumors (benzo group vs non-benzo group) was 3.15 (95% confidence interval: 2.37-4.20).  The hazard ratio for malignant brain tumors was 1.21 (95% confidence interval: 0.52-2.81).  What this means essentially is that one can be 95% confident that the benign tumor association is real, but that the malignant tumor result might have arisen by chance.

The authors also discovered that dosage is an important factor.  The hazard ratios for benign brain tumors increased with dose.  At doses between 36 and 150 mg/year the hazard ratio was 2.12 (1.45-3.10); at doses above 150 mg per year, the hazard ratio was 7.03 (5.19-9.51).

The study in question is a matched-pairs cohort study, rather than a randomized controlled trial, so one can’t state with absolute certainty that the drugs caused the tumors, but given the large number of participants, the meticulous control of confounding factors, and the magnitude of the hazard ratio (three-fold), the results need to be taken very seriously.

There might also be a tendency to dismiss these results on the grounds that the tumors are benign.  But benign tumors can have serious implications..  Here’s what the American Brain Tumor Association says:

“…the location of a benign brain tumor can have a significant impact on treatment options and be as serious and life-threatening as a malignant tumor.”

HISTORY

The first benzodiazepine, Librium, was introduced in 1960, followed in 1963 by Valium.  Today there are dozens of benzodiazepine-class drugs in regular use.

The Harnod et al study is by no means the first time that researchers have drawn attention to the dangers of long-term benzodiazepine use.

Here is a short list of studies that found significant adverse effects for benzodiazepines:

Lader MH, Petursson H, 1981: Benzodiazepine derivatives–side effects and dangers.

“A range of paradoxical effects can occur of which release of aggressive and hostile feelings has excited most attention.”

Lader MH, Petursson H, 1984: Computed axial brain tomography in long-term benzodiazepine users. 

“The mean ventricular/brain area measured by planimetry was increased over mean values in an age- and sex-matched group of control subjects but was less than that in a group of alcoholics.” [Benzo users had more brain shrinkage than controls, but less than alcoholics]

Tata PR, et al, 1994: Lack of cognitive recovery following withdrawal from long-term benzodiazepine use.

“Despite practice effects, no evidence of immediate recovery of cognitive function following BZ withdrawal was found. Modest recovery of certain deficits emerged at 6 months follow-up in the BZ group, but this remained significantly below the equivalent control performance.”

Burke, KC et al, 1995: Medical services use by patients before and after detoxification from benzodiazepine dependence.

“Although a retrospective record review suffers from a range of limitations, the findings suggest that detoxification from benzodiazepines may be effective in reducing use of outpatient medical and mental health services and presumably in reducing costs of care.”

Cohen, SI, 1995: Alcohol and benzodiazepines generate anxiety, panic and phobias.

“In almost half the patients seeking advice for anxiety, panic and phobias the cause was alcohol or benzodiazepines.”

Barker MJ et al, 2004: Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis.

“Results of the meta-analyses indicated that long-term benzodiazepine users do show recovery of function in many areas after withdrawal. However, there remains a significant impairment in most areas of cognition in comparison to controls or normative data.”

Stewart SA, 2005: The effects of benzodiazepines on cognition.

“In an attempt to settle this debate, meta-analyses of peer-reviewed studies were conducted and found that cognitive dysfunction did in fact occur in patients treated long term with benzodiazepines, and although cognitive dysfunction improved after benzodiazepines were withdrawn, patients did not return to levels of functioning that matched benzodiazepine-free controls.”

Berger A et al: 2012: Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study.

“Healthcare costs increase in patients with GAD beginning long-term (≥90 days) treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.”

Kao CH et al, 2012: Benzodiazepine Use Possibly Increases Cancer Risk: A Population-Based Retrospective Cohort Study in Taiwan. 

“In the group with benzodiazepine use, the overall risk of developing cancer was 19% higher than in the group without benzodiazepine exposure…”

Other studies can be found that dispute details of the adverse effects spectrum, but there is general agreement that these effects are wide ranging and, in many cases, serious.

