A Paradox Revealed – Again

Sandra Steingard, M.D.

July 7, 2013

Last week, an important study  (highlighted on MIA) was published in JAMA Psychiatry. Wunderink and colleagues published results of a follow-up study to one he had completed several years ago. In the initial study of  first episode psychosis, subjects were randomized to one of two treatment strategies: maintenance treatment (MT) in which they were maintained on drugs for the two year study or drug discontinuation (DR) in which the drugs were stopped and then restarted if symptoms recurred.

In their initial report, they found that the DR group had a higher rate of relapse.  They found no advantages to DR.  This study supported the standard practice of recommending that individuals remain on these drugs continuously for at least two years.

In this new study, they tracked these individuals 7 years after they had first entered the study. They defined three categories of recovery: symptomatic remission were those who had few or no psychotic symptoms, functional remission were those with good function (self-care, relationships, work), and full recovery were those who met criteria for both symptomatic remission and functional recovery.

At 7 years, there was a clear difference between the MT and DR groups: while both had similar rates of symptomatic remission (~67%), the DR group had a much higher rate of functional remission (46%) and full recovery (40%) than the MT group (19.6% and 17.6%, respectively).  Thirty-four (33%) subjects were on no or very low doses of drug.  Of those ~ 53% were in recovery.

Also of note, at seven years the MT group had the same number of relapses, they just occurred a bit later than in the DR group.

Martin Harrow’s study showed a correlation between neuroleptics and worse functional outcome but since this is a naturalistic study, one could not know if the drug dose caused the worse outcomes.  Wunderink and colleagues randomized their subjects to each treatment approach yet they also found that maintenance treatment was correlated with worse functional outcome.

Wunderink also found that total dose had an impact on outcome.  Lower average dose of neuroleptic – regardless of whether one was in the MT or DR group – was associated with better functional outcome without diminishing symptomatic improvement. 

Timothy Crow, a prominent British psychiatrist and researcher, conducted a somewhat similar study in the 1980′s.  In his study, he randomly assigned 120 subjects who had recovered from a first episode of psychosis with neuroleptics to maintenance treatment with drug or placebo.  In an initial paper published in 1986, his group reported a higher rate of relapse in the placebo group. However, in a later paper on 30 month outcomes, they reported a higher rate of employment in those randomized to placebo.  As they wrote in that paper, “It suggests the disquieting conclusion that the benefits of active neuroleptics in reducing relapse may exact a price in occupational terms.”

More recently, Gleeson and colleagues  reported on the effects of an intensive experimental intervention that was designed to improve adherence to neuroleptic treatment in a group of individuals with first episode psychosis. Their intervention was effective – more individuals remained on drug – and at 12 months the relapse rate in the experimental group was lower.  But similar to Wunderink, they report that at 30 months, there was no advantage with regard to relapse rate for the experimental group and their vocational outcomes were worse.

I do not know who reads my blogs. I know that some of you do not need me to convince you that these drugs have serious problems.  I want to, for a moment, intentionally address those of you who do not know what to make of the disparate messages you may read or hear, those who think that Whitaker and others make some compelling points but have not been able to walk away from the prevailing clinical narrative, and those who are wondering how to translate these studies into practice.  I am still a practicing psychiatrist. I will go to work tomorrow and have these difficult conversations with the people who come to see me.  This is how I am currently making sense of this.

First of all, there is a wide variability in outcome and response.  I continue to believe that there are those who benefit from these drugs in both the short and long term.  I am not able to accept the notion that neuroleptics are no different from other tranquilizers since they seem to yield a specificity of response – a decrease in voices, an increase in coherence – in someone who is appearing fully alert. But this is only for some and there are others for whom the response is not so great and there are those who recover without taking them.  Unfortunately, we have no way of knowing who these people are.  

In a situation where outcome is so variable and hard to predict, it seems imperative to avoid algorithms and directives and maintain an attitude of active shared decision making with the individual and her support system.  “Relapse” is a construct that varies from individual to individual. The risk, therefore, needs to be considered on an individual basis.

Secondly, dose matters.  We have known for at least twenty years, that low doses are as effective as higher ones.  Many of the most troubling side effects are dose related.   Wunderink found that those in the discontinuation group had overall less exposure to these drugs. It may have been this lower exposure, rather than the targeted dosing strategy, that had the greatest impact.  If someone chooses to take one of these drugs, start low and go slow.  Consider dose reductions.

This is important. Right now, there are an increasing number of articles in the professional literature focusing on the use of long acting injectable (LAI) drugs.  This is in no doubt related to the fact that (in the US) with one exception, the current neuroleptics still on patent are LAIs.  This will be the next big push -  to prescribe LAI’s since they reduce relapse. 

This does not need to be a polarized discussion for or against the use of these drugs.  I doubt there is one correct answer.  However, it is important that everyone involved remain knowledgeable about the available evidence.

Sandra Steingard, M.D.

Anatomy of a Psychiatrist: Dr. Steingard chronicles how she is integrating information from Anatomy of an Epidemic into her community mental health practice. She also discusses changes in Vermont’s mental health system and the influence of pharmaceutical advertising on clinical practice.


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54 thoughts on “A Paradox Revealed – Again

  1. Thanks for your article. Just one thing — how long are the LAIs designed to last? I am fearful of what the consequences might be if this becomes standard treatment for the non-compliant (aka misbehaving upstarts who have the radical philosophy of “my body, my choice”).

    • Thanks, Francesca. The LAIs are given either every two weeks or every four weeks depending on the particular drug. But to be clear, LAI’s have been around since at least the 1970′s. The news is that some of the newer drugs are now available in this formulation and these are still on patent.
      Sandy

  2. Thank you for writing this article. It strikes me a good place to start, regarding who should be weaned off these drugs, is to look at whether the use of antipsychotics was started because of antidepressant or ADHD drug use or withdrawal since technically, according to the DSM, that should have precluded a bipolar diagnosis and use of antipsychotics in the first place. But I’ve noticed the main stream US medical industry is still claiming antidepressants “unmask” bipolar. The truth is they can cause mania or hypomania in anyone, including someone on an antidepressant for smoking cessation only.

    And I know in my case, and it seems the studies are coming in showing mine is typical, the withdrawal symptoms can show up much later than the DSM states. And that goes for antidepressant, lithium, and antipsychotic withdrawal.

  3. These studies raise so many questions. Left unmedicated, how long do extreme symptoms persist? Does anyone know how long it takes for receptor sensitivity to develop? When people are discontinued from anti-dopaminergic agents, what percentage relapse and in what time frame. How long do relapses post discontinuation (which I’m assuming reflect drug withdrawal) last? Has anyone tried omega-3s and/or N-acetylcysteine? Evidence-based medicine is suppose to be interventions based on information. One would hope that these studies would prompt the NIH to fund research. When professionals don’t have answers is the ethical thing to do to inform patients and have them make decisions? (Of course, this will undermine the placebo effect.) I don’t remember ever discussing this issue in graduate school.

    With regard to anti-dopaminergic drugs being tranquilizers, clearly they are not. They work to turn off the delusions and hallucinations when people overdo it with cocaine as well. (The mechanisms for the cocaine hallucinations are pretty well worked out.) I also don’t think we know for sure why they shrink brain. My money is on the idea that dopamine is the trigger for astrocytes to release growth factors, but who knows. Does one tell patients about the Ho et al. study? Is this part of informed consent? I think psychiatrists are in a very hard position. Thanks for the post.

    • I don’t know that their position is all that hard. I think they put themselves in a hard position as a profession by asserting things that aren’t true. It seems to me the research is pretty clear about what it suggests, even if the reasons are unclear: the less medication is prescribed (on the average), the more likely it is that the client will be able to maintain a functional social life, and the level of “symptoms” will be relatively unaffected. This is what the Soteria House experiment demonstrated rather conclusively back in the early 1970s. The results haven’t changed since then. If you care about the client’s ability to function in society, the results are fairly clear.

      If psychiatrists are honest about what the research says, it seems clear that they will need to be much more conservative about prescribing antipsychotics, even if they believe 100% in the “chemical imbalance” theory. It appears that “antipsychotics” don’t rebalance dopamine, they appear to throw the balance off. So if antipsychotics are used, they should not be first line interventions, they should be used at as low a dose as possible, and clients should be weaned off as soon as is practical to do so. Much as they do in the Open Dialog program, which has the world’s best success rate with “psychotic” clients.

