Complete Honesty About Psych Meds Must Be Nuanced, Not Black-and-White

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Most of us know that every individual reacts differently to every different psych med, but sometimes we forget to say that they help some people sometmes, at least in the short term,  Here’s one way to say that without diluting our message..

These raw data from an FDA clinical trial of Paxil use in teens shows a wide range of individual variation among the people in the test.  Each line and, dot represents an individual kid.  They show a wide range of individual reactions to the drug.

(This Study 329 is controversial.  It has been called fraudulent.  The principal investigator, Dr. Martin Keller, resigned his position at Brown University June 30, without explanation.  There is some  pressure in the research community to have the study formally retracted.  I kept the data in this story because the scientist who interpreted it for me challenges the study’s conclusions.)

To make sense of this, I had to call on a scientist who shares my values.

FDA Paxil trial data
FDA Paxil trial data

 

According to Corinna West, who has an advanced degree in pharmaceutical chemistry, the trial showed some people do much better on Paxil, and some do much worse.  It’s a miracle for some people, and a dangerous trap for others, she says.

Range of individual reactions in Paxil study
Range of individual reactions in Paxil study

Eleven kids became suicidal on Paxil, only two on placebo, Corinna said. And the study does not show what happened to people after the trial, or after discontinuing medication.

The risk of relapse after anti-depressant medication discontinuation was higher than the risk of relapse after remission on placebo, according to a study published in.Frontiers in Psychiatry, July 7, 2011, Corinna said.

Study 329 does not say what happened to the people after the study:  what was their relapse rate; did they have trouble getting off the drug, and how much of the good outcomes were really placebo effects, Corinna says.

“People need to know they’re up for a lottery with odds less than placebo,” she says.  “People are right to be concerned about the safety of anti-depressants.”

But a completely honest discussion of whether an individual should take them should also say they might help.

Discussions and advocacy regarding medication should be nuanced, not black-and-white, Robert Whitaker says in this video.  .

 

I corresponded recently with a combat veteran, who permitted me to post, this summary of our nuanced discussion.

He said he is still experiencing serious emotional difficulty several years after seeing his friends killed in a war.  He said a popular SSRI anti-depressant helped him when he was overseas, and he has a prescription for it now – but he’s afraid to take it.

When he left the military, and returned to the States, he decided to become an “educated consumer.”  He has trouble sleeping, nightmares, periiods of rage, depression, and suicidal thoughts.  He says his family is supportive, but those relationships become strained sometimes. Yet, he’s afraid to fill his prescription and go back on medication.

He found so many Empowermement movement Facebook pages and websites that say taking meds is bad that he doesn’t know what to do

I told him not to let strangers tell him how to take care of himself.  All but the most strident, ideological critics of psych meds know that every individual reacts differently to every different treatment. If a particular drug helped him before, it might again, BUT:..

  • It would not solve his problems, make him well or keep him well.  Chances are, the best he can hope for from the drug is enough relief from his symptoms to allow him to bring other treatments and resources to the problem that can make him well and keep him well. I suggested he continue individual psychotherapy and support groups with other veterans.
  • I suggested he also follow a non-medical wellness and recovery plan, and recommended Mary Ellen Copeland’s Wellness and Recovery Action Plan (WRAP), which I’ve been using myself, and teaching, since 1997,
  • I suggested he take vacations from the drug every so often: withdraw gradually under supervision, and see how well he does without it, or with less.  “Take as little as you need, not as much as you can stand,” I said.
  • I suggested he Include people in his circle of supporters from outside the mental health world. I said, “Talk about, and do things you enjoy, that take your mind off your mind.”  I sent him my phone number and said it would be an honor to talk to him about anything, not an imposition.
  • I shared some insights I got from reading When Johnny and Jane Come Marching Home by Paula Joan Caplan of Harvard.  We should get away from the term Post-Traumatic Stress Disorder (PTSD), and stop treating troubled vets in medical facilities, she says.

“A lasting emotional reaction:to the horror of war is not a disease or disorder,” Dr. Caplan says.  It’s a normal, human reaction to horrible, abnormal experience.  Calling  it PTSD puts the blame for the suffering on the sufferer, not the war that caused the suffering,  Making people go to medical facilities for treatment reinforces the message that they/re sick..

For years, anti-medication talk created a barrier between me and some national leaders in the Empowerment movement, whom I admired so much for so many other things.  What

they said about medication did not account for my experience, or that of many people I knew, who had good outcomes and no obvious, life-limiting side effects.

When I asked seemingly outspoken medication critics, including David Oaks of Mindfreedom International, if they’re against medication, they almost always said, “Oh, no!  I just mean….”  And they finished that sentence with something I agreed with completely.

