Tag Archives: Psychiatric “spin”

Mental Health First Aid: Another Psychiatric Expansionist Tool

On December 25, 2016, the Baltimore Sun published an excellent article titled Drug companies prey on children, by Patrick D. Hahn, PhD.  Dr. Hahn is an affiliate professor of biology at Loyola University, Maryland.  Here are some quotes:

“I recently attended Youth Mental Health First Aid Training at a local public school. It was an eye-opening experience.”

“Youth Mental Health First Aid Training, sponsored by the National Council for Behavioral Health, is intended to enable teachers, parents and others in contact with young people to identify potential ‘mental illnesses’ in order to facilitate early detection and treatment by our mental health care system. My fellow attendees were surprisingly open about their own experiences with that system. One mentioned that her son became manic after being diagnosed for ADHD. Another said that both she and her roommate became bipolar after being diagnosed for depression. Neither our facilitators nor anyone else present pointed out that mania and bipolar disorder are toxic effects of medications commonly prescribed for ADHD and depression.”

“Our training manual didn’t say anything about this either, although it did claim that depression is caused by a deficiency of serotonin — a fable that by now has become as discredited as the phlogiston theory of chemistry. It also stated that mental health interventions are ‘evidence-based’ and ‘scientifically tested’ — neglecting to mention that much of that evidence is put forth by drug companies who have a fiduciary duty to do everything they can to maximize sales of their products.”

“So is all this a scheme to push more drugs to more kids? The 2013/2014 annual report for the National Council for Behavioral Health, titled ‘A Legacy of Excellence and Impact,’ gives us a hint. It lists the organization’s supporters as including the Pharmaceutical Research and Manufacturers of America (PhRMA) along with no fewer than 12 different drug companies. Would these folks be ponying up the cash if they weren’t confident this program would increase sales? And do the parents and teachers who attend the council’s training program — no doubt with the best intentions in the world — realize that they are essentially sitting through an eight-hour infomercial bought and paid for by the drugmakers?”

“One out of 13 American children between the ages of 6 and 17 has taken a psychotropic medication within the last six months, according to the Centers for Disease Control. Meanwhile, youth suicide rates are at their peak going back at least as far back as 1999, while the number of children receiving disability benefits for mental illness is at an all-time high.”

Please take a look at Dr. Hahn’s article, and pass it on.  Mental Health First Aid is not a good thing.  Rather, it is just another psychiatric expansionist tool.

MENTAL HEALTH FIRST AID

For readers who are not familiar with the term, Mental Health First Aid, according to its own website, is “…an 8-hour course that teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders.”

From its FAQ page:

“The evidence behind the program demonstrates that it does build mental health literacy, helping the public identify, understand, and respond to signs of mental illness.”

Incidentally, I Googled the term “mental health literacy” and got 28.8 million results!  There’s also a Wikipedia article on mental health literacy.  Here’s a quote from the opening paragraph:

Mental health literacy has been defined as ‘knowledge and beliefs about mental disorders which aid their recognition, management or prevention. Mental health literacy includes the ability to recognize specific disorders; knowing how to seek mental health information; knowledge of risk factors and causes, of self-treatments, and of professional help available; and attitudes that promote recognition and appropriate help-seeking.1‘”

So mental health literacy doesn’t just mean the acquisition of some information and skills; it also means accepting the psychiatric hoax:  “attitudes that promote recognition and appropriate help-seeking”.  The goal is not just the dissemination of psychiatry-friendly information, but also the active conversion of skeptics to the psychiatric cause.

Reference # 1 in the above quote refers to Jorm et al “Mental health literacy”: a survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment, Med J Aust. 1997 Feb 17;166(4):182-6.  The survey in question was conducted in Australia in 1995 and sheds particular light on the present discussion.  Here’s the abstract of the article:

“OBJECTIVES:
To assess the public’s recognition of mental disorders and their beliefs about the effectiveness of various treatments (‘mental health literacy’).

DESIGN:
A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia.

PARTICIPANTS:
A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette.

RESULTS:
Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so. Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics.

CONCLUSION:
If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised. Further, public understanding of psychiatric treatments can be considerably improved.”

So, in 1995, the general public in Australia, as represented by the sample of 2031 individuals in this study, had some interesting views concerning psychiatry.

  1. They rated GP’s and counselors as more helpful than psychiatrists and psychologists for problems of “depression” and “schizophrenia”.
  1. They rated many “standard psychiatric treatments” (antidepressants, neuroleptics, electric shocks, and psychiatric wards) harmful, more often than helpful.
  1. They rated some “nonstandard treatments” (increased physical or social activity, relaxation, stress management, reading about people with similar problems) highly.
  1. They rated vitamins and special diets helpful more often than antidepressant and neuroleptic drugs.

At the risk of stating the obvious, those of us on this side of the issue would consider the general public’s beliefs, as reflected in this survey, to be accurate, and grounded in common sense.  But from the aspect of psychiatry – and particularly psychiatry’s expansionist agenda – these findings are cause for particular concern.  And so, as the authors state:  “…the level of mental health literacy needs to be raised…”

Here’s an interesting quote from the study’s Introduction:

“The lifetime risk of developing a mental disorder is so high (nearly 50%)2 that almost the whole population will at some time have direct experience of such a disorder, either in themselves or in someone close. A high public level of mental health literacy would make early recognition of and appropriate intervention in these disorders more likely.”

Incidentally, the survey was conducted by the Australian Bureau of Statistics, presumably at public expense.

Three years later, Dr. Jorm, the lead author, and his wife Betty Kitchener, founded Mental Health First Aid.  According to his biography on the University of Melbourne site, Dr. Jorm is a highly cited mental health researcher whose work “…focuses on building the community’s capacity for prevention and early intervention with mental disorders.”

The MHFA program spread rapidly in Australia, and by 2015, 350,000 people had received the training.

And Dr. Jorm has been busy promoting mental health literacy in other venues.  In 2000, he published a paper in the British Journal of Psychiatry, the stated aims of which were:

“To introduce the concept of mental health literacy to a wider audience, to bring together diverse research relevant to the topic and to identify gaps in the area.”

And in 2012, he and Nicola Reavley published a paper Public recognition of mental disorders and beliefs about treatment: changes in Australia over 16 years, also in the British Journal of Psychiatry.  The conclusions of this paper were:

“Although beliefs about effective medications and interventions have moved closer to those of health professionals since the previous surveys, there is still potential for mental health literacy gains in the areas of recognition and treatment beliefs for mental disorders. This is particularly the case for schizophrenia.”

THE SCOPE OF THE MENTAL HEALTH FIRST AID PROGRAM

Here’s another quote from MHFA’s FAQ page:

“Mental Health First Aid is intended for all people and organizations that make up the fabric of a community. The course is presented to chambers of commerce, professional associations, hospitals, nursing homes, rotary clubs, parent organizations, social clubs, and other groups. Professionals who regularly interact with a lot of people (such as police officers, human resource directors, and primary care workers), school and college leadership, faith communities, friends and family of individuals with mental illness or addiction, or anyone interested in learning more about mental illness and addiction should get trained.”

And so the tentacles of psychiatric destruction, disempowerment, and, ultimately, despair, are spread to all parts and segments of our society, and people of all ages and all walks of life are shoveled indiscriminately into the insatiable maw of psychiatric dependency and premature death.

Mental Health First Aid (USA) lists on its website 109 organizations across the US (including 45 NAMI chapters) that offer MHFA training.

MHFA AND THE APA

Not surprisingly, the APA has enthusiastically endorsed the program.  Here are some quotes from Mental Health First Aid:  Training for Communities and Families, which you can find on the APA website:

“Mental Health Fist Aid (MHFA) is an eight-hour, in-person training that teaches how to help a person struggling with a mental illness or in a crisis. It provides a basic understanding of mental illness and addiction, signs of addiction and mental illness, the impact of mental and substance use disorders, what helps individuals experiencing these challenges get well and local resources for help.”

Note the emphasis on “mental illness” and “mental disorders”, and the notion that individuals “experiencing these challenges” need to “get well” by accessing “local resources for help”.

“Trainees are taught a five-step action plan and how to apply it in a variety of situations such as helping someone experiencing psychosis, engaging with someone who may be suicidal, or assisting an individual who has overdosed. The training uses role play and demonstrations to convey the information.”

“Five-Step Action Plan – ALGEE

  1. Assess for risk of suicide or harm
  2. Listen nonjudgmentally
  3. Give reassurance and Information
  4. Encourage appropriate professional help
  5. Encourage self-help and other support strategies”

Note:  “encourage appropriate professional help”, conveniently ignoring the reality that the most common form of “professional help” (psychiatric drugging) is causally implicated in the creation of the problems.

“More than 250,000 people have been trained in Mental Health First Aid in the U.S. by 5,200 certified instructors. Twenty-one states have legislation to support Mental Health First Aid, and federal grants support training in some communities.”

So American psychiatry has effectively recruited 250,000 volunteer sales reps, and has managed to get state and federal money to support this enterprise.

“A recent national study of the training concluded that MHFA improves confidence about being able to recognize someone who may be dealing with a mental health problem or crisis and to actively and compassionately listen to someone in distress. Researchers surveyed more than 35,000 people who had completed the training for the study published in the APA journal Psychiatric Services.”

The study mentioned is Crisanti AS, Luo L, McFaul M, et al. Impact of Mental Health First Aid on confidence relation to mental health literacy: a national study with a focus on race-ethnicity. Psychiatric Services in Advance. Published online Nov. 2, 2015.

Here’s the abstract:

“OBJECTIVE:
Low mental health literacy (MHL) is widespread in the general population and even more so among racial and ethnic minority groups. Mental Health First Aid (MHFA) aims to improve MHL. The objective of this study was to determine the impact of MHFA on perceptions of confidence about MHL in a large national sample and by racial and ethnic subgroup.

METHODS:
The self-perceived impact of MHFA on 36,263 people who completed the 12-hour training and a feedback form was examined.

RESULTS:
A multiple regression analysis showed that MHFA resulted in high ratings of confidence in being able to apply various skills and knowledge related to MHL. Perceived impact of MHFA training differed among some racial and ethnic groups, but the differences were small to trivial.

CONCLUSIONS:
Future research on MHFA should examine changes in MHL pre-post training and the extent to which perceived increases in MHL confidence among trainees translate into action.”

In other words, people who take the Mental Health First Aid course expressed confidence that they could apply the skills and knowledge acquired to actual situations.  The implication is that this is important because “Low mental health literacy (MHL) is widespread in the general population and even more so among racial and ethnic minority groups.”

Note that the term “mental health literacy” has now been reified into a desirable commodity, the lack of which can be identified, measured, decried, researched, funded, etc., in the interests of bringing more and more people into psychiatry’s insatiable clutches.  Mental health literacy means the extent to which one has bought the psychiatric hoax.  Those of us who are active in the anti-psychiatry movement are, of course, by implication, mental health illiterates.

There are absolutely no limits to psychiatry’s expansionist agenda.  Despite the well-established destructiveness of their “treatments”, they will never voluntarily curtail their relentless drive for more victims.

And they will not commission, or even call for, a formal, comprehensive study to examine the now blatantly obvious link between psychiatric drugs and the murder-suicides that have become commonplace in our communities.  Psychiatry is intellectually and morally bankrupt.  They have no valid response to their critics, but instead resort to spin and tawdry marketing tactics to shore up their crumbling sand castle.  But just as the tide cleans the foreshore, so the light of logic and truth, and the outspoken protests of its survivors, will one day wash the world of the blight known as psychiatry.

The Biological Evidence for “Mental Illness”

On January 2, 2017, I published a short post titled Carrie Fisher Dead at Age 60 on Behaviorism and Mental Health.  The article was published simultaneously on Mad in America.

On January 4, a response from Carolina Partners was entered into the comments string on both sites.

Carolina Partners in Mental Healthcare, PLLC, is a large psychiatric group practice based in North Carolina.  According to their website, they comprise 14 psychiatrists, 7 psychologists, 34 Advanced Practice Nurse Practitioners/Physicians Assistants, and 43 Therapists and Counselors.  They have 27 North Carolina locations.

Partners’ comment consists essentially of unsubstantiated assertions, non sequiturs, and appeals to psychiatric authority.  As such, it is fairly typical of the kind of “rebuttals” that psychiatry’s adherents routinely direct towards those of us on this side of the issue.  For this reason, and also because it comes from, and presumably represents the views of, an extremely large psychiatric practice, it warrants a close look.

I will discuss each paragraph in turn.

“We strongly disagree with this article, which neglects a lot of important information and uses selective hearing to distort what Carrie Fisher was about and also to distort the evidence for mental illness as a real disorder.”

My Carrie Fisher article was brief (566 words), and was intended as a counterpoint to the very widespread obituaries that lionized her as a champion of “bipolar disorder”.  The essential point of my article was that Ms. Fisher had been a victim of psychiatry, and like a great many such victims, died prematurely.  Obviously I neglected a lot of important information.  I could have gone into great length as to the recklessness of psychiatry assigning the bipolar label, with all its implications of helplessness, disempowerment, and “chemical imbalance” to a young woman who by her own account was, at the time, using any drugs she could get her hands on.  But I felt that a brief and respectful statement of the facts was all that was needed.

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

“Mental illnesses have a long history of biological evidence. For example, researchers have demonstrated that people with depression have an overactive area of the brain, called Brodmann area 25. Schizophrenia has been linked to specific genes, as PTSD and autism have been linked to specific brain abnormalities. Suicide has been linked to a decreased concentration of serotonin in the brain. OCD has been linked to increased activity in the basal ganglia region of the brain.”

Brodmann area 25 (BA25)
Partners did not provide a specific reference in support of this contention, but my best guess is that the reference is Mayberg, HS, et al (1999) Reciprocal Limbic-Cortical Function and Negative Mood: Converging PET Findings in Depression and Normal Sadness (Am J Psychiatry 1999; 156:675–682).  Here’s the study’s primary conclusion:

“Reciprocal changes involving subgenual cingulate [which includes Brodmann area 25] and right prefrontal cortex occur with both transient and chronic changes in negative mood.”

What this means essentially is that negative mood, whether transient or enduring, is correlated with changes in both the subgenual cingulate (Brodmann area 25) and the right pre-frontal cortex, and that when the depression is relieved, the changes are reversed.

This, of course, is an interesting finding, but provides no evidence that depression, mild or severe, transient or enduring, is caused by a biological pathology.

The reality is that all human activity is triggered by brain activity.  Every thought, every feeling, every action has its origins in the brain.  I cannot lift a finger, blink an eye,  scratch my head, or recall my childhood home without a characteristic brain function initiating and maintaining the action in question.  Without stimuli from the brain, my heart will stop beating, my respiratory apparatus will shut down, and I will die, unless these functions are maintained by machines.

So there is absolutely no surprise in the discovery that sadness and despondency have similar neural triggers and maintainers.  It would be amazing if they didn’t.  But – and this is the critical point – this does not warrant the conclusion that sadness which crosses arbitrary and vaguely-defined thresholds of severity, duration, and frequency is best conceptualized as an illness caused by pathological or excessive activity in BA 25.

Depression is a normal state.  It is the normal human reaction to significant loss and/or living in sub-optimal conditions/circumstances.  It is also an adaptive mechanism, the purpose of which is to encourage us to take action to restore the loss and/or improve the conditions.

All consciously-felt human drives stem from unpleasant feelings.  Thirst drives us to seek water; hunger, food; hypothermia, warmth; hyperthermia, coolness; danger, safety, etc.  Sadness and despondency are no exceptions.  They drive us to seek change, and have been serving the species well since prehistoric times.

But – as is the case with all the above examples – when a drive is not acted upon, for whatever reason, the unpleasant feelings worsen.  Just as unrequited hunger and thirst increase in strength, so the depression drive when not requited deepens.

The reality is that most people deal with depression in appropriate, naturalistic, and time-honored ways.  If the source of the depression is the loss of a job, they start job-hunting.  If the source is an abusive relationship, they seek ways to exit or remediate the situation.  If the source is a shortage of money, they seek ways to budget more sensibly, or increase their earnings; etc.

Depression, either mild or severe, transient or lasting, is not a pathological condition.  It is the natural, appropriate, and adaptive response when a feeling-capable organism confronts an adverse event or circumstance.  And the only sensible and effective way to ameliorate depression is to deal appropriately and constructively with the depressing situation.  Misguided tampering with the person’s feeling apparatus is analogous to deliberately damaging a person’s hearing because he is upset by the noise pollution in his neighborhood, or damaging his eyesight because of complaints about litter in the street.

Our feeling apparatus is as valuable and adaptive as our other senses.  But psychiatry routinely numbs, and in many cases permanently damages, this apparatus to sell drugs and to promote the fiction that they are real doctors.  Their justification for this blatantly destructive activity hinges on the false notion that depression becomes a diagnosable illness when its severity crosses arbitrary and vaguely-defined thresholds.  But deep despondency is no more an illness than mild despondency.  The latter is the appropriate and adaptive response to minor losses and adversity.  The former is the appropriate and natural response to more profound or more enduring adversity.  Though, of course, what constitutes profound adversity will vary enormously from person to person.  An individual, for instance, raised to the expectation of stable and permanent employment may be truly heartbroken at the loss of a job.  Another individual, raised to the notion that there’s always another job “around the corner” will, other things being equal, be less affected.  And so on.

In this regard, it’s noteworthy that Partners’ comment refers to overactivity in BA 25.  The use of the prefix over implies pathology, but in reality there is no yardstick to determine what would be a correct amount of activity for BA 25.  All that can be said, on the basis of Mayberg et al’s findings, and subsequent BA 25 research, is that when a person is sad, there is more activity than when he is happy.  So the use of the term “overactivity” is deceptive – sneaking in the notion of pathology without any genuine or valid reasons to consider it so.  The “reasoning” here is:

–  depression is an illness
–  depression is correlated with high activity in BA 25
–  therefore high activity in BA 25 is pathological

In other words, the contention of pathology rests on the assumption that depression is an illness.  To turn around and use this falsely inferred pathology to prove that depression is an illness is obviously fallacious.  It is also typical of the kind of circular reasoning that permeates psychiatric contentions.  In reality, there is nothing in Mayberg et al or in subsequent research that warrants the conclusion that the increased activity in BA 25 is pathological or excessive.

