Tag Archives: major tranquilizers

Allen Frances on the Benefits of “Antipsychotics”

On February 1, Allen Frances, MD, published an interesting article on the Huffington Post blog.  The article is called Do Antipsychotics Help or Harm Psychotic Symptoms?, and is a response to Robert Whitaker’s post of January 27:  “Me, Allen Frances, and Climbing Out of a Pigeonhole.  This post, in turn, was a response to Dr. Frances’s Psychiatric Medicines Are Not All Good or All Bad, which was published in the Huffington Post on January 15.  Readers may remember that I published a critique of this latter article on February 9.

A detailed analysis of the debate between Dr. Frances and Robert Whitaker is beyond the scope of this article.  My primary observation is that in his February 1 response, Dr. Frances does not address the points that Robert made on January 27.  Instead, he sets up caricatures of these points, and dispatches these caricatures with the skill and verve of a shadow-boxer who imagines he is engaged in genuine combat.

My present purpose is to take a closer look at Dr. Frances’s February 1 article, and to spell out some of its implications.  Here are some quotes, interspersed with my comments.

“Bob’s [Robert Whitaker’s] advocacy is ambitious, global, and future oriented- requiring a radical reconception of the US approach to people with psychosis. I am preoccupied more by the desperate, unmet needs of patients living dreadful lives in the current moment. In furthering his long range agenda, I believe Bob is misjudging what is best for severely ill people in the present. His recommended ideal treatment can only have a chance of success in an ideal treatment system. People who might do well with less medicine in his ideal world often get in terrible trouble if they try to stop medicine in our shamefully neglectful real world.”

Note the truly exquisite spin. Robert is “ambitious, global, and future-oriented”, while Dr. Frances is the humble pragmatist rising tirelessly to the daunting challenge of meeting the “unmet needs” of desperate “patients”.

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

“Bob acts as if there is an inherent tension between service users and psychiatric providers. I see the current animosity as an unfortunate and idiosyncratic phenomenon, peculiar to the US, and partly contributed to by Bob’s own passionate and somewhat misleading rhetoric.”

This is a huge issue.  The heart of the matter is that there is “tension” between psychiatrists, on the one hand, and some of their former clients, on the other.  Dr. Frances’s contention is that this conflict is not inherent, but, rather, is “an unfortunate and idiosyncratic phenomenon”, for which Robert Whitaker is, at least partly, to blame.

The reality, of course, is quite different. There is indeed “tension” between psychiatrists and many of their former clients.  This “tension”, which I would call out-and-out conflict, also embraces a very large, and growing, number of other mental health professions and members of the general public.  This conflict has arisen because:

  1. Psychiatry’s definition of a mental disorder/mental illness embraces every significant problem of thinking, feeling, and/or behaving, and psychiatry has been using this definition to medicalize problems that are not medical in nature for more than fifty years.
  1. Psychiatry routinely presents these labels as the causes of the specific problems, when in fact they are merely labels with no explanatory significance.
  1. Psychiatry has routinely deceived, and continues to deceive, their clients, the public, the media, and government agencies, that these vaguely defined problems are in fact illnesses with known neural pathology.
  1. Psychiatry has blatantly promoted drugs as corrective measures for these illnesses, when in fact it is well-known in pharmacological circles that no psychiatric drug corrects any neural pathology. Indeed, the opposite is the case.  All psychiatric drugs exert their effect by distorting or suppressing normal functioning.
  1. Psychiatry has conspired with the pharmaceutical industry in the creation of a large body of questionable, and in some cases fraudulent, research, all designed to “prove” the efficacy and safety of pharma products.
  1. A great many psychiatrists have shamelessly accepted pharma money for very questionable activities. These activities include the widespread presentation of infomercials in the guise of CEUs; the ghost-writing of books and papers which were actually written by pharma employees; the promotion of new drugs and “diagnoses” by paid psychiatric “thought leaders”; the publication of fraudulent advertising in psychiatric peer-reviewed journals; the acceptance of pharmaceutical money by the APA; targeting of captive and otherwise vulnerable audiences in nursing homes, group homes, and foster-care systems for prescription of psychiatric drugs; etc., etc…
  1. Psychiatry’s spurious diagnoses are inherently disempowering. To tell a person, who in fact has no biological pathology, that he has an incurable illness for which he must take psychiatric drugs for life is an intrinsically disempowering act which falsely robs people of hope, and encourages them to settle for a life of drug-induced dependency and mediocrity.
  1. Psychiatry’s “treatments”, whatever tranquilizing effects or transient feelings of well-being they may induce, are almost always destructive and damaging in the long-term, and are frequently administered involuntarily.
  1. Psychiatry’s spurious and self-serving medicalization of every significant problem of thinking, feeling, and/or behaving, effectively undermines human resilience, and fosters a culture of powerlessness, uncertainty, and dependency. Relabeling as illnesses, problems which previous generations accepted as matters to be addressed and worked on, and harnessing billions of pharma dollars to promote this false message is morally repugnant.
  1. Psychiatry neither recognizes nor accepts any limits on its expansionist agenda. In recent years, they have even stooped to giving neuroleptic drugs to young children for temper tantrums, under the pretense that these children have an illness called disruptive mood dysregulation disorder.

The anti-psychiatry movement has been in existence, and vocal, for decades.  But it had been successfully marginalized and ridiculed by pharma-psychiatry until the explosion of Internet access provided a voice that even pharma-psychiatry couldn’t silence.  Robert Whitaker has been a powerful, reasoned, and if I may say, restrained voice in these endeavors, and Mad in America is at this time one of the primary outlets for anti-psychiatry views and information.  But blaming the world-wide anti-psychiatry sentiment on Robert is a bit like blaming news reporters for wars, plagues, famines, and natural disasters.  It’s not only false, but betrays a fundamental disconnect with reality.  The anti-psychiatry movement exists because psychiatry is something fundamentally flawed and rotten.  And it is fundamentally flawed and rotten because its leaders have made it so.

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

“Bob’s misreading fails to take into account the fact that psychotic presentations vary greatly in cause, severity, chronicity, prognosis, and appropriate treatment. Many psychotic episodes are transient. Some are stress related- eg a soldier in combat, a college kid or traveller who becomes delusional when away from home. Some are a transient part of mood disorder and remain quiescent if the mood disorder is successfully treated. Some are related to substance intoxication or withdrawal. Some are caused by head trauma or medical illness. And some normal people have hallucinatory experiences that cause no impairment and have no clinical significance. Transient psychotic symptoms in the above situations may require a short course of antipsychotics, but these should be gradually tapered after the episode has resolved. Generally this can be done without much risk of return of psychosis- assuming the stressor, substance problem, mood disorder, or medical problem has resolved. Bob and I would agree on short term or no antipsychotic treatment for such transient psychoses.”

Once again, note the spin.  Robert Whitaker’s article was about people who had been labeled schizophrenic, but Dr. Frances is “refuting” Robert’s contentions by focusing on “psychotic episodes” that clearly do not meet the APA’s criteria for schizophrenia.  This discrepancy persists throughout Dr. Frances’s post.  In Robert’s article the word “schizophrenia” occurs 12 times, but in Dr. Frances’s response, the word is nowhere to be found.  Dr. Frances is obviously aware of these distinctions, and it’s extremely difficult to put a benign interpretation on this kind of obfuscation.

The central point of Robert’s paper is, I believe, contained in the following passage:

“Every important detail from the conventional narrative, which tells of a great medical advance, can basically be filed under the heading of ‘not really true.’ The arrival of the antipsychotics into asylum medicine did not lead to deinstitutionalization; a change in social policy did. The dopamine theory of schizophrenia arose from an understanding of how drugs acted on the brain, and not from an understanding of what was going on in the brains of people so diagnosed, and when researchers looked to see whether people diagnosed with schizophrenia had overactive dopamine systems as a matter of course, they didn’t find that to be so. The drugs were not like insulin for diabetes. Nor was there evidence that the arrival of the antipsychotics kicked off a great advance in outcomes for schizophrenia patients. Indeed, in a 1994 paper, Harvard researchers reported that long-term outcomes were now no better than they had been in the first third of the 20th century, when water therapies were a mainstay treatment.

In contrast, a scientific understanding of antipsychotics supported the patients’ counter-narrative. Thorazine, Haldol, and other first-generation antipsychotics powerfully blocked dopamine pathways in the brain, which reduced one’s capacity to respond emotionally to the world and to move about it. Hence the zombie feeling. Antipsychotics did cause brain damage, as could be seen in the twitchings of people who developed tardive dyskinesia after years on these drugs. Moreover, research had shown that in compensatory response to the drug’s blockade of dopamine receptors, the brain increased the density of its dopamine receptors, and, there was reason to worry that this increased the person’s biological vulnerability to psychosis. Given these facts, there was plenty of reason for people diagnosed with schizophrenia and other psychotic disorders to want to stop taking them.

In terms of the ‘evidence base’ cited by psychiatry for its use of the drugs, which is held up by psychiatry as its trump card in this battle of narratives, it is easy to see that the evidence for long-term use is flawed. Researchers had conducted any number of studies in which a group of stabilized patients were either maintained on an antipsychotic or abruptly withdrawn from the drug, and with great regularity, the drug-withdrawal group relapsed at a higher rate. This was seen as proving that continual drug use lowered the risk of relapse, and thus provided evidence for maintaining patients indefinitely on the medication. But, of course, another conclusion to be drawn is that the high relapse rate is a drug-withdrawal effect, and not evidence of the long-term risk of relapse in unmedicated patients. The relapse studies also didn’t provide any evidence about how well schizophrenia patients functioned on the drugs, or their quality of life, particularly over the long term.”

Note that the word “schizophrenia” occurs five times in this passage alone, and it is clear that Robert is referring to individuals who have been labeled schizophrenic and who have been “treated” from that perspective.  Dr. Frances’s discussions concerning transient “psychotic episodes” are not pertinent, particularly in the light of psychiatry’s long-held insistence that “schizophrenia” is a life-long degenerative illness.

So it’s not a case of Robert Whitaker misreading the matter, but rather one of Dr. Frances miswriting the matter.

Nor is the miswriting inconsequential.  By juxtaposing the terms “schizophrenia” and “transient psychotic symptoms”, Dr. Frances has managed to convey the impression that he personally favors a more selective and tapered approach to neuroleptic drugs than that which has been typically adopted by psychiatrists since the drugs first came on the market.  This approach has been:  keep taking the “medications” even after a first episode has been successfully “treated”.

Dr. Frances is also conveying the impression that he has favored a less-is-more approached since the ’60s:

“I began my career in psychiatry in the mid 1960s, just when antipsychotics were first being used widely. The new meds dramatically improved psychotic symptoms, but equally dramatically produced dreadful side effects, especially in the ridiculously high doses then being tried.”

and

“Troubled by this, I was one of the principal investigators on a multisite NIMH funded study testing the feasibility of two new approaches to reducing medication burden. The first was very low dose treatment; the second was expectant treatment, with meds used intermittently only when patients needed them. Patients were randomly assigned to 3 conditions: 1) standard dose injectible med; 2) one-fifth standard dose injectible med; 3) placebo injection with oral meds added as needed. All three groups also received intense individual and family therapy and social support, often done in the home. Many patients in the low dose and expectant groups did well, but the catastrophes were sometimes catastrophic and irreversible. I became convinced that the risks of going off meds for people with chronic psychosis usually overwhelm the benefits. It is the patients’ decision to make, but my advice has been not to rock the boat when chronic psychotic symptoms are responding to meds. Stay on the lowest possible dose, but stay on it over time. When psychosis has been chronic, the risks of discontinuing medication usually far outweigh the benefits.”