  • In 2009, Judi Chamberlin, told me in an interview, “I’m not against medication.  If medicine is helping you, you should take it.  I just think it should be offered as one of many options, not the only option.”  I completely agree.
  • When I asked Dr. Dan Fisher the same question, he said, “Is that what people think?  I PRESCRIBE medication at a clinic one day a week!”
  • Corinna West of Wellness Wordworks says she’s not against medication.  She’s FOR full disclosure and truly informed consent.  I completely agree

I think alternative treatments should be tried before psych meds, not as an afterthought or footnote to a treatment plan.  Maybe it will minimize dosage, or psych meds will never become necessary at all.

I disagree with Scientologists, who say all psych meds are bad for everybody all the time, and claim they have a home cure that makes psych meds unnecessary.  Irresponsible claims like that might tempt people, like my best friend David Hilton, who ultimately took his own life, to go off meds the wrong way. Too many people hate to take these medicines for a million good, and not-so-good, reasons.  Applying anti-medication ideologies to individuals can do serious harm.

And I HATE to think of my new friend, the combat veteran, afraid of a treatment that might help him, because a stranger on Facebook told him medicine is bad.

 

 

   

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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64 COMMENTS

  1. I totally agree but the problem is that in real life people who come for the first time in contact with psychiatry don’t know anything about psychiatric medication or how psychiatry works. Most people tend to trust psychiatrists and they get told an awful lot of lies. They are not told about side-effects or how difficult it will be to get off the drugs once on them. If you ask too many questions or resist the psychiatrist’s advice, you get forcibly medicated. The person who comes into contact with psychiatry for the first time has never heard of Robert Whitaker or “Mad in America”, Will Hall or Peter Breggin. You become wise afterwards once you have experienced the whole horror of it.

  2. Great point, Keith. While I totally subscribe to the MIA consensus that psychiatry does more harm than good, and that drugs are dangerously over-prescribed and overused (without proper information or attention to side-effects, not counting that the drug focus often prevent the real problems to be addressed), a nuanced thinking is required for many reasons:

    – MIA scientific credibility: saying that it is impossible to be helped by drugs, not leaving room for at least the possibility that drugs (or maybe future drugs) could be helpful for some small percentage of people experiencing debilitating emotional pain, is so unscientific, dogmatic, ideological that nobody actively making such radical claims would be worth being listened too by the general public.

    – Human right to self-determination: at the end of the day, if somebody reasonably informed decides to try a drug and find it helpful and working (in their individual case, and possibly as a temporary crutch), it would be totalitarian thinking, incredibly offensive, and humanly absurd to deny their experience. The right to refuse treatment goes hand-in-hand with the right to choose treatment (you cannot defend one without the other).

    – MIA goals of transforming psychiatry: this website is a great support and knowledge community for people harmed by psychiatry or critical of psychiatry. But it cannot get influence and credibility to a wider-public, and in particular to many mental health professionals that are open to change, if it can easily be dismissed by the status-quo proponents as dogmatic, radical, extremist, or only relevant to a minority of cases. A pro-choice, pro-information stance is fundamental to the success of the MIA enterprise (only the people already convinced will listen to “anti” stances).

  3. All of what is stated above I think is very true. This is why I think we need to keep focused on the larger issue – this is NOT about whether or not meds will work for a particular person. It’s about the process of criminalizing or medicalizing the range of normal human responses to the complex and often oppressive society we live in. The use of medication as a primary intervention I view as more a “symptom” of this larger “disease.” Identifying mental/emotional/spiritual distress as a medical “disease” or “disorder” enables us to avoid confronting the actual horrors that we are experiencing as a culture and a society, from warfare to racism to poverty to abusive families to forced “mental health treatment.” If any negative reaction or behavior is a result of a problem that resides in the person reacting, then we have no responsibility to improve our institutions or treat people more respectfully or work together on improving economic and environmental conditions.

    It’s so much easier to blame the victim.

    If people want to use medication to help them feel better temporarily, that’s always an option. But let’s not LIE to them about the nature of their “condition” or the likelihood that this pseudo-medical intervention will actually help fix what is rarely a medical condition at all.

    —- Steve

    • I agree we should never blame the victim (and emphasize individual and collective responsibility for improving our society). But there are cases where the same person is at the same time victim and abuser (where becoming an abuser is within the “normal human response/reaction” to some abnormal upbringing or traumatic experiences). Then there is a dilemma between the need to improve society (preventing further abuse) through coercion of the abuser/victim, and acknowledging the victim status of the same abuser/victim. It is not obvious to escape the criminalizing or medicalizing choice in those rare cases.

      Fortunately most victims don’t turn into abusers. Assuming that victim-hood leads to abusive-identity would be the worst kind of “blame the victim” attitude in addition to being plain wrong. So I am trying to stay cautious and nuanced, but I think the existence of such cases (same person being both victim and abuser) is a contributor to some psychiatry shortcomings, and acknowledging those cases is required to better defend against some psychiatrists abusively generalizing and seeing that situation everywhere.