      Sounds fairly simple to me.

      —- Steve

    • Well, it’s not like psychiatry didn’t put itself there in the hard spot. Now it has to deal with what it helped create. Unfortunatley, now millions of other people also have to deal with the problems, through no fault of their ownn. People on the receiving end of the so-called “treatment” didn’t put psychiatrists there. Psychiatrist put themselves there by their own choice.

      Fortunately, there are some, like Dr. Steingard, who are willing to struggle to try to make some heads and tails out of the overwhelming problems we are experiencing because of the poor choices and decisions made.

  4. Hi Jill,
    Thanks for the comments. I am not sure if you are asking me to answer these questions but I will give answers where I have them:
    Left unmedicated, how long do extreme symptoms persist?
    I do not think there is one answer but in my read of the Soteria studies, Open Dialogue, and my own observation, it seems there is a group in whom symptoms last several months and then abate. I think it is highly variable. I would add that my direct experience of this has been with individuals who were abusing substances.

    Does anyone know how long it takes for receptor sensitivity to develop?
    We do not know what happens in humans because it is hard to study. In rats, it happens quickly.

    When people are discontinued from anti-dopaminergic agents, what percentage relapse and in what time frame.
    In the older drug discontinuation studies, there was ~ 70% relapse in individuals who discontinue drugs. In the Wunderink study, 43% in the DR group relapsed in the first two years and most of them were within a year. What was interesting is that those in the MT group had the same rate of relapse but it was just delayed.

    How long do relapses post discontinuation (which I’m assuming reflect drug withdrawal) last?
    I do not know and I guess I part ways with many of the folks here who assert that ALL relapse is drug withdrawal.

    When professionals don’t have answers is the ethical thing to do to inform patients and have them make decisions? (Of course, this will undermine the placebo effect.) Does one tell patients about the Ho et al. study? Is this part of informed consent?
    I lumped these questions together because I think you are asking the same thing. I think we have to discuss this. I am not going to write these blogs here and then pretend to not have this information when I am in my office talking to the individuals for whom I have the greatest responsibility as a physician. I agree that this seems likely to undermine the placebo effect. It is one of the things that make me wonder if I can keep working.

    Sandy

    • Hi Sandy-thanks for the answers. I’m wondering about whether you can write a grant to SAMSHA for setting up an Open Hand type treatment project. Perhaps collaborating with an academic institution to address the question of predictors for each arm of response to non-drug treatment. I’ve seen the Bob Whitaker video (google Kermit Cole) about some get better on own within year or so time span. Some get meds acutely and then can be withdrawn. Some need meds continuously. I’m a subscriber to biology playing a role in psychosis. Everyone believes that schizophrenia categorizes on basis of symptoms not underlying mechanism. Seems like such a study offers promise of identifying categories based on mechanisms. Could be intellectually fun and certainly a service to humanity.

      • I am a subscriber to biology playing a hand in everything but the fact that our thoughts and mental experiences are based on some biological substrate does not mean that we require a drug to alter it. Smiling alters some aspects of brain functioning and improves mood or at least the sense of well being.

        There are two ongoings studies of Open Dialogue or a dialogic approach funded by the Foundation for Excellence in Mental Health Care. One is to characterize it more and to create manuals and the other is a treatment study.
        http://femhc.org/Projects.aspx
        I think we will learn more about his in the next few years.
        Sandy

        • Well said, Sandy! There are tons of ways to improve brain functioning or make it worse. Antipsychotics are a crude tool used to attack a crudely-defined problem in a very crude way. They appear to make brain functioning worse rather than better. I was just reading another blog about how the Quaker “asylums” that involved fresh air, exercise, calm companionship, and a calm environment were more effective by far than anything we see today. Were the Quakers improving people’s brain chemistry by love and support? You bet they were!

          The idea that the psychological impact of the environment can somehow be extracted from a person’s life and that we can work on brain chemistry physically without regard for that psychological environment is the primary fallacy that has led us down this destructive path.

          — Steve

    • Sandy: “I agree that this seems likely to undermine the placebo effect. It is one of the things that make me wonder if I can keep working.”

      One thing about the placebo thing is that the people who got placebo also regularly went to talk to a doctor or whoever. Maybe just seeing someone regularly and talking to her about his problems helps. Feeling like one’s in best possible treatment or care, under safe wings, etc. I don’t know if it’s just the belief in that pill.

  5. Sandra,

    Assuming the following (your) hypothetical:

    “First of all, there is a wide variability in outcome and response. I continue to believe that there are those who benefit from these drugs in both the short and long term. I am not able to accept the notion that neuroleptics are no different from other tranquilizers since they seem to yield a specificity of response – a decrease in voices, an increase in coherence – in someone who is appearing fully alert. But this is only for some and there are others for whom the response is not so great and there are those who recover without taking them. Unfortunately, we have no way of knowing who these people are.”

    Question: How does any psychiatrist justify the use of force, if there is no way to determine who might “benefit?”

    And much more importantly, who might be gravely injured?

    Duane

      • Thanks, Duane.
        Those of you who work to abolish or limit the involuntary use of these drugs should be using all of this information in your efforts.
        In the state where I work, the indivdual response carries enormous weight in the legal prcess. So if a person has not shown any benefit to these drugs in the past, it will be much harder to obtain a court order permitting their use.
        If a person has never been on these durgs, the decison is a much harder one to make.
        As you know, I am fully in support of having as many options available so that we maximize individual decision making in this process.
        It is hard for everyone when a young person is in an extreme state and she and her family are overhwelmed by complex and confusing information.
        I think we all need to be humble about the limits of our current knowledge.
        Sandy

  6. Hi Sandy,

    I’ve been also reading your comments at 1boringoldman and I appreciated your pointing out the lack of evidence for certain claims being made there that I have found quite upsetting given Dr. Insel’s recent announcement admitting DSM INVALIDITY and having read Gary Greenburg’s very enlightening book, THE BOOK OF WOE, about the lies and junk science behind the DSM and DSM 5 in particular in which he interviews and quotes Dr. Allen Francis quite a bit. Similarly, I have ordered a new book by very prominent experts like Stuart Kirk and David Cohen called MAD SCIENCE:PSYCHIATRIC COERCION, DIAGNOSIS AND DRUGS, which covers similar information, which I highly recommend (On Amazon and discussed on the web). There are many others out including one called CRACKED by Dr. James Davies also exposing the fraud of the DSM and how BIG PHARMA bought out psychiatry, causing huge harm to so called patients/victims. I realize this was done by those in power like Robert Spitzer, Allen Francis, government officials and others, so this is not meant to attack you. I am just very glad that this predatory medical/industrial cartel with its dangerous junk science is coming to light since so many have been harmed, especially children in the guise of mental health and medicine like Joseph Beiderman’s child bipolar fad fraud that resulted in the infamous death of Rebecca Riley and many other children and toddlers no less on neuroleptic cocktails.

    I would like to ask your opinion of ECT since it seems to come up quite a bit at Dr. Nardo’s web site. Given the fact that Dr. Nardo seemed to applaud Dr. Bracken’s article on the need for a new paradigm in psychiatry and the fact that this article showed that real ECT was no better than sham ECT in terms of benefit, I question why there are so many cheerleaders for ECT on Dr. Nardo’s web site. Well, the answer was quite clear to me once I checked out the web site a bit more, but I will hold off saying much more until you can hopefully give your views about ECT if you would be so kind. Your high opinion of Dr. Nardo and others’ led me to start reading his web site. I was very impressed with his work exposing the fraud with many psych drugs, but red flags started going off as discussions of ECT became more prevalent and eerily familiar.

    Also, I saw that you were involved in writing a book covering neuroleptics and their side effects quite some time ago listed at Amazon. I would like to know please how you would compare neuroleptics and ECT in terms of the brain damage and other harmful effects that both of these brain disabling treatments cause per my hero, Dr. Peter Breggin and many others.

    I appreciate the fact that you continue to struggle with these issues, but I must say I continue to be against bogus, life destroying DSM stigmas and the current lethal, coercive brain damaging treatments of biopsychiatry.

