On July 28, I published a post called Simon Says: Happiness Won’t Cure Mental Illness. The article was essentially a critique of a post written by British psychiatrist Simon Wessely, who is the current President of the Royal College of Psychiatrists. In his post Dr. Wessely had stated:
“…you can come at this from the other direction i.e. that by treating their mental illness, patients will inevitably become happier as their suffering is alleviated. And I certainly can’t argue with that.”
To me the meaning of this statement, particularly the use of the word “inevitably,” is clear: all psychiatric treatment alleviates suffering and makes people happier. The falsity and self-serving aspect of this contention is glaringly obvious, and I drew attention to this:
“The word ‘inevitably’ strikes me as grandiose. What of the people who have been so damaged by SSRI’s that they are virtually incapable of feeling normal joy? What of those people whose lives have been destroyed by neuroleptic-induced tardive dyskinesia and akathisia? What of the people whose lives have been ruined by benzodiazepine withdrawals? What of the victims of electric shock treatment who can’t remember that they went to college and got a degree? The notion that “psychiatric treatment of mental illness” will inevitably make people happier is the very height of psychiatric arrogance. In my experience, the only inevitable outcome from long-term psychiatric treatment is significant to profound organic damage, coupled with disempowerment and stigmatization.”
This drew the following Twitter response from Georgia Belam, a GP working in the UK, and a member of the International Health Humanities Network.
“Crikey. ‘In my experience, the only inevitable outcome from long-term psychiatric treatment is significant to profound organic damage, coupled with disempowerment & stigmatization.’ That’s a pretty awful thing to say, doesn’t take any notice at all of the people who have been helped.”
Dr. Belam’s contention, that the drugs help at least some of the people who take them, is often heard in this debate, and warrants some discussion. It is certainly the case that a great many people who take psychiatric drugs say that they find the products helpful. In fact, all evidence of efficacy of psychiatric drugs, whether the evidence is derived from research trials or from practice feedback, hinges ultimately on the self-report of clients.
And the issue here is not that the clients are lying. The point is that there are two huge inducements to endorse the products. The first is what’s known as the placebo effect: the good doctor has given me these nice pills, so, of course, I’m going to say they’re helpful. The second is that if I want a refill, I’d better say that I’m doing better. Not too much better, mind – but sufficiently improved to warrant continued treatment.
But – and this is a much more fundamental question – have the individuals been truly helped as Dr. Belam so strongly contends?
To put this question in perspective, let’s focus briefly on illegal drugs – cocaine, for example. The popular perception is that people who use cocaine descend inevitably and quickly into a quagmire of dependency, dysfunctionality, and unmitigated wretchedness. The reality is different. Many, perhaps most, cocaine users, in fact, show few signs of dependency, and most of them express the belief that the drug helps them. They will say that it enhances their enjoyment of special occasions; that it gives them “an extra edge”; that it makes them more competitive at work; enhances sexual pleasure; etc…
Most of the people who use alcohol or marijuana moderately also endorse their products of choice. They say that the drug helps them “mellow out”, or helps “break the ice” at social gatherings. Smokers say that nicotine helps them concentrate. And so on.
Alcohol and nicotine are interesting in this context, because they have been used by humans for centuries, and their effects, both short-term and long-term, are well known. But imagine if these products had not been discovered centuries ago. Imagine, instead, that they had been developed synthetically in a pharmaceutical lab in the 80’s or 90’s.
The chemists would have injected these drugs into rats and mice, and studied the outcome. They would have noticed that the alcohol seemed to have an anxiety-reducing effect, and that the nicotine seemed to sharpen the animals’ concentration. Cries of “eureka” would have been heard; randomized, controlled trials would have been conducted (with pharma’s customary rigor, of course); FDA approval would have been given; the marketing people would have come up with brand names (Alcolium and Nicotin come to mind), and the pantomime would quickly have gotten into full swing.
Psychiatrists would be writing prescriptions, and vehemently denying that these “medications” were addictive – unless, of course, people exceeded the prescribed dose!
And the great majority of “patients” would say that they were really helped by these “medications.” And when cantankerous, old geezers like me protested that these drugs ultimately damaged people, physicians like Dr. Belam would retort: “What of all the people who have been helped?”
The analogy is precise.
. . . . .
My essential point is this: psychiatric drugs; illegal street drugs; alcohol and nicotine, all have in common that they confer a temporary good feeling. That’s why people use them. But they also have in common that they are toxic substances, and if taken in sufficient quantity over a long enough period, they will inevitably cause organic damage.
But it is only within psychiatry that the temporary good feeling is deceptively and self-servingly adduced as evidence that the drugs are not only benign, but are medicine necessary to treat illnesses!
So Dr. Belam is absolutely correct. My statement that: ” . . . the only inevitable outcome from long-term psychiatric treatment is significant to profound organic damage, coupled with disempowerment and stigmatization” is indeed an awful thing to have to say. But the much more fundamental question is: Is it true? My position is that it is indeed true, and awful as it is, it needs to be said. And it needs to be said strenuously and repeatedly to combat the false assertions of psychiatry.
In this context, it is worth asking why Dr. Belam did not take exception to Dr. Wessely’s obviously false and, I suggest, very damaging and misleading assertion that psychiatric treatment “inevitably” alleviates suffering and makes people happier. No legitimate medical specialty would make such a grandiose claim.
It seems fitting to leave the last word to Joanna Moncrieff, another British psychiatrist:
“The data surveyed in this book suggest that psychiatric drug treatment is currently administered on the basis of a huge collective myth; the myth that psychiatric drugs act by correcting the biological basis of psychiatric symptoms or diseases. We have seen that for the three main classes of drugs used in psychiatry there is no evidence to substantiate this view. Instead, the evidence suggests that these drugs induce characteristic abnormal states that can account for their so-called therapeutic effects.” (The Myth of the Chemical Cure, 2009, p. 237)
* * * * *
This article first appeared on Philip Hickey’s website,
Behaviorism and Mental Health
“That’s a pretty awful thing to say, doesn’t take any notice at all of the people who have been helped.” Dr Bedlam.
Depends how you view the term helped I guess.