      • Ah, but there we have a clearer distinction – abusive behavior can be identified as such and sanctioned socially or criminally. But then we have a real criterion of being harmful to the rights of another, so it’s a human rights/safety issue, rather than a “mental health disorder.”

        It’s a very slippery slope when we start deciding what is a medical problem based on behavior. We’ve seen psychiatry historically leap to aid repressive regimes in NAZI Germany and in Stalin’s Soviet Union, and they were all to happy to use “mental illness” as a pretext for imprisoning social dissidents or anyone deemed “deviant” by the state. I’d rather stick to imposing appropriate civil and/or criminal sanctions on those who violate the rights of others, and leave the medical field out of it altogether, unless they can identify an objectively verifiable PHYSICAL abnormality that is related to the dangerous or disrespectful behavior.

        This leaves the question open as to how to genuinely assist those in distress who want such assistance, which is, I think, the bigger part of our mission here at MIA. But that question SHOULD be open, because the current approach has clearly failed massively and needs to be abandoned. It’s pretty easy to acknowledge that individual experience may vary, but where I think we need to be very black and white is in insisting that mental/emotional/spiritual distress is NOT a de facto medical problem and that doctors have no more authority than your best friend across the street to tell you what the cause or solution to such distress may be for you.

        • Psychiatrists in Germany were murdering people labeled as mentally ill long before Hitler and his Nazis came along. The killing of people labeled as mentally ill was sanctioned by the government at the instigation of psychiatrists. Hitler came along and took over the program and had the psychiatrists train his SS. the gas chambers and ovens were the creation of the German psychiatrists, not the Nazis. The facts are all in the records but few people know or talk about this. In 1942, an address was given by a doctor, not a psychiatrist, to the APA in which euthanisia for the “feeble-minded” was proposed. It had many adherents and an editorial in a prominent psychiatric journal came out in favor of such a proposal. I myself think that this is very frightening and chilling. Absolute power given to any one group corrupts. Psychiatrists have an awful lot of power these days in this country. Most people would say that a euthanasia proposal could never be made in this country; but it was. In Germany, even after Hitler stopped the official program of the government murdering people labeled as mentally ill the psychiatrists running the mental institutions continued to carry out the extermination through starvation and overdosing with drugs. For me the toxic drugs are secondary to my concern about the power that psychiatry in this country has gathered into its hands and how it has gotten into bed with the jail and prison system and big pharma.

          • You said it! Psychiatry, along with a big arm of psychology, was pivotal in pushing the eugenics movement forward. A lot of words we use for “stupid” (moron, idiot, retarded) came out of this movement. The desire to label people or their behavior as more or less desirable is central to the history of psychiatry and intimately related to how the DSM developed and why biological theories are so favored. When most people think of the history of psychiatry, they think of Freud and psychoanalysis, but that was only a small movement in a much larger profession, whose main efforts were to contain, restrict, disable, and even kill those they felt were genetically inferior.

            Any profession that ever decided that inducing a coma through overloading the body with insulin, putting high-voltage electricity through the brain to induce a seizure, or running an ice pick into the eye socket to rip the frontal lobes apart were forms of “help” is not to be trusted. Not ever.

        • “unless they can identify an objectively verifiable PHYSICAL abnormality that is related to the dangerous or disrespectful behavior.”

          “I agree with you. Unusual behavior should never be assumed to be a medical problem without proof.”

          Define proof? As Sandra Steingard has pointed out here since she is writes left handed her brain will show abnormalities from right handed people. Does that mean she is ill and that being left handed is wrong?

          You two just said that if psychiatry could prove this or that disorder had an origin in the brain you would change your opinion of whether they should have authority to treat it. Why? They are definitely going to find unequivocally the differences in the brain that they are looking for at some point in the future. Will that mean that the people so labeled are disease, or just different? Surely the brain of a psychotic person can not be functioning the same as a non-psychotic person. Is that proof that psychosis is a disease?

          • For so many psychiatrists “different” is “diseased.” They want to be the only ones who are doing the deciding and I don’t accept that. There is no “normal” but listening to them you’d sure think so. There is typical and there is average, but there is no “normal.” This group has way too much power and I don’t know how we’re going to get it and our lives back from them.

  4. So, what happens next, Ken?

    Does MiA begin to send out the thought police?

    To we begin to ban expression that appears to be ‘black-and-white’?

    Or, do we just have to keep reading posts like this one that remind us that ‘black-and-white’ thinking is not the answer?

    Peter Breggin, M.D. – U.S. Military and Psychiatry –

    http://www.toxicpsychiatry.com/military-issues/

    I think the ‘black-and-white’ thinking of men like Peter Breggin is the only thing keeping our society from falling apart at this point.

