Tag Archives: myth of mental illness

Mental Illness: A Man-made Monster

Nelson Mandela quote

 

I found the above image online yesterday, at the site The Things We Say.

Mental illness is also man-made.  It is the invention of psychiatry – their spurious medicalization of all significant problems of thinking, feeling, and/or behaving.  Its purpose is to legitimize the prescription of dangerous psychotropic drugs to as many people as possible.   It benefits psychiatrists and drug companies, but damages, stigmatizes, and disempowers its victims.

It was made, promoted, and expanded by venal, unscrupulous people.  It is justified by psychiatric leaders in the same way that slavery and apartheid were justified by their proponents in their respective eras.

Mental illness is a man-made concept that has no objective reference – it corresponds to nothing real.  An artifactual tribute to human self-deception, ambition, and greed, it is a wrong turning in the history of human development.  Every day thousands of people die prematurely on the altar of this gilded idol.

But like all spurious bigotry, it withers when exposed to the light of critical scrutiny.

If you’re not already doing so, please speak out.  Pass the word.  Just a few years ago, those of us who challenged psychiatric orthodoxy were marginalized as cranks and eccentrics.  The protests of psychiatric survivors were condescendingly dismissed as symptoms of their putative illnesses.  Today we are a worldwide movement, gaining daily in numbers and momentum.  Each one of us alone and isolated can achieve little or nothing.  But united, we can close once and for all this sordid chapter of human history.

 

Dr. Lieberman and ’60 Minutes’

On October 23, Psychiatric News (the APA’s media outlet) ran an article titled ‘60 Minutes’ Interviews APA President on SchizophreniaThe article was written by Mark Moran, a Psychiatric News reporter.

The piece opens with a quote from Jeffrey Lieberman, MD (President of the APA):

“’60 Minutes’ showed a genuine interest beyond simply producing what was expected to be a popular segment and indicated a desire to do follow-up reporting on psychosis and violence.”

The article provides a brief sketch of the 60 Minutes segment which aired on September 29, and a follow-up interview with Dr. Lieberman.  Dr. Lieberman recounts that there were three main themes in the interview:

1.  Schizophrenia is a brain disease that can cause people to be violent.
2.  Mental health services in the US are inadequate at present.
3.  The mass shootings “…are disproportionately caused by people with mental illness who have not gotten treatment”

Dr. Lieberman then stated:

“I was delighted that ‘60 Minutes’ did such a good job dealing with a complex and controversial topic.”

So I thought I’d take a look at the 60 Minutes segment, which was called Untreated mental illness an imminent danger?  It ran to 14 minutes, and you can see the transcript here.

Here’s the opening statement by CBS reporter Steve Kroft:

“The mass shooting at the Washington Navy Yard two weeks ago that resulted in the deaths of 13 people, including the gunman, was the 23rd such incident in the past seven years. It’s becoming harder and harder to ignore the fact that the majority of the people pulling the triggers have turned out to be severely mentally ill — not in control of their faculties — and not receiving treatment.”

This is followed by an interview with E. Fuller Torrey, MD, saying the kinds of things Dr. Torrey says:

“About half of these mass killings are being done by people with severe mental illness, mostly schizophrenia. And if they were being treated, they would’ve been preventable.”

The reporter applies this concept to James Holmes, the Aurora movie theater shooter who, we are told:

“… had been a brilliant graduate student…studying the inner workings of the brain, until something suddenly went wrong with his…”

Dr. Lieberman is then quoted as saying that this is not unusual:

“You can be the most popular student, you can be the valedictorian of your class. And if you develop schizophrenia it will change the functioning of your brain and change the nature of your behavior.”

There’s some footage of Dr. Lieberman working in a lab, dressed in a white coat and blue latex gloves, transferring liquid to a test tube with a pipette.  He shows the reporter some brain scan slides:

“You can see the structural abnormalities in a brain scan.”

The reporter asks:

“This is really a disease of the brain.  Not a disease of the mind?”

To which Dr. Lieberman replies:  “Absolutely.”

The rest of the segment is given to interview of clients, family members, and Tom Dart, Sheriff of Cook County, Illinois.

DISCUSSION

In the Psychiatric News article, as I mentioned earlier, Dr. Lieberman commended CBS for doing “… such a good job dealing with a complex and controversial topic.”

In fact, they did an extraordinarily biased and one-sided job.  Perhaps the most fundamental issue in this regard is the notion that the condition labeled schizophrenia is a brain disease.  There is a growing and convincing body of opinion (and research) that challenges this view.  If 60 Minutes had wanted to do a good job with a complex and controversial topic, they should surely have presented this alternative perspective.

Secondly, Dr. Lieberman in his white coat trotting out brain scan slides was nothing more than tawdry PR.  Here again, there is mounting evidence that the brain pathology noticed in people whom psychiatry labels schizophrenic is the direct result of the neurotoxic drugs used to “treat” this condition, rather than a feature of the so-called disease.  CBS made no mention of this, and made no attempt to challenge Dr. Lieberman’s facile contentions.

Thirdly, CBS accepted at face value the notion that the majority of the people pulling the triggers (in the mass shootings) have turned out to be “…severely mentally ill…and not receiving treatment.”

The only source they quote in support of this contention is Dr. Torrey who, incidentally, puts the figure at “about half,” and who is known for his one-sided views on this topic.

Fourthly, psychiatrists have been systematically expanding their diagnostic net for the past five decades.  Today, it is widely claimed that at any given time, a fifth of the population meets the criteria for a DSM “diagnosis.”  Virtually any kind of significant human problem is a mental illness.  Mass murderers tend to be people with problems.  So – by definition – mass murders are committed by people with mental illness.  This is psychiatric logic.

Fifthly, evidence is accumulating that some psychiatric drugs increase the likelihood of violent behavior.  There is also abundant anecdotal evidence that many of the mass shooters were taking psycho-pharmaceutical products at the time of the killings.  It was widely reported, for instance, that Aaron Alexis, the Navy Yard shooter whom CBS mentioned in the segment, had received two prescriptions for Trazadone (an antidepressant of the serotonin antagonist and reuptake inhibitor (SARI) class) from the VA in the weeks prior to the killings.

It is widely believed that Adam Lanza, the Newtown killer, was taking a psychiatric product at the time of the murders.  The Office of the Attorney General of Connecticut won’t release information on this, however, for fear that it might “…cause a lot of people to stop taking their medications”. This, I suggest, can only be interpreted as a confirmation that he was in fact on “meds.”

It has been reported in the media that James Holmes, the Aurora Movie Theater shooter, had psychotropic drugs and scripts in his home at the time of the shootings.

Psychiatry is under attack.  Its concepts are being exposed as spurious and disempowering, and its “treatments” denounced as dangerous and destructive drugging.