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

Schizophrenia linked to specific genes
This assertion, that schizophrenia is linked to specific genes, is frequently adduced in these debates, as evidence that “schizophrenia” is a real illness with a biological pathology.  Here again, Partners do not provide any references in support of this assertion, but there have been a number of studies in the past fifteen years or so that have found links of this kind.  However, in all cases, the correlations have been small.  In other words, there are always a great many individuals who have been assigned the “schizophrenia” label, but who do not have the gene variant in question; and there are a great many who have the gene variant, but who do not acquire the label “schizophrenia”.  To date, no genetic test has been found helpful in confirming or refuting a “diagnosis of schizophrenia”.

An additional problem arises here, in that the assertion that “schizophrenia has been linked to specific genes” is often interpreted as meaning that “schizophrenia” is a genetic disease, which it emphatically is not.  To illustrate this, let’s look briefly at a real genetic illness:  polycystic kidney disease (PKD).  This is a well established genetic illness caused by cysts in the kidneys.  The cysts progressively block the flow of blood through the kidneys, causing tissue death.

Most cases of PKD are caused by the defective gene (PKD-1).  In polycystic kidney disease, the pathology occurs because the PKD-1 gene causes the nephrons to be made from cyst wall epithelium rather than nephron epithelium.  And cyst wall epithelium produces fluid which accumulates in, and ultimately destroys, the nephrons and the kidney.

So the gene determines the structure of the nephron wall.  This is the primary genetic effect.  This structure causes the wall to produce fluid.  As the nephrons become increasingly blocked, the kidneys produce less urine.  So, reduced urination is a secondary effect of the gene PKD-1.  Symptoms of PKD don’t usually emerge until adulthood, but about 25% of children with PKD1 experience pain and other symptoms.  So a child growing up with polycystic kidney disease may feel sick much of the time.  Such a child, other things being equal, is likely to be fussier and more distressed than other children, and it is entirely possible that one could find a weak correlational link between gene PKD-1 and childhood fussiness, though, of course, any search for such a correlation will be confounded by the obvious fact that children can be habitually fussy for other reasons.  The fussiness would be a tertiary effect of the gene PKD1.

And from there the causal chain could continue in various ever-weakening directions.  For instance, the child might become somewhat sad and despondent.  Or it could be that the child received extra attention and comforting from his parents and was fairly content, and so on.  Ultimately the outcome is impossible to predict with any kind of precision, and the best we can expect from genes vs. subsequent behavior studies are weak, tenuous correlations.

Cleft palate is another example of a pathology that is caused by a gene defect; actually a gene deletion.  This condition results in a characteristically strained and nasal speech quality which can be quite stigmatizing.  The nasal speech is a secondary effect of the gene deletion.

Children with this kind of speech are sometimes mocked and bullied by their peers.  The child might react to this kind of stigmatizing by speaking as little as possible, by withdrawing socially, or in various other ways.  These reactions would be considered tertiary effects of the defect.  And so on.  As with the PKD, each step in the chain takes us further from the genetic defect, and the statistical associations grow proportionally weaker, and it would be stretching the matter to say that the lack of speech was caused by the gene deletion.  Nor would one conclude that the child’s social withdrawal was a symptom of a genetic disease.  And this is true even though the link between the deletion  and the cleft palate is clear-cut and direct.

In the same way, it is simply not tenable to claim that “schizophrenic” behaviors (e.g. disorganized speech) are symptoms of a genetic disease.  This is particularly the case in that correlations between the “diagnosis” and genetic anomalies are typically very small.  The effects of any minor genetic anomalies that might exist have had ample opportunity to be shaped by social and environmental factors, and these are more credible causal constructs.

“Schizophrenia” is not a unified condition.  Rather, it is a loose collection of vaguely defined behaviors.  For this reason, any genetic research done on this condition will inevitably result in conflicting and confusing results.  It’s like looking for genetic similarities in all the people who play bridge, or read romance novels, visit libraries, play football, or whatever.  If the sample sizes are large enough, and in genetic research sample sizes are often enormous, one could probably find small effects in all or most of these areas, but no one would conclude from this that these are genetically determined activities, much less illnesses.

A person’s ability to learn depends on two general factors:  a) the structure of his brain, as determined by his DNA, and b) his experiences since birth.

One can’t learn to play the piano, for instance, unless one has appropriate neural apparatus, and fingers, both of which require appropriate DNA.  But even a person with good genetic endowment in these regards, will never learn to play unless he is exposed to certain environmental factors.  He must, at the very least, encounter a piano.  In the same way, a person whose genetic endowment might be relatively marginal might become an excellent pianist, if he were to receive persistent environmental encouragement and support.

Similar reasoning can be applied to the behavior of not-being-“schizophrenic.”  This behavior involves navigating the pitfalls of late adolescence/early adulthood, and establishing functional habits in interpersonal, occupational, and other important life areas.  Obviously it requires appropriate neural apparatus, hence the weak correlations with genetic material, but equally clearly it calls for a nurturing childhood environment, with opportunities for emotional growth and acquisition of social, occupational, and other skills.

Given all of this, it’s not surprising that researchers are finding correlations between DNA variations and a “diagnosis” of schizophrenia, but given the number of links in the causal chain and the multiplicity of possible pathways at each link, it is also not surprising that the correlations are always found to be weak, and of little or no practical consequence.

Nor is it surprising that the correlations between being labeled “schizophrenic” and various psychosocial factors are by contrast generally strong.  Having a schizophrenia label is correlated with childhood social adversity, childhood abuse and maltreatment, poverty, and a family history of migration.

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

Generally similar considerations apply to Partners contentions with regards to “PTSD”, “autism”, suicide, and “OCD”, but space precludes a detailed discussion here.

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

“Eric Kandel, MD, a Nobel Prize laureate and professor of brain science at Columbia University, says, ‘All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases…The brain is the organ of the mind. Where else could [mental illness] be if not in the brain?'”

Dr. Kandel (now 87 years old) is an eminent neuroscience researcher at Columbia University.  There’s an extensive biography in Wikipedia.  His early research focused on the neurophysiology of memory.  He has received numerous awards, including the Nobel Prize in Physiology/Medicine (2000), and is widely published.  His record of research achievements is enormous, and his knowledge and expertise are vast, but in the statement quoted by Partners, and, incidentally, by other psychiatry adherents, he is simply wrong.

Let’s take a closer look.  Logically, the Kandel quote can be stated symbolically as:  A is identical to B; therefore malfunctions or aberrations in A are malfunctions or aberrations in B.

On the face of it, this seems sound, and indeed, it is a valid inference in some situations.  For instance, the furnace in a person’s home is the primary heating appliance; therefore, malfunctions in the furnace are malfunctions in the primary heating appliance.  Indeed, in a simple example of this sort, the statement is tautological.  We are simply substituting the synonyms furnace and primary heating appliance, and the inference contains no new information or insights.  But the inference is fallacious in more complex matters.

Let’s concede, for the sake of discussion, that the premise of the Kandel quote is true, i.e., that all mental processes are brain processes.  The term mental processes embraces a wide range of activities, including sensations, perceptions, thoughts, choices, positive feelings, negative feelings, hopes, beliefs, speaking, singing, general behavior, etc.

The term “disorders of mental functioning” is harder to define, but, again for the purposes of discussion, let’s accept the APA’s catalog as definitive in this regard.  Let’s accept that anything listed in the DSM is a “disorder of mental functioning”.

It’s immediately obvious that some of the DSM entries are indeed the result of brain malfunctioning.  In the text these are referred to as disorders due to a general medical condition or to the effects of a substance.  But in the great majority of DSM labels, no such biological cause is identified, and so the conclusion in the Kandel quote would appear to call for some kind of evidence or proof.  However, in the Kandel quote, the conclusion is not presented as something that has been, or even needs to be, proven.  Rather, it is presented as a logical conclusion inherent in, and stemming directly from, the premise.  And it is from this perspective that the Kandel quote needs to be evaluated.

To pursue this, let’s consider the example of “oppositional defiant disorder”.  This is a disorder of mental functioning as defined above, because it is listed in the DSM.  And according to Dr. Kandel’s “logic”, it is also therefore a “biological disease”.  The “symptoms” of oppositional defiant disorder as listed in DSM-5 are:

  1. Often loses temper.
  2. Is often touchy or easily annoyed.
  3. Is often angry and resentful.
  4. Often argues with authority figures or, for children and adolescents, with adults.
  5. Often actively defies or refuses to comply with requests from authority figures or with rules.
  6. Often deliberately annoys others.
  7. Often blames others for his or her mistakes or misbehavior.
  8. Has been spiteful or vindictive at least twice within the past 6 months. (p 462)

Obviously for any of these behaviors to occur, there has to be corresponding neural activity. But there is no necessity that the neural activity is diseased or malfunctioning in any way.  A child learning from his environment, developing his behavioral repertoire in accordance with the ordinary principles or learning, could acquire any or all of these behavioral habits without any malfunctioning in his neural apparatus.  We acquire counterproductive habits as readily, and by essentially the same processes, as we acquire productive ones.  In general, if a child discovers that he can acquire power and control in his environment by throwing temper tantrums, he will, other things being equal, acquire the habit of throwing temper tantrums.  Similarly, if arguing with parents and other authority figures yields positive results, there is a good chance that this also will become habitual.  And this is not because there is anything wrong with the child’s brain.  Rather, it’s because his brain is functioning correctly.  He is internalizing as habits those decisions and actions that pay off.  It is often observed in child-raising practice that if you’re not training your children, they’re training you.

Similar observations can be made about the other seven “symptoms” of oppositional defiant disorder, and indeed all the DSM labels.  A person with a perfectly normal-functioning brain can acquire the habits in question if the circumstances are conducive to this learning.

So to return to the question in the Kandel quote:  “Where else could [mental illness] be if not in the brain?”, the answer is clear:  In the self-serving and unwarranted perception of psychiatrists.  Mental illness is the distorting lens through which psychiatrists view all problems of thinking, feeling, and behaving.  It is the device they use to legitimize their drug-pushing and to maintain the fiction that they are practicing medicine.

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

“You’re right that mental illness is also affected by social and environmental conditions–by a person’s disposition, or upbringing, or current environment. It’s also true that mental illness is affected by drug use (both prescribed and not prescribed). So are other medical conditions, such as heart disease and cancer.”

I’m not sure where Partners are coming from here, because I never made any such statement.  In my view, which I have stated clearly on numerous occasions, “mental illness” is a psychiatric invention, self-servingly created to promote the spurious notion that all problematic thoughts, feelings, and/or behaviors are illnesses.  And not just illnesses in some vague allegorical sense, but real illnesses “just like diabetes”, which need to be treated by medically trained psychiatrists with mood-altering drugs and high voltage electric shocks to the brain.

Partners’ vague concessions concerning environment, child-rearing, and drug effects is a fairly standard psychiatric sop, but doesn’t mitigate their earlier contentions on the “long history of biological evidence” and their uncritical endorsement of the logically spurious Kandel quote.

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

“And it’s true that mental illness is often difficult to diagnose because of
1) the current limitations of the field of research. Thomas R. Insel, MD, director of the National Institute of Mental Health, for example, talks about how the diagnosis and treatment of mental illness today is where cardiology was 100 years ago, concluding that we need to continue scientific research of mental illnesses.  (There’s a longer quote on this below.)”

And (from later in the comment)

“Longer aforementioned quote:
Take cardiology, Insel says. A century ago, doctors had little knowledge of the biological basis of heart disease. They could merely observe a patient’s physical presentation and listen to the patient’s subjective complaints. Today they can measure cholesterol levels, examine the heart’s electrical impulses with EKG, and take detailed CT images of blood vessels and arteries to deliver a precise diagnosis. As a result, Insel says, mortality from heart attacks has dropped dramatically in recent decades. ‘In most areas of medicine, we now have a whole toolkit to help us know what’s going on, from the behavioral level to the molecular level. That has really led to enormous changes in most areas of medicine,’ he says.

Insel believes the diagnosis and treatment of mental illness is today where cardiology was 100 years ago. And like cardiology of yesteryear, the field is poised for dramatic transformation, he says. ‘We are really at the cusp of a revolution in the way we think about the brain and behavior, partly because of technological breakthroughs. We’re finally able to answer some of the fundamental questions.'”

It is at least forty years since I started hearing about psychiatry’s great biological breakthroughs that were just around the proverbial corner, and the promise, if my readers will pardon the pun, is getting a little old.

What’s noteworthy, however, is that in other disciplines, where there is hope or expectation of breakthroughs, the proponents of these endeavors generally wait until the evidence is in, before implementing practices based on these hopes.  In fact, to the best of my knowledge, psychiatry is the only profession whose entire work, indeed, whose entire conceptual framework, is based on “evidence” and “breakthroughs” that are not yet to hand.

Note also the truly exquisite contrast between Partners’ earlier and confident contention that “mental illnesses have a long history of biological evidence” with the assertion here that the “diagnosis” and “treatment” of “mental illness” today is where cardiology was 100 year ago.

Incidentally, Dr. Insel, former Director of the NIMH, also said:

“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’ – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.” (Transforming Diagnosis, 2013)

And let us be quite clear.  “Lack of validity” in this context means that the “diagnoses” don’t actually correspond to any disease entities in the real world.  Note also that Dr. Insel didn’t say poor validity, or low validity.  He said lack of validity – meaning none.

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

Back to the Carolina Partners comment:

“2) mental illness symptoms often overlap with symptoms caused by other illnesses, for example, someone with cancer may also become depressed after diagnosis. Or someone’s fatigue may be caused by a vitamin deficiency, rather than by depression.

While considering all these factors, it is still completely inaccurate to state that there is no biological foundation for mental illnesses. They are not ‘make-believe’ diseases, but rather are caused by a variety of factors, including biological ones. As we understand more about mental illness through research we will (as we have with cardiology, for example) gain more precise vehicles for measuring and understanding the biological implications of these disorders.”

This is a little rambling, but let’s see if we can unravel it.

“… someone with cancer may also become depressed after diagnosis.”

This is true.  In fact, I would say that most people who contract serious illness become somewhat sad and despondent.  But this in no way establishes the notion that the sadness should be considered an additional illness.

“…someone’s fatigue may be caused by a vitamin deficiency, rather than by depression.”

This quote contains one of psychiatry’s core fallacies:  that the various “mental illnesses” are the causes of their respective symptoms (as is the case in real illness).  To illustrate the fallacy, consider the hypothetical conversation:

Client’s wife:  Why is my husband so tired all the time?
Psychiatrist:  Because he has an illness called major depressive disorder.
Client’s wife:  How do you know he has this illness?
Psychiatrist:  Because he is tired all the time.

Psychiatry defines major depression (the so-called illness) by the presence of five “symptoms” from a list of nine, one of which is fatigue, and then routinely adduces the “illness” to explain the symptoms.  In reality, the “symptoms” are entailed in the definition of the “illness”, and the explanation is entirely spurious.  There are many valid reasons why a person might feel fatigued, but none of these is because he “has a mental illness”.  Mental illnesses are merely labels with no explanatory significance.  And because of the inherent vagueness in the criteria, they’re not even good labels.

“…it is still completely inaccurate to state that there is no biological foundation for mental illnesses.”

As stressed above, there is a biological foundation to everything we do – every thought, every feeling, every eye blink, every action.  But – and this is the point that seems to evade psychiatry – there is no good reason to believe that the various problems catalogued in the DSM are underlain by pathological biological processes.  And there are lots of very good reasons to believe that they are not.

“They are not ‘make-believe’ diseases, but rather are caused by a variety of factors, including biological ones.”

I don’t think I’ve ever used the term “make-believe” to describe psychiatric “illnesses”, though I do routinely describe psychiatric labels as invented.  The two terms are not synonymous.  What psychiatry calls mental illnesses are actually nothing more than loose collections of vaguely-defined problems of thinking, feeling, and/or behaving.  In most cases the “diagnosis” is polythetic (five out of nine, four out of six, etc.), so the labels aren’t coherent entities of any sort, let alone illnesses.

But the problems set out in the so-called symptom lists are real problems.  That’s not the issue.  I refer to these labels as inventions, because of psychiatry’s assertion that the loose clusters of problems are real diseases.  In reality, they are not genuine diseases; they are inventions.  They are not discovered in nature, but rather are voted into existence by APA committees.

“As we understand more about mental illness through research we will (as we have with cardiology, for example) gain more precise vehicles for measuring and understanding the biological implications of these disorders.”

But meanwhile psychiatry has made up its mind.  Within psychiatric dogma, all  significant human problems of thinking, feeling, and behaving are illnesses that need to be “treated” with drugs and electric shocks.

. . . . . . . . . . . . . . . . . 

FINALLY

All of this is interesting, and I suppose it’s important to refute the more or less steady stream of unsubstantiated assertions, fallacious reasoning, and spin that flows from the psychiatric strongholds.

But meanwhile the carnage continues.  There is abundant prima facie evidence that psychiatric drugs are causally implicated in the suicide/murders that have become almost daily occurrences here in the US.  My challenge to organized psychiatry is simple:  call publicly for an independent, definitive study to explore this relationship.  And my challenge to rank and file psychiatrists is equally simple:  pressure the APA to call for such a study.  If what you are doing is unqualifiedly wholesome, safe, and effective, then what do you have to fear?

 

My Response to a Defender of Psychiatry

On October 13, an interesting article was published on the Huffington Post Blog.  The author is Jessica Gold, MD, a psychiatry resident at Stanford University; the post is titled Inpatient Psychiatry: Not all Needles, Drugs And Locks.

The article is a personal experience/opinion piece, the gist of which is that people who criticize or condemn psychiatry simply don’t understand the complexities and needs of psychiatry’s “patients”, particularly the need for locked wards.

The article is generally unremarkable in that the arguments adduced are well-worn by more senior psychiatrists.  But it is interesting, and indeed tragic, to see a new entrant to the field absorbing psychiatry’s defensive nonsense, and trotting it out uncritically for public consumption.

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

Dr. Gold begins by describing the kinds of interactions she experiences in social settings when people learn that she is a psychiatrist.