    Call me crazy, Ken.

    Duane

  5. I think that it is important to know who you are addressing before putting together your message.

    When I want to confound and challenge service profider or lobby politicians than Corina’s interpretation of the paxil experiments are probably the most useful thing. They seriously put doubt into the minds of people who want to listen about the messages drug companies put out and what most Dr’s believe.

    When talking to uppity survivors I’m happy to say the drugs cause more harm than good, plus a little bit more, but not a lot.

    When talking to individuals I’d say personal choice is the thing, after all that is what people do, make personal choices, as per the above article. But I’d also say that things are more complicated than that, that services don’t often offer good social support, that good social support might not be what the person has been able to access, that if they had this maybe they might not need or want psyche drugs. But given the situation we are in they might, at this moment, choose to take them. And then I might spend time getting to know them, trying to find out why they are taking them and seeing if I can think of somehow to support them that will make the drugs irrelevant.

    But only on a good day…. Mainly I am a self employed gardener and miseryguts (technical term – may not translate to the USA)

  6. SSRI’s “help” people like cigarettes “help” people. They were conceived from a faulty premise and fraudulently tested/marketed. But if people want to take them after learning and understanding all the potential PERMANENT side effects, as well as the mountain of fraud that got them to market, than have at it.
    As for your veteran friend, one of the reasons why so many vets are killing themselves is because of psych meds. They pump them with psych meds so they become desensitized to killing and can go on their 2nd,3rd,4th,5th tour of combat duty. As for the “trouble sleeping, nightmares, periiods of rage, depression, and suicidal thoughts”, this reads like the insert of an SSRI. Giving him an SSRI while already agitated could makes these symptoms worse. SSRI’s should be one of the last things given to combat vets.

    • I think it’s the rare psychiatrist who truly works at informed consent. An example that sticks out to me is that at one point in the hospital I was on Effexor, which I found out later causes big problems with blood pressure. I already had extremely high blood pressure that is difficult to control even with medicine and the damned doctor put me on Effexor! He never told me about the blood pressure problems. I’m beginning to think he didn’t know diddly about the drug he put me on. He knew I had high blood pressure because he had to treat me for it along with my supposed depression and this is what he did. Then, he decided to change me to citalopram, an SSRI. Did he tell me that the damned stuff can cause heart attacks? Absolutely not. And guess what? I had a heart attack!. So much for informed consent. And the blood pressure medicine he put me on while I was in the hospital causes all kinds of significant problems and you’re supposed to stop it immediately if any of the side effects show up. Did he tell me this? No. I had to find all of this stuff out for myself by reading the papers that come with the drugs when you get prescriptions filled. And this guy is considered to be one of the best psychiatrists in the hospital where I was held! I hate to think about what kind of informed consent the lesser psychiatrists are giving their patients!!!!! Am I upset and hot? I think you can figure out the answer to that question on your own. And you know who informed me about all of these meds and toxic drugs? My lowly nurse practitioner bless her!!!!She just shook her head when she found out all of this stuff.

      • Wow. I have come to the conclusion that eugenics plays a very prominent role in psychiatry whether known or unknown to the psychiatrists themselves (it seems like your doctor knew what they were doing and just didn’t care). And i am convinced that the Guidance Center i went to when i was 17 is also a eugenics operation when looking back on it and then following up 4 years later. More or less i was told by the director of the place that Prozac is working very well on little kids. These drugs are poison whether Robert or whoever else wants wants to admit it. Does that mean they should not be used? I can see some cases where these drugs can be used, but not many.

  7. Ken,

    I always enjoy your insightful and honest posts, both on MIA and your own website.

    One point that could be added to your list of considerations is simply the great uncertainty about the long-term effects of drugs. Any given person simply doesn’t know if the substances they took in the past (plan to take in the future) made (or will make) their suffering worse. Those of us who have already taken the drugs will never have a definitive answer to these questions.

    My advice to your veteran friend: hang in there, but look elsewhere for relief. Drugs are a crapshoot you can lose.

  8. “But a completely honest discussion of whether an individual should take them should also say they might help.”

    I’ve always considered this to really be the case anyway. Not that people are told that but that people already think that. Most people don’t actually believe that the drugs are fixing anything wrong with them and most people are aware that such drugs work no better than placebos, after all it’s been on national news at least a couple of times recently. But people still buy lottery tickets even though the odds are slim that they’ll win, but a lottery ticket doesn’t eat at your health and endanger you and everyone around you.

    Instead of telling people that something might work to help them, I think it’s more important to look at what that something is and determine in what ways it might help them. According to Irvin Kirsch’s research the AD’s only “work” by creating hope and expectation. I would like to think that such things could be created without using dangerous drugs.