    Are you making much progress with Open Dialog these days? If I recall either R.D. Laing and/or Loren Mosher used regular, non-expert people to provide much of the contact among the “patients” of both these famous doctors. The reason I mention this is because I realize it must be hard for you and other limited number of experts where you work to find the time to do such a seemingly labor intensive approach to psychosis. I’m wondering if a peer/trained volunteer approach might help including various family members taking certain shifts.

    I’m just making suggestions because I hate to see biopsychiatry go on with business as usual and I must say I am very disappointed when reading Dr. Nardo’s claims.

    I would appreciate hearing your thoughts on the above. It was very brave of you to come back after the reaction to your last post and that’s why you are admired and respected by most if not all of us for hanging in there when people who have been gravely harmed by psychiatry get traumatic triggers from some of the topics discussed. I imagine you are used to that in your work though I’m sure it doesn’t make it any easier to take. So, I want you to know that I truly admire and appreciate your hard efforts to learn and do the right thing. As Matthew Cohen said recently in a heated debate, I would rather have you where you work any day than the typical BIG PHARMA rep doctors pushing the latest lethal drugs on patent in toxic cocktails and highest doses. But, I also hope that this horrible paradigm will change some day because I don’t believe medicalizing human life, problems, crises, sorrows and other challenges is any solution whatever. Dr. Joanna Montcrieff and others address this issue in DE-MEDICALIZING MISERY and MADNESS CONTESTED among others.

    Finally, I find it ironic that you said you dropped psychoanalysis long ago due to its lack of science while pursuing biopsychiatry for its perceived science. Do you find that ironic now? I sure do! I still think there is plenty of room for a kind, compassionate, empathic person talking to people to help them with common sense problems/solutions that is not so common in our alienated, capitalist, materialistic society; validating abused/traumatized women and children or even work and school victims of bullies while providing practical advice, referrals, etc. though that probably wouldn’t fit your definition of science? Or have you reconsidered what might be scientific when it comes to messy humanity with all of its complex emotions, sorrows, joys and challenges?

    Again, thanks for being here and there is no rush if you are kind enough to respond.

    • Hi Donna,
      Thank you for your nice words.
      You raise many points. I will address what I can.
      1. ECT – It would take me a lot of time to truly answer this question. I am currently reading Dr. Moncrieff’s book in which she reviews some of the data on ECT. You undoubtedly are more familiar with this than I. I have observed some individuals in extreme states have what appeared to be miraculous improvements from ECT but I have observed some people get it (even long term)who did not improve much. As with all of these things we offer, it needs to be used judiciously and with full informed consent. The consent needs to include information about both long and short term – and possibly irreversible – memory loss. I believe that is required by statute in VT due to the hard work of one tireless advocate.
      2.I respect Dr. Nardo even though we may not entirely agree on everything. There is rarely agreement on complex topics and in a field in which there is so much uncertainty, we should expect divergent views, even among decent, honest, and thoughtful individuals. I do not agree with Robert Whitaker about everything although I agree with him on many things and I admire him tremendously.
      3. Although I am studying dialogic practice, I think I may have inadvertently left the impression that I am offering Open Dialogue. I apologize for any role I have played in that. Open Dialogue is as much of a system of care as it is a particular treatment approach and it is nearly impossible to transform an entire system of care to replicate what they do in Finland. I may in the future write more about my experiences but in our new outreach team in which we are tyring to integrate some aspects of dialogic practice, we do employ people with lived experiences and they have been a wonderful addition to our team. You are correct that this is time intensive work and that is a big challemge for me. The numbers are so low that I am worried about writing about this in a confidential way. I am also worried that I will appear to be more of an expert than I am and I have received some critcism for that.
      4. Yes, I find the arc of my career surprising and ironic. However, what I have thought for many years is that empathy is something that needs to be part of every doctor patient relationship and is not the provence of psychoanalysis. I continue to have reservations with many aspects of psychoanalysis although I suspect that my early teachers influenced me in a way that has colored my clinical work through the years. Once again, during that time I met people who I admired and respected even though in the end we did not agree on many things. The wrongs of the pharma driven world do not excuse or correct the wrongs of other approaches and everthing should be open to honest crtique.
      5. Thank you for the book recommendations. I will add them to my ever growing pile! Summer reading…
      Sandy

      • Hi Sandy,

        Thanks for your usual thoughtful response. The only reason that I became more aware of the perils of ECT is because I had great admiration for Dr. David Healy’s excellent work exposing the dangers of psychiatric drugs and the bipolar fad fraud in particular in his excellent book, MANIA: A SHORT HISTORY OF BIPOLAR DISORDER. I have been posting on this site for quite some time as you probably know.

        Since Dr. Healy addressed many of my pet peeves, I had/have no incentive to discredit him in any way, but rather, was very reluctant to see him discredited or do so myself. Neither I nor any family members have had the misfortune to get ECT, but I must protest this barbaric practice because I subscribe to the idea that no man/woman is an island…..And as Dr. Peter Breggin says, “Where was I when they came for the shock patients?”

        I happened to come across an article by Dr. Peter Breggin, my hero and savior as I’ve said repeatedly, that exposed Dr. Healy as an ECT stealth psychiatrist taking over the fraud Max Fink’s role as the greatest ECT promoter:

        http://www.huffingtonpost.com/dr-peter-breggin/electroshock-treatment_b_1273359.html

        As Dr. Breggin exposes, he and others like Dr. Joseph Glenmuller and others have been exposing the dangers/lethality of biopsychiatric visits, stigmas and toxic drugs for decades while Dr. Healy was a new kid on the block with an apparently different incentive: to replace these lethal drugs with the even more brain damaging, memory destroying ECT. Needless to say, when I did tons of research on this topic by neurologists, psychiatrists and psychologists like Bentall and Read’s excellent overview, Dr. Breggin was absolutely correct as usual. I’ve posted many such articles on Dr. Healy’s blog in the past once I found this out that seem to have disappeared and many other articles here touting ECT as having efficacy and less harm when the opposite is true. Even Dr. Harold Sackeim, the greatest long term ECT advocate in the U.S. ultimately admitted in a study funded by the NIMH very late in his sordid career that his so called patients he had discredited based on their so called mental illness had been right; ECT does cause permanent brain damage, memory loss, death, etc. It came out that Sackeim had huge conflicts of interest with an ECT machine maker as does Max Fink. This is true for many if not all in this sordid, lucrative, select group of ECT pushers. The book, DOCTORS OF DECEPTION, by Linda Andre and recommended by Robert Whitaker is an excellent book on the topic.

        As I read more of Dr. Nardo’s web site there appeared to be many ECT cheerleaders there with Dr. Nardo being one of them by touting Dr. Healy, Dr. Michael Taylor, Dr. Edward Shorter, Dr. Max Fink and many others in this select group touting ECT as the penicillin of psychiatry with any supposed harm “urban legends.” I learned to my chagrin that Max Fink was able to get catatonia in the new DSM 5 that both he and David Healy use as an excuse for ECT. This group has also been fighting for melancholia to be added based on its supposed biological nature to further push ECT as well. Dr. Healy and Dr. Shorter wrote a bogus infomercial of a book on ECT that was condemned by one and all experts for its total lack of science, evidence, facts and honesty. This book is a huge embarrassment for Dr. Healy given his excellent work on drugs.

        So, though I think you are right that one can agree and disagree up to a point with various others, I think there is a point where agreeing can constitute huge harm, the perpetration of lies, fraud and down right evil if one does not speak up about the truth especially when it comes to ECT causing irreversible brain damage and the destruction of those parts of the brain that make us human in the frontal lobes per Dr. Breggin.

        Perhaps I sound old fashioned by trusting Dr. Breggin, but at least I know when he speaks about something, he’s mostly if not always right and he won’t be pulling some other lobotomy inducing dirty tricks out of a black bag with the pretense of medicine.

        I cannot say if Dr. Nardo has been misled by these dishonest advocates or if he is one of them, but based on the tons of research I’ve read by experts, it is all too clear that ECT is a barbaric practice that results in an electrical permanent lobotomy with brain damage, permanent amnesia, and lack of any efficacy beyond the initial short vegetable induced status per expert studies by those like Bentall and Read summing up by stating that given the huge harm of ECT and total lack of efficacy along with risk of death, it cannot be justified in any way. This was the study included in the Bracken article just citing the lack of efficacy and not the huge damage caused.