Then:

“However, what frustrates me most are the times when after describing my day-to-day as a psychiatry resident, I am met with bewilderment, followed by misplaced sarcasm as I am asked, ‘And why would you want to do that?'”

Dr. Gold then becomes reflective:

“After reminding myself not to get defensive (as I continued to do throughout writing this piece) or just stop the conversation completely, I became intrigued. While doctors may not evoke the same respect and adoration of the days of house visits, no one asks the other doctors (non-psychiatrists) in my family with such strong negative connotation why they chose their respective specialties.

I began to wonder if it’s because the difference between a locked ward and a medical ward can seem confusing and scary to an outsider or a patient. Without knowing the safety rationale, it can feel degrading to have your clothes taken away, along with your cell phone, shoelaces, and sharp objects, only to sleep in a boring room with heavy, non-moveable (or throw-able) furniture. If you lack insight into your illness and do not understand the necessity of hospitalization, it can feel prison-like to be on a locked ward without the ability to leave it. And, without understanding the therapeutic benefit of engaging in connections with others on the unit, it can feel restrictive to have visiting hours and not be able to have a significant other or family member spend the night.”

So Dr. Gold is frustrated by the sarcasm she encounters when social acquaintances discover that she is a psychiatrist, and notes that other medical specialties do not generally attract this kind of response. She wonders if the reason for this differential response might be:

“… because the difference between a locked ward and a medical ward can seem confusing and scary to an outsider or a patient.”

This is a truly delightful piece of self-deceptive spin.  Psychiatry’s so-called patients might well feel scared of locked wards, and understandably so.  But the notion that fears of this sort underlie the general public’s negative perception of psychiatry is arrant nonsense.  The general public’s negative perception of psychiatry, as compared to genuine medical specialties, is grounded in a realistic appraisal of psychiatry’s spurious concepts and destructive “treatments”.  In particular, psychiatry is negatively perceived because:

  1. Psychiatry’s definition of a mental disorder/ illness, as set out in DSM III, IV, and 5, embraces virtually every significant problem of thinking, feeling, and/or behaving. Psychiatry uses this definition to fraudulently medicalize problems that are not medical in nature.
  1. Psychiatry routinely presents these so-called illnesses as the causes of the specific problems, when in fact they are merely labels: abbreviated rewordings of the presenting problems with no explanatory function or value.  These labels, which cause enormous damage to the individuals to whom they are assigned, serve only to legitimize the pushing of drugs, and to enable psychiatrists to bill for the services they provide.  Unlike real diagnoses, they provide no insight into the nature or essence of the presenting problems, but are nevertheless defended tenaciously by psychiatrists and their pharma funders.
  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. The classic example of this is the chemical imbalance theory of depression – a blatant hoax which was pushed so heavily by psychiatry that it has now become “common knowledge”.  And the most noteworthy aspect of this is that although the hoax has been exposed repeatedly – (most recently by Terry Lynch in his book Depression Delusion), psychiatry has taken no concerted steps to correct this misinformation, and indeed in many quarters is still promoting this fiction as established medical fact.
  1. Psychiatry has blatantly promoted drugs as corrective measures for these illnesses, when in fact it is well-known in pharmacological and psychiatric circles that no psychiatric drug corrects any neural pathology. In fact, the opposite is the case.  All psychiatric drugs exert their effect by distorting or suppressing normal brain functioning.  It is also well known that the adverse effects of these products are often devastating and permanent.
  1. Psychiatry has collaborated and conspired with pharma in the development of a vast body of fraudulent research, all designed to “demonstrate” that psycho-pharmaceutical products are safe and effective. The methods by which this fraud has been perpetrated include:  the routine suppression of negative results; the use of ridiculously short follow-up intervals; over-stating of marginal results; suppression of adverse effects; etc., etc.
  1. A great many psychiatrists have shamelessly accepted large sums of pharma money for very questionable activities. These activities include the widespread presentation of pharma infomercials in the guise of CEUs; the ghost-writing of books and papers which were actually written by pharma employees; targeting of captive and vulnerable audiences in nursing homes, group homes, and foster-care systems for prescription of psychiatric drugs; etc., etc…   Two glaring examples of this kind of venality are:

In this context, it should be noted that Dr. Biederman and Dr. Frances are among the most eminent and prestigious psychiatrists in the US.

In addition, 70% of the DSM-5 task force members had received funding from the pharmaceutical industry.

  1. Psychiatry’s labels 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 robs people of hope, and encourages them to settle for a life of drug-induced dependency and mediocrity.
  1. Psychiatry’s “treatments”, whatever transient feelings of well-being or tranquilization they may induce, are always destructive and damaging in the long-term. Neuroleptic drugs cause tardive dyskinesia.  Extended use of antidepressants produces a state of chronic joylessness.  Benzodiazepines are addictive.  High-voltage electric shocks to the brain erase memories.  Psychiatry’s notion that one can solve people’s problems by tinkering irresponsibly with their brains, betrays a degree of arrogant naivety unequalled in other professional groups.
  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 dependence. Powerful, time-honored concepts such as the need for critical self-appraisal, and personal improvement through effort, have been systematically marginalized by psychiatry’s expanding list of “illnesses”, and ever-flowing supply of drugs.  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 and professionally repugnant.
  1. Psychiatry’s primary agenda over the past four or five decades has been the expansion of its list of “illnesses”, and the assignment of these illnesses to more and more people. It has now become routine practice to prescribe neuroleptic drugs to elderly nursing home residents who become “unmanageable”, and to young children for temper tantrums!

This is the profession that Dr. Gold chose to enter and now chooses to defend with patronizing platitudes.

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

Back to Dr. Gold’s paper:

“Dear future and past patients: I. COMPLETELY. GET. IT. Nothing about being on a psychiatric ward is typical, even for a medical setting. But I (and every nurse, social worker, psychologist, occupational therapist, physical therapist, nursing assistant, and physician I have ever worked with) also really want to help you. That is why I chose a career in medicine, and even more true of the reason why I chose to specialize in psychiatry. I worry the images you have of inpatient psychiatry scare you and prevent you from seeing me as an ally. Even when I tell you that I am here to help, I can see the skepticism in your eyes and hear the fear in your voice. I am trained to observe, after all.

It is not surprising, then, that when I read descriptions or see my job portrayed as forceful or horrific, I want to take the time to correct them. I am not doing this simply because I want to protect my profession, but am actually doing this in defense of and in support of anyone who might need mental health help in the future. Stigmatizing attitudes toward psychiatric illnesses already exist; fear of psychiatry and seeking care do not need to be added to the equation.”

In recent years, the psychiatric survivor movement has grown, both in numbers and in the volume of output.  Survivors are writing about the mistreatment they have received, often for decades, at the hands of psychiatry.  But Dr. Gold dismisses these protests as erroneous and misinformed over-reactions.  Psychiatry’s so-called patients:  “lack insight” into their illnesses; do not understand “the necessity of hospitalization”; do not understand “the therapeutic benefit of engaging in conversations with others on the unit”; don’t realize that the psychiatrists who authorized the forcible injection of akathisia-inducing drugs “really” want to help; etc..

And Dr. Gold is taking the time to correct these misperceptions, not simply because she wants to protect her profession (Heavens, no!), but rather in defense and support of anyone who might need psychiatric help in the future.  How noble!

“Maybe people will always fear psychiatry, mental illness and what they do not know…But maybe those attitudes can be changed and as mental health advocates, we need to do everything we can to assuage those fears. Unfortunately, even well-meaning former patients perpetuate those fears, whether inadvertently or because of the limited lens through which they viewed their own hospitalization.”

To which I might respond:  Even well-meaning psychiatrists perpetuate these fears, whether inadvertently or because of the erroneous and destructive disease-focused lens through which they view their “patients” and their “treatments”.

The rationalizations and self-justifications continue:

“I’ve been screamed at, cursed at, rushed towards, demeaned and have seen patients and nurses get seriously injured.  Even still, I do not make these decisions lightly or lead a conversation with a needle.”

The great irony here is that the neuroleptic drugs that psychiatrists routinely use to control aggressive behavior frequently produce a condition called akathisia, which in turn is a known precipitator of suicide and violence.  Crowner, Douyon, et al, conducted a short study of this matter in 1990.  Here’s a quote from their paper:

“Akathisia is a common side effect of neuroleptic drugs that may present with behavioral disturbances. There have been preliminary reports on the association between violence and akathisia. We report the first observational study of this relationship. Patients studied were from a special unit for violent patients. A closed-circuit television camera was installed in each of the corners in its dayroom. Incidents of assault plus the 5 minutes preceding each assault were recorded on videotape. Participants and bystanders were rated for the motor component of akathisia. For each of nine incidents, we compared the akathisia scores for participants and for bystanders. Both victims and assailants were akathisic before about half of all incidents; bystanders rarely were. The classification of the movements we rated and the implications for further studies are discussed.”

It would be interesting to know how many of the individuals who screamed, cursed at, rushed towards, and demeaned Dr. Gold were experiencing akathisia as a result of neuroleptic or antidepressant drugs that she had prescribed for them.  It is also interesting that no major follow-up of the Crowner, Douyon, et al study has been undertaken by psychiatry.

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

“Given the responses to our career selection in casual conversation, it is probably not shocking that I (and my peers) can sometimes hesitate to say my medical specialty, despite having no shame or regrets about my decision. Knowing now that hiding my profession only further contributes to its stigma, and without a voice or a face, psychiatrists and their patients will always just be a part of a power struggle…, I will never again shy away from it:

I am a psychiatrist-in-training. My job is complicated, weird, unique, fun, fulfilling, and challenging… but that’s what makes it beautiful.”

Well all of this is nice to know, but in my view, psychiatry is neither fun nor fulfilling for those on the receiving end, especially in the long-term..

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

The reality is that psychiatry is not something good that needs some minor corrections.  Rather, it is something fundamentally flawed and rotten; a wrong turning in human history, trailing death, disability, and disempowerment in its worldwide wake.  No amount of rationalization or platitudinous exculpations can mitigate this reality.  Psychiatry kills people every day, and adamantly refuses to recognize this reality and take appropriate action.

 

Allen Frances:  Still Blaming Everyone But Himself

On May 7, Allen Frances, MD, posted an article on the HuffPost site.  The piece was titled Antidepressants Work, But Only For Really Depressed People.

Superficially, the article presents itself as a call to limit the prescribing of the so-called antidepressant drugs to severe cases; but the piece can, I suggest, be more accurately characterized as Dr. Frances’s latest attempt to distance himself, and psychiatry in general, from the pill-peddling frenzy that has characterized the profession for the past thirty or forty years

Here are some quotes, interspersed with my comments and observations.

DSM-III’S “BIGGEST MISTAKE”

“The biggest mistake in DSM III was introducing the very broad and heterogeneous category ‘Major Depressive Disorder’. This combined under one rubric what had previously been two separate and quite different presentations: 1) severe, melancholic, delusional, or incapacitating depressions, and 2) reactive to stress, mild, and often transient depressions. The result is that many people get the label Major Depressive Disorder, even though their presentation isn’t really ‘Major’, isn’t really ‘Depressive’, isn’t really ‘Disorder’. Mild sadness in reaction to stress and disappointment is lumped together with the most severe suffering known to man.”

At issue here is the old psychiatric distinction between endogenous depression and exogenous depression.  The later was conceptualized as a reaction to some external fact or circumstance, whereas the former was considered to have arisen from within the person – i.e. without any external loss or hurt.  The distinction was always problematic, in that it’s impossible to know, with certainty, that a person’s depression is not a response to some external loss, hurt, or circumstance, but the distinction was considered important within the psychiatric community generally.

In any event, the terms “exogenous” and “endogenous” went out of vogue, though the underlying concepts remained in place in DSM-III.  And, contrary to Dr. Frances’s assertion in the above quote, they remained in place as separate entities.  These were: “major depressive disorder”, and “adjustment disorder with depressed mood”.

In DSM-III, adjustment disorder is defined as “A reaction to an identifiable psychosocial stressor…”.  DSM-III made no provision for specifying severity of adjustment disorder (e.g. mild, moderate, severe), but in the text it states clearly that people may have “a more severe form of the disorder” or “only a mild form of the disorder”.  Major depressive disorder in DSM-III could be formally and explicitly coded as mild, moderate, and severe.

Now it’s no part of my agenda to defend any edition of the DSM, a document which in my view has all the scientific rigor and practical usefulness of a witch-hunter’s manual.  Rather, my purpose here is to point out that Dr. Frances’s assertion in the above quote is simply false.

Essentially what Dr. Frances is saying, or at least forcefully implying, is that since this great “error” in DSM-III, psychiatrists, misfortunate lambs that they are, have simply had no way to reflect in their “diagnostic assessments” that the individual’s depression “isn’t really ‘Major’, isn’t really ‘Depression’, isn’t really ‘Disorder’.”

And because of this truly arduous imposition, psychiatrists are constrained to lump “mild sadness in reaction to stress and disappointment” with “the most severe suffering known to man”.

It may well be that psychiatrists have been avoiding the use of “reaction to stress”, “mild” and “transient” qualifiers in their “diagnostic assessments”.  But this is emphatically not because such qualifiers were rendered impossible by DSM-III.  A much more likely explanation is that the use of these qualifiers militates against the notion, avidly promulgated by psychiatry for the past forty years, that depression, of whatever severity, is a chronic illness, (just like diabetes); a chemical imbalance in the brain, for which the “patient” must take so-called antidepressant drugs for an extended period, and possibly the rest of his/her life.  For all of this time, it has been an integral part of psychiatry’s informal, but avidly asserted, message that although depression might have been triggered by an external event, it is essentially an illness residing within the person’s neurochemistry.

But, even if we put all that aside; even if we acknowledge that Robert Spitzer and his DSM-III co-authors made a dreadful error, a critical question remains:  why did Dr. Frances himself and his DSM-IV co-authors, so uncritically follow suit?  And why has Dr. Frances not acknowledged his own perpetuation of this so-called error in the present paper?  It’s easy, and perhaps a little craven, to point fingers at the recently deceased Dr. Spitzer, when in fact, Dr. Frances himself followed precisely the same path.

And in fact, Dr. Spitzer was open enough to admit that he and his DSM-III co-workers had made a much more fundamental error.  Here’s a quote from an interview he gave to British film maker Adam Curtis.  The interview was screened by the BBC in 2007, and the 50 second excerpt can be viewed here, starting at minute 34:10.

Robert Spitzer, MD:

“What happened is that we made estimates of prevalence of mental disorders totally descriptively without considering that many of these conditions might be normal reactions which are not really disorders.  That’s the problem.  Because we were not looking at the context in which those conditions developed.”

Adam Curtis:

“So you have effectively medicalized much of ordinary human sadness, fear, ordinary experiences, you’ve medicalized them.”

Spitzer:

“Uh, I think we have, to some extent.  How serious a problem it is is not known.  I don’t know if it’s twenty percent, thirty percent, I don’t know.  But that’s a considerable amount if it is twenty or thirty percent.”

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

Back to the Huffington Post piece.

“Drug companies jumped on the opportunity to peddle a pill for every problem and misleadingly described all depressions as a chemical imbalance requiring a chemical solution. Treatment studies that previously showed clear superiority of medicine over placebo for severe depression showed little or no superiority with patients whose depression was mild or questionable. And biological marker studies that showed promise in tagging severe depression came up empty with the watered down Major Depressive Disorder.”

There it is again.  Those mean old opportunistic drug companies!  How could one ever trust them?

But again, a major distortion of reality.  Drug companies can’t sell these products without FDA approval, and a physician’s prescription.  It was psychiatrists who created and promulgated the questionable research that elicited FDA approval and legitimized the wholesale use of these products.  Admittedly, these psychiatrists were handsomely paid by pharma, but they were not constrained.  Dr. Frances is surely familiar with this process.  In 1995, he and his two colleagues Drs. John Docherty and David Kahn, reportedly accepted $515,000 from Johnson & Johnson to write “Schizophrenia Practice Guidelines”, which blatantly promoted Risperdal (risperidone), a drug manufactured by Johnson & Johnson.  For a full and compelling account of this sordid tale, see Paula Caplan’s very thorough exposé here.

The notion that psychiatric research would clearly support the use of the drugs and would identify biological markers for depression, if only the “mild or questionable” depressions were excluded, is fanciful.  Depression has been extensively researched for decades, by psychiatrists, highly motivated by pharma largesse to find significant positive results.  These studies routinely report that “diagnoses” were confirmed by scrupulously careful evaluations using psychiatric interviews and validated screening tools.  So why would there by “questionable” cases in the studied samples?  In fact, in his Introduction to DSM-IV (1984), Dr. Frances explicitly acknowledged DSM-III’s contribution in this area.

“The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) represented a major advance in the diagnosis of mental disorders and greatly facilitated empirical research.  The development of DSM-IV has benefited from the substantial increase in the research on diagnosis that was generated in part by DSM-III and DSM-III-R.” (p. xviii) [Boldface added]

An identical passage was included on page xxvi in DSM-IV-TR six years later (2000)

And furthermore, individuals whose depression is mild can be eliminated readily and legitimately from a study by limiting the scope to moderate and severe cases.

PSYCHIATRY DID PROMOTE THE CHEMICAL IMBALANCE THEORY

And what are we to make of Dr. Frances’s assertion that the drug companies “…misleadingly described all depressions as a chemical imbalance requiring a chemical solution”? In fact, it was psychiatry who promoted the chemical imbalance hoax.  Pharma certainly tagged along, with their blatantly false commercials, but psychiatry could have stopped this fraudulent inanity in its tracks at any time, by issuing a clear and definitive press release disavowing the hoax, and by filing a formal complaint of false advertising with the Federal Trade Commission.

But psychiatry took no such action.  Psychiatry blatantly, and without compunction, foisted this falsehood on their “patients”, on the public, and on other practitioners – knowing it to be false – for the purpose of promoting their own guild interests, and selling more drugs.  It is simply beyond comprehension that Dr. Frances continues to try to slough off the responsibility for this hoax, this gross violation of the public trust, onto his erstwhile pharma benefactors.