    We know now for a fact that SSRI’s don’t fix anything but on the other hand we know for a fact that they wreak havoc on the brain. Even if they do help someone by psychologically motivated them to feel better they still might wind up suffering more real and harder to treat problems as a result of their now dysfunctional brain.

    I guess what I’m trying to say is that I don’t think it’s ever right to tell somebody to go on psych drugs. I wouldn’t do it.

  9. Three points Ken
    they may help you since you seem to have missed the point somewhere along the line

    1. As Dr. Breggin says often -it’s like the out of control drunk who thinks he’s the life of the party when he is the death of it- Thinking the drug is helping is not tantamount to the drug helping. People often “respond” to the idea of help coming or the hope of some change or control.

    2.As Whitaker touches on in MIA weren’t there people for whom the high velocity showers were “effective”? Didn’t some patients report to some success with spinning chairs? Or Lobotomies? Or blistering?

    3.Why ignore the original trial studies that placed the SSRIs at best on the level of placebo. Have you read nothing Ken?

    -As John Hoggett says “it is important to know who you are addressing” – you are addressing people in the year 2012 often in America. It’s a little like wanting people to parse their words about the evils of Fascism in say 1947.
    I ain’t having it
    -John S.

    • I love these three points, fredricknyc! Yes, we are America 2012 and we are collectively enchanted with these antidepressants. Voices of caution are few and far between, and besides who is listening when you could be listening to Prozac?

      I love that self-described liberal, compassionate, nuanced thinkers are ready to listen to you while getting you on the drugs but where will they be when you need help getting off?

  10. Hi Ken, I agree with a call for a more nuanced conversation, yet note a common tendency to keep a focus on the medication issue, and resist a nuanced conversation about emotions and their *physiological* foundations?

    IMO The key words in your essay here are “serious emotional difficulty,” yet there is no comment on the “internal” dynamics of our emotional makeup? What I’m trying to point out, is our common preference of avoiding internal awareness, by *diagnosing* emotion with a cause & effect, cognitive analysis, which is the very foundation of black & white logic? IMO The lack of nuance in general debate comes from the physiological underpinnings of our so-called reason.

    We seem to falsely assume that our reasoning is more “insightful” than we care to admit to, hence you write;
    “Corinna West of Wellness Wordworks says she’s not against medication. She’s FOR full disclosure and truly informed consent. I completely agree”

    Yet if this statement about an “assumed” response to full disclosure is true & insightful, why do human beings still take up smoking in their millions? IMO What is left out of the “full disclosure,” assumption is deeper self-awareness of our unconscious, emotional functioning.

    You write about the medical label of PTSD, as a “cognitive” diagnostic term;

    ““A lasting emotional reaction:to the horror of war is not a disease or disorder,” Dr. Caplan says. It’s a normal, human reaction to horrible, abnormal experience. Calling it PTSD puts the blame for the suffering on the sufferer, not the war that caused the suffering, Making people go to medical facilities for treatment reinforces the message that they/re sick..”

    There has been an increasing trend since World war one, to take the “visceral,” impact of psychiatric diagnosis out of the language of psychiatry, and we need to question the function of this tendency to “objectify” emotional processes with these more neutral terms? In my exploration, of the inner emotional dynamics of my so-called bipolar disorder, once more viscerally described as “manic-depression,” I write;

    “The body has its own energy “language,” beneath the minds cognitive language?

    A doctor once told me that the new term bipolar was more objective, less emotional and therefore more useful for a detached analysis and correct diagnosis. “You mean, you need to remain as unaffected as possible by my raw emotions?” “Lets not get into that now,” he replied, refusing to be distracted from his predetermined coarse of action. I understand his need of coarse, to remain cool, calm and collected in the face of heated emotions and keep his cognitive capacity intact?

    Yet it begs the question of a hidden agenda, in our ever increasing cognitive labels for emotional-mental anguish and what to many seems a lopsided focus on brain chemistry. “Are we trying to separate what we think from what we feel, too much?” In my own journey of self discovery/recovery I came through a recent episode of mania with a new “cognitive” appreciation of my inner experience;

    “Perhaps all activity within the body/brain is essentially about energy regulation, including our thoughts? Its a different way to understand oneself, compared to our taken for granted sense of objectivity in daily discourse?” (facebook.com post).

    Is there a hidden need to regulate energy via both body & mind, which is miss-perceived in much of the science research into the brain’s electro-chemical function? “Its so fascinating,” says a young neurologist of their brain research work, although perhaps unaware of regulating the raw energies of their body/brain through the expression of innate interest-excitement?

    My Grandmother once told me, “we didn’t need anyone to tell us he’d been frightened out his mind and fear had driven him mad,” describing her older brother’s return from the 1st world war. “We bit our lip and tried not to be scared, not to turn away and just be there for him.” When I’d asked her how it had worked out, “it took a long time and kind of drove us all a bit crazy for a while there, but he did settle down and get over it eventually.” After a few minutes of reflection she added, “it was as though we’d shared the load with him somehow.”