As I mentioned in my earlier article, I have been unable to find this particular study, and Dr. Frances provides no reference, so I have no way of ascertaining the methodology or the formal outcome/conclusions.  It does seem odd that Dr. Frances would refer to a piece of research in two successive articles without providing a citation to enable his readers to access the study.

Dr. Frances’s subjective assessment that the “catastrophes were sometimes catastrophic and irreversible” and his equally subjective conviction that “the risks of discontinuing medication usually far outweigh the benefits” are interesting, but obviously are subject to the kind of selection bias that formal studies are designed to overcome.  Dr. Frances saw individuals come off the “meds”, and subsequently crash and burn, but by the same token, those individuals who came off the “meds” and did well, wouldn’t necessarily have come to his attention.  Indeed, it is entirely credible that many of these latter individuals would have actively avoided the ministrations of psychiatry.

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

“Antipsychotics have many grave disadvantages that make them a last resort. They suppress symptoms, rather than curing them. They can cause unpleasant side effects and dangerous medical complications. They contribute to shortened life expectancy. And they are subject to wide overuse even when there is no indication. We should be extremely cautious and selective in their use quite independent of Bob’s tenuous claim that they worsen psychosis.”

This paragraph is interesting, particularly when compared with The Expert Consensus Guidelines for the Treatment of Schizophrenia published by Dr. Frances and his two colleagues, John Docherty, MD, and David Kahn, MD in 1996 (Journal of Clinical Psychiatry, Volume 57, Supplement 12B).  The final chapter in this supplement (p 51-58) is “A Guide for Patients and Families”.  Here are some quotes:

“Schizophrenia is a disorder of the brain like epilepsy or multiple sclerosis.  This brain disorder interferes with the ability to think clearly, know what is real, manage emotions, make decisions, and relate to others” (p 51)

Ongoing antipsychotic medication is necessary in both the acute and preventive phases. During the acute phase, medications help relieve the positive symptoms that are often out of control.  After the acute phase ends, ongoing antipsychotic medication greatly reduces the chances that acute symptoms will recur (a relapse).” (p 52) [Boldface in original text]

“The drugs used to treat schizophrenia are called antipsychotics.  They help relieve the delusions, hallucinations, and thinking problems associated with the disease.  These drugs appear to work by correcting an imbalance in the chemicals that help brain cells communicate with each other.” (p 53)

There is no evidence that the individuals whom psychiatry labels as schizophrenic have an imbalance in their brain chemicals.  Nor is there any evidence that neuroleptic drugs correct any neurological problem.  In fact, they are neurotoxic.

“The newer drugs are called atypical antipsychotics because they are less likely to cause some of the annoying and distressing side effects associated with the conventional antipsychotics.” (p 53)

So, the side effects which today Dr. Frances calls “dreadful”, and which he concedes cause “dangerous medical complications” and “shortened life expectancy”, he characterized in 1996 as “annoying and distressing”.  And this is not because any new information has been uncovered.  The devastating adverse effects of these products had been known for at least 30 years when Drs. Frances, Docherty, and Kahn (incorporated ironically as Expert Knowledge Systems, LLC) produced the document.  And given that the chapter in question is “A Guide for Patients and Families”, it is difficult to interpret this understatement as anything other than a deliberate attempt to deceive the target audience, and to counter any resistance individuals might have to ingesting these products.

“Usually patients respond well to treatment of a first episode of schizophrenia, but if there are repeated episodes or schizophrenia, symptoms sometimes persist despite treatment with the standard antipsychotic medications.  Fortunately, the newer drugs can often help patients whose symptoms no longer respond to the standard antipsychotic medications.  For such patients, the experts recommended that risperidone be tried first.” (p 53)

Incidentally, the Treatment Guidelines were funded by a grant from Janssen Pharmaceutica, the manufacturer of risperidone.  The promotion of risperidone, which is clearly evident throughout the guidelines, is not a coincidence.  It has been reported (here) that on July 3, 1996, Drs. Frances, Docherty, and Kahn (as Expert Knowledge Systems) wrote to Janssen:

“We are also committed to helping Janssen succeed in its effort to increase its market share and visibility in the payor, provider, and consumer communities.” (p 16)

This matter is in the public record (Texas v. Janssen LP, D-1GV-04-001288, District Court, Travis County, Texas), and has been reported by several writers, including Paula Caplan, PhD, but has never, to the best of my knowledge been addressed by Dr. Frances or either of his colleagues, although the venality of the statement is extreme even by psychiatric standards.  Drs. Frances, Docherty, and Kahn were reportedly paid $515,000 by Johnson and Johnson (owners of Janssen) for their work on the guidelines.

Back to the Treatment Guidelines document:

“The good news is that schizophrenia is very treatable.  A cure for schizophrenia, like diabetes, has not yet been found, but the symptoms can be controlled with medication in most people.  Prospects for the future are constantly brighter through the pioneering explorations in brain research and the development of many new drugs.  To achieve good results, however, you must stick to your treatment and avoid substance abuse.  Be sure to take your medicine as directed.  Even if you have felt better for a long time, you can still have a relapse if you stop taking your medication.” (p 54) [Boldface in original text]

“Because people with schizophrenia have to take their medications for a very long time, often for their whole life, it is very important to recognize and try to treat any side effects they may have from these medications.” (p 54)

“For patients who don’t take their medication regularly, more active interventions are likely to be needed to be sure the patient takes medications.  There are community treatment programs in which staff frequently go see patients and may give them their medications.  For such patients, the experts also recommended day hospitals where patients go 3-5 days a week and participate in several hours of programming that help insure that medication is taken.” (p 56) [Italics in original text]

“The most important factor in keeping patients with schizophrenia out of the hospital is having them take their medications regularly.  The best compliance with treatment is obtained when the family works with the patient to help him or her remember the medicine.  Sometimes long-acting injectable forms of medication are used when patients find it hard to take a pill every day.” (p 57)

The above quotes call into question Dr. Frances’s present assertion that coming off the “meds” is “the patient’s decision to make”.  This is even clearer in the guidelines proper where under the heading “Intervention During Continuation and Maintenance Treatment”, it states unambiguously:

Medication responsive patient – frequently not compliant   ■ Assertive community treatment (ACT);  Day hospital with medication management. (p 11)

There are a great many other passages in the schizophrenia treatment guidelines that indicate that Drs. Frances, Docherty, and Kahn promoted the use of neuroleptic drugs on a more or less indefinite basis.  The Schizophrenia Treatment Algorithm on pages 13 and 14, for instance, sets out in schematic form the treatments and adjustments that should be made in a variety of emerging situations.  In none of these situations is it suggested that the “medications” be stopped or that such a move even be considered.

But, in fairness to Dr. Frances and his colleagues, I have to acknowledge that there is a section headed “Psychosocial interventions” on page 11 of the guidelines.  Here’s the entire passage:

Psychosocial intervention

  • Ensure continuity from inpatient to outpatient care (e.g., schedule first outpatient appointment within 1 week of discharge, give enough medication to last until that appointment, telephone follow-up if patient misses appointment)
  • Psychoeducation for family to support and encourage medication compliance”

Incidentally, in the treatment algorithm mentioned earlier, under the neuroleptic complication “Agitation or insomnia”, only one intervention is given:  “Add benzodiazepine”.

In this context it needs to be stressed that the Schizophrenia Treatment Guidelines were widely distributed and influential.  Indeed, this was the intention from the start.  Here’s another quote from David Rothman’s expert testimony:

“The guideline team [Drs. Frances, Docherty, and Kahn] promised wide distribution of its product, including publication in a journal supplement.  The team was prepared to have J&J participate in its work, not keeping the company even at arms length.  With a disregard for conflict of interest and scientific integrity, the group shared its drafts with J&J.  On June 21, 1996, Frances wrote Lloyd [John Lloyd, J&J’s Director of Reimbursement Services]:  ‘We are moving into the back stretch and thought you would be interested in seeing the latest draft  of the guidelines project….Please make comments and suggestions.’  (Italics added).  So too, the group was eager to cooperate with J&J in marketing activities.  Frances wrote without embarrassment or equivocation:  ‘We also need to get more specific on the size and composition of the target audience and how to integrate the publication and conferences with other marketing efforts’  (Italics added)” (p 15)

Back to Dr. Frances’s current article:

“This debate does have serious real world consequences.  There is no more momentous decision in the life of someone who has had psychotic symptoms than whether or not to stop meds- and it always comes up in the treatment, often repeatedly. If the person’s symptoms have been brief and not life threatening, I fully encourage a decision to gradually taper and then stop. It is, under these circumstances, definitely worth the fairly minor risk of relapse to avoid the major risk of medication side effects and complications. Many of Bob’s most enthusiastic followers are in this category- harmed by prolonged overtreatment for transient problems.”

But there’s a catch 22.  For a “diagnosis of schizophrenia”, the DSM requires the presence of two or more of five “characteristic symptoms” for a significant portion of time during a one-month period “or less if successfully treated” [emphasis added].  And when this “diagnostic” determinant is coupled with psychiatry’s long-standing preference to use the drugs as the “treatment” of first resort, it is clear that the concept of transience in this context becomes meaningless.  There is no way of knowing if a person’s “symptoms” have been brief, if they are routinely suppressed with neuroleptic drugs as soon as they become evident.  The individual is still eligible for a “diagnosis of schizophrenia”, (a “life-long disease”) and will be pressured relentlessly by psychiatrists and the mental health system to continue to take the “meds” indefinitely.  And this is a situation to whose making Dr. Frances has been a major contributor.

Of course, we can all make mistakes, and we can all learn from our mistakes.  And if Dr. Frances is saying that his earlier enthusiasm for neuroleptic drugs and his downplaying of the entailed risks were mistakes, that would be one thing.  But to suggest that he has always been a proponent of moderation and restraint in this area is, I suggest, a distortion of the readily checkable historical facts.

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

Interesting as all these matters are, there is a much more fundamental issue that seldom gets aired:  the nature and effects of neuroleptic drugs.  In recent years, psychiatrists and pharma have been promoting the term “antipsychotics” for these products, denoting that they eliminate, or correct, psychotic thoughts in the same way, for instance, that antibiotics eliminate germs.  In fact, the term antipsychotic is much more a marketing device than an accurate descriptor, and it is to psychiatry’s shame that they have adopted and promoted the term so enthusiastically.  What these drugs are, and what they were originally called, is major tranquilizers.  Back in the 60’s and 70’s, their action was routinely likened to piling damp grass on a fire.  The fire wouldn’t go out, but its action and intensity were greatly reduced.  Nor are the actions of these products specific to psychotic thoughts and speech.  They suppress all activity.  In fact, they don’t normally eliminate delusions or hallucinations; rather they render the individual indifferent to them.  In the 50’s, the action of chlorpromazine, the first major tranquilizer, was likened to a chemical lobotomy.