        I think there are too many people or “experts” on this site and Dr. Nardo’s that still rely on their gut, feelings, thoughts when making supposed scientific, biological claims and I admire you for pointing that out because such “gut feelings” based on long term experience can be deadly to others when one considers the gut feelings that led to lobotomy, blood letting, ECT, etc. On the other hand, we have learned that so called evidence based medicine can prove anything the funders/stakeholders want to prove, so it all boils down to honesty, integrity and admitting one’s own prejudices, while “first doing no harm, which may mean doing NOTHING as you have learned and practice at times. The golden rule is a good standard in my opinion. Sadly, like you, I tend to avoid doctors as much as possible, so that is the legacy we have been left by the medical/BIG PHARMA cartel with the KOL’s of biopsychiatry leading the way: complete destruction of any trust in medicine for any informed person more common now with the Internet, etc.

        I don’t think you have been at all misleading about your learning about Open Dialog. As you can see, I got the point that you work in a busy, probably underfunded Community Mental Health Center and its obvious you don’t have the staff, resources, or time to fully implement this practice. But, I think it is a sign of your dedication to do the best you can by learning about these methods with your staff and trying to incorporate them as much as possible in your work with the use of volunteers/family members/peers while studying the best, least harmful methods of using psych drugs judiciously or not using them at all when possible. Perhaps, some day a group of like minded experts in Vermont could try to get a grant to start something like a Soteria House. Actually, I believe MIA has a blogger who does this already? Have you worked with him at all?

        I believe in an eclectic approach to psychiatry or what often amounts to human suffering, crises, emotional distress because we are all unique individuals and one size does not fit all especially when most biopsychiatrists refuse to even listen to their clients or consider context or social stressors in any way, which I believe is a huge betrayal that caters to the power elite as a great cover up of the harm done by corporate cronyism, etc.

        When I pointed out your saying quite some time ago that you rejected psychoanalysis due to its lack of science, I was not implying you were wrong about that. Seth Farber, Alice Miller, Jeffrey Mason and others have exposed that Freud continued Augustine’s concept of original sin by blaming his so called patients for their problems as does biopsychiatry, so we can thank Freud for the continuation of this evil paradigm with the new focus on the original biological original sin genes/chemical imbalances/bad wiring or the latest eugenics of the day. Freud also has been exposed for covering up the incest he discovered in his so called “hysterical” female patients to aid and abet the abusers in power just as biopsychiatry does for the misogynist rapists/abusers today that often include females too I am sad to say. There have been many bogus, harmful “therapies” like the bogus memory recovery movement extremes, the adult child/codependency movement and many others that have been debunked. That’s why I believe that an empathic psychiatrist willing to listen to the unique individual in front of them to either validate their reality or make suggestions for improvement based on common sense and basic human psychology, the latest health information on diet, vitamins, exercise, toxic or good relationships, drug abuse recovery, eclectic therapy and other helpful things could once again make psychiatry a valuable profession rather than an extremely harmful one it became with BIG PHARMA fraud.

        So, my only point was that given you went into biopsychiatry due to its supposed superior science, it is somewhat ironic that the house of cards behind the DSM, the KOL’s of psychiatry selling out to BIG PHARMA and the supposed magic bullet drugs exposed by Bob Whitaker and others turned out to be as bad and worse than what it replaced given that it became an equal opportunity global destroyer for the most part.

        If I come off as angry, it is because of the huge, fraudulent misdiagnosis and overdiagnosis of the supposed worst, serious “mental illnesses” like schizophrenia and bipolar known as updiagnosing by very unethical psychiatrists to profit from others’ suffering while doing as much harm as possible. I don’t get the impression you are doing that when you struggle with how to deal with psychosis without doing more harm.

        I tend to do lots of reading to validate my reality since many of these crimes against humanity are so hard to believe. That’s why those who take the risk of exposing it are my heroes.

        You were a coauthor of that older book on the first neuroleptics at Amazon, right?

        Again, I appreciate your response and your bravery and fortitude for hanging in there at MIA.

        • Hi Donna,
          There is much in this statement. Although these physicians are more than capable of speaking for themselves, I would suggest that there is an important distinction between someone who asserts that ECT may play a role in helping some individuals and being someone who has a hidden agenda to promote it. I do not believe that Drs. Nardo and Healy have a hidden agenda nor do I think that they would characterize ECT as a penicillin of psychiatry. At the same time, when one looks at the history of psychiatry and its many failed treatments, I understand your skepticism. We may just have to agree to disagree on aspects of this discussion. We do share an anger about the misrepresentations that have been made about drug treatments.
          I was not a co-author on a book about drug side effects but I wrote a chapter for a book many years ago. I am surprised it is still for sale at Amazon.
          Sandy

          • Hi Sandy,

            I appreciate your responding, but I can’t agree to disagree on something as critical as the huge harm done by ECT and the denial by certain experts like Dr. Healy who should certainly know better given his opposite approach to psychiatric drugs.

            Here is Dr. Breggin writing about Dr. Harold Sackeim’s study done at the end of his sordid career of being the most influential voice promoting ECT in the country whereby he FINALLY admits to the well known brain damage, permanent memory loss, cognitive dysfunction and loss of many abilities destroying many careers that he lied and denied the whole time. That is the reason Ernest Hemingway and Sylvia Plath committed suicide; they could no longer be creative and write due to the ECT induced brain damage and memory loss.

            The reason for the study was that Sackeim had gotten a huge grant for it from the NIMH he avoided doing his whole career hiding his huge conflict of interest with an ECT machine manufacturer the entire time. He routinely denied “patient” complaints of cognitive dysfunction by blaming their so called “mental illness” to discredit them.

            http://breggin.com/index2.php?option=com_docman&task=doc_view&gid=203&Itemid=3

            As Winston Churchill says, “you can have your own opinions, but you can’t have your own facts.”

            I don’t think one can isolate the brain damage and harm done by neuroleptics and ignore the even worse harm done by ECT and other barbaric treatments of biopsychiatry. One must look at the big picture since psychiatry’s brain disabling/damaging treatments come and go.

            I realize you may not have a great deal of experience or knowledge about ECT in that you probably do not prescribe it yourself?

            Here is an article by Dr. Friedberg, Neurologist, about ECT induced brain damage. He states many psychiatrists are unaware of the huge harm of ECT since it is not addressed in psychiatric text books or APA officials for obvious reasons.

            http://endofshock.com/friedberg.htm

            An excellent review of Dr. Healy and Dr. Shorter’s book, SHOCK THERAPY, by Richard Wagner:

            http://endofshock.com/Review%20of%20Shock%20Therapy%20pgs.pdf

            Here is the famous AHRP reviewing Dr. David Healy’s book, SHOCK THERAPY, where she cites him and Dr. Shorter for their dubious claims that ECT is the penicillin of psychiatry you found so hard to believe.

            http://endofshock.com/Sharav%20on%20electroshock.pdf

            So, per your claims, here is Dr. Healy “speaking for himself on ECT,” which makes him a danger to others if not himself.

            Though I know I risk annoying you and others, I cannot remain silent as long as such horrific human rights violations continue in a so called democracy.

          • Hi Donna,
            You are not annoying me but we may be at an impasse. I continue to think the issue is one of informed consent. Although I do not administer ECT I have worked with people who have received this treatment. Some of whom have had it and find it to be of great benefit despite their experience of memory impairment. It seems that like many things, it comes down to weighing the potential risks and benefits. You may see no benefit so therefore you would never suggest it. There are others who experience some benefit and find the benefit outweighs the problems.
            However, to make this even more complicated, I have known individuals who from my vantage point seem to derive limited benefit yet they insist on this form of treatment. I have argued against this form of treatment in those cases and they have blamed me for interferring with their right ot get something that they insist is of help. People are complicated.
            Sandy

          • Dr. Steingard explains, “nor do I think that they would characterize ECT as a penicillin of psychiatry.”

            Dr. Steingard (Sandy):

            The book Healy co-authored with Shorter (Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness) says exactly that.