If Dr. Frances has any residual doubts as to psychiatry’s role in the dissemination of this falsehood, he might usefully take a look at Terry Lynch’s book Depression Delusion or my post Psychiatry DID Promote the Chemical Imbalance Theory

Or … he might want to revisit something he himself wrote in 1998.  Here’s a quote from Am I Okay? by Allen Frances, MD, and Michael B First, MD:

“Depression is really no different than hypertension.  Medicines that treat high blood pressure are taken to reestablish the body’s ability to maintain a normal blood pressure.  Antidepressants work in the same way—restoring brain neurochemistry to its original natural state.  In contrast to drugs like heroin and cocaine, which make virtually everyone feel euphoric, an antidepressant does nothing for a person without depression except produce unpleasant side effects.  There is no street market for antidepressants and they are not addictive.  Finally, in the same way that it would be ludicrous to think that someone can simply will their elevated blood pressure down to normal, true grit is not by itself sufficient to cure clinical depression.” (p 49-50)  [Emphasis added]

Incidentally, Dr. Frances’s promotion of the now defunct chemical imbalance theory of depression in the above quote is particularly interesting in the light of the statement made by the very eminent psychiatrist Ronald Pies, MD in his April 2014 article Nuances, Narratives, and the Chemical Imbalance Debate:

“To the extent the ‘chemical imbalance’ notion took hold in our popular culture, it was due mainly to distorted or oversimplified versions of the catecholamine hypothesis. These were often depicted in drug company ads; pop psychology magazines; and, in recent years, on misinformed Websites and blogs. In short, the ‘chemical imbalance theory’ was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.”

Dr. Pies, meet Dr. Frances.

With regards to Dr. Frances’s assertion that there is no street market for antidepressants, here is a letter in the February 2007 issue of the American Journal of Psychiatry.  The letter is from Greg Tarasoff, MD, a psychiatrist, and Kathryn Osti, and is titled Black-Market Value of Antipsychotics, Antidepressants, and Hypnotics in Las Vegas, Nevada. The letter reports that, at that time, antidepressants were selling on the street for $3-$5 per dose.

Also, here’s a 2013 article from globalnews.ca, Toronto, which describes an active street market in Wellbutrin.  The article was written by Jennifer Tryon and Nick Logan, and it reports that Wellbutrin is referred to as “the poor man’s cocaine”.

I realize, of course, that Am I Okay was written before these articles, but here are two studies that predate the book:

Abuse of Amitriptyline by Cohen, Hanbury, and Stimmel: JAMA, Sept 1978:

“A survey of 346 persons enrolled in a methadone maintenance program showed that 86 (25%) had admitted taking amitriptyline with the purpose of achieving euphoria.”

And Identification of misused drugs in the clinical laboratory. I. Tricyclics, by Vasiliades, J; Clinical Biochemistry, February 1980:

“A systematic approach evaluating the abuse of tricyclic drugs in the hospital emergency room from the laboratory point of view is presented…Increasing misuse of tricyclic antidepressants requires that the clinical laboratory have a systematic approach to identify and confirm the presence of these drugs in emergency room patients.” [Emphasis added]

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

FRANCES PROMOTED THE DRUGS

Back to Am I Okay?  Here’s a quote in which Drs. Frances and First promoted the drugs as “very effective” in the treatment of “major depressive disorder”:

“For those suffering from Major Depressive Disorder, antidepressant medications are very effective—the overall odds that an antidepressant treatment will work eventually are probably at least 90 percent.  But you have to be patient and forbearing along the way.  It usually takes at least several weeks for the medication to begin working, and a couple of months before it has reached its maximum effect.  It might also take time and effort to find the most effective medication for you and to determine its proper dose.  Some people must endure several trials of different antidepressants until they find the one that is a winner for them.  To give you some perspective, two thirds of depressed patients will have a good response to the first medicine that is tried. For those who do not respond initially, the odds of a second antidepressant working are about fifty-fifty—this gets us to about 80 percent total response rate.  If you have still not yet responded after two tries, a third or fourth or even a fifth try may be necessary to find the medicine or combination of medicines that will eventually work.  The good news is that there are close to thirty available antidepressants on the market and new ones are being developed all the time.  Hopefully sooner, but almost certainly eventually, one of these or some combination will work for you.

The use of antidepressant medication has risen dramatically over the past several years, but many people who might benefit have misconceptions that make them reluctant to give one a try.  One common concern is that the changes resulting from antidepressant use are artificial and, by implication, somehow illegitimate.  Others worry that they will become physically dependent on antidepressants in the same way that a heroin addict cannot function without his daily fix.  Yet others feel that having to rely on antidepressant medications to maintain one’s mood (and productivity) represents a weakness in moral fiber—that you should be able to get rid of the depression by sheer will power alone.” (p 49)

There are several noteworthy points in this quote.

Firstly, Dr. Frances does not limit his assertions to cases of “severe, melancholic, delusional, or incapacitating depressions“, even though such options were available within the psychiatric “diagnostic” system.  The phrase “…those suffering from Major Depressive Disorder” clearly embraces mild, moderate, and severe unless otherwise delineated.  In fairness to Dr. Frances, he does acknowledge elsewhere in the text that the drugs are not always necessary, but his assertions in this regard are generally less compelling, e.g., “antidepressant medications are probably overused.” (p 50) [Emphasis added]

Secondly, the tone of the quote with regards to taking the drugs is upbeat and optimistic.  The drugs “…are very effective”; “the odds of successful treatment…are probably at least 90 percent”; “…there are close to thirty available antidepressants on the market…”; “…one of these or some combination will work for you.”

Thirdly, the authors acknowledge that antidepressant use has risen “dramatically”, but then go on to encourage further use.

Fourthly, there are clear efforts on the part of the authors to undermine people’s resistance to drug-taking. The authors dismiss concerns that the effects of the drugs are “artificial” and that the drugs might be addictive.  Bearing in mind that the book was written for general audiences (A Layman’s Guide to the Psychiatrist’s Bible), the assertion that antidepressants restore “…neurochemistry to its original natural state”, with its almost Edenic connotations, is nothing short of outrageous.

And incidentally, here’s another quote from the same chapter:

“ECT is a terrifically effective treatment  that is also relatively safe considering the great benefits that can often be gained.  ECT is especially useful for psychotic mood disorders, people who need a really fast response, medication nonresponders, and for those who cannot tolerate antidepressant medication.  Electroconvulsive therapy has a higher response rate (80 to 90 percent versus the 65 to 70 percent achieved by medication combinations) and also works more rapidly.  However, it has the disadvantage of providing fewer clues as to what type of medication is likely to work to prevent recurrences in the maintenance phase.  Due to misguided fears, ECT has been most typically considered a treatment of last resort when nothing else works.  It probably deserves to be used earlier and more often.” (p 51-52)

Note that the success rate of antidepressants which on page 49 was given as “at least 90 percent”, is now, two pages later, given as “65 to 70 percent”.

Note also that Dr. Frances is advocating an expansion of the use of high voltage electric shocks to the brain as a “treatment” for depression, and makes no mention of the permanent memory damage that this “treatment” entails.

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

Back to the HuffPost article:

“Critics of medication jumped on this to argue misleadingly that depression is a myth and/or that medication treatment for depression doesn’t work.”

I don’t know of anyone on this side of the debate who argues that “depression is a myth”.  I myself argue – as do a great many others – that depression is not an illness.  But depression is real, and I don’t believe that I’ve ever heard anyone suggest otherwise.  My own position is that depression is the natural human reaction to loss or to ongoing hardship/drudgery, and that severe depression is the normal reaction to a major loss or to ongoing hardship/drudgery that is particularly arduous.  It is not something that needs to be “treated”; rather, it can be alleviated, either by supporting individuals through their loss, or actively helping them identify and extricate themselves from the depressing circumstances.  What the pills do, in some cases, is provide an altered mental state, which some people find preferable to the depression.  But the pills produce no lasting benefits, and usually do a great deal more harm than good.  The issue here is not whether people should or shouldn’t take these pills.  That’s each person’s individual choice.  The issue is psychiatry pushing these dangerous serotonin-disruptive chemicals on people, under the pretense that they have an illness, for which the pills are an effective and safe treatment.

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

At this point in the article, Dr. Frances introduces Mark Kramer, MD, PhD.  Dr. Kramer restates and elaborates on some of the points made by Dr. Frances, who in turn closes the article with some concluding remarks, including:

“The next point seems too obvious to be stated, but nonetheless desperately needs stating. Only people who are clearly clinically depressed and clearly need antidepressants should be included in research studies and should be taking antidepressants in everyday clinical practice. Depression has been too carelessly diagnosed- encouraged by the loose DSM definition, by Pharma’s desire to push product; by rushed doctors; and by people’s hope for a quick fix for life’s problems.”

It should be noted that the term “clinically depressed”, despite its widespread usage, has no formal meaning in psychiatry.  In practice, it is used to mean having a “diagnosis” of major depressive disorder or dysthymia, but because of the medical connotations of the word “clinical”, it is also used to convey and promote the notion that depression is an illness.  So Dr. Frances is telling us that only people who clearly meet the criteria for major depressive disorder or dysthymia, and who clearly need antidepressants, should be taking antidepressants.  But this is nothing more than an empty platitude.  What’s the alternative?  Take antidepressants even though you don’t really need them?  Who is suggesting that? And anyway, wasn’t the whole point of the DSM to provide rigorous definitions of the various “mental disorders”?  Hasn’t this been the standard psychiatry patter since DSM-III?  In fact, here’s the opening paragraph from the Introduction to Dr. Frances’s own DSM-IV:

“This is the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV.  The utility and credibility of DSM-IV require that it focus on its clinical, research, and educational purposes and be supported by an extensive empirical foundation.  Our highest priority has been to provide a helpful guide to clinical practice.  We hoped to make DSM-IV practical and useful for clinicians by striving for brevity of criteria sets, clarity of language, and explicit statements of the constructs embodied in the diagnostic criteria.  An additional goal was to facilitate research and improve communication among clinicians and researchers.  We were also mindful of the use of DSM-IV for improving the collection of clinical information and as an education tool for teaching psychopathology.” (p xv)

and later, concerning DSM-III:

“DSM-III introduced a number of important methodological innovations, including explicit diagnostic criteria, a multiaxial system, and a descriptive approach that attempted to be neutral with respect to theories of etiology.” (p xvii-xviii)

So if the problem is “loose DSM definitions”, Dr. Frances needs to direct at least some of the responsibility for the present state of affairs in his own direction; firstly for drafting a document that slavishly followed the errors he now ascribes to DSM-III, and secondly for  falsely hyping DSM-IV in that edition’s Introduction.

In should also be noted, that the “diagnostic” definitions in all editions of the DSM are notoriously vague and “loose”.  But in addition, Dr. Frances’s own DSM-IV added an entire layer of looseness:

“The specific diagnostic criteria included in DSM-IV are meant to serve as guidelines to be informed by clinical judgment and are not meant to be used in a cookbook fashion.  For example, the exercise of clinical judgment may justify giving a certain diagnosis to an individual even though the clinical presentation falls just short of meeting the full criteria for the diagnosis as long as the symptoms that are present are persistent and severe.” (p xxiii) [Emphasis added]

How short is “just short”?  What duration would be considered persistent?  In the case of “major depressive disorder”, we know that “persistent” means two weeks!

Dr. Frances tells us that depression (by which he clearly means the mythical illness) has been too carelessly diagnosed by

– pharma’s desire to push product;
– rushed doctors (note, not specifically psychiatrists); and
– people’s hope for a quick fix for life’s problems

In short:  everyone is to blame for the drug-pushing except psychiatry; that dauntless and noble pillar of compassionate rectitude, standing valiantly alone against the surging tide of venality, corruption, disease-mongering, slovenliness, and disempowerment that characterizes all the other players in this epic tragedy.

The notion that the loose definitions, the inexorable expansion of the “diagnostic” net, and the broadening of “indications” for the drugs were errors, is simply not credible.  If these were errors, then psychiatrists must surely be a most inept group of people.  Rather, these developments were, and still are, an integral part of psychiatry’s plan to expand its scope and to strengthen its hegemony.  And this plan, in the implementation of which Dr. Frances played a leading part, is still in place.  Psychiatry, with the help of their pharma allies, is actively promoting early screening for various “diagnoses”.  Active steps are being taken to have mental health services embedded in every school and in every GP’s office.  Children as young as three years old are being given major tranquilizers to “treat” temper tantrums, and vulnerable individuals in nursing homes, foster care, and group homes are being drugged at unprecedented levels.

If Dr. Frances genuinely wants to distance himself from this institutional degeneracy, he must first acknowledge the role that he himself played in its creation.

THE FUNDAMENTAL PROBLEM

Important as all these issues are, there is a fundamental, over-riding issue that is much more critical.

The assertion that the so-called antidepressants are being over-prescribed implies that there is a correct and appropriate level of prescribing towards which reformative efforts should be directed.

And this premise is false, for three reasons.  Firstly, because depression, regardless of its severity or persistence, is not an illness which needs to be treated with medication.  Secondly, because the drugs, despite the psychiatric-pharma hype, are not particularly effective in ameliorating depression.  And, thirdly, because these serotonin-disruptive drugs have a wide range of adverse effects, the seriousness of which has been routinely downplayed by pharma and by psychiatry.

The widespread and increasing use of the so-called antidepressant drugs is certainly a matter for concern, as is the assignment of depression “diagnoses” to more and more people.  But these problems stem directly and inevitably from the fact that psychiatry invented these spurious illnesses and generated the bogus research to legitimize the use of the pills as safe and effective “treatments”.  Given the inherent vagueness of the criteria and the absence of an identified and confirmable biological pathology, it was inevitable and predictable that “diagnosing” and pill-pushing would increase. To put the matter briefly, there is no way to determine who has the illness called depression and who doesn’t, because no such illness exists.  Psychiatry invented this entity, concocted an inane checklist of “symptoms” to create the appearance of medical legitimacy, peddled the pills with abandon, and reaped the profits.

Allen Frances’s bemoaning the “over-prescribing” at this late stage in the game is not only hypocritical.  It also serves to distract his readers from the real issue:  that psychiatry is, at its very core, an enormous and destructive hoax, and cannot be saved from its own self-serving excesses by these kinds of platitudinous calls to clean house.

ADHD:  The Hoax Unravels

At the risk of stating the obvious, ADHD is not an illness.  Rather, it is an unreliable and disempowering label for a loose collection of arbitrarily chosen and vaguely defined behaviors.  ADHD has been avidly promoted as an illness by pharma-psychiatry for the purpose of selling stimulant drugs.  In which endeavor, they have been phenomenally successful, but, as in other areas of psychiatry, the hoax is unraveling.

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

In 2001, the American Academy of Pediatrics published Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder Here’s a quote:

RECOMMENDATION 3: The clinician should recommend stimulant medication (strength of evidence: good) and/or behavior therapy (strength of evidence: fair), as appropriate, to improve target outcomes in children with ADHD (strength of recommendation: strong).

The clinician should develop a comprehensive management plan focused on the target outcomes. For most children, stimulant medication is highly effective in the management of the core symptoms of ADHD. For many children, behavioral interventions are valuable as primary treatment or as an adjunct in the management of ADHD, based on the nature of coexisting conditions, specific target outcomes, and family circumstances.”

Clearly, this recommendation is pushing the drugs (evidence good), and is downplaying the usefulness of behavioral interventions (evidence fair).  The reference to behavioral interventions “…as an adjunct…” doesn’t inspire a great deal of confidence in their use as the primary intervention.  And, indeed, this is how “treatment” of “ADHD” has developed in the intervening years:  pills for all, and occasional behavioral programs, many of which were geared towards accepting one’s “illness” and promoting “medication compliance”.

And all of this in a context in which ADHD was being fraudulently promoted by psychiatry, and by its pharma partners, as a neurochemical imbalance which was corrected by stimulant drugs.  Here’s what the eminent Harvard psychiatrist Timothy Wilens, MD, wrote on the matter in the article Paying Attention to ADHD in Family Circle magazine on November 20, 2011:

“ADHD often runs in families.  Parents of ADHD youth often have ADHD themselves.  The disorder is related to an inadequate supply of chemical messengers of the nerve cells in specific regions of the brain related to attention, activity, inhibitions, and mental operations.”

“Contrary to what most parents think, medication is one of the most important treatments for ADHD and is essential for long-term success of these kids.” (p 65)

The above quotes were clearly aimed at mothers, were designed to break down parental resistance to drug-taking, and are typical of what psychiatry generally has been saying on this subject for decades.

Dr. Wilens is an Associate Professor of Psychiatry at Harvard, and works as a psychiatrist at Massachusetts General Hospital.  In 2014 he was named Chief of Staff in Child and Adolescent Psychiatry.  So promoting the chemical imbalance hoax has certainly not harmed his career.

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

In recent years, psychiatrists have been experiencing increased scrutiny and criticism from the media, the general public, and some legislators, for the “pill for every problem” approach.  In this context, the American Academy of Pediatrics, in 2011, published an updated set of guidelines for ADHD under the title ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents  In this revised document, their recommendations for treatment are divided into three parts:  preschool children (4-5); elementary school children (6-11); and adolescents (12-18).  Here is a quote from each section:

Action statement 5a: For preschool-aged children (4–5 years of age), the primary care clinician should prescribe evidence-based parent and/or teacher-administered behavior therapy as the first line of treatment (quality of evidence A/strong recommendation) and may prescribe methylphenidate if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child’s function.

Action statement 5b: For elementary school-aged children (6–11 years of age), the primary care clinician should prescribe FDA-approved medications for ADHD (quality of evidence A/strong recommendation) and/or evidence -based parent- and/or teacher-administered behavior therapy as treatment for ADHD, preferably both (quality of evidence B/strong recommendation).

Action statement 5c: For adolescents (12–18 years of age), the primary care clinician should prescribe FDA-approved medications for ADHD with the assent of the adolescent (quality of evidence A/strong recommendation) and may prescribe behavior therapy as treatment for ADHD (quality of evidence C/recommendation), preferably both.

Note in particular that for preschool children, the recommended “first line treatment” is behavior therapy administered by the parent and/or teacher, and the pills are recommended only if the behavioral interventions are not effective, and the problem is moderate-to-severe.  This is a sea-shift from the earlier guidelines.