DRUG DEPENDENCE

Benzodiazepines were initially promoted as non-habit-forming, but in fact reports of dependence for each of the various products emerged, usually within a few years of its launch.  Withdrawal reactions from Librium were noted in a 1961 article (Withdrawal reactions from chlordiazepoxide (Librium), in the journal Psychopharmacologia 1961, 2: 63-68).  Reports of addiction to Valium were noted in a letter to the BMJ in 1967 (Addiction to diazepam (Valium), Br Med J 1967;1:112.1).  In 1976, a report of withdrawal symptoms in newborns who were exposed to benzodiazepines in utero appeared in the American Journal of Obstetrics and Gynecology.  In 1977, a similar report appeared in the Journal of Pediatrics.  In 1986, Professor Heather Ashton, DM FRCP, of the University of Newcastle, UK, wrote a comprehensive account of the benzodiazepine withdrawal syndrome in an article titled Adverse Effects of Prolonged Benzodiazepine Use.  Here are some quotes:

“The syndrome can be of considerable severity and has similarities to abstinence syndromes associated with alcohol, opiates, and barbiturates.”

“Agoraphobia, other phobias, and depression are common during withdrawal…”

“Perceptual distortions (sometimes hallucinations) and feelings of depersonalisation and unreality are characteristic. Acute psychotic episodes occur occasionally, but obsessions, intrusive thoughts and memories, and paranoid feelings are not uncommon. Irritability, rage, and aggression are also frequent…”

“Neurological symptoms include episodes of paraesthesiae and numbness, tremor, muscle pains, stiffness, weakness and fasciculation, ataxia, and blurred or double vision…”

“Major convulsions or temporal lobe seizures sometimes occur on abrupt withdrawal.”

“Gastrointestinal symptoms are very common…”

“Cardiovascular symptoms (palpitations, flushing, chest pain), hyperventilation, urinary symptoms (frequency, urgency, incontinence), and loss of libido are similar to those seen in anxiety states. An influenza-like syndrome with prostration and increased upper respiratory tract secretion may occur and resembles that seen after narcotic withdrawal, although it is more protracted.”

In an American Journal of Psychiatry editorial in 1991, Carl Salzman, MD, Chair of the APA Task Force on Benzodiazepine Dependence, Toxicity, and Abuse, acknowledged that:

“True physical dependence can arise from chronic therapeutic use, defined by the appearance of a constellation of discontinuance symptoms following abrupt withdrawal.”

Some individuals withdrawing from benzodiazepines experience protraction of withdrawal symptoms for months, and in some cases more than a year.  Lader M et al (2009), in Withdrawing Benzodiazepines in Primary Care, state:

“No clear evidence suggests the optimum rate of tapering, and schedules vary from 4 weeks to several years.”

Prescriptions for benzodiazepines continue to rise.  Alprazolam (generic Xanax) is the most prescribed psycho-pharmaceutical product in the US today.  The number of prescriptions written for this drug increased 9% from 2009 to 2011 (PsychCentral).

Psychiatrists claim that anxiety is an illness, and that the prescription of benzodiazepines is a legitimate medical intervention.  The reality is that anxiety is the natural consequence of the relentless, stressful, isolative, unfulfilling kind of lifestyle that is becoming increasingly common in the US and other industrialized countries.  Benzodiazepines are a fast-acting, addictive drug that dulls the pain, but often at enormous cost.  Their effects, including long-term adverse reactions, are similar to alcohol, but they can be used discreetly in situations where alcohol use would attract disapproval (workplace) or even legal consequences (public places).

Popping a benzo to cope with life’s difficulties and challenges is essentially on a par with taking a nip from a hip flask filled with whisky.  It might get one through the day, but it’s not an effective or personally fulfilling way to tackle life’s problems, and the adverse consequences can be truly horrendous.

 

More SSRI Side Effects: Upper GI Bleeding

Earlier this month, the American Journal of Psychiatry published an article by Yen-Po Wang, M.D., et al, titled Short-Term Use of Serotonin Reuptake Inhibitors and Risk of Upper Gastrointestinal Bleeding.  [Thanks to Mad in America for the link]

The research was conducted in Taiwan.  The authors studied the records of 5,377 psychiatric inpatients with gastrointestinal bleeding between 1998 and 2009.  Study subjects served as their own controls, i.e. the incidence of bleeding in the period following the antidepressant prescription was compared with the incidence of bleeding during a period when they were not taking antidepressants.

FINDINGS

The adjusted odds ratio for the risk of upper gastrointestinal bleeding after starting an SSRI was 1.67 (after 7 days), 1.84 after 14 days, and 1.67 after 28 days.

CONCLUSIONS

“Short-term SSRI use (7–28 days) is significantly associated with upper gastrointestinal bleeding.”