            Beginning on page three and continuing to page four, it explains,

            “Our research convinces us that ECT is an important, responsible, and reliable therapy that deserves to be more widely used…”

            and,

            “…there should be little controversy over whether it is safe or effective. Somatic therapies like ECT easily trump anything in the psychopharmaceutical medicine chest as the most effective treatment for such severe illnesses as melancholic depression, catatonia, or manic excitement; it also has a place in the treatment of schizophrenia,”

            and,

            “Why today, seventy years after its discovery, is ECT highly stigmatized, both among patients and many physicians? ECT is, in a sense, the penicillin of psychiatry. We would be baffled if the benefits of penicillin were not widely touted in the patients’ world, lauded by the press, and accepted as a matter of fact by medical doctors. Why has this not happened with ECT? The question is especially important because there are a great many people with depression who do not respond to antidepressant drugs.”

            [I have added bold print there for emphasis, in addressing your skepticism, that they would have said such a thing.]

            That book was first published just six years ago.

            To my knowledge, neither Healy nor Shorter have ever retracted any of its content.

            And, all the while, Healy has been running an ECT clinic.

            The “David Healy (psychiatrist)” Wikipedia page explains:

            “He also heads the psychiatric inpatient unit at Bangor, North Wales, where treatments include electroconvulsive therapy (ECT) and psychiatric medication.”

            Donna has recommended a review of that book he co-authored with Shorter.

            Here’s another link to a thoroughgoing review of it:

            http://www.ect.org/book-review-shock-therapy-by-david-healy-edward-shorter-and-max-fink/

            Here’s a paragraph from that review:

            “The first clue that that this book is nothing more than the industry party line on ECT comes on the very first page, but you might not pick up on it. Funding for the book, the authors admit, came from the Scion Natural Science Association. What they don’t tell you is that Scion is Max Fink’s private family foundation, one he started decades ago to fund research favorable to ECT from his personal money. Fink, age 84—often called the grandfather of shock—has been promoting ECT for half a century. He makes promotional videos for shock machine company Somatics, publishes books and articles denying any adverse effects of ECT, and has helped many younger men and women build careers as shock doctors. No one alive has a greater investment in shock. Public records show Fink’s foundation paid the authors $34,000 to write this book. Fink also co-wrote the book, according to sources like Wikipedia and the State University of New York website.”

            IMO, something’s fishy in North Wales.

            That’s just my opinion…

            Respectfully,

            ~Jonah

            P.S. — about your stating that you, “continue to think the issue is one of informed consent.”

            Here, as follows, is a paragraph from page 205 of Peter Breggin’s Book, Electroshock, its brain-disabling effects (that was first published eight years prior to the Shorter/Healy book):

            “Even if it were possible to give voluntary, informed consent during a patient’s stay in a mental hospital, and even if ECT advocates made its hazards known beforehand, electroshock presents a special problem that effectively rules out consent in most or all cases. Despite giving initial consent to the treatment, the patient typically tries to reject it when he begins to experience the onset of an acute organic brain syndrome. His fear and outrage are always ignored, and often he is drugged, isolated and/or given extended ECT treatments, until rendered unable to protest with any strength or coherence. As the patient passes from abject terror to incoherence, his psychiatrist may use his growing mental incompetence to justify further treatment on the grounds that the patient is too irrational to know what is good for him. I have never seen or heard, or read of a single individual whose ECT was prematurely terminated on the grounds that he had changed his mind after experiencing the treatment and no longer wanted it. Most so-called voluntary ECT patients, therefore, become truly involuntary as soon as they experience its devastating effects. At first they are involuntary because their protests are ignored. Later they become involuntary because they are too brain-damaged to protest their worsening condition.”

          • Correction:

            The Breggin book was published 28 years prior to the Shorter/Healy book. From this point of view, it’s likely that ECT promoters would say Breggin’s take on the subject is outdated. (Probably, they’d claim that ECT has become a very civilized procedure in this past quarter century.)

            However, I doubt that most of the issues raised by Breggin (e.g., in that paragraph, which I’ve offered) have really changed.

            One other book on the subject, that’s much more current, comes highly recommended; that’s Professor Linda Andre’s, Doctors of Deception: What They Don’t Want You to Know About Shock Treatment.

            http://www.amazon.com/Doctors-Deception-About-Shock-Treatment/product-reviews/0813544416/ref=cm_cr_pr_hist_5?ie=UTF8&filterBy=addFiveStar&showViewpoints=0

            I’ve not yet read it — but do intend to…

            ~J.

  7. Sometimes I wonder if we shouldn’t just rip up all we know about ‘schizophrenia’ and start again; from the person, from the symptoms, from the beginning, perhaps taking, what Jo Moncrieff calls, a drug centered approach to these medicines, as opposed to a disease centered approach. These are not diseases we are dealing with, the drugs are not antipsychotic but rather drugs with effects on dopamine systems, a by-product of which might be symptom control. And if there is no disease there is no need for life long adherence, but a real need to develop services that get people understanding their symptoms in the context of their experience, providing problem solving, functional rehabilitation, family interventions, mindfulness based treatments, spiritual care… basically anything which prevents this chronicity. The current system seems to promote chronicity through the promotion of a disease model. The drugs may play a role but only as tools to manage symptoms and therefore built into careplans from the beginning should be an exit stratergy for helping people get off the drugs without provoking another relapse. The science as you suggest seems to support this view. Very little science really supports the traditional disease based model of psychosis care.

    • Thank you Jeremy for these excellent comments. I am reading Dr. Moncreiff’s book right now and I like the notion of the drug centered appraoch. That is why I included the comments about the relative specificty (not so much for a “disease” of schizophrenia but for the phenomena of voices, disorgainzed thoughts) of neurolpetics.
      Sandy

      • Sandy,

        I can see where you would feel a no win with ECT when you try to tell people about its harmful effects and your opinion it won’t help when they get angry and accuse you of depriving them of this great therapy.

        I think if you do the right thing, it’s always better than being manipulated into doing the wrong thing in cases like this with the wrong thing subjecting such people to ECT when you know it will cause more harm than help.

        I can give you an embarrassing example with hindsight. I used to get bronchitis attacks from smoking and would routinely go to my doctor and get antibiotics for it. When he started using Physician Assistants and I went for such a visit, this woman doctor refused to give me the antibiotic because she said my smoking was the problem and the antibiotics would cause more harm by overuse, which is a great problem today.

        I was mad and thought she was a witch at the time by not giving me what I thought were badly needed drugs to cope with my constant coughing. But, later, when I learned the many dangers of the overuse of antibiotics and how such prescriptions were really just masking the problem of my need to quit smoking, I admired this doctor much more and know she did the right thing in hindsight. Of course, she knew that too and could more easily live with herself than those doctors handing out antibiotics, statins, SSRI’s and other dangerous drugs like candy. It also motivated me to quit smoking.

        As I learned the hard way, we are never going to please everyone, so in my opinion, if you do your best to do what’s right to the best of your knowledge and power, you can live with yourself much more easily. Also, I am sure being a doctor can be much like being a parent in that at some point your clients and children may admit you were right at least some times. I say that tongue in cheek.

        In my opinion, you can never go wrong denying ECT and reducing neuroleptics as much as possible while treating your clients with respect, empathy and compassion, which I believe you do.

        Thanks for your patience and input.

        • Donna-
          This is an interesting anecdote; thank you for sharing it.
          Don’t you think that it raises the question that when we are angry at the reponse we get from a doctor that it is hard to know where we are on the arc that you describe above: is the doctor being unreasonable? is the doctor inadequately educated about the true nature of the treatment? is the person who is seeking consultation overly influenced by outside sources (cultural expectations, advertsing) to accept the doctor’s point of view?
          I will concede that you have read more about ECT than I. It is not a treatment I administer but I try to be honest and in that spirit I acknowledge that I have referred individuals for consulation for ECT. As you know, ECT was not the topic of this blog.

          However,for me the conundrum – the paradox which was the topic of this blog – is not that many of the things psychiatrists prescribe have no benefit but rather that the short term benefit may not be worth the long term consequences. Explaining that to individuals who are sufffering or to families whose loved ones are suffering and at risk of getting in harms’ way is challenging. And what is the “right” thing to do when someone says I do not care about the long term, I want relief now. Who should determine if that person truly understands the risks, who should determine how to balance those risks? I can tell you that as angry as people are on this site at doctors who were overly optimistic or even misleading about the benefits of treatment, there are scores of people out there who are angry that doctors would not give them the thing they were certain they needed. Some commentators on this site have talked about the benefits of marijuana; however, this is a drug that appears to trigger psychosis in some individuals. Is this a good drug or a bad drug?
          I contend that there are often no clear or easy answers.
          With your permission, I may want to use your anecdote as the basis for a future blog.
          Sandy

          • Sandra,

            Nicotine is addictive, as is smoking.