I was reminded of a TV show The Last of the Summer Wine from many years ago. A character called Compo (i think) was a tramp who we see picking up an injured dove on the street. A heartwarming sight and if left there we would have imagined he was taking the poor thing home to help it heal. Instead he crosses the road and gives the injured bird to a cat.
Helped the cat a great deal, not so much for the injured bird.
Keep speaking your truth Dr Hickey, because whilst some may find it “awful” it need to be spoken.
Thankyou.
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Nice analogy, boans, shipping patients off to the psychiatrists is like handing an injured bird over to a cat. It helps the psychiatrists, but kills the injured patient, so true.
Thank you, once again, Dr. Hickey, for speaking the almost unfathomable in scope “awful” truth. Since absolutely, the psychotropic drugs do NOT “inevitably” make all patients “happier,” nor is their “suffering” necessarily “alleviated.” Quite to the contrary, my case is proof the opposite is true. Absolutely, Dr. Wessely suffers from “grandiose” delusions, and is misinforming his fellow psychiatrists with is delusions of grandeur. Some people suffer only adverse effects to the psychiatric industries’ toxic “wonder drugs.”
(My initial “mental illness” was a desire to quit smoking. Is that really a “mental illness”? I was lied to and told Wellbutrin was a “safe smoking cessation med.” Wellbutrin did NOT help me quit smoking, so I was abruptly taken off it. This resulted in the known withdrawal symptoms of “brain zaps,” powerful dreams, and increased libido, which IS an odd sexual side effect. The doctors still don’t know Wellbutrin CAUSES odd sexual side effects. These Wellbutrin withdrawal effects were then misdiagnosed (according to the DSM-TR-IV) as the “life long, incurable, genetic, mental illness,” “bipolar.” I had no prior personal or family history of any “mental health” issues. I was immediately put on Risperdal, which resulted in a terrifying psychosis, within two weeks of being put on the drug, and a confessed in my medical records, “Foul up.” And then, rather than correcting the misdiagnosis and taking me off the drugs, I was subjected to an onslaught of egregious and massive miss-medication with drugs that have major drug interaction warnings. No doubt, with an intent to cover up the prior malpractice, and the adverse effects to the psychiatric industries’ “new wonder drugs.”)
It is unwise for the current President of the Royal College of Psychiatrists to continue to delude his fellow psychiatrists into believing that defaming people with invalid diseases and forcing patients to take drugs now known to take 25 years off a person’s life, which have been known to be “torture” drugs for decades, to cure them of drug dependence on legal drugs that will reduce a person’s life by perhaps 10 years, merely because the psychiatrists profit off the more lethal and debilitating drugs, but don’t personally profit off of cigarettes or alcohol, is morally wrong.
Thank you for speaking the truth, Dr. Hickey.
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Someone Else,
Thanks for this. I think that the practice of throwing another drug at the problem that the first drug caused is very common.
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Users who report drugs helpful sometimes like being impaired. Also cannot even tell they have been hurt, like a TBI patient who can’t tell all of what they’ve lost..
It is one of those weird things where there doesn’t even have to be real improvement but both sides will say there is and generally there is no significant benefit long term. Patient is also normally confused by drugs effects and nerve damaging effects. Later they might complain of side effects and symptoms they never had until after starting drug treatment, though, .. Its sad because many people I know didn’t even realize they’d get hurt by taking the drug, and only did so to wait out court ordered treatment, or were trying to be social and compliant, but then it was too late.
http://www.obamasweapon.com/
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Interesting point about enjoying impairment. I knew one person who said their evening pill was like a daily drink (alcohol).
I tend to view the issue like this. If any potentially harmful substance prevents someone from say, suicide, harming someone else, or being hospitalized, then it’s a lesser evil. That’s not to say that there are not better ways to deal with psychological unwellness. Problem is, we live within certain structures, at a given moment in history. So it’s true, many people do believe the sometimes dubious findings of scientific research. I think many people on drugs (note that I do not say “meds”) should do so with a view toward finding a better solution.
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boans,
Thanks for the encouragement.
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What is interesting is that many of the street drugs that we call out as being particularly “evil” such as heroin and cocaine, are in many ways relatively easier to withdraw from than many of the psychiatric drugs. Though withdrawal from heroin can be temporarily horrendous, the worst of it is over within a week or two. Not so with psychiatric drugs such as benzodiazapenes or antipsychotics that can be truly harrowing to try and quit. For many it takes months and sometimes years to get off these drugs and some never succeed.
At the same time, I do acknowledge that many people report feeling tremendously helped by psych drugs and I believe them. If they feel helped and not bothered by side effects and concerns of long term health effects then all power to them. I don’t think it helps our cause to criticize people who have found help from a drug, even if we feel that drug is generally harmful.
The problem comes when the idea that 20 percent of Americans have a “mental illness” and are prescribed “medications” becomes normalized. What the hell happened there? Does anyone really think that 20 percent of us need to take pharmaceutical drugs to regulate emotional distress? And if not, how do we turn back the clock on this massive abuse of prescribing power?
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This is exactly the issue! People get quite defensive as if someone wanted to come into their homes and take their medication away. I don’t have a problem with anyone taking medication if they truly think it’s helping. I do have a problem with every piddly thing being diagnosed as a “life-long, biological, mental illness” and drugs being the first and mostly only treatment available.
Trauma of any kind produces a vast array of symptoms which psychiatry will label as clinical depression, anxiety disorder etc. If anyone is reading this comment I thoroughly suggest David Berceli’s books on trauma. He explains this so well and gives gentle exercises to work through trauma (which I don’t have time to explain here but are very helpful!)
Anyway Jonathan, my point was that I fully 100% agree with your well written last paragraph 🙂
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fluffybunny,
I agree.
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I don’t have a problem with people taking their drugs just as I don’t have a problem with people drinking a beer or smoking as long as:
– they’re not children
– they are truly informed about the short and long term consequences and possible “side effects”
– they choose to do so and are not getting intoxicated involuntarily
We should stop calling psych meds medicine (or at least not in the context of “mental illness” – they are some legitimate uses in medicine).