But they adamantly refuse to address these issues, and as the pressure increases, they retreat deeper and deeper into their cocoon of self-deception.  The only tactics they seem to understand are deception and spin.  It’s not – and never has been – a question of “how can we improve our performance?” but rather:  “how can we improve our image?”  They seem unable to grasp the reality:  that the illnesses they are promoting are spurious and the product they have been selling is destructive nonsense. They are drug-pushers masquerading as doctors.

And their latest spin plumbs a new depth – even for psychiatrists.  It goes like this:  “mentally ill” people are really dangerous.  They’re the ones who are behind these mass shootings.  We psychiatrists are the only ones who can save the world from this peril.  Just give us more money, and more psych wards, and more drugs, and more power, and we’ll be on the job like the super-heroes that we are.

Psychiatrists are capitalizing on the public’s fear to rescue their tarnished image, and have no hesitation in further stigmatizing their clients in the process.

 

Another Critique of Psychiatry’s Medical Model

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

Table of Contents

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

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

Here’s a quote from the final chapter:

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

I strongly recommend this book.

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

 

 

 

The Stigma Attached to ‘Mental Illness’

On Monday, October 7, 2013, The Sun, a British tabloid newspaper ran the following headline:  1,200 Killed By Mental Patients.  Shock 10-year toll exposes care crisis.  It took up almost all of the front page.

The headline precipitated a great deal of protest from politicians, advocacy groups, mental health professionals, and others.  The general points in most of these protests were that the headline was sensationalistic, misleading, and would serve to increase the stigma associated with “mental illness.”

Other British newspapers,  including the Guardian, the Independent, and the New Statesman, ran articles criticizing the Sun’s piece.

The Guardian pointed out that people with a history of “mental” problems are already considerably stigmatized, and cited interesting figures from an NHS survey.  The Guardian also challenged the accuracy of the 1200 figure, and stated that 738 was the true total for the decade.

The Independent reported on the various individuals and agencies that protested the headline.  The Independent also pointed out that people with mental illness are ten times more likely to be victims of crime than the average person.

The New Statesman attacked the Sun’s headline as misleading, and expressed the opinion that:

“…part of the reason the government is able to impoverish and stigmatise those receiving care in the community with relative ease, is that there has been a relentless campaign against mentally ill benefit claimants, a campaign led by right-wing tabloids like the Sun.”

The New Statesman also states that:

“In Britain and across the global north, one in four people will experience significant mental health problems in their lifetimes.”

Apparently the Sun has responded to these criticisms by claiming that they were not trying to stigmatize the mentally ill, but rather to draw attention to the fact that these people have been let down by inadequate mental health services over the past decade.

So what should we make of all this?

Firstly, I need to say that I have not read the Sun’s article because it’s behind a paywall, but I have seen a copy of the front page in question.  It’s embedded in some of the other papers, including The Huffington Post UK, and it is clearly sensationalistic, stigmatizing, and irresponsible.  But it probably sold copy, and that, I imagine was the idea.

Secondly, there are no mental illnesses.  Mental illness is the name, or label, that psychiatry gives to an ever-increasing range of human problems of thinking, feeling, and/or behaving, in order to promote psychiatric turf and to legitimize the sale of psycho-pharma products.  Psychiatrists have taken this notion a step further by actively promoting the unfounded notion that these “mental illnesses” are really brain illnesses, and that the drugs they prescribe are necessary to correct and “treat” these neurological malfunctions.

Thirdly, although psychiatry routinely claims that their relentless process of medicalizing human problems reduces stigma, the opposite is actually the case.  The promotion of biogenetic models of human problems actually increases stigma.  Angermeyer et al (2011) systematically reviewed 39 population studies  that had addressed the stigma question, and concluded that:

“…biogenetic causal beliefs or interventions are negatively associated with expectations of recovery and good prognosis.”

and

“…there seems to be a danger that biogenetic illness concepts increase rather than decrease public stigma of mental illness.”

So, reprehensible as the Sun’s headline was, it seems to me that its actual stigmatizing impact pales in comparison with that inflicted by bio-psychiatry over the last 50 years.

And in the same context, let’s not lose sight of American psychiatry’s present attempt to capitalize on the mass killings by promoting the notion that the “mentally ill” are inherently dangerous and will likely become more so unless mental health services are expanded.  This, despite the growing indications that psychiatric drugs are a significant causative factor in these incidents.

It’s one thing for a yellow press tabloid to engage in scaremongering sensationalism.  We expect no better.  But for a helping profession to engage in this sort of thing is, in my view, very questionable.  Here are a few examples:

Perhaps the truth is that psychiatry is not really a helping profession.

The Concept of Mental Illness: Spurious or Valid?

On January 17, 2013, Peter Kinderman, PhD, Professor of Clinical Psychology at the University of Liverpool, wrote an article titled Grief and Anxiety are not mental illnesses.

On February 4, 2013, Steven Novella, MD, wrote a critique of Dr. Kinderman’s article.

On February 20, I wrote a critique of Dr. Novella’s article.

And finally, on September 17, Dr. Novella wrote More On Mental Illness Denial and How Not to Argue, a critique of my critique.

There are a number of fundamental issues involved, and I feel I should try to address at least some of these.

THE CONCEPT OF MENTAL ILLNESS

In his critique of Dr. Kinderman’s article, Dr. Novella stated:

“The question is essentially how we should think about symptoms of mood, thought, and behavior.”

Apart from the word “symptom,” I am in complete agreement.  The essential question, the central issue at the core of this entire debate is:  how can we best conceptualize problems of mood, thought, and behavior.

I would prefer to say problems of feeling, thinking, and behaving (i.e. verbs rather than nouns) because in my view, this better reflects the fact that these are activities rather than entities.  But this is not crucial to the central issue.

However, the use of the word “symptom” rather than “problem” is central.  Dr. Novella is saying that the essential question is: how do we conceptualize problems of mood, thought, and behavior – but rather than address this question, he anticipates the answer – they are symptoms, which, I suggest, entails the clear implication that “behind” these “symptoms” there are “illnesses.”

Dr. Novella goes on to express the belief that the best approach (to problems of thinking, feeling, and behaving) is something that recognizes “… the relative roles of biology, situation, and culture (and their interactions) in forming a person’s mental state.”  And if by “mental state” he means thinking, feeling and behaving, then I would agree.

Next Dr. Novella points out that the brain is an organ which can malfunction.  I don’t think anyone would disagree with that.  But he goes on:

“Further, even a biologically healthy brain can be pushed beyond tolerance limits resulting in an unhealthy mental state. We can reasonably define ‘unhealthy’ in this context (probably a more appropriate word than ‘abnormal’) as follows – a mental state that is significantly outside the range of most people, may represent the relative lack of a cognitive ability that most people have, and results in definable harm. That last bit is critical – it has to be harmful.”