Note also that for older children, pills and/or behavioral therapy are recommended, “preferably both”.  Here again, behavioral interventions are being emphasized a good deal more than was the case in 2001.

Later in the guidelines document, the authors clarify what they mean by behavior therapy:

“Behavior therapy represents a broad set of specific interventions that have a common goal of modifying the physical and social environment to alter or change behavior. Behavior therapy usually is implemented by training parents in specific techniques that improve their abilities to modify and shape their child’s behavior and to improve the child’s ability to regulate his or her own behavior. The training involves techniques to more effectively provide rewards when their child demonstrates the desired behavior (eg, positive reinforcement), learn what behaviors can be reduced or eliminated by using planned ignoring as an active strategy (or using praising and ignoring in combination), or provide appropriate consequences or punishments when their child fails to meet the goals (eg, punishment). There is a need to consistently apply rewards and consequences as tasks are achieved and then to gradually increase the expectations for each task as they are mastered to shape behaviors.  Although behavior therapy shares a set of principles, individual programs introduce different techniques and strategies to achieve the same ends.” [Emphasis added]

Note that what’s being recommended here is that the parents be trained in the ordinary, time-honored principles of effective parenting.

And remember, this was in 2011 – five years ago, but the shift in the pediatric guidelines has not resulted in a significant shift in practice.

In response to this inertia, on May 3, 2016, the Centers for Disease Control and Prevention (CDC) issued a press release titled More Young Children with ADHD Could Benefit from Behavior Therapy.

Obviously the CDC considers ADHD to be a disease, but if you can bear with the medicalization wording, here are some interesting quotes:

“The American Academy of Pediatrics recommends that before prescribing medicine to a young child, healthcare providers refer parents to training in behavior therapy. However, according to the Vital Signs report, about 75% of young children being treated for ADHD received medicine, and only about half received any form of psychological services, which might have included behavior therapy.” [Emphasis added]

Note that what’s being stressed here is the need to refer parents to behavioral training.

“Parents of young children with ADHD may need support, and behavior therapy is an important first step.  It has been shown to be as effective as medicine, but without the risk of side effects. We are still learning about the potential unintended effects of long-term use of ADHD medicine on young children. Until we know more, the recommendation is to first refer parents of children under 6 years of age with ADHD for training in behavior therapy before prescribing medicine.” [Emphasis added]

“CDC is calling on doctors, nurses, and allied health professionals who treat young children with ADHD to support parents by explaining the benefits of behavior therapy and referring parents for training in behavior therapy.” [Emphasis added]

In addition to the press release, the CDC also provided a press telebriefing in which reporters were able to put questions to senior CDC officials.  One of the questions was from Ariana Cha with the Washington Post.  Her question was:

“Hi.  I had a quick follow-up question about the — about insurance.  And when you say that these should be covered, are you also talking about kind of the gold standard, which is A.B.A. [Applied Behavior Analysis]  Therapy, which is incredibly expensive and usually used for autism but also to address a lot of the same behaviors that you see in ADHD?”

Two CDC officials responded.  First was Anne Schuchat, MD, Principal Deputy Director for CDC:

“No, you know, the treatments are quite different.  And I’d like Dr. Georgina Peacock to comment on that because we don’t believe the same interventions for autism should be used for children with ADHD.”

And then Georgina Peacock, MD, MPH, FAAP, Director, Division of Human Development and Disability:

“So we are talking about behavioral therapy, but this particular behavioral therapy is parent training.  So parents learn skills that help promote positive behaviors in their children.  There’s also a strengthening of the relationship between the parent and the child.  And some of the other things, some of the examples of things that happen, is parents learn about limit setting.  They learn about applying appropriate consequences for inappropriate behaviors and learn about how to improve communication between the parent and the families.  That’s the type of behavioral therapy that we are talking about and the American Academy of Pediatrics recommends for families.” [Emphasis added]

It is clear from these responses that the CDC is not conceptualizing these recommendations as the provision of some kind of specialized treatment to the children, but rather as training the parents in the basic principles and practices of effective parenting.

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

In other words, as we “mental illness deniers” have been saying for years, the problem does not reside in the child in the form of some hypothesized brain dysfunction.  Rather, the problem is the direct result of ineffective discipline, training, and correction on the part of caregivers.  And the truly ironic thing is that older people, with no particular training in psychology, psychiatry, social work, counseling, etc., have been saying this for decades, shaking their heads in sadness and disbelief as they watch their children and grandchildren accept pharma-psychiatry’s hoax, and feed the serotonin-disruptive drugs to their children in ever-increasing numbers.  Grandparents – nature’s own trainers in parenting skills – have been effectively silenced by pharma-psychiatry’s spurious, self-serving insistence that these kinds of misbehaviors constitute a brain illness which needs the attention of medically-trained experts.  These unsubstantiated assertions undermine parental confidence, open “uncooperative” parents to accusations of child neglect, and create an environment in which the levels of mastery and self discipline that were the norm for children fifty years ago, are rapidly becoming the exception.

Even CHADD, not noted for challenging the ideology of their pharma benefactors, makes some concessions in this direction.  Here’s a quote from their About ADHD document:

“Problems in parenting or parenting styles may make ADHD better or worse, but these do not cause the disorder. ADHD is clearly a brain-based disorder. Currently research is underway to better define the areas and pathways that are involved.”

This, incidentally, is a truly delightful example of typical psychiatric mental gymnastics.  Let’s take a closer look.

“Problems in parenting or parenting styles may make ADHD better or worse…”

Now, as is well known, ADHD is defined by the presence of six or more habitual behaviors from either or both of two checklists of nine items each.  So if it is being conceded that “problems in parenting” can make ADHD worse, this can only be in terms of a deterioration on one or more of the criterion items.  But since all the criterion items are continuous variables, this inevitably entails a recognition that problems in parenting can push a child past whatever threshold of severity or frequency is required to constitute a “hit”.  Which in turn entails the fact that problems in parenting can produce the six or more hits required to make the “diagnosis”.  In other words, problems in parenting, by CHADD’s own admission, can cause ADHD.  Obviously the drafters of the document realized that they had opened this door, and immediately tried to slam it shut by countering even their own logic with their customary mantra-like assertion:  “ADHD is clearly a brain-based disorder”, the proof of which will be forthcoming any decade now!

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

And incidentally, the American Academy of Pediatrics guidelines includes a section on the adverse effects of stimulant drugs.  Here’s a quote:

“An uncommon additional significant adverse effect of stimulants is the occurrence of hallucinations and other psychotic symptoms.”

In 2009, Mosholder et al conducted a study on the incidence of these kinds of events and found:

“A total of 11 psychosis/mania adverse events occurred during 743 person-years of double-blind treatment with these drugs, and no comparable adverse events occurred in a total of 420 person-years of placebo exposure in the same trials. The rate per 100 person-years in the pooled active drug group was 1.48. The analysis of spontaneous postmarketing reports yielded >800 reports of adverse events related to psychosis or mania. In approximately 90% of the cases, there was no reported history of a similar psychiatric condition.”

Eleven cases in 743 person-years (i.e. one in 68 person-years) sounds like a small effect.  But in any given year, about 3.5 million American children take a stimulant drug for ADHD.  And if we assume that each of these children takes the pills for an average of six months (almost certainly an under-estimate), this amounts to approximately 25,700 drug-induced psychosis/mania incidents each year in the US alone.  To the best of my knowledge, no large-scale, systematic study of the outcome of these incidents has been undertaken.

. . . . . . . . . . . . . . . . 

SUMMARY

The 2011 pediatric guidelines, reinforced as they were by the CDC’s recent press release and telebriefing, represent a formidable broadside against psychiatry’s promotion of ADHD as a brain illness residing within the child.  If this “illness” can be “cured” by improved discipline/correction on the parents’ part, isn’t it eminently reasonable to conclude that ineffective discipline was the precipitating cause of the problem in the first place?  We can be sure that pharma-psychiatry are already working on counter-measures to neutralize the impact of these documents, and we should not expect the bastions of bio-bio-bio psychiatry to crumble overnight. But as Andrew Lloyd Webber and Tim Rice put it so lyrically back in 1968:

“But if my analysis of the position is right,
At the end of the tunnel there’s a glimmer of light”
(Joseph and the Amazing Technicolor Dreamcoat)

On all sides the hoax is unraveling, and psychiatry has  no response other than the repetition of the same unsubstantiated assertions, laced generously with PR, obfuscation, and the assignment of blame to others for their own errors and deceptions.

 

Allen Frances on Anti-Psychiatry

On February 22, Allen Frances, MD, published an article titled:  Psychiatry and Anti-Psychiatry on the HuffPost Blog.  The general theme of the article is that psychiatry may have some problems, but it is basically sound, wholesome, and necessary.

Here are some quotes, interspersed with my comments:

“Psychiatry used to be a biopsychosocial profession that allowed time to get to know the person, not just treat the symptom. But drastic cuts in the funding of mental health services have dramatically reduced the quality of the service they can provide. Psychiatrists are now forced to follow very large panels of patients. Most of the limited time they are allowed with each is spent discussing symptoms, adjusting the meds, and determining side effects. Little time is left to forge a healing relationship, provide support, and teach skills through psychotherapy. And patients usually get to a psychiatrist- if at all- as a last resort, only after other things have failed- and with the expectation by the patient and referral source that the main purpose of the visit is just to prescribe medication.”

The impression being conveyed here is that psychiatry’s abandonment of a biopsychosocial approach and embracing of the brief med-check was the result of “drastic cuts in the funding of the mental health services”.  This is very misleading, in that psychiatry’s interest in, and enthusiasm for, psychosocial concepts was largely confined to the psychoanalysts, the great majority of whom worked in private practice, and were paid directly by their clients. There was some acceptance of psychoanalytic concepts in the asylums, but for the most part psychiatrists working in those facilities had always shown a marked propensity for biological “cures”, and enormous creativity in the development of these “treatments”, which included:  fever therapy; insulin coma; rotational therapy; hydrotherapy; mesmerism; malaria therapy; chemically induced seizures; lobotomy; high voltage electric shocks to the brain; etc.

It is also worth noting that when Thorazine was introduced to American psychiatry in the early 1950’s, the psychoanalysts objected strenuously, but their objections were swept aside by the enthusiasm of their colleagues.  By about 1965, the bio-bio-bio approach dominated psychiatry, but it was not forced on psychiatry.  Rather, it was embraced avidly, and for two self-centered reasons:  firstly, it provided misplaced credibility and prestige for psychiatrists, who could now claim to be real doctors, treating real illnesses with real medications; and secondly, because it enabled psychiatrists to make a great deal more money than was possible providing psychotherapy.

The contention that psychiatrists “are now forced to follow very large panels of patients” is not only false, it is absurd.  The notion that tens of thousands of psychiatrists in the US would really like to be practicing psychotherapy, where they could forge “healing relationships”, “provide support” and “teach skills”, but are frustrated in these desires and “forced” to trudge endlessly the tiresome treadmill of the 15-minute med check is pure fiction.  Heartrending, but still fiction.  The fact is that psychiatry set its own course when it jumped enthusiastically on the pharma bandwagon, and apart, from a miniscule minority who remained aloof from the drug-pushing, has made no attempt to alight.

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

“Psychiatrists didn’t invent this system, but they have to live within it (except for those whose patients can pay out of pocket for much more personalized care).”

Actually, psychiatrists did invent this system.  They pursued the pharma money shamelessly, embraced and pushed pharma’s products, conducted the fraudulent research, drafted the treatment guidelines, invented “diagnoses” to justify the administration of the drugs, and pocketed the money.  If, as Dr. Frances contends, this was all “forced” on psychiatrists, then it has to be acknowledged that the victims of this coercion have put an extremely good face on the matter, and have borne the yoke of their servitude with unstinting courage and valor.

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

“Another important factor in treatment failure is that most ‘psychiatry’ is not done by psychiatrists. Primary care doctors prescribe 90% of benzodiazepines; 80% of antidepressants; 60% of stimulants; and 50% of antipsychotics. Some are great at it, but most have too little time and too little training and are too subject to sales pitches from drug salesmen. Psychiatrists are clearly responsible for some of the harm done by excess medication, but the bigger problem by far is rushed primary care doctors, prescribing the wrong meds, to patients who often don’t need them. Misleading drug company marketing increases inappropriate prescription by convincing both doctor and patient that there is a pill for every problem.”

The blame-it-on-the-poorly-trained-and-naïve GPs has become a common theme among psychiatry’s elite in recent years.  But it is seldom acknowledged that not a single one of these prescriptions could be written if psychiatrists hadn’t invented the “illnesses” for which they are prescribed.

Note also how Dr. Frances deftly moves the blame to “misleading drug company marketing”.  And indeed, a great deal of pharmaceutical marketing in this field has been misleading – actually to the point of blatant falsehood.  But it is also the case that psychiatrists – including eminent and prestigious psychiatrists, the “thought-leaders” of the profession – have been hand-in-glove with pharma in this process.  Remember the conference jamborees where “CEU’s” were awarded to psychiatrists for listening to one of their colleagues present a pharma infomercial?  Remember the not-so-distant days when psychiatric associations (including the APA) ran misleading pharma ads in their own journals?

And note the blaming of GP’s for “prescribing the wrong meds to patients who often don’t need them”.  This is truly exquisite spin.  Psychiatry creates a  “diagnostic system” called the DSM, the essential message of which is that every significant problem of thinking, feeling, and/or behaving is a medical illness.  The DSM provides simplistic lists of “symptoms” to enable any practitioner who can read to make – and more importantly to justify – any of these hundreds of “diagnoses”.  And in addition, the psychiatric researchers (and I use the term loosely) fill reams of journal pages with “research” proving the effectiveness of the spurious drug companies’ products in the “treatment” of these so-called illnesses.  But now here comes the very eminent Dr. Frances castigating these GP’s for believing, what has been the central pillar of psychiatric “treatment” for at least 50 years:  that there is a pill for every problem, that these pills correct chemical imbalances in the brain, and in many cases, need to be taken for life.

Pharma-psychiatry’s bogus hype has been so successful in fact that a conscientious GP, who failed to prescribe a drug for a significant problem of thinking, feeling, and/or behaving, could conceivably find himself defending a malpractice suit, if his refusal to prescribe was followed by a serious adverse event.

Portraying psychiatry as the helpless innocent spectator in this scenario is not consistent with the facts.

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

“Psychologists criticize psychiatry for its reliance on a medical model, its terminology, its bio-reductionism, and its excessive use of medication. All of these are legitimate concerns, but psychologists often go equally overboard in the exact opposite direction- espousing an extreme psychosocial reductionism that denies any biological causation or any role for medication, even in the treatment of people with severe mental illness. Psychologists tend to treat milder problems, for which a narrow psychosocial approach makes perfect sense and meds are unnecessary. Their error is to generalize from their experience with the almost well to the needs of the really sick. For people with severe mental illness- eg chronic schizophrenia or bipolar disorder- a broad biopsychosocial model is necessary to understand etiology- and medication is usually necessary as part of treatment. Biological reductionism and psychosocial reductionism are at perpetual war with one another and also with simple common sense.”

Some psychologists do indeed criticize psychiatry for its reliance on an inappropriate medical model and its bio-reductionism.  But, at least in my estimation, most psychologists do not.  On the contrary, most psychologists, and I say this with a measure of professional embarrassment, have bought the psychiatric agenda lock, stock, and barrel.  In some states they are legally authorized to prescribe psychotropic drugs, and they continue to lobby for this in other jurisdictions.  The American Psychological Association has even published a list of “practice guidelines” for this activity.

Dr. Frances’s contention that psychologists “go…overboard” with what he calls “psychosocial reductionism” in the same way that psychiatrists do with bio-reductionism has a nice ring of fairness and equability.  But it misses the point.  There is no argument among psychologists, or any other group, that brain injuries and malfunctions can have an adverse effect on a person’s thinking, feeling, and behaving.  Where psychiatry has gone wrong is in making the spurious leap from this obvious reality to the false conclusion that all problems of thinking, feeling, and /or behaving are caused by brain malfunctions.

When those of us on this side of the debate contend, for instance, that depression is caused by depressing events or depressing life circumstances, this is not some kind of distortive reductionism.  It is simply the most parsimonious way of looking at the matter.  To assume, without evidence, a neurological etiology in all such cases isn’t just blind doctrinaire reductionism, it is frankly inane, particularly in that no biological etiology has ever been discovered, despite psychiatry’s fraudulent claims to the contrary, and despite decades of highly-motivated, and lavishly funded, research.

Dr. Frances then attempts to score cheap points by undermining the credibility of psychologists.  They “tend to treat milder problems”; they haven’t worked with the “really sick”; their work is with the “almost well”.  The implication being that only psychiatrists can understand the problems of “people with severe mental illness…schizophrenia or bipolar disorder”.  In working with the latter individuals, Dr. Frances tells us that “a broad biopsychosocial model is necessary to understand etiology …”  The implication here is that psychiatrists understand the biological etiology in those individuals that they label schizophrenic and bipolar.  In reality, no such biological etiology has ever been discovered.

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

“The most important and troubling attacks on psychiatry come from people who feel harmed by it. It has been surprising to me that my many forceful critiques of psychiatry have met so little criticism from psychiatrists, while my much less frequent and muted defenses of psychiatry have drawn such flak from dissatisfied patients. Whenever I twitter or blog anything suggesting that psychiatric treatment is valuable for some people but not others, I receive a flurry of angry responses declaring it is totally harmful for everyone.”

Well, Dr. Frances should not be surprised by this at all.  His criticisms of psychiatry have always been of the excessive-drugging-is-bad, or drugging-people-who-don’t-need- it-is-bad.  Criticisms of this sort are the injunctive equivalent of tautologies.  They are always valid, and for that reason, are empty and void.

For instance, although I know next to nothing about bridge engineering, I can say authoritatively and without the slightest fear of contradiction, that excessive measurement tolerance in the construction of box-girders is a bad thing; or that the use of steel rivets in situations in which they are inappropriate is a bad thing.  The point is that words like excessive and inappropriate already contain within themselves the value judgment, and the statements amount to nothing more than pious platitudes.  In effect, all that Dr. Frances is saying is that bad things are bad, the appropriate modern response to which is:  “Duh!”  His psychiatrist readers feel no threat from this kind of “criticism”, precisely because there is none.