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Jonathan: I point blank asked my teacher’s union rep, the regional union rep and the Human Resources manager what was our school’s policy on psychiatric drugs. (As an instructor, I receive e-mails concerning which students are in the drug abuse class-I choose not learn their identities.) I am also not interested, nor do I think it is my business, which students are on psych drugs, I just want to know the policy-I believe that this is the first step in acknowledging that we as a society have gone blindly down a hazardous path. None of them could give me an answer. It’s like many institutions in our society, change comes down the pike, and nobody questions it. I still owe it to every one involved to put this on paper, and include a letter to the Department of Labor as well. In a staff meeting, I remarked that there was a lot of loose talk among staff regarding the psychiatric diagnosis of students. I also coped to my own “MI History’ ” and I wondered out loud if some of the students’ problem of sleeping in class was some how linked to psychiatric drugs, and that knowing this as a possibility, I did not feel comfortable enforcing sleeping as a disciplinary matter.
At my other job, a non-profit, we had a client who started behaving in a demanding, and when rebuffed, an increasingly erratic manner. He was discharged, and the note in the log mentioned that he had not been taking his medication. I did not know any more of the specifics, but I did log in my own note that went something like this: Stopping psychiatric medication cold turkey is a bad idea, and can result in behavior that mimics the psychiatric symptoms that drew the attention of the psychiatric authorities in the first place. I also accompany clients to counseling and psychiatric appointments. I tell they clients they are free to ask questions of the professional if they want to.
As an employee, I walk a tight rope on this issue. I feel that I have done something, but that I can do more. So on MIA, I am given the opportunity to tell my own story as well as to pursue the policy issues here as they relate to my clients my students as well as myself.
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chrisreed,
I, and I’m sure many others reading your comment, appreciate the efforts that you’re making in this area. So many staff in the mental health business walk the same tightrope – horrified by what they’re seeing, but apprehensive about speaking out, for fear of losing their jobs. Psychiatry has created a monster that is destroying people.
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“The problem comes when the idea that 20 percent of Americans have a “mental illness” and are prescribed “medications” becomes normalized. What the hell happened there?”
Take a look at our society. I surprised the numbers aren’t higher of people just trying to cope with the nightmare that is the modern workplace not to mention elsewhere.
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Well yes- I agree a lot of people are self-medicating due to the challenges of modernity in general- but they are being abetted by the medical establishment. There has been a 400 percent rise in the prescription of antidepressants since the 80’s- and this is mainly happening in GP’s offices.
They have become far too comfortable handing out psych drugs with impunity.
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I agree, GPs “have become far too comfortable handing out psych drugs with impunity.” And they’re misinforming the patients by claiming antidepressants are “safe smoking cessation meds.” Then withdrawing patients abruptly from the drugs, when the antidepressants don’t help with smoking cessation, which is an inappropriate way to withdrawal someone from antidepressants. Then they’re misdiagnosing the common withdrawal symptoms of the antidepressants as “bipolar.” We have a medical industry full of either completely misinformed and deluded doctors, or some very unethical and egomaniacal doctors.
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I think this is really the epicenter of the “epidemic”. Wierdly, I almost think that It would be smarter if only psychiatrists could prescribe psych drugs. then GPs would be forced to refer patients to a psychiatrist for “meds.” Because there are so few psych docs compared to GPs it would create a massive bottleneck that would effectively act as a shut off valve for the vast over prescription of these drugs.
Just as GPs have to refer patients out for renal issues, or for cancer, a requirement to refer out “psych” patients might slow down the rush towards medicating all of society for normal human emotional distress.
Just a thought experiment really.
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I don’t disagree. My comment was based on the fact that even if Rx numbers weren’t going up, we’d still have a population in need of relief just due to the way we live today.
About allowing only psychiatrists to prescribe these meds, wouldn’t hurt my feelings if it were this way. However, since that will not happen in my lifetime, how about people just stop going to GP’s for emotional issues.
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Anon,
It isn’t that simple. Many people get prescribed psych drugs by primary care physicians for complaints that obviously had nothing to do with psych issues. Unfortunately, this was an easy way way for doctors to solve the case without having to do investigate further the physical causes of the complaint.
Additionally, many PCPs are now doing routine screening for psych issues. So if the patient isn’t savvy to avoid answering in a way that will get him/her labeled, that would be another way for someone to get prescribed a psych med.
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AA,
I understand what you are saying, but unless it is coerced, our decisions are still our own. And I know this is easier said than done; I’m in the middle of my own 2 year battle against short-cut medicine.
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Tell it to all the stigma campaigners “depression is a biological disease cause by chemical imbalance”. People see that bullshit on TV and read in the news and then they don’t think “I have life problems” but “I am sick”.
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Jonathan,
Yes. But the GP’s can only do this because the psychiatrists invented the illnesses. If the problems are demedicalized, then the drugging has to stop. But as long as these problems are “officially” designated as illnesses, then a GP who doesn’t prescribe the pills is opening himself to liability. The rot runs very deep.
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It reminds me of the morphine epidemic in the past. It was prescribed by doctors for any kind of distress including emotional problems (it was considered safe and effective) and lo and behold – people got addicted and had their lives badly affected and sometimes destroyed. In today’s world the psych drugs are much worse and the size of the epidemic is expanding exponentially.
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Anon,
Yes. And the psychiatric fiction that the problem is “in the individual” is promoted vigorously – indeed is embedded in every facet of psychiatry.
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And this is the key to why people oppress themselves rather than organizing to defeat the system. Rather than collectively throwing off the objective conditions which create all this “personal” misery, we are all trying to figure out how to make things better by changing our attitudes, etc. But the problem is objective and collective, not subjective and personal.
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Oldhead
“…THE PROBLEM IS OBJECTIVE AND COLLECTIVE NOT SUBJECTIVE AND PERSONAL.”
Great line that sums up keys points that we need to use in our future struggle. I am sure that I will borrow this phrase many times in coming battles.
Richard
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Serves our “masters” to keep it this way, doesn’t it?
I only see the mental health system as bit players in all this. Powerful, but not really when you think about it. They could all be replaced with somebody and something else. Much worse most likely, because you can still find those who are helpful within it now. Take them out of the picture and what is going to be left?