And this, of course, is where we have to part company.  Assuming, as I said earlier, that by “mental state” he means a kind of composite snapshot of an individual’s thinking, feeling and behaving, then in my view a mental state can be neither healthy nor sick, in any conventional sense of these terms.

But, as is clear from his definition of “unhealthy” quoted above, Dr. Novella is not using these terms in their conventional sense.  Let’s take a look at his definition:

  • significantly outside the range of most people
  • may represent the relative lack of a cognitive ability that most people have
  • and results in definable harm

This is clearly not a definition of sickness in the normal medical sense.

Now I will certainly concede that in common speech, the words sick and unhealthy have been considerably extended in recent decades.  People routinely talk about an unhealthy lifestyle, for instance, when what they mean is an unwholesome lifestyle; and behavior that is crude or offensive is often referred to as sick.  But in formal speech and writing, and certainly within general medical practice, the words sick and unhealthy mean something wrong with the anatomy or physiology of the organism.  One can speak of a sick person or a healthy person, or, for that matter, of a sick horse or a healthy horse.  But one can’t validly speak of thinking, feeling, and/or behaving as being sick or healthy.  The activity of thinking can legitimately attract adjectives such as cogent, muddled, inconsequential, bizarre, etc…  The activity of feeling could be described as painful, joyous, etc… The activity of behaving could be described as productive, counterproductive, relaxed, frenetic, etc…  But one can’t attribute sickness or health to thoughts, feelings, or behaviors any more than one can attribute the quality of color to concepts.

I can’t, of course, dictate to Dr. Novella how to use or not use words, but what has to be acknowledged is that when he uses the term “unhealthy mental state,” he is very emphatically not using the word unhealthy in the conventional, formal medical sense.  The adjectives sick and healthy simply don’t apply to the activities of thinking, feeling, and behaving in the same way that they apply to organisms.  And this is true even if the thoughts, feelings, and behaviors are “outside the range of most people,” and/or “result in definable harm.”

It is noteworthy that Dr. Novella expressed the belief that “unhealthy” is a better choice of word than “abnormal” without giving any reasons or arguments to support this position.  In my view, the choice of words like unhealthy, sick, ill, etc., in this context has no special value or advantage, and is, in fact, misleading.  The words also beg what Dr. Novella concedes is the fundamental question:  i.e. how best to conceptualize problems of thinking, feeling, and behaving; for Dr. Novella they are to be conceptualized as illnesses.

If Dr. Novella had stated that “…even a biologically healthy brain can be pushed beyond tolerance limits resulting in…” problematic thoughts, feelings, and or behavior, then we would be in general agreement.  But by arbitrarily labeling problematic thoughts, feelings, and/or behavior as unhealthy mental states (i.e. as mental illnesses), he is assuming the answer to the very question that he himself concedes is critical and essential to the whole issue.  For Dr. Novella (and indeed for psychiatry generally), problematic thoughts, feelings, and or behavior are mental illnesses.  This is not something they discover; rather, it is contained within their definition.  It is how psychiatry has decided to conceptualize these problems, and it is a decision that has profound implications in psychiatric practice.

STANDARD PSYCHIATRIC PRACTICE

All of this leads fairly naturally into a second point of dispute between Dr. Novella and myself.  It is my contention that it has become standard practice in American psychiatry to tell clients that their presenting problem, whether it be depression, anger, worry, paranoid thoughts, misbehavior, etc., is the result of a mental illness which is a real illness “just like diabetes” and needs to be “treated” with drugs.  Dr. Novella suggests that this is a caricature that he has never encountered in practice.

He expresses the belief that the standards and philosophy that underpin a profession can be gleaned from official publications, academics, and published standards rather than from the “average private practitioner in the field.”

To which I can only say that I disagree.  As a case in point, would the official publications, published standards, etc., of, say, ten years ago have alerted a naïve outsider to the extent to which psychiatric research and psychiatric prescribing had been corrupted by pharmaceutical money.  But even setting aside those kinds of unethical matters, it seems almost self-evident to me that the best way to find out what psychiatrists are doing is to interact with psychiatrists.  And in my experience, psychiatrists routinely say to their clients things like:  depression is an illness, just like diabetes; and just as a diabetic has to take insulin to treat his illness, so a person with depression must take his antidepressants.  This has never been any kind of secret.  I have often heard psychiatrists make these kinds of statements, and I have heard literally dozens (perhaps hundreds) of clients repeating these kinds of statements and attributing them to psychiatrists that they had seen.  In addition, this kind of message was a mainstay component of a good deal of psycho-pharmaceutical advertizing for years.  If this was not psychiatry’s philosophy, why did they not take steps to stop the ads or at the very least publish counter-information in appropriate places?

Now obviously, I haven’t conducted any kind of formal study of psychiatrists’ behavior, and my observations are limited by my experiences.  It’s possible that my interactions with psychiatrists and with clients have not been representative of American psychiatry generally.

However, I have just Googled the phrase “mental illness just like diabetes” and got 1.3 million hits!  So somebody has been saying that mental illnesses are real illnesses “just like diabetes” and the notion is generating a great deal of discussion.  I have also Googled the term “chemical imbalance” and got 960,000 hits.  Here again, it was psychiatry that promoted this concept, and it is still being discussed actively, and in my experience, is still widely believed.

In his September 17 article, Dr. Novella contends that the general practice of psychiatry is not based on the simplistic formula: mental illnesses are real illnesses just like diabetes, and are treated with drugs.  Rather, he states that psychiatric practice recognizes that problems of thinking, feeling, and behaving:

” …are caused by the full spectrum of influences from biology to social and environmental.”

It is certainly possible that Dr. Novella is accurately portraying psychiatric practice as he has experienced it.  But it is difficult to reconcile his portrayal with the fact that most psychiatric practice has degenerated into 15-minute “med checks” every two or three months.  How much attention can one give to social and environmental considerations in 15 minutes, given that at least some of this time is already budgeted for discussion of drug side effects?

From the tenor of his earlier writings, it occurs to me that Dr. Novella might dispute my contention that 15-minute “med checks” have become the norm, so I spent five minutes on the ‘net and found two articles.  The first is by Douglas Mossman, MD, Director of the Institute of Law and Psychiatry, University of Cincinnati.  It’s called Successfully navigating the 15-minute-‘med check’.  Here’s a quote:

“Even psychiatrists who deplore 15-minute med checks recognize that they have become standard care in psychiatry.”

The second article was published on Psychiatric Times in September 2009.  It’s called Deconstructing the “Med Check,” and was written by Glen Gabbard, MD.  Here’s a quote:

“There can be little doubt in our current era that the brief ‘med check’ is becoming standard practice in psychiatry.”

Even Jeffrey Lieberman, MD, President of the APA, has gone on record lamenting the practice of “…hurriedly written prescriptions…” which, incidentally, he attributes to changes in reimbursement systems.