A second factor that needs to be recognized is that people very seldom enter psychiatry’s orbit on the grounds of craziness alone.  One can be as crazy as one likes in the privacy of one’s home.  And indeed, I suggest that most of us adhere to some notions that would meet psychiatry’s definition of delusions:  “A false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary.” (DSM-5, p 819).  I, for instance, believe that there are no mental illnesses:  that the medicalization of all significant problems of thinking, feeling, and/or behaving is a hoax, designed to enhance psychiatry’s prestige, and to sell pharma products.  I occasionally receive emails and comments suggesting that I must be crazy to entertain such ideas, and I suppose, from psychiatry’s point of view, my beliefs could be considered delusional. But, oddly enough, I’ve never been picked up on a 72-hour hold, or court-ordered to have a psychiatric evaluation.  Even if I were to stand peacefully on the sidewalk in front of a mental health center distributing anti-psychiatry pamphlets, it is unlikely that I would be molested, though I might be asked to keep a certain distance back from the door and not to impede pedestrian traffic, etc…

But, if I go inside the building and start noisily and agitatedly berating the psychiatrists, and tearing down the pharma-distributed infomercial posters, I will likely be arrested within five minutes.  And if I continue to express my views in a loud and agitated manner at the police station, and if my general presentation seems odd or eccentric, it is possible that I will be remanded to a psychiatric facility for a 72-hour evaluation, and will be assigned “a diagnosis of schizophrenia”.

This is the critical point.  It is the expression of unusual or non-conformist views, coupled with expressions of anger, agitation, and aggression, that precipitates many of these “diagnoses of schizophrenia” and subsequent “medical” incarcerations.  It is certainly possible for an individual to find himself in this situation without any display of anger or agitation.  But in many cases, it is presentations of this kind that draw official attention and result in civil commitment, incarceration, and forced drugging, even though the person may not have committed any crime.  And yet, amazingly, it is almost unheard of for these interventions to entail any inquiry into the source(s) of the agitation or any attempt to ameliorate the anger in any way other than with tranquilizing drugs.

The central issue is not whether “antipsychotics” are effective in the treatment of “schizophrenia”, but rather, whether major tranquilizers are effective in the suppression of anger, agitation, and aggression.  And of course, they are, provided we discount the fairly common adverse effect of akathisia, the manifestation of which, incidentally, according to Dr. Frances’s own Guidelines, may be confused with – and the irony of this is beyond words – “psychotic symptoms”. (p 55).  (In other words, one of the long-established adverse effects of the drugs is to make a person seem crazy – and, presumably, eligible for more “treatment”!)  But, for the most part, the drugs are strong tranquilizers which reduce general activity and speech, and dampen feelings and emotions.

Neuroleptic drugs have often been called chemical straightjackets.  And the question as to whether or not these products should be used to control agitation, anger, and aggression, is not a medical matter.  It is a human rights/legislative issue.  The use of physical restraints by law enforcement officers is subject to ongoing legislative and judicial oversight, but the use of chemical restraints by psychiatrists is effectively unregulated.  The fundamental question is not:  are antipsychotic medications effective in the treatment of schizophrenia, but rather:  is it morally acceptable to use major tranquilizers, that have devastating adverse effects, as chemical restraints, frequently for years and even decades?  It is time to start calling a spade a spade; and it is beyond time for legislative and judicial bodies to recognize the abuse and deception in this area and to take appropriate action.  There is a pressing need to recognize that these products are not medications in any ordinary sense of the term.  They are chemical restraints.

The Use of Neuroleptic Drugs as Chemical Restraints 

On July 17, I wrote a post on the use of neuroleptic drugs as chemical restraints in nursing homes.  The article generated some comments, one of which touched on some very fundamental issues which, in my view, warrant further discussion.  The comment was from drsusanmolchan and read as follows:

“All drugs can be dangerous toxic chemicals when not used appropriately. While many valid points are made in this article, it’s very one-sided and could be considered biased in that it’s written by a psychologist. I’ve seen many patients and families benefit from their use.

Dr Susan Molchan (psychiatrist who doesn’t ascribe to DSM or Pharma)”

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

“All drugs can be dangerous toxic chemicals when not used appropriately.”

Let’s consider an example of a real medication, prescribed to treat a real illness.  If a person has complete kidney failure, he inevitably becomes anemic, because it is a secretion from the kidneys that triggers the bone marrow to produce red blood cells.  To counteract this problem, nephrologists prescribe EPO, or a more modern substitute (darbepoetin alfa), which compensates for the kidneys’ deficit, and resolves the anemia.  This is a perfect example of a medication correcting a functional pathology within the organism.  Of course, if the nephrologist prescribes too much medication, then the concentration of red cells in the bloodstream will get too high, and the medication can truly be said to be having a toxic effect.

But this is not at all comparable to what happens with psychiatric drugs.  Despite decades of deceptive assurances to the contrary, no psychiatric drug has the effect of correcting a functional or structural pathology within the organism.  In fact, the reverse is the case:  all psychiatric drugs operate by creating a pathological state within the organism.

EPO and darbepoetin alfa can indeed become toxic if administrated in wrong doses – but they are not in and of themselves toxic to the organismAll psychiatric drugs are toxic in and of themselves regardless of dosage.  The so-called therapeutic effect and the toxic effect are one and the same.

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

 “While many valid points are made in this article, it’s very one-sided and could be considered biased in that it’s written by a psychologist.”

Whilst I appreciate the recognition that the article contains “many valid points,” I find myself troubled slightly by the notion that it could be considered biased because “…it’s written by a psychologist.”

My arguments against psychiatry are, and have always been, based on logic and evidence.  Turf is not an issue.  Indeed, I am as critical of psychologists who endorse psychiatry’s spurious philosophy and practices as I am of psychiatry itself, and I am strongly opposed to the extension of prescription authority to psychologists.

I will admit, however, that I am biased!  I am biased towards cogency, critical thinking, honest, impartial research, etc…And I am biased against spurious, simplistic explanations; corruption; and despotic paternalism.  But I am not biased towards psychologists, as such.

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

“I’ve seen many patients and families benefit from their use.”

What Dr. Molchan has written in this one short sentence is the essence of psychiatry’s claim to legitimacy:  the drugs work.

My contention, of course, is that the drugs don’t work, in the sense that any putative short-term benefits are far outweighed by the long-term adverse effects.  I have discussed this matter throughout the website with regards to the various classes of drugs that psychiatry uses, but for now I would like to focus on neuroleptics, which is what my original article was about.

My point was that the neuroleptics were – and are – being used as chemical restraints with people who are agitated, aggressive, or otherwise “difficult to manage.”  The article referred specifically to nursing homes and DD group homes, but it is my general contention that neuroleptics are used in this way in all contexts.  Psychiatrists routinely refer to these drugs as “anti-psychotics,” implying that they target crazy thinking.  This is not only erroneous, it is a blatant lie.  They are neuroleptics in the sense that they “grab hold” of the nervous system and have a marked tranquilizing effect.  In an earlier post, Agitation and Neuroleptics, I drew attention to two experiments in which mental health workers had voluntarily taken neuroleptics in order to assess and describe the effects.  Both studies reported marked drowsiness and sedation as the dominant effect.  Neuroleptic drugs also give rise later to a wide range of devastating adverse effects, including a marked increase in movement and agitation – but that’s a different issue.

My primary contention here is that they are used as restraints, and in many cases this is done without the client’s consent.

Western laws on forcible restraint, both statutory and regulatory, have been developed over centuries, and are still developing.  They vary somewhat from place to place, but in all situations, the restrainer is required to act within the limits of the law, and is subject to judicial review in doubtful cases, and to censure, if it is found that the degree of restraint was excessive.

By medicalizing agitation, aggression, and general “unmanageability,” however, psychiatry has effectively skirted and insulated themselves from the ordinary legal safeguards that differentiate civilized society from police states.

In a civilized society, if a police officer injures a person he is restraining, he will be required to answer for this.  Essentially he will have to show that the degree of restraint he applied was needed to ensure safety.  Obviously there are cases of abuse – but that is the standard.  An officer convicted of using excessive force will face sanctions.

But in the psychiatric context, the pretense is made that the chemical restraint is actually medicine needed to treat an illness.  The resulting damage is ignored, and psychiatrists are almost never held accountable.  On the rare occasion that they are held accountable, it is not to the ordinary legal standards applicable to restraints, but rather to the medical standard of “established practice.”  And these standards are drawn up by psychiatrists themselves.  In this way, they manage to circumvent hundreds of years of common law, by claiming that they are doctors treating an illness, when in fact anybody who has had any experience with the system knows that the drugs are used as restraints.

The fact is that neuroleptic drugs do act as chemical restraints, and that is the main use to which they are put in psychiatric practice.  Given their devastating adverse effects, this ought to be a matter of huge concern.  The people who are forcibly restrained in this way are truly living in a pre-civil rights world.  Their restrainers are not held to the same standard of accountability and responsibility as police officers and others whose jobs require them to use physical restraints on occasion.  This situation is all the more disturbing in that the damage potential with the chemicals is so much greater than with physical restraints.

It is time that we as a society come to terms with the reality that these drugs are not medications in any ordinary sense of the term.  They are chemical restraints with no medical qualities whatsoever.  The travesty of hiding these procedures in the guise of “necessary medical intervention” needs to be exposed and brought to an end.

Neuroleptics and Tardive Dyskinesia in Children

There’s an interesting February 11, 2014, article on Peter Breggin’s website:  $1.5 Million Award in Child Tardive Dyskinesia MalpracticeThanks to Mad in America for the link.

Here’s the opening paragraph:

“On February 11, 2014 a Chicago jury awarded $1.5 million to an autistic child who developed a severe case of tardive dyskinesia and tardive akathisia while being treated by psychiatrists with Risperdal and then Zyprexa between 2002 and 2007. The drug-induced disorder was diagnosed when he was fifteen years old and by then had become disabling and irreversible.”

Tardive dyskinesia is a movement disorder characterized by repetitive, involuntary movements, including:  grimacing, tongue movements, chewing, lip smacking, puckering of the lips, purposeless limb and body movements, etc…  The movements are sometimes described as Parkinsonian-like.

Tardive akathisia involves feelings of inner restlessness that can range from a mild sense of inner discomfort to an almost unbearable feeling of generalized tension. Victims of this condition can seldom sit still.  They usually pace a great deal, sometimes for hours on end, and even when they sit or lie down, their limbs are in more or less constant motion.

Apparently the individual in Dr. Breggin’s paper was diagnosed with autism as a child and was prescribed SSRI’s before the age of seven.  The SSRI’s caused some deterioration in the child’s behavior and mental condition, to combat which his first psychiatrist prescribed Risperdal (risperidone).  Subsequently a second psychiatrist added Zyprexa (olanzapine) to the cocktail.  Both Risperdal and Zyprexa are neuroleptics (euphemistically known in psychiatric circles as antipsychotics), and are known to cause tardive dyskinesia.

On the face of it, one would think that this would be a big story.  One can picture the headline:  “Psychiatrists Destroy Child’s Brain.”  But in fact, the only references to this case that I’ve been able to find are the present article on Peter Breggin’s site, and links to Dr. Breggin’s article on Mad in America and Carl Elliott’s blog (Fear and Loathing in Bioethics).  Pharma’s stranglehold on the media is as effective as a government security blackout.

The truly tragic aspect of all this is that the neurotoxic effects of SSRI’s and neuroleptics are well known.  It’s not like the thalidomide tragedy of the early 1960’s, in which the teratogenic effects weren’t known until it was too late.  At which point, incidentally, the drug was taken off the market.

In the case of neuroleptics, or major tranquilizers as they used to be called, the link to tardive dyskinesia has been known for decades.  In fact, Jean Delay and Pierre Deniker, French psychiatrists who are generally “credited” with introducing neuroleptics into psychiatry in the early 1950’s, promoted the notion that the dyskinesic effect was linked to the putative therapeutic effect.  For this reason, they routinely raised the dose until this produced noticeable dyskinesia.