I am no fan of the current lie, but there is a much bigger problem here than MDs.
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Jonathan,
For the record, I have never criticized people for taking drugs, legal or illegal. I consider this a personal matter, and nobody’s business but the individual’s. But if a drug inevitably causes harm in the long run, shouldn’t that be said?
I don’t think we will ever make progress with regards to the second point you raise until we make a clear and consistent distinction between a person’s report that he found the drug helpful, and the inevitable long-term damage. It took a massive honesty campaign to impact tobacco use.
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To the second paragraph- I think its fair to say that psych drugs cause damage- though we do need to be careful about talking about the diference between taking 20 mg of prozac for 20 years and taking a combination of haldol, zyprexa, lithium and xanax for 20 years. There is a continuum of harm here. So by inevitable long term damage we have to talk more specifically about which psych drugs in what combos, etc.
To the first paragraph- Yes it should be said- and I have said these drugs cause harm frequently- but I also acknowledge that many people seem to find relief and feel helped by drugs. I have known very “natural minded” folks who have taken mood stabilzers with a full understanding of their damaging effects, and have felt helped by the drugs. So be it.
Though we may find fault with it, many people are willing to take the health trade off for what they perceive to be a psychic/mental distress improvement. Saying all people who take drugs(in any dosage and combo) will experience “significant to profound organic damage, coupled with disempowerment and stigmatization” is not quite an accurate statement to make. But I think it is fair to focus strongly on the perils of these drugs and to help educate the public to their severe complications.
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The only problem is that all of these people who are happy to take the drugs are nine times out of ten never told about the long term effects that will probably affect them if they stay on the things. These things are never conveyed to people in the state hospital where I work. What happened to informed consent?
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Hi Stephen,
I vaguely remember my psychiatrist saying that the long term effects of the meds were unknown which was a bunch of BS. I definitely recall him advising me to get blood work to make sure nothing unusual was happening. But all that would have done would be a switch to another med which would have eventually also caused damage.
Yup, informed consent has disappeared big time.
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What consent, what informed? I just talked today to the director of a hospital they held me in after I made a complaint about the mistreatment. I asked her if she knows that anterograde amnesia is a side effect of benzodiazepines. She told me that’s not true so I asked her to go to pubmed and type in “benzodiazepines anterograde amnesia”. At that she said “yeah but that’s only very high doses” to which I told her she should consult the leaflet of the very drug they gave me where this side effect is listed. At that she told me she is the one with medical degree and she ,not I, knows about drugs. Later she also threatened me to sue me for defaming if I dare to suggest that they don’t know what the effects of drugs which they’re prescribing can be.
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I’m not comfortable second guessing the statements of other people about their own experience just because it conflicts with my own worldview. That’s what institutional Psychiatry does. It says, if you say you experience things differently than i, the expert, am saying you experience things, its because you are wrong and too sick or ignorant to know your own experience “correctly.” Maybe i do know something the individual doesnt, but really thats not for me to say (i say this as someone who does not prescribe meds.) If someone says that medications they take are helpful to them, and the are aware of the costs that are also there, then its not my place to tell them their experience is wrong and i know whats best for them. That’s just as reprehensible as the kind of paternalistic dehumanizing attitudes of the system we stand against.
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Has anyone on this page actually said any of these things that you are uncomfortable with? Please don’t get me wrong. I think that shaming people in distress for taking psych drugs is callous and counterproductive, but I don’t see that happening here. Maybe I missed it?
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uprising,
I agree.
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How is someone supposed to know they might be wrong about something, if it’s never pointed out to them ?
Why isn’t it for you to say ? Sounds paternalistic as well.
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barrab,
Thanks for coming in. I think real doctors are far more honest with regards to adverse effects than psychiatrists.
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Andrew,
You’re raising an important point, but I think you’re also missing another point. I would never tell a person that his experience was “wrong.” If a smoker tells me that smoking helps him concentrate, I assume that he’s telling the truth. But it is also true that smoking is destroying his health and shortening his life expectancy.
Exactly the same situation exists with regards to psychiatric drugs. If a person gets a positive experience from them, who am I to argue? But in the long-term, they all cause damage. If a person chooses to ignore that aspect of the matter, that’s his own business. But for a so-called medical specialty to pretend that these are medications correcting imbalances or whatever is a scandal.
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Sorry I am late and perhaps too late to the discussion, but Andrew’s comments resonate with me. I have posted on this site before and my ambivalence (at best) about the perceived benefits of psychiatric medications are well documented. But what I find off-putting is the assumption that if one accepts that there may be some scientific basis supporting psychiatric drug use, then they are necessarily self-delusional or victims of deception. I am neither a doctor nor a scientist, but I have spoken with and read the work of some in both fields, and it seems clear reasonable minds can disagree on the validity of claims that, for some, the cost benefit analysi may weigh in favor of taking psychiatric drugs to some well-deliberated-upon degree and for a well-deliberated-upon term , over never taking them for any purpose or duration at all whatsoever. Many on this site, including unless I’m mistaken the author, take the latter view. I, myself, am not an absolutist. One can accept that the science remains as yet unconfirmed or even unknowable, without full-throatedly accepting a kind of “chemical imbalance” theory. Well-documented and scientifically rigorous observations that that medication — of some varieties in some doses and for some durations — eases distress for some are difficult to dismiss as merely the stuff of Big Pharma shareholder concerns, junk science, and a corrupt guild of psychiatrists.
The paternalism and scientific presumptuousness that is inflicted upon those here whenever they so much as even suggest that the cost benefit analysis given what is currently known might weigh in favor for some is, as Andrew describes, off-putting. Very few who take such a position ever post, as a result. Are our views not valued? Is our role on this site merely to be benevolently deprogrammed? I”m not saying that the offense I describe is being done openly or even intentionally in this thread and manyothers, but it is beyond doubt that this is the subtext
There is not the kind of scientific consensus in either direction on brain chemistry as there is, for example, on climate science. Maybe we’ll get there, in either direction, but we’re not there yet. I doubt we will, perhaps not for generations if ever. Whether some peoples’ extreme moods and/or perceptions may be derived from ideosyncracy and/or childhood trauma or something else, if medication in some measure, alongside other efforts, legitimately helps some people, then that conclusion need not be disparaged in the way that a psychiatrist might disparage the kinds of evidence we have pointed to on this site in the service of helping people.