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

“Typically, they [dissatisfied patients] have had a disastrous experience with psychiatric medication that was prescribed in too high a dose and/or for too long and/or in odd combinations and/or for a faulty indication. They are angry for a perfectly understandable reason- meds made them worse & going off meds made them better. Their natural conclusion is that medicine is bad stuff- for everyone.”

These are the kind of injunctive tautologies that I discussed above.  Perfect examples, actually.

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

“The shameful coercion today is the criminalization of mental illness and being forced to live in dungeons.”

This is nice rhetoric, but it’s false.  In the US, and I believe in all western democracies, people get sent to jail and prison for committing crimes.  Whether or not an accused individual carries a stigmatizing psychiatric label is a secondary matter, and is usually adduced by his defense, and accepted by the bench, as a mitigating factor.

. . . . . . . . . . . . . . . . 

“People with psychiatric problems who used to be coerced in state mental hospitals now suffer the much worse coercion of extended jail time (about 350,000)…”

Dr. Frances apparently considers this number excessive, but if we remember that, according to psychiatry’s own much-touted figures, one-fifth of the population at large have a diagnosable “mental illness” in any given year, it is clear that these individuals are underrepresented in prison and jails.  One-fifth of 2.2 million (the number of people incarcerated in the US) is 440,000.  This is particularly striking in that several psychiatric “diagnoses” are heavily weighted with blatantly criminal activity (e.g., conduct disorder, antisocial personality disorder, intermittent explosive disorder), which should have the effect of skewing the numbers in the opposite direction.

It is also highly questionable whether the coercion experienced in jails and prisons is “much worse” than that in the state mental hospitals.

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

“The Psychiatry/Antipsychiatry rift has had a devastating effect on the lives of people with severe psychiatric problems. For them, this is the worst of times and the worst of places – the lack of effective advocacy has many of them shamefully neglected in prison dungeons or living on the street. The wrong battle lines have been drawn. We should all be fighting together so that our most vulnerable citizens will have access to a decent place to live and to humane and comprehensive care.”

Note the beautiful spin:  people with “severe psychiatric problems” are experiencing great difficulties because of:  the lack of effective advocacy, and the Psychiatry-Antipsychiatry rift.  If those of us on this side of the issue would just stop being so obtuse; if we would just be reasonable and accommodating (like, e.g., Dr. Frances); if we would just get on board and stop challenging psychiatry, and pull together; then our “most vulnerable citizens” will have decent homes, and will receive humane and comprehensive care.

Why, oh why, dear readers, are we not convinced by the logical and conciliatory tone of Dr. Frances’s compassionate pleas?  Why do we, in the manner of stubborn children, reject the wisdom and assertions of those who know better than we do?  Why do we remain so willfully blind to the “patient-centered and humanistic” quality of psychiatry, and to its unstinting devotion to the welfare and care of “our most vulnerable citizens”?

And the answer is clear:  because psychiatry is not something good that needs minor corrections.  Rather, it is something fundamentally flawed and rotten, based irretrievably on spurious premises, and, in its practices, destructive, disempowering, and stigmatizing.  No amount of rhetoric or spin can alter these realities, in the creation of which, Dr. Frances himself has been, and continues to be, a major player.

Psychiatry Bashing

Last month (February 2016), the British Journal of Psychiatry published an online bulletin titled BASH: badmouthing, attitudes and stigmatisation in healthcare as experienced by medical students, by Ali Ajaz et al.  Here’s the abstract:

“Aims and method We used an online questionnaire to investigate medical students’ perceptions of the apparent hierarchy between specialties, whether they have witnessed disparaging comments (‘badmouthing’ or ‘bashing’) against other specialists and whether this has had an effect on their career choice.

Results In total, 960 students from 13 medical schools completed the questionnaire; they ranked medical specialties according to the level of badmouthing and answered questions on their experience of specialty bashing. Psychiatry and general practice attracted the greatest number of negative comments, which were made by academic staff, doctors and students. Twenty-seven per cent of students had changed their career choice as a direct result of bashing and a further 25.5% stated they were more likely to change their specialty choice. Although 80.5% of students condemned badmouthing as unprofessional, 71.5% believed that it is a routine part of practising medicine.

Clinical implications Bashing of psychiatry represents another form of stigmatisation that needs to be challenged in medical schools. It not only has an impact on recruitment into the specialty, but also has the wider effect of stigmatising people with mental health disorders.”

Note in the “Clinical implications”, the assertion that “bashing” psychiatry “has the wider effect of stigmatizing people with mental health disorders.”  This contention, which is widely promoted by psychiatry, is, I suggest, simply false.  Criticism of psychiatrists neither entails nor implies any criticism of their clients.  Indeed, within the anti-psychiatry movement, where the criticism of psychiatry finds its most vocal and ardent expression, psychiatry’s clients are routinely afforded a very high level of consideration and respect.  Indeed, it is my impression that more than half of the individuals associated with the anti-psychiatry movement are themselves former “patients”.

A second noteworthy matter is the use of the term “bash” in the title and in the Clinical implications section. The issue here is that it is apparently common practice in medical schools for students and faculty to make disparaging remarks about specialties other than their own.  It is also clear, from the survey itself, that the practice is not seen as particularly harmful or serious.

“The majority of comments (40.4%), either directly or indirectly, minimised any negative connotations associated with badmouthing other specialties or the impact on students’ future career choices. The most frequent comments stated that badmouthing was nothing but harmless fun and was done without any maleficent intentions. There was a real sense among some students that badmouthing was beneficial as a source of conversation and bonding within clinical teams. There was some recognition that some medical students might be influenced by the negative comments about certain specialties, but this was dismissed as being due to their own insecurities about their career choice rather than being affected by the remarks.”

Using the word “bashing” to describe this kind of activity constitutes overstatement to a misleading degree.  I have personally heard physicians make negative comments about psychiatry, but these have always been directed against the widely-acknowledged invalidity of its “diagnoses”, and the general lack of science in the development and assessment of its “treatments”.  It is interesting in this regard that two of the three examples Ajaz et al provide of psychiatry-bashing were:

  • ‘psychiatrists are not actual doctors’, and
  • ‘psychiatry – not real medicine’

And, seen in this regard, it is clear that such comments are warranted.  For decades, psychiatry has arbitrarily and self-servingly claimed as its legitimate domain all significant problems of thinking, feeling and/or behaving.  Within this domain, they have invented and promoted a truly bewildering array of fictitious illnesses, for each of which they falsely claim to have highly effective treatments in the form of neurotoxic drugs and high-voltage electric shocks to the brain.  Psychiatry has also conspired with pharma to produce a large body of fraudulent research and ghost-written books and papers to promote the sale of psychiatric drugs.  And on the wider scale, psychiatry’s “diagnoses” are inherently disempowering and stigmatizing, and serve to foster a culture of drug-induced dependency.

Psychiatry remains utterly deaf to these kinds of criticisms.  In fact, the more acutely and tellingly psychiatry is criticized, the more adamantly it defends its concepts and practices. But it seldom addresses the actual criticisms, relying instead on spin and on the endless regurgitation of the same tired old assertions:  we’re real doctors; we treat real illnesses; our treatments are effective; and – as in the present context – we deserve more respect.

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

All of this is very interesting, but there’s more.  On February 27, the Royal College of Psychiatrists (the British equivalent of the APA) issued a press  release on the Ajaz et al study.  The release is titled Royal College calls for an end to ‘Bashing’ Psychiatrists

Here are some quotes, interspersed with my thoughts and observations.

“The stigma surrounding psychiatry doesn’t begin and end with the experiences of patients; doctors too experience stigmatisation – for deciding to become psychiatrists.”

Note again, the spurious linking of the disparagement of psychiatrists with the stigmatization that attaches in some contexts to psychiatry’s clients.  In reality, the primary source of the stigmatization of their clients is psychiatry’s long-standing, though false, insistence that these individuals have incurable brain illnesses for which they need to take pills for the rest of their lives (Angermeyer et al, 2011; Deacon, BJ, 2013; Read, J, et al, 2006).

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

“Medical students and trainee doctors are reporting that the badmouthing of certain medical disciplines is impacting on their freedom to choose psychiatry as a speciality, and the higher echelons of this specialist branch of medicine are fighting back.”

This is a truly extraordinary statement.  Medical students and trainee doctors are reporting that negative comments about psychiatry that they hear around the colleges are impacting on their freedom to choose psychiatry as a specialty!  Impacting on their freedom to choose!  The poor lambs!  Those mean ol’ real doctors just keep picking on them, and you know, they just don’t know what to do with their lives.  Shouldn’t this be a “diagnosis” for DSM-6:  Excessive-insecurity-about-vocational-choice disorder?  But have no fear my little lambs, your leaders are fighting back!

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

“President of the Royal College of Psychiatrists, Professor Sir Simon Wessely is launching a campaign to support medical students and trainee doctors by exposing the practice of badmouthing – known as ‘bashing’ – that threatens to deplete an already under-subscribed medical specialism.”

So, in the best tradition of St. George the Dragonslayer, Sir Simon is going to “expose” psychiatry bashing.  I wonder how that will work?  Posting on bulletins the names of offenders?  Public denouncements of psychiatry-bashers at the beginnings of lectures?  Confessions from repentant bashers aired on campus media?  And of course, an army of volunteer snitches.  “Please, Sir, Dr. Wessely, in the cafeteria this morning I heard Rodney Thornwhistle saying that psychiatrists aren’t real doctors.”

And undoubtedly, psychiatric action will be swift and decisive.  “Don’t worry, Willis, I’ll have the bounder stripped of his honors and drummed out of the college within the hour.”

“Oh, thank you Dr. Wessely.  It’s been so upsetting;  I hardly know what to do with myself.”

“Well take a few days off, Willis.  We don’t want you contracting PTSD, do we?”

“Oh, thank you, Dr. Wessely.  It’s such a comfort to have a person of your understanding at the helm.”

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

“Psychiatry continues to face a worldwide problem with recruitment. In the UK, the Royal College of Psychiatrists has maintained an active recruitment programme for several years, but rates of students interested in psychiatry as a career remain at 4-5%; insufficient to meet future needs.”

Arguably, the single most important factor in human endeavors is the ability to deal rationally and self-critically with our failings, personally and organizationally.  Psychiatry is failing because it is everywhere being exposed as the facile and destructive hoax that it is.  But psychiatry has always been averse to anything remotely akin to critical self-scrutiny.  So they blame their decline on others.  And here we see this process plumbing the very depths of inanity:  recruitment is down because of the mean things that people are saying to psychiatry students in the medical schools!

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

“Professor Wessely said:  ‘There is no psychiatrist in the land who cannot remember the reactions they received from some colleagues – especially the senior ones – when they announced that they wanted to pursue a career in psychiatry.  A bit of humour is all very well, but behind this is something unacceptable – an implication that the best and brightest doctors are somehow wasting their time in psychiatry. This has to stop, and this campaign is going to do that. People with mental disorders – just like those with physical disorders – deserve the best minds to find new treatments and provide the best care.’  He will launch the campaign on Saturday 27 February at the National Student Psychiatry Conference 2016 in Edinburgh.”

Note the dictatorial tone:  “This has to stop”!

And the grandiosity:  “this campaign is going to do that.”

So the Royal College of Psychiatrists is launching a campaign that will stop medical students and trainee physicians from ribbing each other concerning their chosen specialties.  Why not start with something easy, like world peace?

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

But there’s more!  On March 2, BMJ Careers ran a piece on Dr. Wessely’s anti-bashing campaign.  The article is titled Stop bashing psychiatry, royal college urges medical students.  Here are some quotes:

“‘The current generation of students don’t put up with the things we used to,” Wessely told BMJ Careers. ‘Derogatory comments about race, sexuality, and gender are not common now, and when they do occur students complain. We want them to become the people who call others out when they denigrate psychiatry and mental health.'”

Isn’t that the most delightful piece of spin.  So for a medical student or trainee physician to assert that psychiatry isn’t real medicine or that psychiatrists are not actual doctors is akin to slurs based on race, sexual preference, or gender.  Equating interdisciplinary college banter with the exploitation, victimization, and at times downright savagery, that has in the past been directed towards the groups mentioned is, I suggest, insulting to the point of obscenity.

And isn’t it particularly interesting that a growing number of psychiatry’s former “patients” are recognizing that the “diagnostic” labels conferred on them by psychiatrists were (and are) inherently disparaging, disempowering, and stigmatizing, often permanently!

Dr. Wessely is essentially calling for a kind of thought police mentality in Britain’s medical schools.  Students are encouraged to “call out” those who breach the code of silence by describing psychiatry as the unscientific non-medical hoax that it is.

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

“He [Dr. Wessely] added, “’I remember being told that I would be wasted in psychiatry because I was too smart. What that says is that mentally ill patients only deserve crap doctors.'”

No, Dr. Wessely, that’s not what it means.  It means that psychiatry is a destructive, hocus-pocus, facile sorting activity which assigns so-called diagnoses, and distributes neurotoxic drugs to people whose problems are not medical in nature.  It is not intellectually challenging to even a moderate degree.  In fact, its primary requirement is the “ability” to systematically blind one’s cognitive capacities to its total lack of intellectual and conceptual rigor.

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

“As part of the campaign, the college will be working with mental health charities and medical school deans to drive home the message that bashing psychiatry is no longer acceptable, and Wessely will be visiting every UK medical school to discuss the issues.”

Visiting every medical school in the UK to stamp out interdisciplinary ribbing!  What an extraordinary way for a person of Dr. Wessely’s stature to spend his time.  Does he actually imagine that he can achieve this?  Or that even if he did succeed in eradicating this kind of thing, that it would make the slightest difference to psychiatry’s status or to its ever-downward trajectory?

Perhaps we’re witnessing the death-throes of a profession.  Locked irrevocably to a bio-bio-bio ideology; buffeted on all sides by critics, including some from within; and with no defense to the conceptual and practical criticisms, they tilt at the flimsy windmills of college banter in their futile drive to establish their medical bona fides.  As if saying it often enough, and with sufficient conviction, will make it so.

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

But there’s more!  Dr. Wessely’s campaign to exorcise anti-psychiatry banter has its own tee shirt!

As often happens in criticizing psychiatry, I don’t know whether to laugh or cry!

Allen Frances Still Trying to Excuse Psychiatry’s (and his own) Role in the ADHD ‘Epidemic’

On November 9, 2015, Allen Frances, MD, posted an interesting article on the Huffington Post’s Blog.  The article is titled Why Are So Many College and High School Kids Abusing Adderall.

The gist of the article is that the “excessive use of ADHD medication” is a more legitimate target for a war on drugs than the ongoing war with the drug cartels.

The Huffington Post article is unusual, in that most of it is written by Gretchen LeFever Watson, PhD.  Dr. Frances wrote the introduction, ending with  “I have invited Dr Gretchen LeFever Watson, a clinical psychologist and public health researcher, to describe this growing problem.”  Dr. Watson wrote the main body of the piece; and Dr. Frances finished up with some brief concluding remarks.

Dr. Watson’s section of the post contains some very helpful information, including the fact that:

“Adderall and other stimulant medications like Concerta, Focalin, Vyvanse, and Ritalin have a high addictive potential.”

and

“Over time, use and abuse of these drugs can induce violent and aggressive behavior, anxiety and paranoia, even hallucinations and delusions. Some students experience an emotional numbing or incoherence. Withdrawal can lead to a depressed mood, fatigue, short-term memory loss, inability to concentrate, and psychomotor agitation or lethargy.”

In his parts of the post, Dr. Frances states:

“ADHD meds are the most dangerous legal drugs among young people in college and high school.”

and

“We need to stop overdiagnosing and overmedicating ‘ADHD,’ in order to reduce the massive reservoir of legally prescribed pills available for diversion to the secondary illegal market.”

and

“…we need to educate students and educators that using Adderall for recreation or performance enhancement has considerable risks and is not a normal part of life.”

and

“The epidemic of mislabeled ADHD has medicalized childhood, turning normal immaturity into a mental disorder. The excessive use of ADHD medication has been fueled by irresponsible drug company marketing; careless physician diagnosing and prescribing; worried parents; and harried teachers.”

DISCUSSION

The most notable feature of the article is the fact that Dr. Frances makes no mention of the role that psychiatry in general, and he himself in particular (as DSM-IV architect), played in the medicalizing of normal childhood immaturity.

It is an obvious fact that there occurred in DSM-IV a general liberalizing of the criteria for many of the so-called diagnoses, including ADHD.  DSM-III listed 14 criteria items for this label; DSM-IV listed 18.  One DSM-III item was dropped.  The additional five items in DSM-IV are:

“1 (a)  often fails to give close attention to details or makes careless mistakes in  schoolwork, work, or other activities.” (p 83)

Has there ever been a small child who didn’t fail to give close attention to details or didn’t make careless mistakes?  Isn’t this almost a defining feature of early childhood?

“1 (e)  often has difficulty organizing tasks and activities”

Remember, we’re talking about children below the age of seven.  Not many five/six year-olds are great organizers.

“1 (f)  often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such  as schoolwork or homework)”

The word “or” is particularly important.  So if the child doesn’t like doing his/her homework, this counts as a “symptom” of ADHD!

“1 (i)  is often forgetful in daily activities” (p 84)

Again, the pathologizing of the normal.

“2 (c)  is often ‘on the go’ or often acts as if driven ‘by a motor'”

These colloquialisms are sometimes used by parents and other family members to describe young children, without any intent to pathologize. By including these phrases into the DSM’s list of symptoms, Dr. Frances and his work force have pathologized these terms, and have increased the likelihood that children who have been so described will be caught in the ADHD net. Besides, how could the terms ever be reliably defined?

In addition, the following fairly extreme item in DSM-III

“(14)  often engages in physically dangerous activities without considering possible consequences (not for the purpose of thrill-seeking), e.g., runs into street without looking” (p 53) [Emphasis added]

was liberalized in DSM-IV to the much more banal

“2 (c)  often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)” (p 84)

In DSM-III, the “age of onset” had to be before the age of seven.  In DSM-IV, this criterion was relaxed to “Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.” [Emphasis added] (p 84)

And, perhaps most significantly of all, DSM-IV added a “Not Otherwise Specified” category, where nothing of the sort had existed in DSM-III.