As the second generation neuroleptics became available, it was widely touted by pharma and by psychiatrists that these new drugs would not cause tardive dyskinesia.  That claim is now discredited.  The second generation neuroleptics do cause tardive dyskinesia, though perhaps at a slower rate than the earlier drugs. [CATIE Study]

The incidence of tardive dyskinesia among people who take neuroleptics is high.  The risk generally increases with higher doses and longer duration.  Psychiatrists justify this neurotoxification on the grounds of the “benefit” outweighing the risk, but it is truly difficult to imagine what benefit the individual in this case derived from these drugs that would outweigh his present plight.

Another argument that psychiatrists use in this area is that through careful observation, they can spot tardive dyskinesia in its very early stages, and by stopping the drug at that point, can arrest the problem.  The argument is specious, however, on two grounds.  Firstly, although the drugs cause this problem, they also mask its manifestation.  By the time the problem is sufficiently pronounced to break through the masking effect, it has already reached an advanced stage.  Secondly, the tardive dyskinesia is not only a disabling and disfiguring movement disorder, it is also an indication of more generalized neurological damage.  Here’s a quote from Joseph Glenmullen’s book Prozac Backlash (2000):

“We still do not fully understand how tics reflecting permanent brain damage develop with major tranquilizers.  But when one looks at the symptoms, the best model to explain them is that the appearance of noticeable tics is merely the final stage in a process of slow, progressive damage.” (p 57) [Emphasis added]

For readers who are not familiar with tardive dyskinesia, there are videos herehere, and here.  If you do a Google search, you can find others.

In my experience, there is a widespread belief among the general public that tardive dyskinesia is a “symptom” of the condition known as schizophrenia.  Almost everybody over the age of 40 who has been “diagnosed” as “schizophrenic” has been prescribed neuroleptics, and most of these people have tardive dyskinesia, so it’s not surprising that the public is confused.  Tardive dyskinesia is extraordinarily disfiguring and disabling, and serves to confirm the popular view – avidly promoted by psychiatrists – that “schizophrenia” is a progressive brain disease.  This is even more the case in that, as the victims of this neurotoxic assault continue to ingest these drugs, their presentation becomes steadily more disfiguring and more stigmatizing – “confirming” that “schizophrenia” is a progressive condition.

Organized psychiatry routinely claims that it is working hard to reduce the stigma associated with “mental illness,” and they castigate us “mental illness deniers” for allegedly increasing this stigma.  If psychiatry were seriously interested in destigmatizing these individuals, they would take some of the money that they are currently using to promote their profession, and use it to tell the public the truth:  that tardive dyskinesia is caused by psychoactive drugs!; that tardive dyskinesia is caused by psychiatrists and is entirely preventable.  But apparently the APA feel that they have better things to do with their money.

Psychiatry in America today is little more than a marketing arm for pharma.  Neuroleptics are neurotoxic drugs that, at least initially, have a controlling and dampening effect on agitated, aggressive behavior.  In the long term – and psychiatry routinely promotes them as long-term treatments – they are fraught with truly horrendous adverse potential.

Whatever might be argued about their use for consenting adults (and I recognize psychiatry’s creative understanding of the word “consent”), it’s difficult to even imagine how practitioners can foist these products onto children, whose brains are still developing.  By what kind of mental gymnastics can a psychiatrist prescribe these products to a child, and at the same time maintain even a semblance of self-esteem?

How much more destruction and how many more lawsuits is it going to take before psychiatrists recognize the obvious truth:  that you can’t help people by damaging their brains?  What is it about psychiatry that renders its adherents so narcissistically unreceptive to this patently clear reality?

In December 2012, Mark Olfson, MD, et al, published an article in the Archives of General Psychiatry.  The title is National Trends in the Office-Based Treatment of Children, Adolescents, and Adults with AntipsychoticsThe authors collected data from the National Ambulatory Medical Care Surveys for the period 1993-2009, and looked for trends in antipsychotic prescribing for children, adolescents, and adults in outpatient visits.  Here are the results:

Age Increase in no. of antipsychotic prescriptions per 100 population (1993-2009)
0-13 0.24-1.83 (almost 8-fold)
14-20 0.78-3.76 (almost 5-fold)
21+ 3.25-6.18 (almost 2-fold)

 

The authors provide a breakdown of the diagnoses assigned to the children and adolescents during the antipsychotic visits.

Diagnosis Visits %
Children
(0-13)
Adolescents
(14-20)
Schrizophrenia 6.0 8.1
Bipolar 12.2 28.8
Depression 11.2 20.9
Anxiety 15.9 14.4
Dev Disorders 13.1 5.0
Disruptive Behavior Disorders 63.0 33.7
Other Dx’s 18.0 16.8

 

Percentages do not total 100, because some individuals were assigned more than one diagnosis.

As one can see, the most frequent use of these products for children of all ages, but especially for those under the age of 14, is disruptive behavior disorders.  In other words, the drugs are being used to control misbehavior.

On September 24, 2012, an article by Richard Friedman, MD, psychiatrist, appeared in the New York Times.  The article was titled A Call for Caution on Antipsychotic DrugsHere’s a quote:

“…there has been a vast expansion in the use of these second-generation antipsychotic drugs in patients of all ages, particularly young people. Until recently, these drugs were used to treat a few serious psychiatric disorders. But now, unbelievably, these powerful medications are prescribed for conditions as varied as very mild mood disorders, everyday anxiety, insomnia and even mild emotional discomfort.”

There is nothing to suggest that Dr. Friedman’s call for caution has been heeded.  In fact, according to Drugs.com, Abilify (aripiprazole), a second generation neuroleptic, was the best-selling drug in the US for all four quarters of 2013. (Q1, Q2, Q3, and Q4.)  Not just the best-selling psychiatric drug – the best selling drug, period!

Psychiatry is not something good that needs some minor corrections.  Psychiatry is something fundamentally flawed and rotten.  Organized psychiatry is so intoxicated by its own self-congratulatory rhetoric, that it has rendered itself blind to the reality – that it is destroying people’s brains.

Psychiatric Dogmatism

In November, Joanna Moncrieff, MD, a British psychiatrist who works as a Senior Lecturer in psychiatry at University College London and a practicing consultant psychiatrist, started her own blog.  What’s remarkable about this blog is that it is highly critical of psychiatry.  Dr. Moncrieff marshals important facts and arguments in this area, and it is probably safe to say that her popularity among her peers is in decline.

The facts that she adduces, however, are indisputable, and her qualities of honesty, courage, and integrity are evident in everything she writes.

So far, she has written six posts. The central theme of three of these posts is antipsychotic (or as I prefer to say, neuroleptic) drugs.

Psychiatry has its head in the sand: Royal College of Psychiatrists rejects discussion of crucial research on antipsychotics (Dec 20)  Quote:

“It seems not to be interested in discussing the serious harm its drugs can do to both physical and mental health, and in taking the steps necessary to minimise this harm. The profession appears to believe that if it keeps quiet about these inconvenient findings, and discusses them as little as possible, the fuss will blow over and nothing need change.” 

Antipsychotics and brain shrinkage: an update (Dec 13)  Quote:

“People need to know about this research because it indicates that antipsychotics are not the innocuous substances that they have frequently been portrayed as. We still have no conclusive evidence that the disorders labelled as schizophrenia or psychosis are associated with any underlying abnormalities of the brain, but we do have strong evidence that the drugs we use to treat these conditions cause brain changes. This does not mean that taking antipsychotics is not sometimes useful and worthwhile, despite these effects, but it does mean we have to be very cautious indeed about using them.”

Long-term Antipsychotics – making sense of the evidence (Dec 9)  Quote:

“This study [Wunderink et al] should fundamentally change the way antipsychotics are used. These are not innocuous drugs, and people should be given the opportunity to see if they can manage without them, both during an acute psychotic episode and after recovery from one. If psychiatrists had not forgotten the lessons of the past, and if they had been prepared to acknowledge what they saw the drugs doing with their own eyes, this would have come about long ago.”

Whilst all of Dr. Moncrieff’s writing is compelling, it was this last quote that particularly caught my attention, and caused me to articulate the following questions:

  • Why have psychiatrists not acknowledged what they saw the drugs doing with their own eyes?
  • How did it come to be that highly educated and intelligent people became so enamored of their professional dogma that they failed to recognize the damage that neuroleptic drugs were doing and continue to do?
  • And, with particular reference to the last decade or so, how have they been able  to participate, apparently with clear consciences, in the huge increase in the use of these products, even to children as young as 2 years? 

In my view the answers to these questions fall into two general categories:  self-interest and fear.

SELF-INTEREST

For the past fifty or sixty years, the prescribing of psychopharmaceutical products has brought considerable benefit to the psychiatric profession.  Firstly, it has provided them a good living ($190,000 per annum in the US) for relatively non-taxing work (15- minute med checks).  Secondly, it has boosted their perceived status in the eyes of other medical practitioners.

It’s largely forgotten now, but during the 60’s and even into the 70’s, psychiatrists were widely regarded by the medical community as a coterie of quacks who delved endlessly and pointlessly into such chimerical abstractions as unconscious impulses, Oedipus complexes, ids, etc…  Today psychiatrists prescribe drugs, have their own medical journals which often have pictures of brain scans, and conduct randomized controlled trials.  They’ve become “respectable,” or at least somewhat respectable, and they recognize that this respectability is intrinsically dependent on their symbiotic relationship with pharma.

FEAR

The kind of fear that I’m talking about here might more correctly be termed peer pressure – the fear of being ostracized or marginalized by one’s professional colleagues.  In my interactions with psychiatrists during my career, I gained the impression that in medical colleges there’s relatively little emphasis placed on discussion and opinions, and relatively high emphasis on absorbing the facts as passed down by the academics.  Other disciplines stress discourse and debate, especially at doctoral level, but medicine leans towards a traditional didactic model and conformity to orthodoxy.  I’m not saying that this is necessarily a bad thing.  Four years of medical school passes quickly, and there’s a lot of factual material to be learned.  But the inevitable result is that medical practitioners tend to be followers of orthodoxy rather than innovators.  The rationale is that the academic researchers will pursue the innovations, and the toilers in the field will follow protocol.

In and of itself this isn’t a bad model.  Similar dynamics occur in engineering.  But – and this is crucial – for the past 40 years or so academic psychiatry has been hijacked by pharma!  The only innovation that’s allowed to occur is:  more drugs for more people.

In this kind of context it’s almost impossible for a junior psychiatrist in a hospital or a mental health center to challenge the standard philosophy.  And as the years pass, it becomes even more difficult, because any challenge of this sort inevitably involves a critical review of one’s own career.

It’s almost as if there’s a macabre conspiracy of silence among psychiatrists concerning the spuriousness of their concepts and the damage they inflict on their clients.  In their “hearts” they all know that it’s there, and that it’s enormous, but no one is allowed to talk about it.  No one is allowed to wake the monster, because they intuitively know that the monster will devour them all.

 

Neuroleptics for Children: Harvard’s Shame

In December 2012, Mark Olfson, MD, et al, published an article in the Archives of General Psychiatry.  The title is National Trends in the Office-Based Treatment of Children, Adolescents, and Adults with AntipsychoticsThe authors collected data from the National Ambulatory Medical Care Surveys for the period 1993-2009, and looked for trends in antipsychotic prescribing for children, adolescents, and adults in outpatient visits.  Here are the results:

Age Increase in no. of antipsychotic prescriptions per 100 population (1993-2009)
0-13 0.24-1.83 (almost 8-fold)
14-20 0.78-3.76 (almost 5-fold)
21+ 3.25-6.18 (almost 2-fold)

 

The authors provide a breakdown of the diagnoses assigned to the children and adolescents during the antipsychotic visits.