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1. When it comes to chemical imbalance theory – that is surely bs, there’s no question about it. People of course will have varying “brain chemistries” (assuming that it is even a meaningful term) due to polymorphisms and such of receptors etc. but it seems pretty clear from the data that any “mental illness” has nothing to do with too much or too little of a specific neurotransmitter signalling. It’s just not that simple. When you add to that the fact that DSM categories are biologically meaningless then you can trash the whole theory, which I think even the APA admits should be done.
2. “But what I find off-putting is the assumption that if one accepts that there may be some scientific basis supporting psychiatric drug use, then they are necessarily self-delusional or victims of deception.”
When it comes to the people who got “helped” by the drug – I don’t think they are necessarily “delusional”. First of all there is a case of placebo effect, which you can only distinguish in a well-designed placebo-controlled study so a person reporting feeling better may be just benefiting from taking any pill. Secondly, there’s spontaneous remission. Many people talk about looking for years for the “right drug” and finally “finding it”, which in fact may be corresponding to a natural recovery, which happens in many cases. Thirdly, it can be that, although hard to see on a statistical level, there may be individuals who “benefit” from the drugs, I don’t think people here deny that. However, when you look at the actual studies it’s not really apparent. That may be because sometimes certain drugs work only on a subgroup of all people and will never be picked up by a population-wide study. However, as for now there is even less evidence for that than for the general efficacy.
3. “Well-documented and scientifically rigorous observations that that medication — of some varieties in some doses and for some durations — eases distress for some”
Well, here are two things:
– first of all the quality of the evidence, which seems to be dubious at best. The studies on anti-depressants submitted to FDA show practically no clinical benefit over placebo. The studies which show benefits are in most cases funded by pharma and there are serious doubts about conflicts of interest, ghostwriting, data manipulation etc. Also it is now being question if even the very tools used to assess “improvement” are at all meaningful (like practitioner rated checklists). So it’s a hot mess and when the drugs have such severe side effects, which are now quite well documented the balance between “risk and benefit” should be pretty clear. So if you would like to strictly “follow the science” you should take a precautionary principle and not use these drugs at all unless in most dire circumstances.
– Secondly, so what if the drugs work for “some”. Well, what does that even mean? Many people use “illicit” drugs to self-medicate in order to avoid emotional pain. Alcohol, pot, morphine and other drugs can serve that purpose pretty well and in fact in the past were even prescribed by doctors for exactly that purpose. That is not the same as saying that the treat any specific illness. Of course, if you want to discuss whether they could be use as non-specific emotional “painkillers” that’s a legitimate conversation to have but there again comes the “cost to benefit” problem. I guess anyone, including psychiatrists, will tell you that it’s a really bad idea to try to relive “depression” with booze so why should that be a good idea with benzos which are at least as bad it not worse in terms of side effects and addiction potential. Same goes for other psychoactive drugs. Personally, I think narcotics should be legal but they only should be prescribed by doctors in very dire circumstances (like morphine for people suffering from terminal cancer) and strictly regulated. Finally, maybe also some of there drugs “work” for some because they target a completely different underlying cause. There is some evidence for Prozac to affect the action of immune system for instance and it may well be that some forms of depression are caused or exacerbated by ongoing infection or immune system misregulation. However, so far there is no scientific data for it and given the fact that there is no way to prove that or even worse to identify the subset of people who could benefit it’s very problematic to prescribe it to pretty much everyone given the side effects.
In summary, I don’t think people on this site are for the ban of psych drugs in general but the way they are being used now is simply harmful and fraudulent and unless the money incentives are removed from the scientific process we are unlikely to be able to properly assess the real impacts of these drugs and assure relative safety. On top of that I find the practice of forcing these drugs on involuntary patients, minors, elderly and other vulnerable populations repulsive and criminal.
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I don’t know that we disagree much. You do concede at least in at least one sentence, however grudgingly, that science has not ruled out the possibility that individuals may benefit from the mechanism of action of a psychoactitve drug rather than placebo or misunderstood source deriving other than from the brain, i.e. where you say that maybe “sometimes certain drugs work only on a subgroup of all people and will never be picked up by a population-wide study.” I also agree wholeheartedly with the view that “[s]o if you would like to strictly ‘follow the science’ you should take a precautionary principle and not use these drugs at all unless in most dire circumstances.” For these reason I am committed to weaning entirely off of neuroleptics — however cautiously. And, I am not committed to viewing my unwanted moods and perceptions as “disease.” I don’t care what the label is, I care about being functional and happy. Nor do I find forced medication tolerable in probably all circumstances (and, yes, it happened to me).
In light of all of this, two critical questions, for me, are: (1) who ultimately should be relied upon dispositively as an authority on the science and medical standard of care to be followed by an individual having these experiences, in the absence of that person’s own qualifications to engage in empirical research and caregiving on their own? ; and (2) what is a “dire circumstance” that sufficiently balances the scale in favor of taking psychoactive drugs?
I certainly have the freedom to try to wean off of the mood-stabilizer I remain on as well, whether assisted by others or not. But what if the highly regarded psychiatrist who has so effectively helped me to wean off of neuroleptics (and does so routinely with patients) strongly recommends against it? What should be the basis of disagreement with my practitioner? Read more books like Breggins’ and Whitaker’s? Should I read scientific studies? Go to a lab myself? Read Marcia Angell and plaintiffs’ lawsuits concerning Big Pharma’s misdeeds? If a respected physician other than a psychiatrist advises against my taking a medication, I will always research the basis, but there is a limit to where I will go. Eventually, one has to trust someone, and the degree of that trust necessarily factors into the cost-benefit analysis.
What’s your view on Lamictal and why should I trust you?
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I meant to write, if a respected physician advises for or against taking a drug, I will research, to a point. More likely the scenario would involve a doctor telling me I should take something. Whether for a so called “disease,” or some other state that is problematic.
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N.I.
You may be late, but not too late for me.