    My Grandmother’s story speaks to the very nature of human attachment and dependency in many ways. No amount of cognitive self interpretation or medication compliance helped me regulate the energies of bipolar disorder over a 27 year period. Only when I found the kind of knowledge which helped me approach the inner sensations of mania & depression, with a cognitive “Ah, that’s what that is.” did I start to find recovery in a process of internal self discovery. You might say that I’m now investigating the unconscious language of my body, exploring the strange electro-chemical processes within that manifest a conscious sense of being me.

    There is a huge amount of science and other knowledge available, beyond that which suggest’s a medication dependency for the regulation of emotional/mental anguish. Do we each need to go beyond the urge and desire for joining an “us & them,” battle and go looking for it? We love to expose the hidden agenda of profit motivation and malpractice in our pharmacology era, yet there is a deeper hidden agenda within us all? The hidden reality of our electro-chemical body/brain/mind energy regulation, which pure science is only just beginning to explore?

    Beyond the public debate about medication, what is the private experience of recovery?

    http://www.bipolarbatesy.blogspot.com/2012/01/body-language-mental-illness.html

    Warm regards,

    David Bates.

  12. Duane, I think black-snd-white thinking is an unrealistic picture of the shades-of-gray world,that leads to incivility, bad decisions, and terrible public policy.

    But it’s an argument I want to win on the merits,through persuasion, not cenaorship or thought control, which are the most malignant, dangerous forms of black-and-white thinking. They became possible only when black-and-white thinkers have power, as they do in medical psychiatry today. They are certainly NOT on any agenda of mine.

    To repeat what I said in the piece, I am not for medication. I’m for full disclosure and truly informed consent. I’m against a medical psychiatric system based on labels and meds first for everyone for life. I believe in trying alternative treatments BEFORE resorting to meds.

    Being AGAINST meds all the time for everyone, black-and-white, and censoring people who disagree, is also unrealistic. It does not account for my 35 years of experience taking meds, and that of many people I know. (I’m tapering now based on recent long-term outcome studies.)

    I did have a bad experience the one time I took an atypical anti-psychotic briefly. I got off it. The difference between me and people who complain about long-term side effects might be that the meds I take are old, not modern anti-depressants or anti-psychotics.

    I’m also proud of other friends who had long-term problems with meds, were able to get off, and are happier, and doing much better now. I haven’t been able to do that yet.

    That’s nuanced thinking IMHO.

    • Hi Ken, IMHO nuanced thinking is when we can address our physiological functioning in terms of the motivating affect/emotions, beneath an assumption that people actually operate on intelligent reasoning. Example: In the video above that you urge us to watch in a call for more nuanced thinking, Robert makes this statement on two different levels of human functioning.

      1. The physiological need to feel good about himself and maintain an established homeostasis, and also to appear good to others.

      2. Is the attempt to reason an approach to a problem through the power of our intelligent reasoning.

      The flaw in the informed consent, intelligent reasoning, approach, is a failure to see how we “actually function,” far more on level 1., than we do on level 2.?

      Level 1, in any stressful situation is about seeking an immediate relief, which physiologically thwarts any reasoned, intelligent approach to a long-term solution. We want relief and we want it NOW!

      There is a basic-assumption in Western society that we all operate with more intelligent reasoning than we do physiological reaction, yet this myth does not stand the test of any real-life examination of our actions and reactions, when stress producing anxiety is high.

      Furthermore, when trying to organize any community into common goal actions, we fail again to see the physiological foundations of our actual responses. IMHO Society operates around an axis of Strong/Weak, Pride/Shame, particularly when stress producing anxiety is high, as it is in our debate about mental health. A pride-shame axis of reactions which influences individuals and groups in any community, and perhaps even more so in a community struggling with the damaging history of psychiatry’s false assumptions about its intelligent, reasoned approach to mental health care.

      Take a long look at this thread Ken, and ask yourself if your selective responses to comments here are about reasoning or reactions? IMO Unconscious physiological reactions underpin our so-called reasoning, and we resist any approach which asks us to “feel” the reality of our individual self-awareness.

      Respectfully & sincerely,

      David Bates.

  13. “It’s okay to be against forced treatment (thankfully), but it’s not okay to despise the treatment itself.”

    Duane,

    I wanted to respond to this statement by sharing some of my personal experiences. For those of you not familiar with my story, I was on psych meds for several year. I feel they destroyed some productive years of my life.

    Unfortunately, for various reasons, I may be forced to try ambien as much as this possibility sickens me. But when your health is greatly declining due to lack of sleep over months, there may come a point where the benefits of the med outweigh the risks. I am still trying to weigh all of that.