BRAIN DISORDERS CAN CAUSE BEHAVIOR PROBLEMS

There are many specific points of contention between Dr. Novella and myself.  Attempting to pick up and unravel all of these would, I suggest, be tedious and repetitious.  But I would like to pick up just one which I think is representative.  Towards the end of his September article, he states:

“Hickey further explains his position toward the end of his post:

‘The deniers’ point, however, (or at least this denier’s point) is that mental illness is an archaic, pre-scientific concept with no explanatory value, exactly analogous to phlogiston or witchcraft.’

Wait – but I thought that brain disorders can cause behavior problems? Wouldn’t such a case that Hickey acknowledges exists be considered a ‘mental illness?’ I’m trying to be fair, but such comments certainly sound like mental illness denial to me.”

I had made the point in my earlier critique that brain problems can cause behavioral problems.  I have also stated that there are no mental illnesses; that the concept of mental illness is spurious.

Dr. Novella picks up my statement that brain problems can cause behavior problems and then claims to have caught me in a contradiction – because a brain problem that causes a behavior problem is a mental illness.  Therefore, mental illnesses must exist.

The flaw in the argument, however, goes back to the earlier discussion about the meaning of the term “mental illness.”  For Dr. Novella, any significant problem of thinking, feeling or behaving that entails harm is a mental illness.  My position is that mental illness is simply the label that psychiatrists give to significant problems of thinking, feeling, and/or behaving, and of course, that’s their prerogative.  They can call things by any name they wish.  A problem arises in this case, however, because the word “illness” already has an established meaning in the English language.  And labeling problems of thinking, feeling, and behaving as mental illnesses implies that they are illnesses in the conventional sense of the term.  Dr. Novella does indeed make it clear elsewhere that for him the “illness” in “mental illness” is being used in a special sense.  But this is fraught with potential for misunderstanding.  To maintain clarity under these conditions one would need to add the rider “(the word illness is not being used in its conventional sense)” every time one used the term “mental illness.”

But to get back to the point of contention, Dr. Novella has not caught me in an inconsistency.  Brain problems can indeed cause behavioral problems.  Late stage syphilis (when the germ attacks neural tissue) can cause a person to behave in a “crazy” manner.  What’s involved here is a brain illness (a real brain illness), of which the “crazy” behavior is a symptom (a real symptom).  That, for me, is the reality of the matter.  Dr. Novella, however, adds an additional component – that the “crazy” behavior is also a mental illness.  This is not some kind of additional fact or discovery.  It is simply Dr. Novella’s (and psychiatry’s) label being added arbitrarily and pointlessly to a perfectly clear medical phenomenon.  The fact is that the syphilis germ attacks the brain and causes “crazy” thinking and “crazy” behavior.  Dr. Novella, if I understand him correctly, would reword this as:  the syphilis germ attacks the brain, causing a mental illness, which causes crazy thinking and behavior.  Perhaps he doesn’t mean to impute causative significance to the “mental illness,” but that raises the question as to why one would introduce the concept at all?

So to answer his question:  “Wouldn’t such a case that Hickey acknowledges exists be considered a ‘mental illness?’ the simple answer is “no.”  The concept of “mental illness” adds nothing to our understanding of late stage syphilis or to our understanding of the crazy behavior.  It is simply the label that psychiatrists apply, arbitrarily and misleadingly, to all significant problems of thinking, feeling, and behaving, apparently even to problems of thinking that are caused by late-stage syphilis!

THERE ARE NO MENTAL ILLNESSES

In his final paragraph in the September article, Dr. Novella states:

“If there is a reasonable position to be made against the concept of mental illness, I have yet to hear it. So far I have only encountered the level of argument similar to or worse than Hickey’s unfair and confused article. I am open to any reasonable argument to be made against my current position.”

Obviously this is a huge subject, and this post is already fairly lengthy.  But I will try to provide a brief summary of the case against the concept of mental illness.

1.  Psychiatry defines “mental illness” as any significant problem of thinking, feeling, and/or behaving.
2.  Psychiatry identifies a large number of specific “mental illnesses” to reflect specific problems of thinking, feeling and/or behaving.
3.  Psychiatry presents these specific “mental illnesses” as the proximate causes of the problems.
4.  The logic, however, is flawed, as is evident from the following hypothetical conversation.

Client’s daughter:  Why is my mother so sad; why is she so inactive?
Psychiatrist:  Because she has a mental illness called major depressive disorder.
Client’s daughter:  How do you know she has this illness?
Psychiatrist:  Because she is so sad and inactive.

The only evidence for the putative illness is the very behavior it purports to explain.

5.  When we, on this side of the debate, say that there are no mental illnesses, what’s meant is that the concept of mental illness is spurious conceptually, and has no explanatory value – it adds nothing to our understanding of problems of thinking, feeling and/or behaving.  It is misleading, in that it appears to offer an explanation.  It is also destructive, in that it serves to legitimize the widespread and ever-increasing use of drugs, increases the level of stigma attached to people who are experiencing these problems (Angermeyer, M.C. et al, 2011), and communicates the false message that people are powerless to deal with their problems without psychiatric intervention (i.e. drugs).

I have written extensively on these matters throughout the website (e.g. here and here), and the above summary is just that – a summary.

It is my guess that Dr. Novella would dispute much of this summary.  In particular, I suspect that he would object to the notion that “mental illness diagnoses” are presented by psychiatry as the proximate causes of the problems.  My contention is that assertions of this sort are routine in psychiatric practice; Dr. Novella states that this is not so and bases his position on “official publications” and other formal sources.

So let’s take a look at one “official publication” – the APA’s DSM.  This is psychiatry’s Diagnostic and Statistical Manual.

In general medical circles the diagnosis is the cause of the symptoms.  If one is very tired and is coughing up dreadful-looking stuff, and goes to see a physician, he will probably run some tests and may discover that the cause of these problems is pneumonia.  This is the diagnosis.  This is a real illness that causes real symptoms.  If you asked the physician for a diagnosis, he would understand clearly that you were asking for the cause of the presenting problems.

So when the APA produces a book called the Diagnostic and Statistical Manual, there is, I suggest, an implicit assumption that it will present lists of diagnoses (i.e. real illnesses) and the symptoms which these illnesses cause.  And in fact, when one opens the book this is what seems to be the case – lists of diagnoses with their respective symptoms.

Some psychiatrists respond to this point by contending that the book doesn’t actually say that the diagnoses are the causes of the symptoms, and that the diagnoses are really just labels of convenience for clusters of problems.  If this is the case, then I suggest that the title of the book is very misleading.  It ought to be called something like:  A listing of significant problems of thinking, feeling and behaving, together with their labels of convenience as used by psychiatrists.