Unfortunately I don’t get the sense of a search for the truth from many of the regulars here. I think most who post here already think they’ve found the truth (for everyone) and when those who disagree with them threaten this truth, they are treated accordingly.
I don’t single them out on this either. I only speak of human nature. I’ve seen commenters as vicious as some here on other blogs where when the article questions the use of antidepressants for psychological or spiritual issues. Google “Depression is Selfish” for one such blog. The offense some take there is no less than here but on the total opposite side of the debate.
I also don’t think being “helpful” is some nice to have unicorn dream the way it seems to be brushed off here. “Helpful” literally can be the difference between living on the street or holding down a job.
I am not advising anyone to take meds to solve their current issues at the expense of the their long term health. Everyone has to make their own decisions, and unfortunately, do their own research. You should no more trust a random person on the internet than the doctor in front of you. Personally, I’ve never been one to trust doctors much, but then again, I haven’t been one to distrust them either. Ditto for people on the internet.
I follow my own path. And, even though you say you have to trust someone, to which I agree to a certain extent, I think the real answer is to trust yourself.
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“(1) who ultimately should be relied upon dispositively as an authority on the science and medical standard of care to be followed by an individual having these experiences, in the absence of that person’s own qualifications to engage in empirical research and caregiving on their own?”
I’m not sure what exactly you’re asking here. If the question is who decides what kind of treatment if any is ultimately administered it should be the individual him/herself. But of course there should be a limit of what these treatments can be and that limit should be set up the following way:
basic science -> clinical trials -> doctor’s experience -> patient’s decision
We have in principle existing mechanism of translating the science into clinical practice. The main mechanism is the FDA. The problem is that the whole system, and that is not only true for medicine, got so corrupted by money that the regulatory bodies are essentially meaningless and the science is a mess because no one can tell what’s good science and what pharma bought science is anymore. So in this day and age, yes, I am afraid you have to inform yourself to the fullest extent of your abilities or you may be in for a nasty surprise. I happen to be one of the lucky people who has education in the relevant field and it’s not always easy for me – we often discuss this with my friends just how f***ed are the people who don’t have such education and are trying to navigate the medical system. It’s the sad reality…
“(2) what is a “dire circumstance” that sufficiently balances the scale in favor of taking psychoactive drugs?”
When everything else has been tried – drugs as a last resort and not the first thing to use. And needless to mention it should always be consensual and informed. In the current system people are given drugs after 5 minutes interview, with no information about what these drugs are, what they can and can’t help with and what effects one should expect. Again, that’s not only psychiatry’s problem but it’s most outrageous in psychiatry.
Also there may be reasonable arguments for banning at least some of these drugs or severely restricting their use just like happened to other medicines in the past. To give you the rationale: look up the case of thalidomide. I’m sure there were people who found it very helpful but it was banned nonetheless because of unacceptable side effects. And now it is being used again in some people as we now understand better how it works and who can take it relatively safely – maybe the same should be done with psych drugs – only allow their use when we have enough information.
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Dr. Hickey,
Thank you for another hard hitting, enlightening article. Based on what you say, what do you think of the following article about women torn between their “crucial” antidepressants and the “minor” risk to their unborn children when pregnant? It seems to me I have read some pretty horrifying things about birth defects and women actually killing their children/family members or otherwise going bonkers when on such psych drugs. Think Andrea Yates?
Anyway, this might be a good topic for a future article since the risk of these dangerous drugs to mother and child is treated so lightly by the doctor consulted in this article and minute risk acknowledged when compared to the supposed negative impact on the baby with an anxious, depressed mother. I think the fact the woman’s first baby died says it all! I seem to recall Dr. David Healy writing about the lethal effects of Paxil on babies when taken during pregnancy. Moreover, the fact that these drugs are supposedly little better than placebo with many toxic side effects says it all. Do you think this is really a Big Pharma puff piece as part of the move to push antidepressants as very beneficial with minor if any side effects like the puff piece you critique here?
http://www.theatlantic.com/health/archive/2014/08/the-dilemma-of-the-depressed-mother-to-be/374899/
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Donna,
Thanks for the link. I’ll take a look. Psychiatry’s generic answer to this whole issue is that the benefits of the drugs outweigh the risk. But I truly don’t know how one can weigh the kind of risks you’re mentioning here against the benefits of antidepressants, which are generally acknowledged to be marginal.
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Btw, there is exactly zero proof that there is any benefit to the child from his/her mother taking anti-depressants. It’s all made up based on: depression in mother is bad for the baby (which I guess may be true) -> antidepressants battle depression (as we all know – not true) -> benefit to the baby. But nobody’s ever shown that a) pregnant women actually get better on these drugs b) the children of unmedicated mother do better than children of medicated ones. So all the talk about benefits outweighing the risks is not based on anything else than wishful thinking and pharma ads.
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Another great article, Philip! Thank you as always.
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uprising,
Thanks for your support.
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http://www.behaviorismandmentalhealth.com/2014/07/28/simon-says-happiness-wont-cure-mental-illness/#comment-1509039161
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“That’s a pretty awful thing to say, doesn’t take any notice at all of the people who have been helped.”
I wish you would have addressed that this is essentially an argument for human sacrifice. At what point does the “benefit” that these people over here claim to have recieved become “worth” all the damage and suffering that those people over there had afflicted on them?
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Jeffrey,
Good point! I’ll try to remember it next time the issue crops up. Knowing psychiatry, there will be a next time!
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Dr. Hickey, I’m sure it will. Psychiatry is so lacking in arguments for its current level of prestige and power. Once they find an argument–however flawed–that supports their cause, they run it into the ground.
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Thank you for this, Phillip. As someone who was, indeed, harmed by taking SSRIs and who has read carefully an awful lot of the literature on this I am mostly in hearty agreement. I do, however, disagree with your suggestion that all illegal street drugs are toxic and cause organic harm. (You do not say “all,” but that seems the implication to my ear; apologies in advance if it was not your intended meaning. Either way, I will go ahead and comment to get what I think is an importnat point across.)