    My point Duane is there are many people like me who need compassion and not condemnation for being traitors to the cause when we are faced with a dammed if you do and dammed if you don’t choice. What I have experienced is hell and the last thing I need or anyone else in my situation needs to read is people unintentionally condemning me for being a traitor.

  14. The real point is that people should be free to chose what they have found that works, with as much complete and honest information as possible to make their decision. Some fully Whitaker informed people have still found that psych meds work for them as individuals, even though there isn’t evidence for aggregate use.

    Sometimes people need a brain disabling treatment (as Breggin calls them) to distance themselves from emotional pain. Just like opiates are useful to help people distance from physical pain. And both should be used as a temporary crutch to develop more permanent solutions, with full awareness of the addiction potential and physical danger of the drug.

    Duane is right from his other posts, that we need to classify these drugs the same as illicit drugs. However cigarettes, alcohol, pot, hard drugs, sugar, caffeine, and chocolate all have some utility for some people some of the time or else people wouldn’t be using them. Compared to some of those drugs, the amount of harm vs. the amount of control the that each particular user has might well weigh in favor of the corporate sponsored drugs.

    Saying corporate sponsored drugs should never ever be used denies the freedom of choice and all the advocacy around self-determination that many of our people have fought for. There are plenty of mechanisms now to start enforcing truth telling by those corporations including what we’re doing right here. We can speak up and keep working on getting the truth out about psych meds, but refusing to accept the personal choice of people on meds isn’t going to help our cause reach the mainstream.

    • I think that any movement trying to change the mental health system has enough on its hands without taking on The War on Drugs and creating a culture that supports a drugs free market. If we are to expose the drugs for what they are, we should expect to see them banned. I don’t want to live in a world where all of this is well regarded fact by the masses – neuroleptics cause brain damage, worsening long term outcomes, ect – and yet there is Little Johnny getting put on Risperdal anyway because his parent(s) attest that he wont behave without it. “It works for us, and our doctors agree. Just because Risperdal didn’t work for the other two million bipolar kids doesn’t mean it wont work for Little Johnny!”

    • 1 in 5 adults in this country are one some form of psychotropic.

      Freedom?

      You mean this movement of ours is to make sure nobody takes away a person’s right to use these drugs?

      I don’t see an effort to do so!

      I thought we were about INFORMED consent, and the right to say HELL NO to the use of FORCE with these *rat poisons*.

      Maybe I missed something.

      Duane

  15. Ken, AA, Corinna,

    These are drugs.
    They are not “medications.”

    We need to be honest with people.
    The *drugs* are unpredictable.
    Going in, and coming off.

    Informed consent?
    We haven’t scratched the surface on what it would mean to truly inform people. Look no further than Whiataker’s timeline for antispychotics –

    http://www.madinamerica.com/2011/11/%ef%bb%bftimeline/

    It’s interesting how the messenger gets shot.
    In one comment section, I’m accused of calling people “traitors” to the cause, not having empathy, and being closed-minded.

    Simply for pointing out the facts.

    For what it’s worth, I do have some empathy.
    From the Mental Health Freedom and Recover Act:

    “The act will respect the predicament of those who are chemically dependent or addicted to psychiatric drugs; who have been on large amounts, for long periods of time, and/or in cocktail forms; who may choose to simply reduce harm or not take part in any aspect of psychotropic withdrawal.”

    http://discoverandrecover.wordpress.com/mental-health-freedom-and-recovery-act/

    Ken and Corinna, you both do a lot *right*. Thank you.
    AA, I’ve been reading your comments for years, and appreciate what you co sisently add to the dialogue. I would never consider you or anyone else a *traitor*. Hardly.

    Duane

  16. I do not think this movement stands a chance if it continues to be nuanced. How strong is our message if we answer opponents’ questions with “Yes, but…” and “Yes, except for when…”? If we do indeed believe this is a civil rights movement, which I do, then we can compare it to the American civil rights movement of the sixties. Imagine answering questions about when it’s okay to answer questions about racial segregation with “yes, but…” and “except for when…”. The question, by the way, has nothing to do with peoples’ choices for “treatment”, if that is what they choose to call it after knowing the answer to the only question that matters: Is behavior medical or not medical? The answer to that question must be black and white. Beyond that, do what you like. If you want to go get drunk at a bar and that makes you feel better, then choose to do that. If you want to go to a Phish concert parking lot and ask everyone around you for “pharmies” and that helps you cope with knowing that your purpose in life is currently to tour with Phish, great. None of these activities are considered medical, nor should they be. Our weak, tiny, unheard of movement cannot afford to be nuanced right now.