 But the use of the terms “diagnosis” and “symptoms” is not the only issueThe notion that the “diagnoses” are being presented as the proximate cause of the symptoms permeates the text.  I haven’t yet had an opportunity to study DSM-5, but a careful reading of DSM-IV and DSM-III-R reveals a great many passages which imply that the symptoms are caused by the putative underlying mental disorders.  For example, many of the symptom lists contain the phrase “the symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder…),” or “the disturbance is not better accounted for by another mental disorder  (e.g.…).”  The term “better accounted for” implies a causal relationship between the putative disorder (the diagnosis) and the symptoms or problems.  The statements:  “The mental disorder accounts for the symptoms” means substantially the same as “the mental disorder is the cause of the symptoms.”

In DSM-III-R, the V codes were described as conditions “…not attributable to a mental disorder.”  The term “attributable to” is, I suggest, essentially synonymous with “caused by,” the implication being that the non-V diagnoses are, in fact, the causes of their respective symptoms.  In DSM-IV, the phrase was dropped, but the concept was retained, embedded in several of the textual descriptions.  For instance, V71.01 Adult Antisocial Behavior “…the focus of clinical attention is antisocial behavior that is not due to a mental disorder (e.g. Conduct Disorder…).”  Similarly, V15.81 Non-Compliance with Treatment:  “The reasons for non-compliance may include…the presence of a mental disorder.”  The terms “attributable to,” “due to,” and “reasons for” imply a causal relationship, and it is clear that the mental disorders are conceptualized and presented as the causes of the problems of thinking, feeling, and behavior.  And this is how the DSM taxonomy is interpreted and used in the field, and is perceived by the general public.

The DSM is not the only “official” publication that promotes the notion that “mental disorders” are the proximate causes of the “symptoms.”  I happen to have on my desk at the present time an APA document titled Five Things Physicians and Patients Should Question.  The general theme of the document, which consists of five recommendations, is that practitioners should exercise more caution in prescribing neuroleptic drugs.  The fourth recommendation is:

“Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.

There is inadequate evidence for the efficacy of antipsychotic medications to treat insomnia (primary or due to another psychiatric or medical condition), with the few studies that do exist showing mixed results.” [emphasis added]

It is clear from the wording of this item that according to the APA, insomnia (a common criterion item in the DSM) can be caused by (“due to”) a psychiatric condition (i.e., a mental illness/disorder).

Another example of this kind of circular reasoning can be found in theJAMA summary that Dr. Novella adduced to support his claim that the condition labeled ADHD is a brain illness.  On page 2 of this document, under the heading Diagnosis, you’ll find the following:

“To be significant, a symptom must have started before age 7 years, be present for at least 6 months, and not be due to another cause.” [emphasis added]

This clearly implies that the “mental illness” called ADHD causes the symptoms.

Another example:  in the NIMH’s education publication Attention Deficit Hyperactivity Disorder, under the heading How is ADHD diagnosed in adults? they write:

“For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have had the disorder since childhood, but who have not been diagnosed, may have developed negative feelings about themselves over the years. Receiving a diagnosis allows them to understand the reasons for their problems, and treatment will allow them to deal with their problems more effectively.” [emphasis added]

Again, the clear implication is that the “mental illness” called ADHD is being conceptualized and presented as the cause of (the reason for) the symptoms.

The Mayo Clinic has a Health Information pamphlet on Insomnia.  Under the heading “Common Causes of Insomnia” it states:

“Everyday anxieties as well as more serious anxiety disorders may disrupt your asleep.” [emphasis added]

It’s very clear that what’s being presented here is the notion that mental disorders cause insomnia.

 The American Academy of Sleep Medicine actually has a publication called Insomnia Due to Mental Disorder.  Here are some quotes:

“This insomnia is caused by a mental health disorder.” [emphasis added]

“Depression and other mood disorders often will result in a degree of insomnia.” [emphasis added]

The University of Maryland has an In-depth Patent Education Report on insomnia.  Here’s a quote:

“The disorders that most often cause insomnia are: [emphasis added]

    • Anxiety
    • Depression
    • Bipolar disorder
    • Attention-deficit hyperactivity disorder
    • Post-traumatic stress disorder”

As explanatory concepts, however, the “diagnoses” are entirely circular, and hence valueless.  Essentially, what’s being asserted is that problems of thinking, feeling and behaving are caused by problems of thinking, feeling, and behaving.  The explanation in fact is not an explanation at all.  It adds nothing to our knowledge.  Rather, by discouraging further inquiry, it acts as a barrier to genuine exploration and understanding, which, incidentally, was one of the points Dr. Kinderman made in his original article back in January, and to which Dr. Novella took such exception.

But let us be clear.  If it were proven that a particular “mental illness” were in fact the direct result of a brain malfunction, then the circularity would be broken, and we would be dealing with a genuine brain illness.  But despite decades of highly motivated research and the spurious claims of psychiatry in this regard, such proof is not available.  For the record, the DSM entries Mental Disorders due to a General Medical Condition are for obvious reasons excluded from these considerations.  The General Medical Condition category, however, does suggest an obvious question:  If the condition known as ADHD is indeed a brain illness as Dr. Novella asserts, then why is it not included in the General Medical Condition category?  After all, a brain illness is a general medical condition.

ADHD

In his response to my critique, Dr. Novella states that only some mental illnesses are brain illnesses, and takes me to task for confusing some with all.  This is a fair point, though I still maintain that the use of the term mental illness conveys the impression that one is talking about a real illness, and that the likely focus of this is the brain.  But we’ve already discussed that matter, and let’s set it aside for now.

As an example of a “mental illness” that he claims is indeed a brain illness, Dr. Novella points to the condition known as ADHD.  He says that there is

“…decades of research which clearly show that ADHD is a genetic disorder characterized by hypofunctioning of the frontal lobes leading to a relative deficit of executive function. This part of the brain serves as a “resource allocator” – allocating brain resources to various tasks. Relative lack of this function results in a reduced ability to pay attention to the things we should be paying attention to.”

Dr. Novella goes on to state that it’s “… difficult to provide a single reference to reflect all this research…” and instead provides a JAMA summary, authored by Denise M. Goodman, MD and Edward H. Livingston, MD.  I opened the JAMA article expecting to find a summary of research findings with citations.  Instead, I found a simplistic JAMA “patient page” that simply asserts that “…ADHD is a biological condition…”

By contrast, I suggest that Dr. Novella take a look at Debunking the Science Behind ADHD as a “Brain Disorder by Albert Galves, PhD, and David D. Walker, PhD.  Dr. Novella might also review Transforming Diagnosis by Thomas Insel, MD, Director of NIMH.  In this paper, dated April 29, 2013, Dr. Insel was critical of DSM diagnoses generally.  He wrote:

“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each.”

“The strength of each of the editions…has been ‘reliability’…The weakness is its lack of validity.” [A lack of validity in this context means that the ‘diagnoses’ do not actually refer to, or mirror, anything in the real world.]