Most psychedelics are remarkably safe from a phisiological and neurological standpoint and, while they are powerful medicines that can do psychological harm if uesed carelessly, they also have been used for a very long time (decades in our society, millenia in others) to quite helpful effect and this is increasingly being documented by careful research. Another example worth citing is MDMA, which does have some potential to cause physiological harm but is still generally quite safe (certainly safe enough to be in Phase II clinical trials) and is showing remarkable promise for treatment-resistant PTSD–that being the main focus of research simply because it can clear regulatory hurdles. There are many other established uses (MDMA was legal until 1984 and used pretty widely as an adjunct to therapy.
These substances do not require regular, or even frequent, use; are not addictive; and work by opening perceptual, emotional, cognitive, and spiritual windows. As is often said, they “expand consciousness,” and help people understand and love both themselves and the world around them better, and they can be remarkably effective in healing deep traumatic memories. They certainly helped me break my SSRI addiction and heal and grow in many other ways. I do NOT recommend using them casually or without thorough education and supervision, but I did want to make sure they got into this discussion at least a bit.
Thank you, again, for your excellent article!
Daniel
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I think what you are saying here is important because it challenges the status quo. In many ways I agree– I think the category of psychopathology in general is a tool and a construct. I also don’t believe in “mental illness” as such. I think it’s deceptive and dehumanizing to prescribe poorly-understood drugs to people in the name of even an immediate need to relieve suffering. I think psychotropics in the way they are talked about and used can often be a huge threat to personhood and agency.
That being said, I feel that the framing of your argument as a response to “what psychiatry says” is reductive and combative. To say that “the only inevitable outcome” is such and such negative things in response to “the inevitable outcome” is so and so positive (yet problematic) things may serve to open up minds, but immediately closes them again around the OPPOSITE idea. It mires the discourse in binaries and dogmas, when it is incredibly complex and sensitive and individual. If both “sides” (if we want to think of it that way) speak in terms of absolutes and insist on causalities rather than correlation and nuance, I think we all lose.
Personally, I take meds. But I don’t take them personally. I don’t say they help me in any definitive or provable way, but there HAS been a correlation to feeling better and taking certain meds over time. I’ve also taken ones after which I saw distinct mental and physical changes. I feel incredibly lucky that I have never been permanently messed up by them. But it’s taken some time to orient myself towards the idea of pills for my brain in a way that feels ok. My experience tells me that the stigmatization and disempowerment that you refer to is not always, completely OR inevitably out of the hands of the individual. These are not primary symptoms of taking meds– they are maybe side effect, but also products of our environment, how we internalize messages, how we frame our experiences, and how we making meaning of them. We all (probably) only have one life to live. If a drug, illegal or not, may help us to live that life, EVEN at the expense of long term health, I think we can be justified in those decisions, as long as we are informed as best we can be. Like why it’s ridiculous to criticize people for smoking cigarettes. These are choices people make with their lives. I guess I just find it unproductive to fight generalizations with generalizations– it further polarizes an already polarized conversation.
Thank you for your article. Keep speaking truth to power, and not-power.
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Yours is a very well reasoned response. If you hadn’t prefaced with your first paragraph, I may have seen some large holes in it, but for now I mainly agree – particularly on the polarization part. Although that is still up to the individual to reside in that camp.
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This comment was in response to Jordan’s.
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http://theconversation.com/cabaret-of-dangerous-ideas-antidepressants-are-not-overprescribed-30181?utm_medium=email&utm_campaign=Latest+from+The+Conversation+for+8+August+2014+-+1836&utm_content=Latest+from+The+Conversation+for+8+August+2014+-+1836+CID_996e5320d7ef3248a0744b952cac3200&utm_source=campaign_monitor_uk&utm_term=Cabaret%20of%20Dangerous%20Ideas%20antidepressants%20are%20not%20overprescribed
Where does one start with the above outrageous, deceitful, dangerous, bogus claims about antidepressants not being over prescribed and how they can cure the so called disease of depression that is far more deadly than cancer and other feared diseases globally!? Talk about malignant narcissism and hubris!!
What is so outrageous and egregious is that a so called psychiatrist could write such a fraudulent article given all the evidence proving the huge harm done by antidepressants including suicide and violence much in the news lately and the fact they are no better than placebo for the most part per Irving Kirsch and many others.
This is another infomercial by another sociopathic psychiatrist in a grossly dishonest attempt to negate all the articles that have recently been coming out exposing the truth about the huge harm done by theses toxic drugs while being totally useless for the junk science, voted in stigma of depression used to medicalize typical human stressors, crises, losses and traumatic events that psychiatry (AKA the mental death profession) refuses to even acknowledge while blaming the brains and other inferiority of their victims’ supposed lesser ability to cope with stress, bad genes, chemical imbalances and other out and out lies.
Such Big Pharma ads make me want to holler.
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Anon,
There was no reply button to your post so I had to respond at the bottom of the page. I think you missed my point.
In your initial post, you said that people needed to stop going to PCPs for emotional reasons and I was trying to point out that people get psych meds even though they didn’t visit for those reasons. I do agree with you that people still have to learn to say no and while I think more folks are learning to do that, obviously, way too many are not and that needs to change.
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AA, I apologize for the c0nfusion. I understood what you said and switched gears too fast there.
I know people who have gone to their GPs because they were cracking under stress and crying all the time and those who have gone to them for PSTD flashbacks. Yet, I have also known those who have gone to them for any number of symptoms but still out comes the Rx pad for antidepressants or any of a myriad of other meds.
My statements address both situations. Why go to a GP for emotional issues. And, why accept treatment from GPs for what they identify as emotional issues?
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Sir,
Your writing is so clear and so easy to understand. The breakdown you published on TMS in particular was incredibly helpful and informative. Those of us with cognitive scrambling benefit so much from translations of data like those you provide. At least I did!
Here is a quote I love that seems to echo so much of what you say here. I imagine if the two of you were to meet on a porch in Kentucky you would have a great deal of accord with one another. I wish we respected our elders more. Maybe we would if more of them were like yourself. Keep up the goid work, it is deeply appreciated.
