Mad in America

Robert Spitzer, MD, the architect of DSM-III (1980), died of heart disease on Christmas Day, 2015, at age 83. Most major media outlets published obituaries in which Dr. Spitzer was praised on the grounds that he had brought scientific rigor to psychiatry by naming and defining the various psychiatric illnesses. Here are a few illustrative quotes: "Dr. Robert L. Spitzer, who gave psychiatry its first set of rigorous standards to describe mental disorders, providing a framework for diagnosis, research and legal judgments — as well as a lingua franca for the endless social debate over where to draw the line between normal and abnormal behavior — died on Friday in Seattle." (New York Times, December 26) ...

On April 5, 2015, Scott Alexander, MD, a trainee psychiatrist, posted an article titled Chemical Imbalance on his website Slate Star Codex. (The writer tells us that Scott Alexander is a blog handle and not his real name, but for convenience, I will refer to him as Dr. Alexander.) Dr. Alexander begins by noting that there have been a number of articles recently that have criticized psychiatry for “botching the ‘chemical imbalance’ theory.” ...

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

The current issue of Acta Psychiatrica Scandinavica is devoted to the topic of psychiatry’s poor image, and what steps might be taken to improve it. Central to the discussion is a study Images of psychiatry and psychiatrists, by H. Stuart et al, - and seven commentaries on this study by various authors. The Stuart et al paper describes a survey of 1057 teaching medical faculty members from 15 sites in Europe and Asia. The overall response rate was 65%, and the results indicate clearly that general medical teaching staff have a poor opinion of psychiatry and psychiatrists. For instance, 90% of respondents endorsed the item “Most psychiatrists are not good role models for medical students.” ...

A very important and compelling article was posted on Mad in America on June 18. It’s by Andrew L. Yoder, and is called An Open Letter to Persons Self-Identifying as Mentally Ill. Here are some quotes: "My physician was not so cautious. He was a very pleasant man that always seemed to take his time with me and did not talk down to me. Yet as I described some of the emotional distress I was experiencing, and the ways it was affecting my life, he told me with great certainty that mine was a totally common experience. He told me that I had a biological condition in my brain, one in which certain chemicals were 'imbalanced.' He told me that there should be no stigma about asking for assistance from him. Specifically he told me, 'Trying to not be depressed is like telling a diabetic to just make more insulin.' He prescribed an antidepressant medication, saying that this was no different than taking medication to regulate blood pressure or manage cholesterol. I was told of the likelihood that I would need to remain on some form of medication for an indefinite future." ...

On June 6, I wrote a post titled Psychiatry DID Promote the Chemical Imbalance Theory. The article was published on Mad in America, and generated a number of comments on that site, five of which were from TherapyFirst, who in his first comment identified himself as Joel Hassman, MD, a practicing psychiatrist. Dr. Hassman did not argue with the general notion that psychiatric practice today consists almost exclusively of the prescription of drugs. Indeed, in one of his own blog posts on June 16, 2013, he wrote in an open letter to newly qualified psychiatrists: ...

In 2006, Laurence Jerome, a Canadian psychiatrist, and two colleagues wrote a paper titled What We Know About ADHD and Driving Risk: A Literature Review, Meta-Analysis and Critique. It was published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry in August, 2006. The primary result of the meta-analysis was: "Current data support the utility of stimulant medication in improving driving performance in younger ADHD drivers." The study is lengthy and well-referenced, but in keeping with standard psychiatric practice, it conceptualizes and presents ADHD as a "…common psychiatric disorder…" with symptoms of "…inattention, impulsiveness and hyperactivity…" In other words, they present ADHD as something that a person has rather than as something that a person does. The problem with this approach is that it creates the impression that meaningful or significant correlations/effects have been found, where in fact all that has happened is an elucidation of the terms used. For instance, the authors refer to a study by Fried et al. (2006) and state: ...

On March 5, Bruce Levine, PhD, published an interesting article on Mad in America titled Psychiatry Now Admits It’s Been Wrong in Big Ways – But Can It Change? Bruce had interviewed Robert Whitaker, and most of the article is the transcript of this interview. Bruce begins by noting that Robert, in his book Mad in America, had challenged some fundamental tenets of psychiatry, including the validity of its “diagnoses” and the efficacy (especially the long-term efficacy) of its treatments. ...

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

Earlier this month, the American Journal of Psychiatry published an article by Yen-Po Wang, M.D., et al, titled Short-Term Use of Serotonin Reuptake Inhibitors and Risk of Upper Gastrointestinal Bleeding. [Thanks to Mad in America for the link] The research was conducted in Taiwan. The authors studied the records of 5,377 psychiatric inpatients with gastrointestinal bleeding between 1998 and 2009. Study subjects served as their own controls, i.e. the incidence of bleeding in the period following the antidepressant prescription was compared with the incidence of bleeding during a period when they were not taking antidepressants. ...