            The difference here is obvious, IMO. First of all, nobody is encouraged to start smoking by a physician, nor is it seen as medically beneficial.

            Prescribing an antibiotic for smoking-induced bronchitis is not ideal, but it’s hardly the same as giving someone ECT, because they demand it.

            I apologize for jumping in here, Donna. Please let me know if I interfered.

            Duane

          • And Donna has provided numerous links to the dangers of ECT, many times.

            IMO, ECT should be abolished. And I’m not alone. Fellow Texan and good friend, John Breeding,Ph.D. agrees, as do many others.

            The Coalition for the Abolishment of Electroshock in Texas. -

            http://endofshock.com/

            Not many things in life are black-and-white, but some things are. Look no further than the zebra.

            Duane

  8. Okay, the question that keeps bothering me about all of this is: If we know that people do better on lower doses, and their overall, longterm outcomes are better on lower doses, why do so many psychiatrists drug people with high doses, sometimes using more than one drug?

    • Hi Stephen-
      I am not sure if this question is rhetorical. I have no good answer. As I wrote in my earlier posts on optimal use of neuroleptics, I think there is a general sense that the drugs are more effective than they really are so when a person does not improve, the assumption is that he just needs more.
      For some reason since these drugs were first introduced, there was a tendency to use higher doses in the US than in other countries. Although I have no good data to support this, I think that this may still be true.
      When Joe McEvoy did his neuroleptic threshold study in the early 1990′s and demonstrated that low doses were as effective as higher ones, there was a moment when that message may have gotten more traction but as the newer drugs were brought to market, the advertsiing led to this sense that they were much safer so people did not have as much concern about pushing the doses higher.
      That is just my speculation about this.
      Here is the link to the blog where I discuss this:
      http://www.madinamerica.com/2013/03/optimal-use-of-neuroleptic-drugs-introduction/
      Sandy

      • Sandy,

        I realize that there are some people like Kitty Dukakis who are willing to live in mere vegetable status and don’t care about the severe memory loss. However, Kitty Dukakis has lived a privileged, wealthy life and did not have to worry about losing her career skills like so many others whose lives were destroyed by psychiatry WITHOUT INFORMED CONSENT.

        I applaud you for telling people the truth about ECT, but perhaps you are not aware of the real sordid truth of massive brain damage caused by ECT. I have cited several articles by experts and reviews of Dr. Healy’s horrible book, SHOCK THERAPY, which is really an infomercial funded by the notorious ECT promoter con artist, Max Fink, who routinely lied and denied the damage caused by ECT though he had acknowledged it early in his career when it was well known that the purpose of biopsychiatry’s “treatments” was to disable and damage the brain to make so called patients easier to control and more docile/stupid.

        Again, I give you a great deal of credit for your honesty with those you encounter and I urge you to read some of this literature on ECT.

        Sorry, but I don’t buy the idea that those promoting ECT for obviously self serving purposes as a very lucrative endeavor along with great conflicts of interest among the greatest promoters like Max Fink, Harold Sackeim, etc. are trying to help patients and aren’t aware of the harmful effects.

        I think Dr. Healy should be very embarrassed to have added his name to the horrible book, SHOCK THERAPY, reviled and debunked by all expert, very qualified reviewers without conflicts of interest.

        Further, I must say that since Dr. Healy promotes ECT for all so called mental illnesses including the dubious catatonia and melancholia promoted by Max Fink and other ECT cheerleaders even for inclusion in the DSM 5 (Fink did manage to get catatonia in the DSM 5 to my horror), it does call his attack on psychiatric drugs into question as Dr. Breggin points out.

        My concern is that if those like Dr. Healy, Dr. Nardo and others demonize the drugs to the point they will be all but banned, then, worse more immediate brain damaging treatments like ECT will become all the more prevalent. I am horrified to see the astonishing comeback of the barbaric practice of ECT, which I believe is happening more as SSRI’s and other drugs are being debunked.

        I did a great deal of research on this topic because I really did not want to believe that Dr. Healy would promote such a brain damaging treatment given his other work that I had admired along with many others. I must say that Dr. Healy’s stubborn refusal to acknowledge the brain damage, memory loss and other well known damage caused by ECT does harm his credibility greatly as is true for anyone promoting it when one reviews the massive evidence.

        Sadly, even if somebody promotes it for the most dire cases, as happened with neuroleptics, such “treatments” tend to be abused with abandon to the great harm of unsuspecting people and it becomes every day business as usual.

        If you check out Dr. Healy’s SHOCK THERAPY book, it is obvious he like many others is not giving his so called patients “informed consent” as Dr. Breggin and other critics make all too clear.

        Thank you for your responses on this critical topic.

        Excellent overview of ECT or shock therapy by Richard Wagner.

        http://endofshock.com/Shock%20treatment.pdf

        • Hi Jonah,

          Good to have you here with your extensive knowledge of ECT.

          Here is updated information from Dr. Breggin’s web site including the infamous Sackeim belated admission in his 2007 study that ECT causes permanent brain damage, memory loss and other horrific permanent “side effects” which are the only effects. I have also included several other critiques exposing the huge harm of ECT in terms of brain damage, permanent memory loss, loss of career and other skills, heart damage, death and total lack of efficacy.

          http://www.breggin.com/index.php?option=com_content&task=view&id=40

          Dr. Breggin updated his famous book, BRAIN DISABLING TREATMENTS IN PSYCHIATRY in 2007, which includes ECT.

          http://www.amazon.com/books/dp/082612934X

          Landmark case: Jury awards over $600,000 for ECT caused brain damage.

          http://www.ahrp.org/infomail/05/07/08.php

          Neurologists, other doctors and experts praise Linda Andre’s book, DOCTORS OF DECEPTION, about the great harm done by ECT.

          http://www.amazon.com/books/dp/0813544416

          John Breeding, Psychologist and ECT protestor article:

          http://www.endofshock.com/breeding.htm

          Dr. Michael Corey, Psychiatrist, fighting to abolish archaic human rights abuse of ECT in Ireland:

          http://www.network54.com/Forum/281849/thread/1209325750/Irish+Psychiatrist+leading+campaign+against+use+of+'archaic'+ECT+in+hospitals

          John Read & Richard Bentall on “The Effectiveness (or lack thereof) of ECT

          http://www.mindfreedom.org/kb/mental-health-abuse/electroshock/irish-times-read-bentall-ect

          Dr. John Friedberg, Neurologist, FIVE BIG LIES ABOUT ECT

          http://psychiatrybuster.blogspot.com/2007/06/5-big-lies-of-ect.html

          Dr. Peter Breggin exposes that new study (2012) shows that ECT causes brain damage though misleading article hides this sordid fact

          http://www.huffingtonpost.com/dr-peter-
          breggin/electroshock-treatment_b_1373619.html

          Former ECT psychiatrist, Stefan P. Kruszewski, MD, praises Linda Andre’s book, DOCTORS OF DECEPTION, in his review:

          http://www.power2u.org/downloads/DrsOfDeceptionBookReview.pdf

          Dr. Colin Ross, The Sham ECT Literature: Implications for Consent to ECT

          http://www.ectresources.org/ECTscience/Ross_2006___Sham_ECT_Literatures.pdf

          Dr. Toby Watson on brain damage and other lethal effects of ECT

          http://isepp.wordpress.com/2011/05/22/a-letter-to-the-editor-regarding-ect-by-dr-toby-watson/

          • “Good to have you here with your extensive knowledge of ECT.”

            Hi Donna,

            I don’t have extensive knowledge of ECT. I have a little knowledge of it, which is gradually growing, thanks largely to the power of the Internet.

            Those are great links you’re offering. I am familiar with some of them.

            Here’s another great link (to a video on Peter Breggin’s Youtube channel):

            http://www.youtube.com/watch?feature=player_embedded&v=r6WXey2b-jA

            Actually, it’s a ‘listen only’ video — a fairly brief debate (just a half hour) on ECT, that’s highly educational.

            (From the Youtube uploader notes: “Peter Breggin debates Helen Lavretsky over electro-shock treatment on Southern California Public Radio, January 26, 2011.”)