“I would argue that it is not human fecundity that is overcrowding the world so much as the technological multipliers of the power of individual humans. The worst disease of the world now is probably the ideology of technological heroism, according to which more and more people willingly cause large-scale effects that they do not see and that they cannot control. This is the ideology of the professional class of the industrial nations—a class whose allegiance to communities and places has been dissolved by their economic motives and by their educations. These are people who will go anywhere and jeopardize anything in order to assure the success of their careers.”
– Wendell Berry
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Oops! That was meant to be read as Trans Cranial Stimulation.
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Dear Philip
Thank you very much this article.
As far as complaining about treatment goes, I think the ‘schizophrenic’ is too weakened and dependent on the system to bite the hand that feeds them. The ‘schizophrenic’ has no rights, the doctor can do what they like with them.
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Another great article.
Psychiatry has become really good at dealing with criticism, it has had lots of practice. Certainly it is great at influencing the thinking of clinicians and consumers. That said I really don’t understand how it can be acceptable for supporters of psychiatry to insist that any criticism of its treatments (even those that have irrefutable proof of causing neurological damage) must carry the caveat, “but let’s not forgot some people are helped”. Perhaps when it is said that we mustn’t forget some people are helped we need ask the question, “is the cure worth it?” and insist of the caveat that such help comes at the expense of neurological damage.
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Robb3, you bring up something that I’ve been thinking a lot about lately. Sometimes I get really riled up and want to write an article or a blog or something about the injustices of psychiatry for the mainstream public. But then I remember that the medical model is so entrenched in society is that no one will take you seriously if you don’t include this “but they work for some” caveat. And that would defeat the purpose of anything I would write. I feel people who a’re already on medication get extremely upset when anyone criticizes said medications. I can see why but it doesn’t help the discussion. If you go around trying to present information on why any psych drugs a’re dangerous or why people shouldn’t be taking them it’s very easy to paint you as an inhuman monster who wants to take away people’s only means of relief from their emotional suffering. Unfortunately this view only exists because so many have bought into the biological model. I feel like people believe less and less that other forms of therapy can help them. Psychiatry has resigned them to drugs.
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“I feel people who a’re already on medication get extremely upset when anyone criticizes said medications.”
Yeah. And they will recite you the pharma propaganda like “people with ADHD react differently to these drugs than normal people” or “they are not addictive” or “they don’t change your personality”.
I think also part of the problem is that this drugs affect cognition itself and people are often not able to see straight or recognise that their personality has changed – same happens in case of illegal drugs but when you tell someone – “hey buddy maybe you should cut down on booze” it’s not being called stigmatisation.
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Likewise if your buddy chooses to cut down on the booze or go dry his bar tender has no legal right to imprison him in some back room of the tavern and force him to drink “therapeutic” amounts of alcohol.
Once Buddy develops insight into his condition, that he’s a genetically inferior subhuman who needs alcohol to survive, the bar tender would send him home. On condition that he remains liquor compliant and drinks a six-pack of beer throughout the day and a double shot of whiskey at night exactly as prescribed, he is a free man. 😀
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There are a lot of parallels here with many modern medical drugs as well.
I remember recently seeing an ad for Pepcid AC. A guy was sitting down at a diner eating a huge philly cheese steak. After polishing it off he looks…uncomfortable. So he reaches down and grabs the Pepcid AC. Then? All smiles.
How bout just not eating the whole damn philly cheese steak? And if he takes Pepcid AC long term he may develop kidney problems.
In so many cases of anxiety, depression, panic disorder, insomnia, etc….lifestyle issues, habits, previous trauma, diet, etc…should be addressed before any prescription. But people see the ads, see how it’s been normalized, and go for what they think is an easy fix, though it often leads to longer term complications. Doctors easily abet the practice and the AMA/APA justify it via bogus “evidence based” research.
I think it’s deeply important to ring the bell of alarm on “Philly Cheese Steak medicating”. I still think getting psychiatry out of the hands of general practitioners is one main way to do it.
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I like this site and the work you’re doing here. I just looked over this article quickly, but would like to add that the placebo effect isn’t only about the patient wanting to play the role of good patient. The patient can also actually feel better, for whatever complex of reasons. Forgive me if you’ve mentioned this here or elsewhere.
Also, I’m not convinced that all psychiatric assessment hinges on patients’ self reports. I think a good psychiatrist could monitor the patient over time and make a reasonable assessment. So even if a patient says, “I had a lousy week,” the doctor might reply, “Well, let’s remember that over the past 6 months, you’ve made significant gains in several areas…”
As for this statement:
“psychiatric drugs; illegal street drugs; alcohol and nicotine, all have in common that they confer a temporary good feeling. That’s why people use them.”
I don’t agree. Some people have “bad trips” with street drugs. And some say they “feel nothing,” especially with THC. Moreover, some say that prescribed drugs make them feel badly. That’s why patients often “play around” when beginning a new drug regimen.
Pls understand that I’m not emphatically for or against psychiatry and psychiatric drugs. I think the benefit/detriment totally depends on the situation.
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“Some people have “bad trips” with street drugs. And some say they “feel nothing,” especially with THC. Moreover, some say that prescribed drugs make them feel badly. That’s why patients often “play around” when beginning a new drug regimen.”
That’s exactly the way it is for psych drugs, only that probably fewer people feel better on them than on street drugs. It’s not very common for a person not to get high on pot but it’s quite normal for people to have zero positive response (and plenty of negative) to SSRIs.
Another problem: as with street drugs people who are going through severe emotional distress should be the last people to be recommended taking them. It’s the shortest way to addiction and not being able to cope with your problems and recover in a normal way but rather going into a downward spiral.
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Another excellent article, thank you. I have however a minor comment to:
“My essential point is this: psychiatric drugs; illegal street drugs; alcohol and nicotine, all have in common that they confer a temporary good feeling.”
That is true for illegal drugs and probably for benzodiazepines which tend to give people an actual high. But most other drugs have extremely varied effects depending on a person. If you’re getting “side effects” of these drugs you’re going to feel disastrous. In other cases people report everything from from feeling better through not feeling any change at all to becoming suicidal. So in a way psych drugs are even worse.
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Dr. Hickey, This was a fine takedown of sacerdotal psychiatry. Very well delienated consideration of intentions and statements between yourself and the window-dressers for the trade monopoly. Thanks all the way around.
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