Diagnosis Visits %
Children
(0-13)
Adolescents
(14-20)
Schrizophrenia 6.0 8.1
Bipolar 12.2 28.8
Depression 11.2 20.9
Anxiety 15.9 14.4
Dev Disorders 13.1 5.0
Disruptive Behavior Disorders 63.0 33.7
Other Dx’s 18.0 16.8

 

Percentages do not total 100, because some individuals were assigned more than one diagnosis.

It is clear that disruptive behavior disorders are the most common diagnoses used in antipsychotic visits for both children and adolescents.

Thirty years ago, the prescription of neuroleptic drugs to children under 14 years of age was almost unheard of.  It was rare in adolescents, and even in adults was largely confined to individuals who had been given the label schizophrenic or bipolar.

By 1993, the first year of the Olfson et al study, about a quarter of 1% of the national childhood population were receiving antipsychotic prescriptions during office visits.  The percentage for adolescents was about three quarters of 1%.  By 2009, these figures had increased to 1.83% and 3.76% respectively.

The devastating effects of these neurotoxic drugs are well known, and it is natural to wonder what forces might be driving this trend.  The authors suggest that:

“Increasing clinical acceptance of antipsychotics for problematic aggression in disruptive behavior disorders may have increased the number of children and adolescents (especially male youths and ethnic/racial minorities) being prescribed antipsychotics.  The increase in the number of clinical diagnoses of bipolar disorder and autistic spectrum disorders among children and adolescents may have further increased antipsychotic use by youths, particularly by boys.”

They also note that:

“The trend in the prescribing of antipsychotics to youths occurred within the context of a dramatic increase in the clinical diagnoses of bipolar disorder among young people.”

The notion that the increase in the prescription of neuroleptics for children is driven by increased use of the bipolar diagnosis is supported by another study:  Most Frequent Conditions in U.S. Hospitals, 2010,  by Plunter et al, January 2013, published by the Agency for Healthcare Research and Quality (a division of the US Department of Health and Human Services).  This study, which analyzed hospital admission data from 1997 to 2010, found that mood disorder, which in 1997 had been in the fourth place (behind asthma, pneumonia, and appendicitis) was by 2010 the most common diagnosis for children aged 1-17.  In the 13-year period admissions for mood disorders had increased 80%, while admissions for asthma and pneumonia had decreased by 30% and 16% respectively.

Most of the increase in mood disorder frequency was for bipolar disorder.  In the period studied, admissions for children for depression rose 12%, but admissions for bipolar disorder rose 434% (from 1.5 per 100,000 population to 8.2).  For children in the age group 5-9, the increase was 696%! – a seven-fold increase.

So, over the last decade or two, we’ve seen a huge increase in the number of children being hospitalized for bipolar disorder and in the number of children being prescribed neuroleptics in office visits.

HOW DID THIS HAPPEN?

Neuroleptics are probably the most damaging drugs used in psychiatry.  The adverse effects, including permanent and extensive brain damage, are devastating, and occur in virtually all of cases where use is prolonged (Breggin, 2011, p 197).  In former decades, their use was confined mainly to adults who had been labeled schizophrenic or bipolar.  It was routinely claimed by psychiatrists that their benefits outweighed the risks, though this contention is not standing up to the increasing scrutiny that has occurred in the past decade or so.

The increase in the prescription of neuroleptic drugs for children is a direct consequence of the increased use of the bipolar label in that population.  And most of the responsibility for that increase can, in my view, be laid at the door of one person:  Joseph Biederman, MD, of Harvard Medical School and Massachusetts General Hospital.  Dr. Biederman will go down in history as the inventor of pediatric bipolar disorder.

DSM-III-R was published in 1987.  It makes no reference to the existence of childhood bipolar disorder.  The total entry under Prevalence is:

“It is estimated that 0.4% to 1.2% of the adult population have had bipolar disorder.” [emphasis added]

DSM-IV, published in 1994, greatly expanded the concept of bipolar disorder, essentially by removing the requirement of a manic episode or a mixed (manic-depressive) episode.  References to age are vague – e.g.:

“Approximately 10%-15% of adolescents with recurrent Major Depressive Episodes will go on to develop Bipolar I disorder.”

It is not clear whether this “development” might occur in late adolescence or in adulthood. There is no suggestion that bipolar disorder can occur in a pre-adolescent child.

By 1996, however, Dr. Biederman and his colleagues at Harvard were promoting childhood bipolar disorder as an accepted psychiatric diagnosis that needed to be treated with pharmaceutical products, including neuroleptics.  This was accomplished primarily by selling the notion that childhood temper tantrums could legitimately be regarded as symptoms of mania.  This blatant distortion of the traditional concept of mania was facilitated by the “not otherwise specified” (NOS) qualifier which has been a component of almost all diagnostic categories since DSM-III.  The purpose of the NOS diagnoses is to enable psychiatrists to assign the diagnosis in question to an individual even though he doesn’t actually meet the criteria.  The fact that this renders the criteria somewhat pointless is generally lost on psychiatrists, but that’s a different story.

What the Bipolar Disorder NOS diagnosis enabled Dr. Biederman and his colleagues to say was essentially this:

We know that temper tantrums aren’t really an integral component of bipolar disorder as it is traditionally conceived.  But we believe that that’s how bipolar disorder presents itself in young children, and so that’s what we’re going to call it.

This is on a par with dermatologists deciding that pattern baldness is a symptom of psoriasis!  In real medicine, this isn’t how it’s done, but in psychiatry it’s the norm.  The “diagnoses” are fictitious.  They can be created, modified, and eliminated with strokes of a pen.  This is what Dr. Biederman and his Harvard colleagues did, and American psychiatry followed.  The neuroleptics-for-children spigot was opened, and is running freely to this day.

The creation and promotion of pediatric bipolar disorder has been described and critiqued by several writers.  Joanna Moncrieff, a British psychiatrist, provides an excellent account in her book The Bitterest Pills (2013 , p 200-205).  Here are some quotes:

“Although it is the adult market that accounts for the bulk of sales of atypical antipsychotics, it is the use of these drugs in children alongside the emergence of the diagnosis of paediatric bipolar disorder that best illustrated the way in which a severe mental disorder can be morphed into a label for common or garden difficulties, as well as the role that money plays in this process.”

“Moreover, by locating the problem in the brain of the child, it seemingly detaches it from the situation within the family.”

“Academic psychiatry fuelled this craze, with added financial incentive from the pharmaceutical industry…”

“In the 1990s, a group led by child psychiatrist Joseph Biederman, who was based at Massachusetts General Hospital and the prestigious Harvard Medical School, started to suggest that children could manifest ‘mania’ or bipolar disorder, but that it was frequently missed because it was often co-existent with other childhood problems like ADHD and ‘antisocial’ behaviour…  In a paper published in 1996 the group suggested that 21% of children attending their clinics with ADHD also exhibited ‘mania’, which was diagnosed on the basis of symptoms such as over-activity, irritability and sleep difficulties…  A year later the group were referring to bipolar disorder in children as if it were a regular, undisputed condition, and emphasized the need for ‘an aggressive medication regime’ for children with the diagnosis…”

“Neither Harvard nor Massachusetts General Hospital nor any other psychiatric or medical institution has commented on the fact that prominent academics were found to be enriching themselves to the tune of millions of dollars through researching and promoting the use of dangerous and unlicensed drugs in children and young people.  Although some individual psychiatrists have expressed misgivings…academic papers continue to discuss the diagnosis, treatment and outcome of bipolar disorder in children as if no controversy existed, with more than 100 papers on the subject published in Medline-listed journals between 2010 and 2012.  Notwithstanding…the disgrace of Joseph Biederman, the practice of diagnosing children with bipolar disorder and treating them with antipsychotics remains alive and kicking.”

The spurious creation of childhood bipolar disorder has been critiqued also by Mickey Nardo, MD, a retired psychiatrist who blogs under the name 1 Boring Old Man (which, incidentally, he isn’t).  On July 2, 2011, he published a post called bipolar kids: an all too familiar lingo…  Here are some quotes:

“What happened in that second half of the 1990s is that they created a new diagnosis – Pediatric Bipolar Disorder. Looking at these articles…or at the COBY Study [started right around this time], Bipolar Disorder in children was becoming a common diagnostic term, but the diagnostic criteria bore little resemblance to the familiar symptom complexes from the Manic Depressive Illness of old. It was something new masquerading as something old [or vice versa]. These kids weren’t euphoric, they were irritable.”

“…the Biederman-led movement to broaden the category to call all kinds of difficult and disruptive children Bipolar had little to no scientific basis. It felt like a rationalization to use the new atypical antipsychotics to control difficult behavior-disordered kids – a trick.”

“And even without knowing what we know today about what happened, at the turn of the last century there was plenty of reason to smell a rat [named pharma]. The articles had all the tell-tale phrases – “urgent public health problem” “emerging new treatments” “need for more research” – an all too familiar lingo that pointed down a well-traveled yellow brick road. And this time it didn’t lead to Oz, it lead to Harvard University. And the guy behind the curtain was Joseph Biederman …”

Ultimately Dr. Biederman was disgraced – not for the spurious expansion of a diagnostic category.  Diagnostic expansion has been psychiatry’s primary agenda for the past 60 years.  A small minority of psychiatrists might have had reservations concerning Dr. Biederman’s work, but the mainstream psychiatry-pharma alliance embraced the new development with their customary zeal and self-serving enthusiasm.

Nor was Dr. Biederman disgraced because he had deliberately encouraged the exposure of thousands of children to neurotoxic chemicals.  Again, that’s just business as usual.  And in fact, he received awards and accolades for drawing attention to the plight of these tragically “underserved” children.  Here are some of the awards and honors he has received since his ground-breaking work on childhood bipolar disorder:

  • NAMI Exemplary Psychiatrist Award
  • NARSAD Senior Investigator Award
  • ADHD Chair of World Psychiatric Association
  • Outstanding Psychiatrist Award, Massachusetts Psychiatric Society
  • Excellence in Research Award, New England Council of Child and Adolescent Psychiatry
  • Mentorship Award, Psychiatry Department, Massachusetts General Hospital
  • William A. Schonfeld Award for outstanding achievement and dedication
  • Distinguished Service Award, MGH/McLean Child and Adolescent Psychiatry Residency

He was disgraced for under-reporting to his employers at MGH and Harvard the amount of money he was receiving from the pharmaceutical industry for conducting research that was used to promote their products.  Here again, there was nothing particularly unusual in this.  The so-called Key Opinion Leaders (KOL’s) in psychiatry have been awash in pharma money for decades.  But Dr. Biederman’s take ($1.6 million) was on the high side, and came to light at a time when the corrupt psychiatry-pharma alliance was being exposed nationally, largely through the efforts of Iowa Senator Charles Grassley.

Dr. Biederman was also criticized for promising Johnson & Johnson a positive result for their neuroleptic drug risperidone in pre-school children before he had actually conducted the research.  Obviously this makes a mockery of the research, but psychiatric research was hijacked by pharma marketing decades ago.  It has long since ceased to be a source of genuine scientific information, and much of it instead is little more than marketing material bought and paid for by the pharmaceutical industry.  Dr. Biederman’s error in this area was that he committed his promises to writing (in the form of slides that he presented to Johnson & Johnson executives), and these slides and other correspondence came to light during lawsuits against Johnson & Johnson for fraudulent marketing of their products.  These are the same lawsuits that Johnson & Johnson recently settled for $2.2 billion.