“314.9  Attention-Deficit/Hyperactivity Disorder Not Otherwise Specified

This category is for disorders with prominent symptoms of inattention or hyperactivity-impulsivity that do not meet criteria for Attention-Deficit/Hyperactivity Disorder.” (p 85) [Emphasis added]

In other words, a child can be assigned the pathologizing and disempowering label (ADHD, NOS) even if he/she doesn’t meet the criteria specified for ADHD.

It is obvious that this liberalizing of criteria has had the effect of increasing the number of people so labeled.   Dr. Frances concedes that the number of people who have been assigned the label has increased enormously, but he consistently fails to connect the dots, and to recognize that it was his own liberalizing of the criteria that was the primary cause of the expansion.  The Surgeon General’s Report of 1999 lamented the fact that “…the majority of children and adolescents who are receiving stimulants did not fully meet the criteria”, but failed to recognize that since the publication of DSM-IV in 1994, with its virtually open-ended NOS category, it was no longer necessary to “fully meet the criteria” to qualify for a diagnosis.

It also needs to be noted that there wasn’t – and never could be – any scientific justification for this expansion.  Despite psychiatrists’ repeated assertions to the contrary, ADHD is not an illness with an identifiable pathology.  Rather, it is a loose collection of vaguely defined childhood problems (and some non-problems).  There is no reality against which psychiatry’s list of symptoms can be checked.  The APA can add or delete items from their checklist at will. This is in marked contrast to real medicine, where the symptoms must conform to the objective reality of the disease in question.

If the American College of Chest Physicians, for instance, were to issue a statement that a purple rash was henceforth to be considered a symptom of pneumonia, there would be an instant outcry from rank and file pulmonologists, and from physicians generally, because a purple rash is not one of the symptoms of pneumonia.  There is a reality – namely the actual disease of pneumonia – against which assertions of this kind can be checked and refuted.

In psychiatry, except for those “mental illnesses” which are due to a general medical condition, no such realities exist.  This is the reason that the APA can add or delete criteria to their labels at will.  Over the past sixty years, they have engaged in an enormous amount of this kind of activity, the effect of which has almost always been to liberalize the thresholds, thereby increasing the prevalence.

ADHD, like all psychiatric “diagnoses” is what the APA, through successive revisions of their catalog, choose it to be.  And Allen Frances and his team of DSM-IV collaborators chose to relax the criteria for the ADHD label. By this simple expedient, they vastly increased the number of people who could be “diagnosed” with this non-illness, and, of course, proportionately increased the quantity of “medications” that were being prescribed for this non-illness.  In March 2010, Dr. Frances published an article in the LA Times:  It’s not too late to save ‘normal’ . In that paper he stated:

“Our panel tried hard to be conservative and careful but inadvertently contributed to three false ‘epidemics’ — attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many ‘patients’ who might have been far better off never entering the mental health system.”

It is frankly impossible to reconcile this assertion with the relaxing of criteria for the “ADHD diagnosis” set out above.  How can the decision to include  as a “symptom” the fact that a child doesn’t like doing his homework be considered conservative?  This “symptom” applies to virtually every child on the planet.

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

But Dr. Frances seeks to deflect the blame for this “epidemic” onto: 

  1.  irresponsible drug company marketing

Certainly pharmaceutical marketing has been excessive, misleading, and at times downright fraudulent.  But there has been no shortage of psychiatric collaboration in these enterprises.  It was psychiatry that integrated pharma’s infomercials into their continuing education requirements.  It was psychiatry’s fraudulent, and often ghost-written, research that established the “efficacy” of the drugs.  And there has been no concerted attempt on the part of psychiatry to rein in the irresponsible advertizing.  In fact, for years, psychiatry ran the ads in their own journals.

  1. careless physician diagnosing and prescribing

Note the use of the word “physician” rather than “psychiatrist”.  This has become a common ploy in psychiatry’s attempts to shift blame from themselves, but it ignores the fact that GP’s couldn’t have written a single prescription for a drug to treat ADHD if psychiatry had not invented the label and relentlessly promoted it as a valid illness, caused by a chemical imbalance in the brain, and necessitating “treatment” with stimulant drugs.  And, of course, by relaxing the “diagnostic” criteria, Dr. Frances ensured that the “diagnostic” net would be widened commensurately.  His assertions in the LA Times article that this widening was inadvertent is not credible when one looks at the changes that were made.  Anybody with even the slightest familiarity with the issues could have foreseen the result.  This is particularly the case in that the drugs in question are addictive, and for that reason, if no other, were assured a strong demand.

  1. worried parents

When I was a child, back in the 50’s, ADHD didn’t exist.  Inattention, hyperactivity, and impulsivity were considered normal traits of early childhood, and were remediated through the time-honored methods of training, encouragement, discipline, etc…  This system worked remarkably well.  Despite larger class sizes, there was no running around or unpermitted leaving of seats in the classrooms, and children whose attention drifted were routinely brought back to task with the oft-heard phrase “pay attention!”

Then along came psychiatry, with the great “insight” that inattention, impulsivity, and hyperactivity were symptoms, of a brain illness!  And not surprisingly, a great many parents, unfamiliar with the fact that psychiatry is founded on a tissue of falsehoods, took this inanity seriously and – guess what? – became worried!  And why wouldn’t they be worried at the prospect of their children being afflicted with brain diseases?  And now Dr. Frances, who single-handedly did more to expand the ADHD net than any other person, is blaming this expansion, and the phenomenal level of entailed drugging, on worried parents!

  1. harried teachers

As I mentioned above, teachers in previous generations accepted, as an intrinsic part of their job, training children to pay attention and to master their impulsive and disruptive tendencies.  Many today would argue that they were overly zealous in this regard, but that’s a separate issue.  The point is that they accepted the job, and they were almost always successful.

But this former culture of successful training and discipline was torpedoed by psychiatry’s blatant, self-serving lie, that overly active, inattentive children had a brain illness that essentially precluded the possibility of successful training.  This false message was developed by psychiatry, and was fully integrated into teacher training curricula.  Today a teacher who doesn’t buy into the ADHD hoax, and who doesn’t make “medication referrals” for these undisciplined and disruptive children, would be at risk of losing his/her job.

Teachers of the world have been deceived and betrayed by psychiatry, and now Dr. Frances has the unabashed gall to blame them for the present state of affairs.  And note the adjective “harried”, with its subtle connotations of disorganization and ineffectiveness.  I couldn’t begin to estimate the number of perplexed teachers that I worked with during my career who struggled endlessly in their attempts to reconcile the obvious reality that the children concerned were essentially undisciplined with the inane psychiatric “orthodoxy” that they were sick.

CONCLUSION

Dr. Frances is correct in saying there is too much diagnosing of ADHD and too much use of stimulant drugs to “treat” this problem. Though he is incorrect in the unstated implication that there is a correct amount of both, which he, and psychiatry generally, have valiantly sought to establish and maintain.

Psychiatry’s obvious agenda in every revision of the DSM, and particularly DSM-IV, has been expansion of their “diagnostic” net.  In this task, they have been ably assisted by pharma, but without psychiatry, pharma could never have gotten even one of their psychotropic drugs to market.

Attempts by Dr. Frances to expose the destructive and disempowering increase in the use of these products, and to put himself on the right side of history, would be more convincing if he would point the finger of blame towards psychiatry, and, in particular, towards himself.

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

ADHD is not something that a child has; rather it is something that a child does.

Allen Frances Names and Shames the Power Players, but Not Himself

On October 13, 2015, Allen Frances, MD, published a post on his Psychology Today blog Saving Normal.  The post is titled What Drives Our Dumb and Disorganized Mental Health Policies, and the subtitle is “Naming and shaming the power players.”  The article has also been published in Psychiatric Times and the Huffington Post.  Dr. Frances is a professor emeritus of psychiatry at Duke University, and was chairman of the DSM-IV Task Force.

The gist of the article is that, here in America, the “severely mentally ill” are neglected, because our policies are based “…mostly on profit, political power, and ideology…”.

The article is fairly standard stuff, similar in a lot of ways to the material that the Treatment Advocacy Center puts out.  Here are the main points:

“1) The overtreatment of the worried well is promoted by Pharma, insurance companies, mental health professionals, primary care doctors, patients, and politicians.”

“2) The neglect of the really sick is promoted by state governments, federal agencies, mental health professionals, and antipsychiatry patient advocacy groups.”

“3) Research efforts provide no help for the currently ill because they are funded either by the NIMH or Pharma- neither of which has much interest in their welfare.”

Within this general framework, Dr. Frances touches on various psychiatry-absolving themes that will be familiar to those of us on this side of the debate.  These include:

  • Primary care doctors prescribe 80% of all psychiatric drugs.

This is probably true, but it ignores the fact that not a single one of these prescriptions could have been written without psychiatry’s fraudulent “diagnoses”.

  • Patients want a quick medication fix for the problems of everyday life.

Again, this is probably true of some of psychiatry’s “patients”, but doesn’t alter the fact that psychiatry routinely pushes drugs as legitimate “treatment” for non-medical problems, and that many of the victims of this drug-pushing become addicted to psychiatric products.

  • Many people with “mental illnesses” get sent to prison for nuisance crimes which would not have occurred had they received appropriate treatment.

Actually, a great many people who had been assigned psychiatric “diagnoses” were receiving psychiatric “treatment” at the time they committed their crimes.  And there is a good deal of prima facie evidence linking psychiatric drugs, not just to “nuisance” crimes, but also to mass murders.

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

In addition, there are three noteworthy points in the article, that to my mind, warrant closer scrutiny.

PSYCHIATRIC RESEARCH IS NO MORE THAN A MARKETING TOOL

“Pharma sponsored ‘research’ does not come close to deserving the name, since it is no more than a tool of marketing aimed at higher profits, not patient benefit.”

I would certainly agree with this, but it strikes me as incongruous coming from Dr. Frances who, in 1996, along with his then partners John Docherty, MD, and David Kahn, MD, produced the “Expert Consensus Schizophrenia Practice Guidelines” which were essentially a marketing tool to promote the neuroleptic drug risperidone (Risperdal).  Dr. Frances, Dr. Docherty, and Dr. Kahn were reportedly paid $515,000 by Johnson & Johnson for producing these guidelines, and it has been stated in a court hearing that on July 3, 1996, Dr. Frances sent the following in an email to Janssen Pharmaceutica, a subsidiary of Johnson & Johnson.  (Janssen is the manufacturer of Risperdal).

“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.” [Emphasis added]

So the pharma-sponsored research, that Dr. Frances so roundly criticizes today, is in fact an area in which he himself was deeply involved, and from which he profited greatly.  Dr. Frances has never apologized for, or as far as I can tell, openly acknowledged, his role in this affair.  The closest he has come in this regard is the following quote from his March 6, 2015 article in the Huffington Post:

“But in retrospect, there are two things about the project I much regret. Firstly, it was very unwise to do guidelines with drug industry funding. Even though they were fairly done, accurately reported, and contained built in methodological protections against industry-favorable bias, the industry sponsorship by itself created an understandable appearance of possible bias that might reduce faith in the sound advice and useful method contained in them. It was an error in judgment on my part that I apologize for. I have learned from my mistake and hope others do as well.

Secondly, I did not at the time anticipate, nor did the experts, that the atypical antipsychotics would be so frequent a cause of obesity and of the serious complications that follow from it. The considerable risks involved in using these new medications, and ways of avoiding these, were then unknown and not covered in the guideline.”

In other words, there was nothing actually wrong with the guidelines, but pharma funding created an appearance of possible bias.  But against this, here’s what David Rothman, PhD, Professor of Social Medicine at Columbia University College of Physicians and Surgeons, had to say about the guidelines in his Expert Witness Report, dated October 15, 2010:

“From the start, the project subverted scientific integrity, appearing to be a purely scientific venture when it was at its core, a marketing venture for Risperdal.” (p 15)

“Indeed, from the start J&J had made it apparent to the team that this was a marketing venture.” (p 15)

“The three men [Allen Frances, John Docherty, and David Kahn] established Expert Knowledge Systems (EKS).  The purpose of this organization was to use J&J money to market the guidelines and bring financial benefits to Frances, Docherty, and Kahn.” (p 15)”

“EKS [i.e., Drs. Frances, Docherty, and Kahn] wrote to Janssen on July 3, 1996 that it was pleased to respond to its request to ‘develop an information solution that will facilitate the implementation of expert guidelines’… In its Summary of the document, EKS wrote: ‘Your investment in the development of state of the art practice guidelines for schizophrenia is already beginning to pay off in terms of positive exposure in the Texas Implementation project.’…” (p 15-16) [Emphasis added]

So it was very much not a question of pharma funding creating “an appearance of possible bias”. Rather, Drs. Frances, Docherty, and Kahn were actually working for Johnson & Johnson, and were “committed to helping Janssen succeed in its effort to increase its market share”.  This is not “an appearance of possible bias”.  This is actual deliberate bias that has been bought and paid for.  And they were doing this while at the same time maintaining that the guidelines were rigorously valid and scientific.  To the best of my knowledge, Drs. Frances, Docherty, and Kahn have never responded to David Rothman’s accusations.  Paula Caplan, PhD, has written a comprehensive and compelling account of this entire scandal.  Her article is titled Diagnosisgate: Conflict of Interest at the Top of the Psychiatric Apparatus.

With regards to Dr. Frances’ assertion that neither he nor “the experts” were aware that the newer neuroleptics caused obesity and  “…the serious complications that follow from it”, it needs to be noted that this information was available in the literature prior to the publication of the guidelines.  In 1995, Umbricht and Kane conducted a meta-analysis titled Risperidone:  Efficacy and Safety.  They examined nine studies, three of which linked risperidone to weight gain:  Müller-Spahn (1992); Hoyberg et al (1993); and Marder and Meibach (1994).

It is also noteworthy that when the guidelines were published, as a supplement in the Journal of Clinical Psychiatry, Alan Gelenberg, MD, Editor-in-Chief of the journal, wrote a preface to the supplement.  In this preface, Dr. Gelenberg stated:

“…in conditions such as bipolar disorder and schizophrenia, where the primary treatments are medications, industry is a looming presence.  Pharmaceutical companies devote enormous sums to academic departments and individual faculty members who consult, conduct research, and teach under the auspices of the company.  These then are the experts who create consensus guidelines.  While few of us sell our opinions to the highest bidder, fewer still are immune from financial influence.” [Emphasis added]

So apparently Dr. Gelenberg could see very clearly, the potential corrupting effect of pharma money, that Dr. Frances could only recognize with hindsight.

And it needs to be borne in mind that Dr. Gelenberg is clearly referring to potential bias on the part of the experts who were  consulted in the construction of the guidelines.  It is unlikely that he was aware that the three psychiatrists who were producing the guidelines clearly conceptualized their role as active marketing of Risperdal, and were committed to helping Janssen increase its market share.

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

Back to Dr. Frances’ article.

CONSUMER ADVOCACY GROUPS PROMOTE THE NEGLECT OF THE “REALLY SICK”

 “Consumer advocacy groups, dominated by former patients who are understandably resentful of psychiatric treatment they found harmful or unhelpful, do so [promote the neglect of the ‘really sick’] by fighting against all use of psychiatric medicine and involuntary treatment – even for those much sicker than they, who desperately require such help lest they wind up in prison, homeless, or harming themselves or others.”

Note the patronizing tone.  These advocacy groups just don’t understand.  They’re “understandably resentful”, and this resentment is clouding their judgment and their perceptions.  Also note the unsubstantiated implication that these “resentful” individuals were obviously less troubled than those who truly need “psychiatric medicine and involuntary treatment”.  If those “resentful” people had been “really sick”, they would be more appreciative of the coerced neuroleptic injections and high voltage electric shocks to the brain that psychiatry had so graciously and unstintingly provided.  Note also how the script has been neatly flipped:  psychiatry’s victims are portrayed as the wrongdoers.

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

EXPLOITING INCIDENTS OF VIOLENCE TO GET MORE FUNDING

“It is also promising that the media are picking up the story, although unfortunately this occurs mostly when someone with a mental illness commits or becomes victim of a violent act. This is unfairly stigmatizing—most of the mentally ill are never violent and most violence is not committed by the mentally ill. But if this is the only way to call attention to the plight of the severely ill and to get funding for adequate  services, and housing, perhaps the tradeoff is worth it.” [Emphasis added]

This is the DJ Jaffe argument:  exploit instances of serious violence to promote compulsory “treatment of the severely mentally ill”.  Dr. Frances acknowledges that this is “unfairly stigmatizing”, but nevertheless condones the sordid, self-serving practice.

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

The fact is that until 10 or 15 years ago, there was no effective anti-psychiatry movement.  There were some isolated voices of protest, including Thomas Szasz, Peter Breggin, CCHR, Leonard Ullmann, Leonard Krasner, and others, but their impact was slight, and psychiatry paid little heed.

Prior to about 2000, psychiatry and psychiatrists had been running the mental health system for about 170 years (since The British Lunacy Act of 1845), pretty much without criticism or even comment from outsiders.  And it was a disaster!  An utter travesty of medical care.

And in the last 50 years or so, they have poured their resources into the spurious medicalization of an ever-increasing range of non-medical human problems – a process, incidentally, in which Dr. Frances himself, as architect of DSM-IV, was a leading player.  For instance, DSM-IV eased the requirements for a “diagnosis of PTSD”.  In DSM-III, the precipitating incident had to be “…outside the range of usual human experience…”.  In DSM-IV this requirement was deleted, clearly opening the “diagnosis” to far more people than was previously the case.  Similar examples can be found throughout DSM-IV.

In this regard, it is worth noting that Dr. Frances was also a member of the DSM-III-R Work Group, and four of its sub-committees.  So his involvement in the expansion of psychiatry’s net goes back at least to 1983, the year that the APA approved the appointment of the DSM-III-R Work Group.  By the time the DSM-IV Task Force was appointed, it was eminently clear that DSM-III and DSM-III-R had resulted in a huge expansion in the use of psychiatric labels and “treatments”.  As chair of the DSM-IV Task Force, Dr. Frances was in a unique position to reverse this trend, but instead, he accelerated the expansion, by easing criteria (as in the above example), and in some cases by the addition of new “diagnoses” (e.g., acute stress disorder).