“…The DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

For the record, I do not agree with other positions taken by Dr. Insel, but his comments concerning DSM’s “diagnoses” are unambiguous.  In the present context, it is noteworthy that he did not exempt the ADHD “diagnosis” (or indeed, any DSM label) from his criticisms.

If there were clear and compelling evidence that the condition known as ADHD is in fact a brain illness along the lines that Dr. Novella asserts, wouldn’t Dr. Insel, the Director of NIMH, have known this, and excluded it from his comments?

In addition, if the condition known as ADHD is a real brain illness, wouldn’t it make sense to diagnose it by brain examination, thereby increasing the Kappa scores from their present value (0.5-0.6) to something approaching 1.0 (i.e. almost perfect reliability).

THE ESSENTIAL QUESTION

Dr. Novella and I are in complete agreement that the essential question in this entire debate is how best to conceptualize significant problems of thinking, feeling, and/or behaving.  Dr. Novella conceptualizes these problems as mental illnesses, which is not surprising because he defines a mental illness as any significant problem of thinking, feeling and/or behaving.

I, on the other hand, conceptualize significant problems of thinking, feeling and/or behaving as – significant problems of thinking, feeling, and/or behaving.

In the now distant days when I was practicing, I sat with my clients and, through unhurried dialogue and discussion, we identified and clarified the problems for which they were seeking help.  Also through unhurried dialogue and discussion, we explored how these problems might have developed, and what circumstances/pressures might be maintaining them.

If my clients said they were depressed, or worried, or angry, I asked them why, and I listened to their responses without interrupting.  In almost all cases, individuals could give perfectly coherent and plausible explanations for their problems without any reference to extraneous, spurious concepts such as “mental illness.”

I conceptualized (and still conceptualize) problems of thinking, feeling, and behaving as so individualized with regard to genesis and development as to defy any kind of simplistic categorization or classification.  I did not see my clients as ADHD’s or MDD’s or OCD’s or Conduct Disorders or Personality Disorders or any other DSM label.  I did not see them as patients who needed to have something done to them – but rather as complex and competent human beings, fellow travelers on life’s journey, who had hit speed bumps, or taken wrong turnings, or run out of fuel, or been battered, figuratively or literally, by the vicissitudes and cruelties of life.

We discussed the importance of habits: how some are productive and others counterproductive.  We discussed how habits are formed and how they can be broken.

We discussed what kind of remedial strategies might be effective, and how best they might be implemented in each particular case.  I took pains to help my clients identify their strengths, and we discussed how these strengths might be mobilized in coping with the present difficulty.

We also tried to identify what social connections the clients might have that might be helpful in the present circumstances.

It was very much not a matter of me, the “expert,” healing people or solving their problems.  Rather, my role was validating people’s experiences and their reactions to those experiences, and helping them mobilize, develop, and use their own resources to move their lives in directions they found more fulfilling.

This is a fundamentally client-centered approach in which there is no place or need for the concept of “mental illness.”

Dr. Novella clearly believes that his “mental illness” model is a better approach.  Perhaps ultimately we’ll just have to agree to differ.

Jon Rappoport’s Blog

If you haven’t seen Jon Rappoport’s blog, please take a look.  Here are two quotes from his September 22 post, Psychiatry targets college students for destruction:

“The concept called ‘mental disorder’ is a sales pitch backed up by extraordinary PR, money, academic gibberish, and government-granted official status.”

“People need to wake up to the fact that the whole panoply of human suffering has been co-opted, taken over, redefined, re-translated into a lexicon of pseudoscience.”

And another quote from his September 28 post, Alexis, Lanza, Holmes and the Psychiatric State:

“Close to 50 years ago, psychiatry was dying out as a profession. Fewer and fewer people wanted to see a psychiatrist for help, for talk therapy. All sorts of new therapies were popping up. The competition was leaving medical psychiatry in the dust.

As Dr. Peter Breggin describes it in his landmark book, Toxic Psychiatry, a deal was struck. Drug companies would bankroll psychiatry and rescue it. These companies would pour money into professional conferences, journals, research. In return, they wanted ‘science’ that would promote mental disease as a biological fact, a gateway into the drugs. Everyone would win—except the patient.

So the studies were rolled out, and the list of mental disorders expanded. The FDA was in on the deal as well, as evidenced by their drug ‘safety’ approvals, in the face of the obvious damage these drugs were doing.

So this is how we arrived at where we are. This was the plan, and it worked.

Under the cover story, it was all fraud all the time. Without much of a stretch, you could say psychiatry has been the most widespread profiling operation in the history of the human race. Its goal has been to bring humans everywhere into its system. It hardly matters which label a person is painted with, as long as it adds up to a diagnosis and a prescription of drugs.”

Jon addresses the spurious and destructive nature of psychiatry in no-nonsense, hard-hitting language.  His material is relevant and current, and very much worth reading.

Thanks to Tallaght Trialogue on Twitter for the link to this blog.

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.

The Burden of Mental ‘Illness’

Thanks to Graham Davey and Richard Pemberton on Twitter for the link to an interesting article in the August 29, 2013 issue of the Lancet.  It’s titled Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010, and was written by Harvey A. Whiteford, et al.

The Global Burden of Disease survey is a systematic, scientific attempt to quantify the comparative magnitude of disease, injuries, and risk factors by age, sex, and geography over time.

The work is coordinated by the Institute of Health Metrics and Evaluation at the University of Washington, and is funded largely by the Bill and Melinda Gates Foundation.

The work is carried out by various universities and by the World Health Organization (WHO).

The Lancet article focuses on the global burden of disease attributable to mental and substance use disorders in 2010.

The survey uses three basic measures to quantify disease burden:

-years of life lost to premature mortality (YLLs)
-years lived with disability (YLDs)
-disability-adjusted life years (DALYs’ equals YLL plus YLD)

FINDINGS

The 2010 survey findings are presented in the follow table:

Proportion of Total DALYs 95% UI Proportion of total YLDs 95% UI Proportion of YLLs 95% UI
Cardio, circulatory diseases 11.9% (11.0-12.6) 2.8% (2.4-3.4) 15.9% (15.0-16.8)
Diarrhoea, lower respir. infections, meningitis, other infectious diseases 11.4% (10-3-12.7) 2.6% (2.0-3.2) 15.4% (14.0-17.1)
Neonatal disorders 8.1% (7.3-9.0) 1.2% (1.0-1.5) 11.2% (10.2-12.4)
Cancer 7.6% (7.0-8.2) 0.6% (0.5-0.7) 10.7% (10.0-11.4)
Mental, substance use disorders 7.4% (6.2-8.6) 22.9% (18.6-27.2) 0.5% (0.4-0.7)
Musculoskeletal 6.8% (5.4-8.2) 21.3% (17.7-24.9) 0.2% (0.2-0.3)
HIV/AIDS, tuberculosis 5.3% (4.8-5.7) 1.4% (1.0-1.9) 7.0% (6.4-7.5)
Other non-communicable diseases 5.1% (4.1-6.6) 11.1.% (8.2-15.2) 2.4% (2.0-2.8)
Diabetes, urogenital, blood, endocrine diseases 4.9% (4.4-5.5) 7.3% (6.1-8.7) 3.8% (3.4-4.3)
Unintential injuries other than transport injuries 4.8% (4.4-5.3) 3.4% (2.5-4.4) 5.5% (4.9-5.9)

 

As can be seen, mental and substance use disorders account for 7.4% of all DALYs worldwide, and 22.9% of total YLDs.  They are in fact the leading cause of YLDs.  The YLL for this category is only 0.5%.  The authors attribute this to the fact that deaths in this population are usually coded to the specific physical cause of death.