The great irony with regard to Dr. Biederman’s premature promise of a positive result for Johnson & Johnson is that he was absolutely correct!  If you give a neuroleptic drug to a misbehaved child, the incidence of misbehavior will indeed decrease.  If you give him enough, he’ll go to sleep and won’t misbehave at all!  That’s why these drugs used to be called major tranquilizers.  Dr. Biederman could accurately predict this result in advance because that’s what major tranquilizers do.  If you conduct a study to see if alcohol will make people drunk you’ll get a positive result.  If you conduct a study to see if major tranquilizers subdue childhood temper tantrums, you’ll get a positive result.  Dr. Biederman couldn’t use this defense, however, because he, like psychiatrists in general, has to play along with the big fiction:  that childhood temper tantrums are a symptom of an illness, and that the drugs are medicines targeting specific faults in neural circuitry or chemical imbalances or whatever.  Dr. Biederman’s proposed study would have produced a positive results for Risperdal in the same way that most industry-sponsored studies obtain positive results:  by limiting outcome criteria to the known effects of the drug, by keeping follow-up times short, and by ignoring adverse effects.

Dr. Biederman’s ethical lapses were thoroughly investigated (for three years) by his bosses at MGH and Harvard, and in 2011 they gave him and two of his colleagues (Thomas Spencer – total take:  $1.0 M, and Timothy Wilens – total take:  $1.6 M) very, very severe slaps on the wrists.  The Boston Globe covered this story.  Here’s a quote:

“The three psychiatrists apologized in their letter for the ‘unfavorable attention that this matter has brought to these two institutions.’  They called their mistakes ‘honest ones’ but said they ‘now recognize that we should have devoted more time and attention to the detailed requirements of these policies and to their underlying objectives.’

They said the institutions imposed remedial actions, requiring them to refrain from all paid industry-sponsored outside activities for one year, with an additional two-year monitoring period during which they must obtain approval before engaging in paid activities. They were also required to undergo unspecified additional training and suffer ‘a delay of consideration for promotion or advancement.'”

The notion that the ethical lapses of these three psychiatrists were “honest mistakes” is a little hard to credit, given that the total dollar amount was more than $4 M!

Today Dr. Biederman is fully rehabilitated and is back in business. He’s receiving research funding from ElMindA, Janssen, McNeil, and Shire, and is once again churning out research papers on topics such as ADHD and, guess what? – pediatric bipolar disorder.

THE BIG QUESTIONS

The two big questions in all of this are:

1.  Why do Harvard and Massachusetts General Hospital stand for this kind of blatant corruption and deception in the upper echelons of their psychiatry department?

2.  Why does the APA not take a stand against the medicalization and drugging of childhood temper tantrums – a problem that parents of previous generations simply took in their stride as an integral part of normal childrearing?

With regards to the APA, it’s really not much of a question.  Their agenda has always been: more psychiatric drugs for more people, and the neuroleptics-for-children development is really just business as usual.  They have dulled their ethical sensibilities through decades of prescribing benzodiazepines, SSRI’s, methylphenidate, and various other neurotoxins for an ever-widening range of human problems, and prescribing a neuroleptic to a 1½ year old for temper tantrums is a short step.

The APA, however, did express some mild concern about the spurious extension of the bipolar label to children.  In DSM 5 (p 132) they state:

“In individuals with severe irritability, particularly children and adolescents, care must be taken to apply the diagnosis of bipolar disorder only to those who have had a clear episode of mania or hypomania – that is, a distinct time period, of the required duration, during which the irritability was clearly different from the individual’s baseline and was accompanied by the onset of Criterion B symptoms.”

But rather than risk losing the pediatric business, hard-won by Harvard’s psychiatrists, they created a new diagnosis:

“When a child’s irritability is persistent and particularly severe, the diagnosis of disruptive mood dysregulation disorder would be more appropriate.”

The effect of all this is that psychiatrists can go on prescribing drugs for childhood temper tantrums, but instead of calling them bipolar disorder, they should use the new label:  disruptive mood dysregulation disorder – but they can continue to use the bipolar diagnosis also, with a few caveats, couched in the APA’s characteristically vague language.

Harvard’s stance on the scandals is a little harder to fathom.  After all, Harvard is hallowed ground – America’s Oxbridge.  It has acquired an image as a center of learning where educational and research standards eclipse all other considerations.

And in fact, there are legal and medical ethicists at Harvard who clearly recognize the implications of the psychiatric scandals.

Earlier this year, the Journal of Law, Medicine & Ethics (Vol 41, Issue 3) published a symposium of 17 papers written by members of Harvard’s Edmond J. Safra Center for Ethics.  Here are some of the titles:

Here are some quotes:

“The pharmaceutical industry has corrupted the practice of medicine through its influence over what drugs are developed, how they are tested, and how medical knowledge is created.” (Light et al)

“In this article, we analyze how drug firms influence psychiatric taxonomy and treatment guidelines such that these resources may serve commercial rather than public health interests.” (Cosgrove and Wheeler)

“Pharmaceutical and medical device companies apply social psychology to influence physicians’ prescribing behavior and decision-making.” (Sah and Fugh-Berman)

Clearly these papers are addressing important and relevant topics.  But what’s particularly noteworthy, from the present perspective, is that they originated in Harvard – the same institution in which senior psychiatry faculty members were hand-in-glove with pharma in the production of fraudulent research and advertizing.  How are we to understand this contradiction?  How are we to understand the minimal response from Harvard’s management, and incidentally from the other academic departments, given that such a wealth of ethical resources was there on their own campus, presumably available and willing to be consulted on these kinds of matters.

BUSINESS ETHICS VS UNIVERSITY ETHICS

In America, it is becoming increasingly recognized, and even accepted, that big businesses are frequently amoral.  Considerations of right and wrong are routinely subordinated to bottom line accounting.  Many big pharmaceutical companies are perceived in this light.  Indeed, the recent $2.2 B  penalty levied against Johnson & Johnson was discussed in some media outlets quite simply as a “cost of doing business.”  The question of whether it is a good thing to promote the use of neuroleptics for children doesn’t even come on the radar.  The perverse calculus is reduced to the difference between the projected profits from the drugs sales, and the fines and lawsuit settlements that might ensue.

Has Harvard’s Psychiatry Department, in concert with their pharmaceutical allies, crossed this line?  Have they now, implicitly or explicitly, adopted the ethical standards of the business world?  Have they subordinated their sense of decency and shame to considerations of prestige and revenue?

And what of the MGH/Harvard leadership?  Do they actually believe that the sanctions imposed on Dr. Biederman and his colleagues are adequate?  Or do they reckon that the years of past and future pharma revenue are worth the cost?  Have they crossed the line into the shady realm of business ethics?

And as we ponder these thorny questions, let’s not forget that the Johnson & Johnson lawsuit listed psychiatric researchers at other renowned universities, including Johns Hopkins, Stanford, UCLA, University of Illinois at Chicago, University of Texas at Austin, Georgia Regents, University of Toronto, and Dalhousie University.

Meanwhile the destructive prescribing continues, and Dr. Biederman is still at MGH, where he is Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, and at Harvard, where he is a full Professor of Psychiatry, a position, which, by his own account, ranks just below God!

Psychiatry’s primary agenda for the past 60 years has been the expansion of their diagnostic net to embrace an increasing range of ordinary human problems, and the unscrupulous prescribing of more and more psycho-pharmaceutical products to more and more people.  In the final analysis, Dr. Biederman’s problem was that he was particularly good at this job.  He was, in effect, a Model Psychiatrist – the perfect embodiment of everything that the APA stands for.

CLARIFICATION OF TERMINOLOGY

My frequent use of the term bipolar disorder in this article should not be interpreted as an endorsement on my part of the ontological validity of this expression, much less its status as an illness or disease.  I use the term bipolar disorder (and the various other so-called diagnoses) for the sake of readability and linguistic convenience.  What I mean by “bipolar disorder” is:  the vaguely defined and loosely clustered behaviors, thoughts, and feelings that psychiatrists call bipolar disorder.

Causes of High Mortality in People Labeled ‘Mentally Ill’

ANOTHER VIDEO FROM DR. LIEBERMAN

On October 28, Jeffrey Lieberman, MD, President of the APA, made another video.  This one is titled An Important Look at Mortality in Mental Illness: A Decade of Data on Psychotropic Drugs, and was made for Medscape.  You can see the transcript at the same site.  Medscape is a web resource for medical practitioners.

The video is Dr. Lieberman’s commentary on an article that appeared in JAMA Psychiatry online on August 28:  Comparative Mortality Risk in Adult Patients With Schizophrenia, Depression, Bipolar Disorder, Anxiety Disorders, and Attention-Deficit/Hyperactivity Disorder Participating in Psychopharmacology Clinical Trials, by Arif Khan, MD, et al.

Dr. Lieberman tells us that:

“The bottom line from this very good and important study, which was carried out with a large amount of data obtained from the administrative database of the FDA, is that psychotropic drugs are in the aggregate very beneficial — not just in suppressing patients’ symptoms, but in extending their overall survival and reducing mortality. In the ongoing debate in the literature as well as in the media about whether psychotropic drugs are overprescribed or are potentially detrimental to health, as physicians we must always be aware that medications should be used only when indicated and very judiciously in all people, particularly in children and the elderly — but we should never withhold them when they are needed, because they are very beneficial in terms of therapeutic effects. They should not be avoided, and their benefits are not substantially mitigated by concerns about adverse effects and shortened life spans.”

and

“They found, as has been previously reported many times, that individuals who have psychiatric disorders, and particularly schizophrenia, bipolar disorder, and depression, have lower overall survival (increased mortality). Of interest, being on a psychotropic medication (antipsychotic, mood stabilizer, bipolar medication or a combination of drugs) was associated with increased survival and lower mortality in patients with schizophrenia or bipolar disorder.”

WHAT THE ARTICLE ACTUALLY SAYS

The JAMA Psychiatry article by Arif Khan et al searched the FDA data bases for Summary Basis of Approval (SBA) reports of new and supplemental drug applications for 28 drugs approved between 1990 and 2011.

The researchers extracted mortality and drug exposure information from these SBA reports and collated the results.  The combined analysis included data on 92,542 clients.

The authors drew the following conclusions.

“These data suggest that increased mortality rates reported in population studies are detectable among adult patients with psychiatric illnesses participating in psychopharmacological trials. Furthermore, 3- to 4-month exposure to modern psychotropic agents, such as atypical antipsychotic agents, selective serotonin reuptake inhibitors, and selective serotonin-norepinephrine reuptake inhibitors does not worsen this risk. Given the inherent limitations of the FDA SBA reports, further research is needed to support firm conclusions.”

 So as you can see, there’s a huge discrepancy between the conclusions drawn by the authors and the “conclusions” promoted by Dr. Lieberman on his Medscape video.  Dr. Lieberman stated that:

“…psychotropic drugs are in the aggregate very beneficial — not just in suppressing patients’ symptoms, but in extending their overall survival and reducing mortality.” [Emphasis added]

The researchers point out that these studies entailed only 3-4 month exposure to the drugs – clearly not enough time to make any kind of definitive statement about reductions in mortality rates.  This is especially true in that psychiatrists routinely tell their clients that they need to take the drugs for extended periods – sometimes for life.