            On that page we find this, too:

            The Dangers of Electroconvulsive Therapy [one can find *many* more educational links regarding ECT here]:

            http://breggin.com/index.php?option=com_content&task=view&id=40

            Of course, there are people (like Kitty Dukakis) who say ECT has helped them.

            But, IMO, once one has studied the truly all-too-frequent long-term “side effects” of ECT (and, especially, once one has gained firsthand accounts of those effects), it’s impossible to imagine how any doctor could support what what Healy and Shorter say about it.

            In one of your comments, above, you say, “As I read more of Dr. Nardo’s web site there appeared to be many ECT cheerleaders there with Dr. Nardo being one of them…”

            To now, I’ve not been aware of Mickey Nardo (a.k.a., 1boringoldman) having anything to say about ECT.

            IMO he’s a quiet sort of pharma-skeptical psychiatrists’ psychiatrist and, yet, is, perhaps, one of the most influential pharma-skeptical psychiatrists now blogging.

            Since you referred to “cheerleading” yesterday, above (on July 9, 2013 at 4:22 pm), I’ve briefly searched “shock therapy” and “ECT” on Dr. Nardo’s 1boringoldman(dot)com website, and I’m not finding his views of ECT; that may be because his blogging style is often highly technical, so it can be difficult for lay readers, like me, to quickly scan and make sense of his posts.

            Can you please provide some example/s (with link/s) of his ‘cheerleading’ for ECT?

            That would be helpful…

            Respectfully,

            ~Jonah

        • Correction: The author of the last article posted above is Richard Warner and not Richard Wagner. The same is true of Richard Warner’s review of Dr. Healy’s shock book where I erred when typing his name.

          • Jonah,

            There is no button under your question, so I have to respond here.

            As I said in a post to Sandy when I became aware that Dr. Healy promoted ECT to my great disappointment and “shock,” I did tons of research on ECT, Dr. Healy and other issues I realized I needed to learn more about.

            As a result, I became quite familiar with the big names like Max Fink promoting ECT and other issues like the fact that ECT causes brain damage, permanent amnesia, loss of career and other skills, epileptic fits, death, heart failure and stroke, early death, dementia, suicide and worse depression in the long run due to its lack of efficacy and permanent damage.

            I started reading Dr. Nardo’s web site having heard many good things about it and some alarm bells started going off when certain experts on the site insisted on claiming certain DSM stigmas like bipolar were biological when there is no evidence and Dr. Insel of NIMH had just declared them invalid. The labels of melancholia and catatonia came up, which were red flags to me since Dr. Healy and Dr. Fink used these bogus stigmas to push dangerous brain damaging ECT as has Michael Taylor et al.

            Dr. Nardo had books by David Healy and Michael Taylor on his web site to presumably promote them such as PHARMAGEDDON and HIPPOCRATES CRIED. Trusting Dr. Nardo, I assumed the latter book would be a great one only to find the author is the head of an ECT unit as is David Healy. Like Healy’s SHOCK THERAPY, Taylor’s HIPPOCRATES CRIED is nothing more than an infomercial pushing ECT for every so called mental illness! Once I asked about this, the books disappeared as far as I can see.

            I expressed my concerns and got attacked by some doctors there while Dr. Nardo was kind enough to respond to me about his view of treatments which include ECT when he believes it necessary like neuroleptic and other drugs used judiciously.

            You would have to read ALL the blogs from the time Dr. Nardo and his friends were batting around various DSM diagnoses they BELIEVE are biological with no evidence that upset me quite a bit to the one where I challenged Dr. Nardo to be equally critical/honest/open about all of psychiatry’s brain damaging treatments including the drugs, ECT and others. Otherwise, it will be the same betrayal as that of David Healy attacking the drugs while supporting an even more dangerous, immediately brain damaging barbaric ECT menace.

            It was obvious that Dr. Nardo was not happy with me and I would probably be banned from the site if I pressed the issue much further if I wasn’t already. He and his “mental health” buddies obviously support ECT quite a bit, which may be due to the influence of David Healy, Max Fink, Michael Taylor and others and other less obvious factors that remain to be seen.

            You are right. I know a lot about ECT based on much research, so I was able to pick up the eerie red flags at Dr. Nardo’s site that I was re-experiencing the same ordeal I had when finding out about Dr. Healy’s push for ECT as he demolished various psych drugs, which made his claims very suspect. I felt very betrayed in both cases, which is why Dr. Peter Breggin remains my trusted hero and always will be since he had never betrayed his followers like this, but rather, has put gigantic efforts into warning one and all about each new fascist, brain damaging agenda of biopsychiatry and its cohorts in power that have included ECT, lobotomy, psych drugs, DSM stigmas, victim blaming/scapegoating, predation on our nation’s children and especially blacks, etc.

            At the same time, you are right that the technical drug articles on Dr. Nardo’s site can be tedious to get through, but I did get through them. Without an equal effort on your part along with lots of ECT research, you may not be able to pick up the subtle ECT agenda there that became obvious to me due to lots of time and effort studying these issues. So, I can’t point you to every word, quote, innuendo for my assessment that you have requested for these reasons. You would have to slog through all those posts as I did.

            I must say that those who are complaining about Matthew Cohen’s recent posting guidelines should be aware of just how open and accepting this web site is in terms of people being allowed to expose bogus, dangerous brain damaging “treatments” in biopsychiatry without being attacked, shunned, blocked and subjected to other censorship.

            Perhaps we are so spoiled here that we don’t realize all the freedom we have been given to share our views, research, knowledge and experience that is not tolerated so well elsewhere.

      • No, it isn’t rhetorical. I appreciate your response and it helps me to understand what I see happening to the “patients” in the hospital where I was once a patient and now work.

        Many people get zapped with doses of this stuff that would knock a horse to it’s knees. It really bothers me to see people in the group that I chair who drool on themselves through our entire meeting, through no fault of their own. We’re supposed to encourage people to participate in our groups but more than half the participants are zonked on the drugs! You can’t run groups nor do any kind of real productive work with people when they’re zonked. It’s very frustrating. And as I pointed out before, many of them are on more than one of these drugs.

  9. I presume we are talking about “The Myth of the Chemical Cure.” And as someone who is not trained in psychiatry, other than two psych classes in college, and the last eight years researching the psycho / pharmaceutical industries so I could medically explain how doctors made me sick to cover up an easily recognized iatrogenic artifact. But who had two children win golds at regional and state science fairs (where the scientific method is stressed as invaluable). My heart went out to Dr. Moncrieff when reading her book.

    I understood from reading it, and from the lived experience of having been made ungodly sick by neuroleptics, that all the research she was searching through was work NOT based on the scientific method. And I felt her angst, in what seemed to me at least, to be her attempt to mentally come to grips with the fact that her industry was wrong about the effectiveness and safety of the antipsychotics. And I realize it must be very difficult for the ethical, but apparently big Pharma misled, psychiatric professionals to come to grips with the reality that in fact they were causing their patients’ illnesses, rather than curing them.

    But as a mom who understands the scientific method, and knew exactly how and when the neuroleptics made me sick, I noticed that almost none of the psychiatric research in the book addresses the reality of withdrawal symptoms or withdrawal induced psychosis, thus almost none of it is of any true scientific value. And I wasn’t certain Dr. Moncrieff realized this, although she may have.

    It’s been over a year since I read her book, so I may be remembering it incorrectly, but what I garnered from the book was, point blank, the total lack of scientific validity of all the psychiatric research. You have to have a control group, otherwise you have nothing with which to meaningfully judge the effects of the drugs.

    • The more I hear what Dr. Oz says I’m beginning to think his last name is very apt and appropriate. I also am wondering about Opra and where her head was when she began promoting this man on national television.

  10. There seems to be very little acknowledgement of the link between electroshock and epilepsy (which has been my own experience, sadly). There are available studies suggesting this link, including one that asserts that post-ECT epilepsy is way under-reported. From a common sense point of view, it certainly seems possible that inducing seizures would cause seizures. My psychiatrist denies this (big surprise!) but my neurologist confirms he sees lots of strange neurological symptoms after ECT. I’m much more inclined to listen to a neurologist.