It is hypocritical beyond words for Dr. Frances to complain about the diversion of resources to those whom he describes as “the worried well”, when in fact, he himself was the prime mover in the spurious pathologizing of these individuals, many of whom are today trapped on the disempowering treadmill of psychiatric drug addiction.  It was Dr. Frances and his DSM-IV Task Force who decreed that these individuals were “mentally ill” and therefore in need of psychiatric “treatment”.  The psychiatric rank and file eagerly followed his lead, and have been avidly expanding the scope of their practices ever since.

Given all this, it’s a little late in the day for Dr. Frances to be re-inventing himself as the voice of psychiatric moderation and restraint.

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

And incidentally, in the entire article, Dr. Frances never once mentions psychiatry or psychiatrists.  He criticizes:  pharma (the hand that once fed him so generously); insurance companies; primary care doctors; “patients”; state governments; federal government; consumer advocacy groups; and the NIMH.  But never psychiatry or psychiatrists.

He does level some criticisms at “mental health professionals”, and presumably that term embraces psychiatrists.  But it also includes:  social workers, counselors, case managers, psychologists, job coaches, life skill trainers, substance abuse counselors, client advocates, grief counselors, marriage and family counselors, play therapists, etc…

But the architects and leaders of the destructive, corrupt, disempowering debacle – the psychiatrists themselves – are never specifically mentioned.  The other mental health professionals – whom, incidentally, psychiatry routinely refers to as “ancillary workers” –have little or no say on major issues and, in fact, are routinely marginalized if they even begin to question psychiatry’s spurious medical model.  Attempting, in this way, to dilute psychiatry’s responsibility for its flawed concepts and disastrous “treatment” is just more psychiatric spin.

The fact is that psychiatry is intellectually and morally bankrupt, and despite the criticisms it has received in recent years, has demonstrated no interest in substantive reform.  Certainly pharma was complicit in the hoax, but the primary responsibility lies squarely on the shoulders of psychiatry, who grievously and persistently deceived their clients and the general public in order to enhance their own status and earnings.

Calling for a shift of resources from the “less severely ill” to the “more severely ill” is simply a distraction.  And attempting to shift blame away from psychiatry is not only craven, it is also a powerful indicator of psychiatry’s self-deceptive arrogance, and its continued refusal to engage in substantive critical self-scrutiny.  Once again, we have a clear demonstration, from an eminent psychiatrist, that psychiatry is beyond the possibility of meaningful reform.

Dr. Pies and Psychiatry’s ‘Solid Center’

Ronald Pies, MD, is one of American’s most eminent and prestigious psychiatrists.  He is the Editor-in-Chief Emeritus of Psychiatric Times, and he is a Professor of Psychiatry at both Syracuse and Tufts.

I disagree with many of Dr. Pies’ contentions, and I have expressed these disagreements in detail in various posts (for instance, here, here, and here).  But there is one area where I have to acknowledge Dr. Pies’ efforts:  he never gives up in his defense of his beloved psychiatry, even in the face of the most damaging counter-evidence.

For instance, on more than one occasion, he has asserted, with apparent sincerity and conviction, that psychiatry never promoted the chemical imbalance theory of depression!

Here’s a quote from Nuances, Narratives, and the ‘Chemical Imbalance’ Debate in Psychiatry, April 15, 2014:

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

And from Serotonin:  How Psychiatry Got Over its “High School Crush”, on September 15, 2015:

“Alas, antipsychiatry bloggers continue to bang away at the notion that ‘Psychiatry’ (that sinister, monolithic corporate entity) deliberately duped the public by promoting a bogus ‘chemical imbalance theory,’ in cahoots with ‘Big Pharma.’ Suffice it to say that this line of argumentation is itself bogus, for reasons I have reiterated at length in several venues.”

His latest contentions in this area were demolished by Robert Whitaker on September 21, 2015, but Dr. Pies has demonstrated a remarkable resilience against factual material that runs contrary to his cherished notions.  So it remains to be seen whether or not he will be back with this particular message.

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

Meanwhile, he’s working on another buttress to shore up the crumbling psychiatric sandcastle.  On October 7, 2015, he published Psychiatry’s Solid Center in the Psychiatric times.  Here’s the opening paragraph:

“Most psychiatrists do not fit neatly into the biological or psychodynamic camps. Instead, like surgeons, they will implement tools that reduce the suffering and enhance the well-being of the patient.”

I’m not familiar with the state of psychiatry at Syracuse or Tufts, but in the rest of the US, the vast majority of psychiatrists very emphatically do fit neatly into the biological camp, and do conduct their practices in accordance with a simplistic biological model.

Of course, my experiences are limited by my horizons.  It may be that, outside of my ken, psychiatrists are busy providing hour-long therapy sessions to their clients – helping them identify and unravel their unconscious emotional conflicts, or engaging in family therapy, conflict resolution, skill training, etc.  Or maybe not.

Douglas Mossman, MD, Professor of Psychiatry, and Director of the Institute of Law and Psychiatry  at the University of Cincinnati, has written on this topic.  Dr. Mossman writes a regular column called Malpractice Rx in the publication Current Psychiatry.  The following quote is from an article dated June 2010, and is in response to a reader psychiatrist who had asked how he could “…attend to patients’ needs, be empathic, listen actively, and still produce proper documentation?”

“In medical malpractice cases, the jury decides ‘whether the physician’s actions were consistent with what other physicians customarily do under similar circumstances.’  Even psychiatrists who deplore 15-minute med checks recognize that they have become standard care in psychiatry.”

In other words, if all, or even most, psychiatrists are doing 15-minute med checks, then there is little chance of a successful malpractice suit.  He is also saying quite clearly that 15-minute med checks have become “standard care” in psychiatry.  And lest there be any residual uncertainty, at the end of the article under the heading BOTTOM LINE, Dr. Mossman wrote:

“Brief medication visits—also known as 15-minute ‘med checks’—have become standard care in psychiatry.”

Not much ambiguity there.

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

And Glen Gabbard, MD, a widely published professor of psychiatry at Baylor and, interestingly, Syracuse, has written in Psychiatric Times, on September 3, 2009:

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

This was in 2009, and there have been no indications in the interim that psychiatry is backing away from this approach.

So if the majority of psychiatrists are spending the majority of their practice time doing 15-minute med checks, isn’t it reasonable to infer that they might “fit neatly”, to use Dr. Pies’ own phrase, into the biological camp?  And in fact, Dr. Pies himself, in an earlier paper (Psychiatrists, Physicians, and the Prescriptive Bond) has written:

“Unfortunately, many prescriptions for psychotropics are written in haste—often after the infamous ’15-minute med check’ – and without any real understanding of the patient’s inner life or psychopathology.” 

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

Dr. Pies continues by telling us that he was fortunate in that his psychiatric training was fostered by those in what he calls the “great solid center” of psychiatry.  This is interesting, of course, and one can readily entertain feelings of joy and gratitude, that Dr. Pies apparently escaped the bio-reductionist nonsense, that has now become a dominant feature of psychiatric training and practice.

Dr. Pies continues:

“And critics of psychiatry who insist that the field has become exclusively ‘biological’ are also missing the larger and more enduring picture.”

Well I think I could count myself as a critic of psychiatry, and I have to say that one of us is certainly missing the bigger picture.  Since the 70’s, I have interacted with a great many psychiatrists in a wide range of contexts and locations, but I cannot recall one who conceptualized his/her role as anything other than the prescribing of drugs or high-voltage electric shocks to the brain.  And in fact, I can recall only one psychiatrist, an elderly man who had trained in Vienna in the ’30’s, who expressed even the slightest regrets or misgivings in this regard.  I can still remember his exact words:  “I was trained as a psychotherapist, but all they want me to do now is prescribe drugs.”

Every other psychiatrist I’ve ever met has expressed nothing but satisfaction with what is sometimes referred to as the “drug revolution” that, according to the rhetoric, has enabled psychiatry to take its “rightful place” as a legitimate science-based medical specialty.

. . . . . . . . . . . . . . . . 

Dr. Pies continues at some length on the wide-ranging aspects of his psychiatric training. He tells us that at one point in his training, he ran a poetry therapy group on an inpatient unit, and that he “…became a believer in pragmatic pluralism and psychiatry’s crucial role as a bridge between the medical sciences and the humanities.”

This last statement is ambiguous, in that it could mean that Dr. Pies believes that psychiatry should be such a bridge, or that psychiatry is such a bridge.  If Dr. Pies intended the former, then that’s interesting, though not pertinent to his main thesis, but if he meant the latter, then I suggest his contention is not only false, but entirely lacking in credibility.  Indeed, in my experience, it is one of psychiatry’s great priorities to dispel any such perceptions, and to establish itself as a “real” medical specialty with expertise in biochemistry, drugs, electric shocks, etc…  In this regard, it is noteworthy that Jeffrey Lieberman, MD, arguably the greatest and most eminent psychiatrist in the world today, has appeared in promotional videos wearing a white lab coat!  One wouldn’t want to make too much of this.  Perhaps he just couldn’t find anything else to wear.  But it certainly militates against the notion that psychiatry is involved in any bridge-building to the humanities.

Dr. Pies tells us that in his 35 years of practice, psychiatry has been such a bridge for him, and I certainly have no reason to doubt this.  But this is not, I suggest, an accurate description of psychiatry generally.  Indeed, with a measure of wistfulness, Dr. Pies himself concedes this point:

“Maybe that’s why I find it so troubling that many in the general public—and indeed, many within the profession—see psychiatry as having pitched its tent squarely and solely in the ‘biological’ camp.” [Emphasis added]

Note the phrase:  “…many within the profession…”  I would say the vast, vast majority within the profession, but let’s not quibble over details.

. . . . . . . . . . . . . . . . 

Back to Dr. Pies’ article: 

“This perception [that psychiatry has pitched its tent squarely and solely in the biological camp] is not without some foundation, and there is no question that, in the 1990s, American psychiatry took a ‘biological turn’ that has never fully swung back to the psychosocial end of the continuum.  But to view today’s psychiatry as merely biology-based is to see it ‘through a glass, darkly.’  When we look to the solid center of this profession, we see thousands of skilled clinicians, researchers, and teachers who are as comfortable with motives as with molecules. The solid center rejects the notion that we must choose between biology or psychology, between medication and psychotherapy.”

Well, perhaps we, on this side of the debate, are seeing psychiatry “through a glass darkly”, but I suggest it is more plausible that Dr. Pies is seeing his beloved profession through a rose-colored glass.  He tells us that there are  “thousands of skilled clinicians, researchers, and teachers who are as comfortable with motives as with molecules”.  This may be true.  But in their actual work, the vast majority of clinicians and researchers appear far more concerned with the latter.  Indeed, indifference to motivation has been enshrined in the DSM since Robert Spitzer’s DSM-III.  Within the context of “psychiatric diagnosis”, it doesn’t matter why a person might, for instance, be very suspicious of his neighbors.  If the suspiciousness crosses a vaguely-defined threshold of severity/implausibility, then it becomes a symptom of “schizophrenia”. Similarly, if a child is routinely disobedient to his/her parents, no attempt is made within psychiatry to explore why this might be so.  The disobedience is simply chalked up as a “symptom” of oppositional defiant disorder.  Similarly, no attention is given within the DSM as to why an individual is feeling depressed, anxious, angry, etc..  The presence of the particular thought, feeling, or behavior is all that’s needed to establish the “diagnosis”, and the “diagnosis” is all that’s needed to justify the prescription.  The why questions are never even asked.

Daniel Carlat, MD, Associate Clinical Professor of Psychiatry at Tufts, and author of the book Unhinged:  The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis, is very open about this.  Here’s a quote from an interview he gave on NPR on July 13, 2010:

“…there’s kind of an unofficial policy among psychiatrists, at least among some, which is the don’t-ask-don’t-tell policy, which is that we have our patients coming in, we know we have 15 or 20 minutes to see them. We want to learn a certain amount about how they’re doing, obviously, because we want to make sure that our medications are working and that we know if we need to increase the dose or add something else.

But on the other hand, we don’t want to ask too many questions because if we start to hear too much information, then we’re going to run into a time issue where we’re going to have to kind of push them out of the office perhaps just at the point where they’re about to reveal something that could really be crucial to understanding their treatment.”

Sounds a bit like biological psychiatry to me.

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

Back to Dr. Pies:

“As a broad generalization, those in the center conceive psychiatric ‘disease’ as something that afflicts persons, not ‘minds’ or ‘brains’—a point stressed by the late Dr Robert Kendell.  Thus, the ‘mental versus physical’ debates are seen as sterile and fruitless. Those following the ‘Middle Path’ (to borrow a term from Buddhism) are preoccupied not with elaborate theories, but with relieving the suffering and incapacity of those who seek our help. Those in psychiatry’s solid center use the best established treatments to alleviate the patient’s illness—whether with ‘talk therapy,’ medication, or both.”

There are several noteworthy features in this paragraph.  Firstly, note that Dr. Pies has placed the word “disease” inside quotation marks.  In normal usage, this would indicate that he’s using the word to mean:  not a real disease. A  Freudian slip perhaps, as Dr. Pies has asserted the disease status of psychiatric “diagnoses” on many previous occasions.

Secondly, the first sentence in the above quote is a truly delightful piece of psychiatric spin.  Let’s open it up.  Dr. Pies is asserting that he and his right-minded colleagues in the “solid center” conceive of psychiatric disease as something that afflicts persons, not minds or brains.  But this is entirely incidental to the main issue.  Take, for example, depression.  Psychiatry conceives of this as an illness (provided a certain ill-defined level of severity is present) – specifically an illness of the brain.  Those of us on this side of the debate argue otherwise – that it is not an illness, but rather the normal, adaptive response to loss, or to an unfulfilling lifestyle.  But both groups agree, indeed it’s hard to imagine how we could disagree, that depression afflicts persons.  Even the most die-hard bio-reductionist would subscribe to that:  depression is a brain disease that afflicts the person who owns the brain!  While those of us on this side would say:  depression is a normal reaction to depressing events/circumstances that afflicts the person experiencing these events/circumstances.

What Dr. Pies has done here is make a statement that looks and sounds like an important distinction, but which in reality is banal to the point of meaninglessness.  And he’s used this non-distinction in his ongoing, futile attempt to defend his beloved profession.  But he’s avoiding the reality:  that psychiatry’s blatant promotion of its various illness theories is a hoax.

Thirdly, the statement “Thus, the ‘mental versus physical’ debates are seen as sterile and fruitless” has similar problems.  The issue is not “mental vs. physical”, posed by Dr. Pies as a kind of theoretical dichotomy.  The issue is whether or not depression, say, should be conceptualized as a normal response to depressing events/circumstances or as a neurological pathology.  This is not a sterile or fruitless debate, and by mischaracterizing it as such, Dr. Pies is either being deliberately deceptive, or has missed the point of the entire conflict.  In fact, whether depression should be conceptualized as a normal response or as a neurological pathology isn’t really a matter for debate at all.   It’s a question of fact:  do all the individuals whom psychiatry identifies as having depressive illness have a characteristic neural pathology?  After forty years of highly motivated and well-funded research, no such pathology has been identified, and the time honored notion, that depression is the normal response to depressing circumstances is as credible today as it has always been.

Fourthly, “Those following the ‘Middle Path’ (to borrow a term from Buddhism) are preoccupied not with elaborate theories, but with relieving the suffering and incapacity of those who seek our help.”  In other words, Dr. Pies and his stalwart colleagues from the solid center are not preoccupied with elaborate theories, (which is good to know, because as a general rule, most of his incursions in this area are riddled with error and fallacy), but with relieving the suffering and incapacity of those who seek their help.  And here again, dear readers, marvel at the spin – the implication, so beautifully and expertly wrapped up, that those of us who do feel strongly about psychiatric fallacy, deception, and destructiveness, are somehow neglecting our responsibilities to relieve the suffering and incapacity of those who seek our help.  Such cads we are.  But never worry, Dr. Pies and his cadre in the “solid center” will step into the breach of our remissness, pick up the slack, and minister dutifully to those who seek their help.  This is such a comfort!

As I’ve said on other occasions about Dr. Pies’ writings:  this is doctoral level spin.

. . . . . . . . . . . . . . . . 

Dr. Pies next provides brief sketches of Karl Jaspers, MD, Eric Kandel, MD, and Glen Gabbard, MD, all of whom Dr. Pies describes as exemplary of the “holistic tradition”.  These are interesting diversions, of course, but they shed no light on Dr. Pies’ primary thesis that “Most psychiatrists do not fit neatly into the biological or psychodynamic camp.”

CONCLUSION

The great irony of all this is that to the best of my knowledge, Dr. Pies has never aligned himself with the bio-reductionist majority, that has dominated psychiatry for the past 40 or 50 years.  But no amount of humanism or eclecticism can rescue him from  psychiatry’s fundamental and pervasive fallacy:  that all significant problems of thinking , feeling, and/or behaving regardless of their genesis – are illnesses.  The fact is that the vast majority of problems of thinking, feeling, and/or behaving are not illnesses, and that treating these problems as if they were illnesses is counter-productive, disempowering, stigmatizing, and deceptive.  This is the critical issue that no amount of psychiatric sophistry or verbal chicanery can neutralize.

Dr. Pies indicated in the article that he has a liking for poetry.  I also have a fondness for poetry, and in the current debate, I often find comfort in the poem Say not the Struggle nought Availeth, by the great Victorian poet Arthur Hugh Clough.  Here’s the third stanza:

“For while the tired waves, vainly breaking,
Seem here no painful inch to gain,
Far back, through creeks and inlets making,
Comes silent, flooding in, the main.”

The main, Dr. Pies, a symbol of that great, cleansing surge of truth and logic, whose flowing tide is already eating at psychiatry’s foundations, and which will one day, when the lifeline of pharma money dries up, wash psychiatry, and all its spurious trappings, into the depths of historical obscurity.