The researchers also point out that the FDA’s SBA reports have some “inherent limitations” with regards to the present study.  They discuss some of these limitations:

“Because of the abbreviated and variable form of FDA SBA reports, we could not assess premorbid history, age and sex of the clinical participant, family history, course of  illness, or details of any autopsy reports. Furthermore, deaths occurring among clinical trial participants exposed to placebo or active comparators were infrequent and difficult to interpret.”

and

“In addition, we could not fully evaluate all the clinical trial data for a variety of reasons. First, the data included in the FDA SBA reports in general consist of data from the registration or “pivotal” trials. These are only a fraction of studies conducted, and unfortunately data from the others cannot be accessed via the FOIA as interpreted by the FDA.” [Emphasis added]

And again, they stress the need for caution in interpreting their findings:

“Our results suggest that further detailed analysis of the clinical trial data by the FDA or the pharmaceutical companies is required before any firm conclusions can be drawn.

Furthermore, it is desirable to acquire much longer-term data, such as a decade in duration, regarding potential mortality risk when exposed to psychotropic agents based on the findings from the population studies. To obtain definitive results, prospectively designed studies are required.” [Emphases added]

DISCUSSION

It is clear that Dr. Lieberman has significantly misrepresented the results of the Khan et al study.  So there are two possibilities:  either he was genuinely confused, or he is consciously attempting to deceive medical practitioners who rely on Medscape.

The notion that he is genuinely confused is hard to sustain because in the first half of his video, he makes it clear that he is aware of the debate concerning the mortality-drugs link.  He says:

“This is important, because it has previously been suggested (and this fact has been used by critics of psychotropic medications) that psychotropic drugs, particularly the second-generation antipsychotic medications or mood-stabilizing drugs, contribute to side effects and medical comorbid conditions that shorten survival and increase mortality. These findings suggest that the opposite is true. Being on the medication in no way increased mortality; in fact, it actually reduced mortality, despite the fact that the studies that were obtained and analyzed were largely acute treatment studies of short duration, not the long duration that patients take these medications.”

Dr. Lieberman is obviously aware of the widely-expressed concerns that neuroleptics and SSRI’s are contributing to the increased mortality of people who take these drugs.  He is also aware that the toxic effects of these products are cumulative, and that most of the mortality effects become apparent in the long-term, rather than in the first 3-4 months.

He should also be aware of the following studies:

Bralet M C, et al, Cause of mortality in schizophrenic patients: prospective study of years of a cohort of 150 chronic schizophrenic patients, Encephale. 2000 Nov-Dec;26(6): 32-41. [original article in French].

“Concerning the comparisons between the deceased subjects and the survivors, there were five significant differences: gender, age, duration of the illness, neuroleptic dosage, negative symptoms (BPRS negative subscale). The deceased subjects were older, there was more men, the duration of the illness and the neuroleptic dosage were higher and the BPRS negative subscale was lower. These five variables were introduced in the discriminant analysis to explore notably their respecting weight. The corresponding power of the five variables were in decreasing order: neuroleptic dosage, negative symptoms, age, gender, duration of the illness.” [Emphasis added]

Honkola J, et al, Psychotropic medications and the risk of sudden cardiac death during an acute coronary event, Eur Heart J. 2012 Mar: 33(6): 745-751.

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

Osborn DP, et al, Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom’s General Practice eRsearch Database, Arch Gen Psychiatry. 2007 Feb; 64(2): 242-9.

“…a higher prescribed dose of antipsychotics predicted greater risk of mortality from CHD [coronary heart disease] and stroke.”

Berg K, et al, Pre-Admission Use Of Selective Serotonin Reuptake Inhibitors Is Associated With ICU Mortality, presentation American Thoracic Society 2012 International Conference, San Francisco.

“After adjusting for age, gender, ICD-9 diagnosis, disease severity and co-morbidities, the researchers found that patients on SSRI/SNRI’s prior to admission to the ICU were 73 percent more likely to die in the hospital (p<0.001), and that the increase in risk persisted at one year.”

Newcomer JW, Antipsychotic medications: metabolic and cardiovascular risk, J Clin Psychiatry. 2007; 68 Suppl 4:8-13.

“…psychotropic agents, including some antipsychotic medications, are associated with substantial weight gain, as well as with adiposity-dependent and possibly adiposity-independent changes in insulin sensitivity and lipid metabolism, which increase the risk of diabetes and cardiovascular disease.”

Sernyak MJ et al, Association of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia, Am J Psychiatry. 2002 Apr; 159(4):561-6.

“In this large group of patients with schizophrenia, receipt of a prescription for atypical neuroleptics was significantly associated with diabetes mellitus.”

American Diabetes Association Professional Tool #1: Screening and Monitoring in a High-Risk Population: Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease

“A 2004 American Diabetes Association (ADA) Consensus Development Conference concluded that certain SGAs [second generation antipsychotics] are associated with the potential for rapid weight gain, deterioration in lipoprotein profile and increased risk of type 2 diabetes. Although the mechanisms underlying these effects remain incompletely understood, these potential side effects are of significant concern because of the association between these adverse cardiometabolic events and risk for diabetes and premature cardiovascular mortality.”

Weinmann S et al, Influence of antipsychotics on mortality in schizophrenia: Systematic review, Schizophr Res. 2009 Aug; 113(1):1-11

“There is some evidence that long-term exposure to antipsychotics increases mortality in schizophrenia. More rigorously designed, prospective studies are urgently needed.” [Emphasis added]

On the basis of all this, it is difficult to avoid the conclusion that  Dr. Lieberman made and published this video with the express purpose of deceiving medical practitioners who rely on Medscape for up-to-date information.  He never once drew attention to the authors’ own cautionary statements.  Even his presentation’s title (as shown on the transcript) is misleading: An Important Look at Mortality in Mental Illness: A Decade of Data on Psychotropic Drugs.  Combining the words “mortality” and “decade” in a title gives the impression that mortality figures were tracked for a ten-year period.  This was emphatically not the case.  What was analyzed was a decade’s worth of data, all of which involved a 3-4 month follow-up period.

His statement towards the end of the video is unambiguous:

“They [psychotropic drugs] should not be avoided, and their benefits are not substantially mitigated by concerns about adverse effects and shortened life spans.”

When we remember the truly horrendous adverse effects of neuroleptics, SSRI’s, and benzodiazepines, it is an extraordinarily sweeping – even reckless – statement.

By way of contrast with Dr. Lieberman’s sweeping statement, here’s what Michael Birnbaum, MD, a psychiatrist at Zucker Hillside Hospital in New York said when asked by Medpage for a comment:

“The majority of the studies included in this paper were of 3 to 4 months’ duration, and so what we really need to do now is appreciate the long-term effects of these medications on the brain and the body…Our psychiatric patients are often on these medications for months if not years, so it would be important for us to recognize the potential impact of these medications on mortality long term.”

Of course Dr. Birnbaum is not an eminent thought leader like Dr. Lieberman.

Psychiatry is under attack on a wide range of fronts.  The attacks are founded, and psychiatry has no rational, coherent response.  All they can do is repeat their spurious mantra that all significant problems of thinking, feeling, and/or behaving are brain illnesses that need to be treated with drugs.  They are blind and indifferent to the damage and disempowerment that they leave in their wake, and they grasp at any straw to support and promote their position.  They appear to be incapable of critical self-appraisal.

INCIDENTALLY

Dr. Khan, psychiatrist, the principal author of the JAMA study, received $1,518,215 from pharmaceutical companies in the period 2010-2012 [Dollars for Docs].  At the present time he serves as Medical Director for two pharmaceutical companies:   Columbia Northwest Pharmaceuticals LLC, and Rhine Pharmaceuticals LLC, of Bellevue, Washington (from his curriculum vitae).

Dr. Khan owns and operates Northwest Clinical Research Center in Bellevue, Washington.  NWCRC is a prolific producer of psychiatric research.  They publish papers in journals, and on posters which are displayed at various medical association conferences.  I looked at two of their articles published in 2011:  Weisler RH, Khan A, et al, and Khan A, Cutler AJ, et al.  Both of these studies found favorable results for their sponsors’ products (Bristol-Myers Squibb and Forest Labs respectively).

MORTALITY AND PSYCHIATRIC “DIAGNOSES”

It is indeed the case that people who are assigned psychiatric “diagnoses” have generally higher mortality rates than the general population.  This fact is frequently presented as proof that the conditions in question are real illnesses.

The logic, however, is fallacious.  Mountain-climbers have higher than average mortality, but nobody would suggest that mountain climbing is an illness.  The same could be said of people who routinely ride bicycles in heavy traffic, engage in unprotected sex, work in dangerous occupations, etc…

The excess mortality associated with psychiatric “diagnoses” derives from two main sources:

Firstly, the DSM criteria that define these so-called illnesses contain many items that are, I suggest, intrinsically linked to higher mortality.  These include:  disorganized behavior; poor nutrition; lack of goal-directed activity; risk-taking; distractibility; disrupted sleep pattern; agitation; attempted suicides; feelings of guilt; social isolation; animosity towards others; outbursts of anger; neglect of health; etc… Psychiatry uses items like these to define “mental illnesses,” and then “discovers” that the people with these “illnesses”  have a high mortality rate.  In fact, the high mortality rate is built into their very definitions of these conditions.

Secondly, the drugs that psychiatry uses to “treat mental illnesses” all have toxic effects, which over time create medical problems and lower life expectancy.

So, instead of helping these individuals overcome these problems and lead fruitful and longer lives, psychiatry drugs them, often involuntarily, and thereby shortens their lives even further.

Psychiatry is not something good that needs some minor corrections.  It is something flawed and rotten that needs to be criticized, exposed, and ostracized.

Submitting Claims for Off-label Prescriptions to Medicaid May Constitute Fraud

In my view, one of the most destructive developments in psychiatry in recent years is the prescribing of neuroleptic drugs to children.  Much of this prescribing is off-label, meaning that the prescribed use is not approved by the FDA.  Off-label drug prescribing is legal, however.  Once the FDA has approved a drug for one purpose, a physician may prescribe it for another purpose.

But under Medicaid rules, the physician is not permitted to bill Medicaid for writing this prescription unless the use of the drug in the specific circumstances is endorsed by any of the three pharmaceutical compendia approved by Congress for this purpose.  A physician who deliberately submits a bill to Medicaid and, thereby, effectively causes Medicaid to pay for, a prescription that is both off-label and unapproved by any of the compendia is open to a charge of Medicaid fraud.  Medicaid, incidentally, is the US government’s health insurance system for poor people.  Eligibility is based on income.

Under the False Claims legislation, the physician writing the prescription and the pharmacist who fills it are both open to charges.

Between 2004 and 2008, Jennifer-King Vassel, MD, a child psychiatrist, reportedly wrote prescriptions for psychotropic drugs for N.B. (a minor).  In 2012, Toby Watson, PsyD, Clinical Psychologist, obtained a copy of N.B.’s medical record from N.B.’s mother.  Through an examination of the record, Dr. Watson established that there had been 49 prescriptions that met the false claim criteria outlined above.

Under whistle-blower status, Dr. Watson filed suit against Dr. King-Vassel for Medicaid fraud, on behalf of the U.S. government.  Such a procedure is fairly common, and would make Dr. Watson eligible for a share of any fraudulently obtained money that was recouped as a result of the suit.

However, the suit was summarily dismissed by the trial court on the grounds that Dr. Watson had not provided any expert witnesses to confirm that the prescribing was off-label and undendorsed by any of the official compendia.

The appeals court, however, on August 28 of this year, reversed the lower court’s finding, on the grounds that an expert witness is not necessary to determine if a drug is listed for a certain purpose in a pharmaceutical reference book.  You can see the ruling (No. 12-3671)  by the US Court of Appeals for the Seventh Circuit here.