      • “It’s like the difference between astronomy and astrology.”
        :)

        Duane, that’s so very true…

        And, now, to illustrate that point for oneself, one can just watch the head of the NIMH, presenting his TEDx Talk, at Caltech:

        http://www.madinamerica.com/2013/07/toward-a-new-understanding-of-mental-illness-thomas-insel/

        In barely over ten minutes’ time, he does a most fascinating job of promoting his field’s new spin on its old claim of addressing “brain disorders” (their “chemical-imbalance-in-the-brain” theory was so weak, at last, it threatened to stall psychiatry’s eternal hope for legitimacy).

        Insel now leads his field of U.S. government researchers, by referring captive audiences to a *supposed* coming technology, that shall (theoretically) offer early childhood “prediction” and “prevention” of would be adolescent “Neuropsychiatric Disorders”; yet, he *never* offers even one single hint as to how such “predictions” can ever be made.

        Only, he insists that his brethren are making progress.

        His Powerpoint demonstration briefly introduces the concept of, “DISORDERS OF THE HUMAN CONNECTOME.”

        So, I’ve been doing a bit of research, beginning with Wikipedia (via their page on ‘connectomes’: …en.wikipedia.org/wiki/Connectome).

        There, we can read,

        A connectome is a comprehensive map of neural connections in the brain.

        The production and study of connectomes, known as connectomics, may range in scale from a detailed map of the full set of neurons and synapses within part or all of the nervous system of an organism to a macro scale description of the functional and structural connectivity between all cortical areas and subcortical structures. The term “connectome” is used primarily in scientific efforts to capture, map, and understand the organization of neural interactions within the brain.

        Ultimately, Insel crosses out these two terms, “Mental Disorders” and “Behavioral Disorders” with a red line — and offers “brain circuit disorders” instead.

        In the end, he quotes Bill Gates on the rise of new technologies and the tendency of such, to come within a decade’s time.

        This is the new “Decade of the Brain” after all.

        Not once does he mention possible environmental factors affecting human brains.

        Oddly, he does not do so even when mentioning “PTSD”.

        (IMO reasonable people who are studying kids and aiming to prevent their would be eventual development of “PTSD” will seek to eliminate likely sources of traumatic events, in their environment — e.g., child abuse within the family, bullying at school, gang violence within the community, etc..)

        To realize he’s speaking to an audience at Caltech (which should, of course, be quite interested in whatever new technology he supposedly has up his sleeve), and that, apparently, no one questions him nor voices any objection to what he’s saying, is to wonder: Is he not, in fact, the U.S. government issued version of the Emperor Who Has No Clothes?

        Here I leave you with just a bit more from Wikipedia:

        The phrase “emperor’s new clothes” has become an idiom about logical fallacies.[28] The story is an example of what happens because of pluralistic ignorance.[29] The story is about a situation where “no one believes, but everyone believes that everyone else believes.”[30]

        http://en.wikipedia.org/wiki/The_emperor%27s_new_clothes

        Reading your comment, I couldn’t help but recall Nancy Reagan’s highly publicized consultations with astrologer, Joan Quigley, after President Reagan was shot.

        According to the Wikipedia page, on Quigley, she “stayed on as the White House astrologer in secret until being outed in 1988 by ousted former chief of staff Donald Regan.”

        Fortunately, she (Quigley) wasn’t applying for U.S. government research grants.

        Respectfully,

        ~Jonah

    • Francesca,

      You are absolutely right. I just found post-ECT epilepsy to be one of the major consequences of ECT along with the tons of other brain damaging effects that are ALL under-reported as in not admitted at all by the great shock doctor promoters. It certainly makes sense that this would occur after such seizures are deliberately induced. See the articles on ECT I posted above.

      I read elsewhere that doctors do all in their power to help epileptic people avoid seizures with medications, etc. because they are known to be very harmful to the brain. So, to deliberately induce them as a supposed treatment is barbaric, horrific and brain damaging as is typical of biopsychiatry’s fascist treatments for the purpose of social control and not medicine in any way, shape or form when such oppressive toture treatments are forced on unsuspecting people via without consent or without INFORMED consent.

  11. Thanks for sharing your reflections, Sandy :)
    Thank you, Donna and Jonah for all that information and links regarding ECT! I have just this second downloaded 2 books regarding the DSM and ECT. I have been so occupied with drugs their dangers, deaths etc that I have kind of left ECT on the sidelines because it is another huge area of human rights abuse and I due to lack of hours in the day thought I will leave that to other super competent activists, but you have gotten me going ;)

    • Olga,

      Thanks for your kind and encouraging post. I am honored that someone of your stature and repute would be influenced by my input and I am also very encouraged that someone like you would see the huge threat of the growing horrific comeback of deadly, barbaric ECT presents as the lethal psych drugs are more exposed. I’ve also read about the equally horrific comeback of lobotomies and so called brain operations with life destroying results per usual.

      These atrocities have been mainly perpetrated against women and the elderly, but the shock doctors are now trying to prey on children just like those poisoning those they fraudulently stigmatized with drugs and other tortures/human rights violations in the guise of medicine for bogus “INVALID” stigmas.

      Thus, I believe that any and ALL of psychiatry’s barbaric, brain damaging, disabling treatments must be included in any discussions of human rights, outlawing torture, etc.

      As you can see from above, I, too, only became aware of the CURRENT huge threat of ECT thanks to Dr. Peter Breggin, who remains my hero as I’ve said many times for this and other reasons!!

      I would appreciate it if you would share which books you downloaded on the DSM and ECT in case I have missed them.

  12. Dr. Steingard, ECT is what it appears to be at first blush: in case this feeling has disappeared for you…inherently dangerous and a very far out idea, almost otherworldly.

    By the same token, the analogy with persons wishing to have their healthy limbs amputated seem not to break down. And wouldn’t it be the scientific thing to do with all supposedly good things to create parallel test groups with patients in no way in need of the additive, whether med or voltage, and compare outcomes with those speculated about–perhaps,to sustain careers?

    I feel the community offered you a great shortcut to narrowing down your reading.

  13. Hi Sandra,

    Thanks again for a balanced and interesting approach on this blog from an actual clinician. I particularly agree with your point about treating each person individually. Serious short term risk often has to be balanced against the potential for negative long term consequences. There isn’t an algorithm and like you, I still believe that neuroleptics are helpful for some people and should be used in some situations.

    I wanted to point out something about the Wunderink study which I don’t think was apparent from your post. It is my understanding that the trial participants were treated with a neuroleptic for the first 6 months and once stable were then randomized to either drug reduction or maintenance arms. It is an important point because it means that the data only directly comment on this specific group. That is those with first episode psychosis who become stable for 6 months with neuroleptic treatment.

    I think the study is very interesting and valuable, but accurate understanding of the context in which the data directly apply is critical. It is certainly not by itself evidence that supports not using neuroleptics at all. In fact, one could argue it supports rapid stabilization on neurleptics followed by judicious attempts to reduce dosage or wean off completely. For a balanced editorial on the article see, http://archpsyc.jamanetwork.com/article.aspx?articleid=1707649. Unfortunately many will not be able to access it due to journal paywalls, but some may be able to read it.

    I understand that there are many types of data that people cite in regards to the negative consequences of neuroleptics. It isn’t my intention to get into that, just to point out that this article applies to a narrow spectrum of patients with first episode psychosis who were successfully treated with neuroleptics prior to being weaned off.

    • Thank you for your thoughtful comments. If you haven’t already done so, you might want to post this on Robert Whitaker’s blog on this topic since many more people will see it.
      Your clarification is valid although I did not suggest that neurolpetics should never be used.
      In this current debate there is often polarization. In the arenas where it is assumed that neuroleptics are intrinsic to recovery and where the concerns about long term problems are minimized, one wants to emphasize the problems associated with these drugs.
      In the arenas where it is assumed these drugs are unquestionably bad, one wants to emphasize, as you do, that they can be beneficial for some.
      I move between both of these worlds and I try to keep my message consistent.
      The data is complex and although this particular study does not address it, I do think there are some people who can recover without these drugs and there may be value in working harder than we do to identify who these individuals are. Our system of care tends to rely heavily on convincing everyone to take these drugs and I would like to be able to have more room for flexibility.
      At the same time, I see individuals who seem to truly struggle when they stop or decline to take the drugs and remains unclear to me that we have good alternatives for everyone.

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