DISCUSSION

This is an impressive paper, and it is obvious that the survey was comprehensive, and cost a great deal in terms of money and other resources.  I would guess that the survey is as accurate and reliable as something of this magnitude can be.

There are two problems, however.  Firstly, the mental and substance use disorders listed in the DSM are not illnesses in any meaningful sense of the term.  They are indeed problems, and sometimes very serious problems, but the notion that they are illnesses is an assumption widely promoted by psychiatry and by their pharmaceutical allies.  The fact that these problems are listed in the survey side  by side with real illnesses like HIV/AIDS, tuberculosis, diabetes, etc., is a tribute to the efficiency of the psychiatry and pharmaceutical propaganda machine, but this doesn’t make the notion true.  One can say that geese are swans for a hundred years, but geese will still be geese.  As the spurious medicalization of all human problems expands, so the global burden of these “illnesses” will expand.

The second problem is more subtle.  In the table shown earlier, it is clear that the problems labeled mental and substance disorders have relatively little impact in the category years of life lost, but a very high impact in the category of years lived with disability.  In fact, in the latter category, it is the highest item.

On first sight, this might seem quite significant, and a casual reader might conclude that mental and substance disorders are very disabling.  However, the DSM criteria for specific disorders routinely include the requirement:  “The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”  “Social” and “other” areas of functioning are difficult to  assess in  a psychiatric interview, and so this requirement is usually met by noting that the person has been missing work.  And, or course, years lost to disability is assessed by substantially the same metric – days missed from work.

So when the Global Burden of Disease survey “discovers” that people with “Mental and substance disorders” score high on years lost to disability, all they’ve really “discovered” is that people who are missing work a lot are missing work a lot.

Psychiatry is riddled with this kind of tautological nonsense.

IMPLICATIONS

The implications of the survey’s findings are grave.  Firstly, the survey endorses the spurious notion that “mental illnesses” have the same kind of ontological reality as real illnesses.  Secondly, they establish the “fact” that these illnesses have a high prevalence rate and a high disability impact.  Thirdly – and most importantly – the survey will result in increasing levels of funding being channeled into the “treatment” of these fictitious illnesses.  And “treatment” means drugs.  So more validation and more profits for pharma, and more destructive side effects for the victims of this worldwide scam.

Psychiatry is like a virus – a virus that has truly gone global.

 

The Illness Theory Is Everywhere

A few days ago, there was an interesting item in the Dear Abby column of our local newspaper.  Dear Abby is a general advice column written by Jeanne Phillips, and is widely read.

The letter in question was written by “Sibling Standing By,” who described his/her 63 year old sister as someone who “…takes no responsibility for her health.” The sibling goes on to say:

“She’s extremely overweight because she overeats and doesn’t exercise.  She complains every day that she feels ‘terrible.’  (I call it self-pitying whining.)”

In her reply, Ms. Phillips, among other things, stated that the family members might

“…suggest that she might have a touch of depression that could be helped if she brings it to the attention of her doctor.  Tell her you all love her, that you’re worried about her, and are willing to help her schedule an appointment with her physician if she’s willing.  I think that would be a loving thing to do.”

Ms. Phillips frequently endorses the bio-psychiatric position that depression is an illness and can be “treated” by physicians.

For an advice column of this sort to succeed, it must have the three R’s:  readability, relevance, and resonance.

Readability and relevance are obvious.  What I mean by resonance is that the advice tendered has to resonate strongly with a large proportion of the readership.  In this sense, Dear Abby is a kind of barometer of societal views on a wide range of issues.

But the Dear Abby column isn’t just a reflection of societal views, it is also to some extent a shaper of public opinion.  By repeating frequently the mantra that depression is an illness to be treated by drugs, the Dear Abby column has become a significant factor in the dissemination and acceptance of this spurious notion.

I have written to Dear Abby to point out that the illness theory is a spurious assumption, but I’m sure my letter went into the “cranks and eccentrics” pile.

The general point here, is that pharma-psychiatry is deeply enmeshed.  You will find the “depression-is-an-illness” mantra in newspapers, magazines, TV shows, movies, and also, of course, in pharmaceutical company commercials.

We have a great deal of work ahead of us.

Dr. Lieberman is Back

Courtesy of Carl Elliott via Twitter, I’ve recently read Dr. Lieberman’s latest post on Psychiatric News. It’s called – believe it or not – Time to Re-Engage With Pharma? dated August 1, 2013.  And it’s classic Dr. Lieberman sleight of hand.

His opening statement, for instance, reads:

“Drug companies aren’t held in high esteem by the public these days.”

This may or may not be true.  But note what he’s done.  The issue here is the long-standing and corrupt relationship between psychiatry and the manufacturers of drugs.

But from his first sentence, Dr. Lieberman has taken psychiatry out of the equation.  He has also lumped the makers of legitimate medicines in with the makers of psychiatry’s drugs.

The real problem is that psychiatry has degenerated into little more than a retail outlet for psycho-pharma.  But Dr. Lieberman is not going to discuss that.  Instead, he’ll focus on the “fact” that “Drug companies aren’t held in high esteem by the public…”

Dr. Lieberman provides six reasons for pharma’s alleged unpopularity:

1.  high drug prices
2.  aggressive marketing practices
3.  direct-to-consumer advertizing
4.  efforts to buy influence with physicians
5.  suppression of data on drugs’ dangerous side effects
6.  reduction in innovative drug development

A good deal could be said on each of these points, but let’s just look at number 4: in fact, just one word in number 4:  “efforts.”

The fact is that psycho-pharma has succeeded in buying influence with psychiatrists, and has been doing it for years.  According to a NPR piece titled How to Win Doctors and Influence Prescriptions, paying a doctor $1500 to give a talk “…would see the speaking doctor write an additional $100,000 to $200,000 in prescriptions…” of the company’s drug.

By using the word “efforts,” Dr. Lieberman manages to lay the blame on pharma (obviously cads and bounders), and lets his own profession off the hook.  Note also in item number 4, the use of the term “physicians.”  This serves two purposes.  Firstly, he’s broadening the target for any flak that might be around, and secondly, he is – as usual – trying to promote the notion that psychiatrists are “real” doctors.