So the case can now go ahead.

I think the case is important, because it is clear that psychiatry will never be dissuaded from its spurious and destructive practices by rational or ethical argument.  Journalists such as Robert Whitaker have made great strides in exposing and publicizing the abusive and disempowering face of psychiatry.  Numerous counselors, psychologists, social workers, and other professionals (and even some psychiatrists) have written volumes marshalling arguments and data, and presenting proven and convincing alternatives to the facile drugs-for-all-forever psychiatric creed.  But psychiatry has dug its heels in, and in fact, without a trace of compunction or hesitation, has increased the number of fictitious illnesses, lowered thresholds, and is routinely prescribing neuroleptics to children to control temper tantrums, and to elderly people in nursing homes to control “difficult” behavior.

Psychiatrists, with their cozy, corrupt ties to the pharmaceutical industry, have become so intoxicated by their own rhetoric and so buoyed by their marketing success that they have lost all sense of restraint, and perhaps even all sense of decency.  And with DSM-5, they have made it clear that as far as they are concerned, it’s full speed ahead – today America, tomorrow the World!

They will only stop when they are made to stop!

For this reason, I support these whistle-blower lawsuits, and I hope we see more of them in the coming years.

Incidentally, there’s a group called PsychRights – Law Project for Psychiatric Rights.  It’s a non-profit group, incorporated in Alaska.  Their purpose is “…to undertake a coordinated, strategic, legal effort seeking to end the abuses against people diagnosed with mental illness through individual legal representation.”  They also stress “…the necessity of educating the public about the truth and creating alternatives to the all drug, all the time mental illness system.”

PsychRights have made “…the massive psychiatric drugging of children and youth, especially poor, disadvantaged children…” a priority.  And who could argue with that?

Thanks to Becky on Twitter, and Mad in America, for the link to the court ruling.

Antipsychotics: A Euphemism for Neurotoxins

I guess everybody knows by now that Robert Whitaker spoke at the NAMI conference in San Antonio last Saturday (June 29).   You can view an outline of his speech, The Case for Selective Use of Antipsychotics here.  He spoke about the fact that for people who have been assigned a “diagnosis” of “schizophrenia,” long-term outcomes are better among those who took relatively little of neuroleptic drugs, and worse among those who took relatively more.

NAMI traditionally is a strong supporter of bio-psychiatry.  For years, Fuller Torrey was their champion and the psycho-pharmaceutical industry was their bank.  I’m told that they’ve recently distanced themselves from Dr. Torrey and have stopped taking pharma money, but I haven’t seen these reports confirmed.

Anyway, the reception to Robert Whitaker’s address was predictably mixed, and there has been a good deal of discussion on the ‘net.

This morning, thanks to Monica on Twitter, I read a comment that was written by Kathy Brandt concerning Robert’s speech.  Kathy is a former president of NAMI and served on their board of directors for six years.  She has a son, whom she says has “…been on and off antipsychotics for more than ten years to treat the psychosis that comes with his bipolar episodes.”

Kathy’s response to Robert’s speech is very balanced, e.g.:

“Most difficult for those with mental illness and their families, me included, was the fear that the medicine we have relied on was damaging and that we had put our trust in the wrong hands.”

In her comment, Kathy raised a number of interesting questions.  Here’s one of them:

“And how on earth do we treat people who are psychotic if not with antipsychotics?”

The fact is that neuroleptics are not antipsychotic drugs.  They are actually neurotoxic major tranquilizers with devastating side effects, including tardive dyskinesia, akathisia, and loss of brain tissue.

These products are called antipsychotics by psychiatrists and by the pharmaceutical industry in order to create, and maintain, the false impression that these drugs somehow target psychotic thinking.  In fact, they do have a suppressing effect on psychotic thinking in some individuals because they suppress all cognitive activity.

Using the term “anti-psychotic” to describe these toxic products is blatant and deliberate deception, but it has tragically become the norm in psychiatric circles.

Kathy – and this is not a criticism – bought the orthodoxy, and her question makes obvious sense.  After all, don’t we treat infections with antibiotics; hypertension with anti-hypertensives; fungus infections with anti-fungals, etc…?

Why wouldn’t one treat psychotic thinking with antipsychotics?  The only problem is that the drugs in this case are not antipsychotics.  (And, of course, psychotic thinking is not an illness, but that’s a different issue.)  The fact that Kathy phrased her question the way she did is a tribute to pharma marketing spin.  These guys really know what they’re doing!

Again, I stress, this post is not a criticism of Kathy.  She’s worried about her son and struggling to do what’s best.  But she has been cruelly deceived for ten years by the profit-driven psychiatry/pharma consortium.  My heart goes out to her.

Incidentally, in recent years these drugs are being widely used to control temper tantrums in children.  It will be interesting to see if psychiatry/pharma changes the name again to spin this development: “anger-abatement antipsychotics” perhaps?

And let’s not forget that these drugs are also being given to returning soldiers for “PTSD.”  “Anger-abatement, anti-painful memories antipsychotics”?

It’s time, I think, to call a spade a spade.

 

The Power of Words to Shape Attitudes

I recently wrote a post called:  Do Major Tranquilizers Make Things Worse?  The post was based on a study by Drs. Harrow and Jobe in which they speculated that the high relapse rate of “schizophrenics” who stop taking their drugs may have more to do with drug withdrawal than the supposed drug efficacy.

Monica, at BeyondMeds, pointed out that these drugs should not be called tranquilizers because some of their effects (e.g. akathisia, tardive dyskinesia, etc.) are anything but tranquil.  And this, of course, is a good point.

I refuse to call them “anti-psychotics” because this name implies that they somehow target psychotic behavior, which is simply psychiatric-pharma spin.  They target all behavior.  Monica suggested neurotoxic chemicals which, of course, is accurate but overly inclusive.  Almost all the psychotropic products are neurotoxic.  I think I’ll go with neuroleptic – something that grips the nervous system.  It’s accurate enough and has a connotation of damage or harm.

In general, I try to be fairly precise with language.  For instance, I don’t usually use the term “mental illness” without putting it inside quotation marks. I do this to make the point that “mental illness” is not something real.  It is a fictitious construct.

Similarly for terms like “schizophrenia,” “bipolar disorder,” etc., the quotation marks, though a hindrance to easy reading, do help clarify the fact that these terms have no objective reference, i.e. they do not correspond to anything that exists in the real world.

But Monica’s comment has me wondering if I need to go even further. Consider the term antidepressant, which I don’t normally put inside quotation marks.  But in fact, we know from numerous studies, including some that were initially suppressed by pharma, that these products do not actually lift depression, but rather contribute to chronic depression.  So perhaps that term needs to be inside quotation marks.

Words are vehicles of communication, but they can also be powerful attitude shapers.  I never use the term electroconvulsive therapy, with its connotations of benign high-tech care.  I prefer shock “treatment.”  But perhaps I should be saying something like electrical destruction of brain cells.  It’s cumbersome but more accurate.

In the same vein, I never use the term medication to describe psychotropic products.  Instead I say drugs.  Psychiatric neurotoxins would be more accurate, but perhaps the general reader might not realize what I meant.

Psychiatry and pharma are aware of the connotative power of words, and they routinely use pleasant or positive sounding names to disguise the true nature of their products and “services.”  (More quotation marks!)

I suggest that we need to become equally vigilant and adept at finding words that convey the spurious nature of their concepts and the destructive effects of their activities.

Or to put it simply:  Let’s watch our language!

 

 

Do Major Tranquilizers Make Things Worse?

BACKGROUND

On March 19 of this year an article by Martin Harrow and Thomas Jobe was published in the Schizophrenia Bulletin:  Does Long-Term Treatment of Schizophrenia with Antipsychotic Medications Facilitate Recovery?  You can see it here.  The term “antipsychotics” embraces drugs such as Haldol, Risperdal, Thorazine, etc…  I prefer the term major tranquilizers, because it is more accurate.

Drs. Harrow and Job have conducted a long-term (15-20 year) study of people diagnosed with the condition known as schizophrenia. They found that individuals who had been given “anti-psychotics” continuously for these long periods showed “…considerable psychopathology and few sustained periods of recovery.”

They also noted that the patients who were untreated (i.e. did not receive drugs) for many years “…showed significantly better outcomes than did those on antipsychotics.”

The authors examined the possibility that the individuals who came off the drugs were better risks to begin with, but they found that some of the “good risk” patients who stayed on the drugs did not show favorable outcomes.

The authors also discuss the finding that when people have been on the drugs for a prolonged period, and then come off the drugs, there is a fairly high relapse rate (25%-55%) within the first 6-10 months.  This is usually cited as evidence for the efficacy of major tranquilizers and for the widespread insistence within psychiatry that the drugs need to be taken for life.

MAJOR TRANQUILIZER WITHDRAWAL

Drs. Harrow and Jobe point out that this drugs-for-life position is incompatible with their primary finding – that in the long-term the undrugged individuals do better.  So they suggest an alternative explanation for the high relapse rate on discontinuation, namely, that the short-term relapses are essentially a reflection of drug withdrawal.  The idea is that the dopamine-blocking action of the major tranquilizers would, over the long-term, cause the organism to produce excess dopamine receptors (or supersensitive receptors).  Then, when the drugs are stopped, there is an abrupt and large increase in dopamine activity in the brain which would result in extreme cognitive and overt behavior.  In other words, while the major tranquilizers are being consumed, the organism is “trying” to normalize its functioning by making maximum use of what dopamine is available.  Then when the major tranquilizers are removed, brain activity increases markedly.

This notion is analogous to the familiar phenomenon of delirium tremens sometimes noted in sudden alcohol withdrawal after prolonged heavy drinking.

The authors call for further long-term research on this topic.  Robert Whitaker has written a helpful commentary on the article.  You can see it here.

SCHIZOPHRENIA IS NOT AN ILLNESS

My own view is that the condition known as schizophrenia is not an illness, and is not even a coherent unified phenomenon.  It arises from a profound and continuous sense of failure which in turn stems from an almost limitless number of reasons, including in many cases childhood neglect and abuse.  The individuals embraced by this “diagnosis” probably have only one thing in common:  the context in which they find themselves is not rewarding, does not bring them the sense of joy and fulfillment that most of us take for granted.  So they, very understandably, withdraw into a world of their own making. They sometimes feel anger and disenchantment towards the world – again very understandably – and their expressions of this anger, often expressed incoherently, bring them to the attention of the authorities.  Sometimes they feel apathy and despair, again very understandably.

MAJOR TRANQUILIZERS TRANQUILIZE

Major tranquilizers are not medications.  They are what the name says:  tranquilizers.  They reduce psychotic behavior because they reduce all behavior.  And they destroy brain cells.  Long-term use of these products has been likened to a lobotomy.  Almost all clients find these drugs very difficult to tolerate, and many (perhaps most) eventually stop taking them.  But if they do it too suddenly, they can precipitate a withdrawal reaction that is often worse then the presenting problem.  A graphic description of this is contained in Jean Davison’s book The Dark Threads.

There is only one genuine “treatment” for this non-illness: help the individual to find a sense of fulfillment in the world by helping him come to terms with the past, and acquire the skills he needs to create a meaningful and fulfilling future.  This has to be done with patience, compassion, kindness, and a profound respect for the person’s uniqueness.

Giving a person major tranquilizers, with their truly horrendous long-term effects, and abandoning him/her to the disempowering milieu of the clubhouse or sheltered workshop, is not only unhelpful, it is extraordinarily destructive.