Dr. Lieberman concludes his first paragraph by stating:

“…it’s not easy to muster much defense of the pharmaceutical industry.”

But in the next two sentences, he does just that.

“But let’s face it, they need us and we need them. We must recognize the important, beneficial role that drug companies have long played in all areas of medicine.”

Never, I suggest, have cads and bounders been rehabilitated so readily and so forgivingly.

And to drive this forgiveness, Dr. Lieberman exhorts us to remember how much the drug companies have done for us all, including the fact that (and I’m not making this up!)

“…their funding has helped to advance research, public outreach, and training.”

In other words, the very things that are so bad about the pharma-psychiatry relationship (the hijacking of research and the substitution of marketing for training) are actually good.

If the pharmaceutical industry were to disappear tomorrow, how, he asks us

“…would much of the essential treatment development research be funded now that the National Institute of Mental Health is focused increasingly on genetics and basic research?”

This is a nice little dig at Thomas Insel, MD, director of NIMH, who, back in April of this year, announced that his agency would no longer fund research proposals that used the DSM taxonomy to define their target populations.  Dr. Insel’s point was, and presumably still is, that the DSM categories have no validity.  But – and this is the critical point – Dr. Insel’s announcement did not represent a major departure from NIMH’s long-standing position.  They’re still searching for the Holy Grail – the biological bases of “mental illness,” – a notion that the APA has been endorsing and promoting for decades.  DSM is irrelevant in this general context, but it’s a big part of the APA’s perceived legitimacy, and Dr. Lieberman has to pretend that NIMH has now abandoned “…essential treatment development research.”  (Just for the record, neither NIMH nor APA has ever had the slightest interest in promoting essential treatment development research in any valid sense of the term.  Their agenda has always been to prove that all significant behavioral and emotional problems are illnesses.  But that’s a different issue.)

What’s especially interesting in this matter is the fact that 90% of industry-funded­ research finds in favor of the sponsor’s product! (Heres et al 2006)  And this is the kind of research that Dr. Lieberman wants to promote!

In his fifth paragraph, Dr. Lieberman says:

“In psychiatry, past problems arose when companies engaged in aggressive marketing practices in the guise of educational activities and paying clinicians and researchers—so-called key opinion leaders—for their advice or research in ways that were perceived as potential conflicts of interest. The issue came to a head in 2007 when Sens. Herb Kohl and Charles Grassley held hearings on the financial relationships between drug and device companies and psychiatrists and called for corrective and punitive actions. Ironically, somehow in this process, our field became the poster child for physician misbehavior. The attention and criticism prompted universities to adopt stricter ethics and financial-disclosure policies, and professional associations, including APA, to pull back and keep companies at arm’s length.”

Note again, the neat way he extricates psychiatry from blame.  Problems, he tells us, “…arose when companies engaged in aggressive marketing practices in the guise of educational activities.”  Perhaps what we’re supposed to imagine here is that the hapless psychiatrists were kidnapped and spirited away to these exotic locations where they were routinely plied with the best accommodation, food, drink, trinkets, and big piles of money – and got their CE requirements taken care of.  And let’s not forget the APA’s CE Committees who approved these “educational” junkets for credit.  Or perhaps the drug companies forced their hands also.  The poor down-trodden psychiatrists.  How hard it must have been for them!

“…and paying clinicians and researchers—so-called key opinion leaders—for their advice or research in ways that were perceived as potential conflicts of interest.”

So let’s get this straight.  Industry executives stroked the egos of psychiatrists by telling them that they were key opinion leaders, and then paid these same psychiatrists generously for promoting the companies’ products, and all the blame for this goes to the drug executives?  The psychiatrists, whom elsewhere Dr. Lieberman assures us are real doctors who always have their clients’ best interest at heart, were blameless in this matter.  How in the world can he lay all the blame for these corrupt practices on the drug executives – who, after all, make no bones about the fact that they’re in it for the money?  Are we to imagine that the drug guys were throwing these wads of money at the psychiatrists while the latter were saying, “No, please.  No.”?

And the best (worst) of all:

“… in ways that were perceived as potential conflicts of interest.” (emphasis added)

Is he saying that they weren’t really conflicts of interest; that it was all just a big misperception?  Would this meet the APA’s criteria for delusional thinking?

And while we’re talking about “so-called” opinion leaders,” Dr. Lieberman seemed to have no difficulty accepting this particular accolade for himself back in the good old days when the gravy train was going full tilt, before the nasty stuff hit the fan.  On the Columbia University Medical Center site, there is an INVIVO interview of Dr. Lieberman.  It has a lovely picture of him smiling for the camera, and the words “opinion leader” are at the top of the article.  You’ll also find an ad on Amazon.com for Comprehensive Care of Schizophrenia, by Jeffrey Lieberman and Robin Murray.  The blurb concludes with the sentence:  “Edited by two distinguished opinion leaders and written by an internationally eminent team, this text is indispensable for those working in the area.”

“The issue came to a head in 2007 when Sens. Herb Kohl and Charles Grassley held hearings on the financial relationships between drug and device companies and psychiatrists and called for corrective and punitive actions.”

In other words, they all got busted!  Matters came to a head because they all got busted.  The truly dreadful part of this is that until they got busted, psychiatrists, with very few exceptions, went along with the bribery and corruption.  Why hadn’t the APA stamped out these pernicious practices decades earlier?  Why hadn’t “opinion leaders” such as Dr. Lieberman railed against the venality of their colleagues?  Why is it, even today, that the most egregious offenders have never received serious sanctions from the APA or state licensing boards?  And why is it that even today – in this very post – the President of the APA is trying to fob the whole sordid business off as the responsibility of the drug companies?

“Ironically, somehow in this process, our field became the poster child for physician misbehavior.”

No, Dr. Lieberman, it is not ironic.  Psychiatrists were criticized more harshly than real doctors because they were in the forefront by far in the scramble for pharmaceutical money.  See the article Psychiatrists Dominate “Doctor-Dollars” Database Listing Big Pharma Payments at Medscape News.

Dr. Lieberman draws his post to a close by lauding the APA for introducing strict ethical policies for members who participate “… in key programs such as the development of practice guidelines and the revision of DSM.”  Presumably this latter applies to DSM-6, because my recollection is that approximately 70% of the DSM-5 work group had financial ties to pharma (Cosgrove and Krimsky, 2012).  But of course that wouldn’t have been the psychiatrists’ fault.  Those mean old pharmaceutical executives just insist on giving them big piles of money, and the psychiatrists – well, they’re just such nice people that they can’t say no.

Psychiatry is not something good that needs some minor corrections.  Psychiatry is something flawed and rotten.  You don’t have to believe me – just read Dr. Lieberman’s blog post.

And this is the person that American psychiatrists have chosen to be their leader in these tumultuous times.  Psychiatry is truly beyond redemption.