    • It’s a weak, tiny, unheard movement because it ISN’T nuanced. It only preaches to the choir because the positions taken are so unwilling to challenge their own assumptions. Mr. Jo Bob Hate My Job on an SSRI who likes his SSRI thinks we’re not able to speak for him. Which we aren’t.

      Sometimes there are no absolute answers to a questions and “yes, but…” is the most honest thing we can say. Racism is more black or white, literally. A person, back in Jim Crow days, was either one race or the other. Now of course the distinction is more gradual. And access was either allowed or prohibited.

      If we want the mainstream to accept a non-disease explanation of normal emotional experiences, we have to produce a message that is accessible as widely as possible. If 1 in 5 Americans is on psych meds, why doesn’t screaming, “psych meds suck” as loudly as possible make them want to hear us?

      How about a discussion of effective social messaging? You are right, obviously what we’ve done so far hasn’t worked, what are some new ideas?

      I’ll sit down and sign Kumbaya with my enemies if that’s what it takes to turn them into my friends. I’ll do all (ethical) things by all possible means for all people, so that I might be able to save a few of them.

      • Corinna,

        There are a few topics in this one comment.

        The first is the issue of what the movement is all about. And frankly, I’m not sure we’ve identified it.

        For starters, I’m not trying to make sure ” mainstream accepts a non-disease explanation of normal emotional experiences.” IMO, there can be actual phyical conditions that need to be addressed (lyme disease, celiac disease…)

        I’m for an end to the use of drugs by force, and and end to their use as a first-line and often only-line of treatment for some vulnerable groups – children (especially foster care and Mediciad), seniors (especiallly in nursing homes) and military services (especially in war theater and upon return home for trauma).

        Saving lives?
        Peter Breggin saves lives.
        We should learn from him.

        Although I think he misses out on the great work done by groups like the Autism Research Institute, Feingold Association, and physicians in functional, environmental and holistic medicine who appreciate the connection between the body and mind, and have helped children and seniors overcome “mental” ilness by adressing underlying physical conditions.

        IMO, if there is black-and-white thinking to be overcome it remains in the knee-jerk reaction that *all* “mental” illness has *no* underlying physical functioning underneath. We are complex beings – mind, body, spirit. More research is needed –

        http://discoverandrecover.wordpress.com/research/

        IMO, we are mising the obvious. If we want to become more mainstream, we should be working with church groups and the military. There are millions of people talking to ministers, priests, rabbis, and clergy have not a clue on where to tell people to find support. Folks in the military need our support, and we need their appreciation for freedom, and its cost.

        IMO, we do *not* need to waste a lot of time trying to win the hearts and minds of people who like their drugs. Many of them simply like their drugs. We do not need to waste our time with NAMI. NAMI has heard our message, and they’ve ignored it. If some groups want to join us, fine. But we lead, they follow. Not the other-way-around.

        Nuanced approach?
        Maybe with some of it, but not with the issue of force. These drugs have been fraudulently researched and marketed. They are unpredictable and dangerous. And they should not be *forced* on anyone.

        Duane

        • I just think the question of choices, where we can go when we are in distress, how to support a family member when they are, how to fathom climbing out of one’s own despair… all of these pertinent, Now questions have a confusing catalogue of answers until we focus our underlying message. I could not imagine how to answer those questions without the knowledge that “mental illnesses” are metaphors and have no place in the medical realm. The mental health world as it is now is fraught enough with ambiguity. Being unequivocal about one thing- human struggle does NOT belong in the medical realm- is our strongest, most indisputable claim. If we sacrifice that for nuanced messaging, we do not have two feet to stand on. And others on this site have said that all the other issues would take care of themselves if we could be solid on this point. Forced drugging, based in the medical realm. Choosing from legal prescription drugs, based in the medical realm. Watching a beloved family member take their problems to the shadowy secret of a psychiatrist’s clinic that promised solutions, based in the medical realm. Psychiatry’s reach has so many different faces that there are very few aspects of my family life which have not indirectly been marred by its influenced; but all of that began at one extremely unambiguous fork in the road. We must be the signposts at that fork in the road when people initially ask “is my problem medical or not?”. Once that question is answered in one strong syllable, I believe change would be forthcoming. No, of course I don’t know how to do this. It overwhelms me!!! But if we all cannot agree on the importance of the great distinction made when anyone with any problem asks for help, then where on earth do we begin? Successful movements have slogans; do we even know what ours would be?

          • I think a “mrntal” illness can involve many things – the throid, poor intestinal absorption, hormonal imbalances.

            It’s not that simple. –

            http://discoverandrecover.wordpress.com/root-causes-of-mental-illness/

            A focused message, IMO would be an end to *monopolized* care by one professional group, psychiatrists. An end to the use of *force*.
            Freedom to seek options of choice.

            A family who is seeking answers for a young child diagnosed with autism should be able to seek non-drug options from a doctor who helps them learn more about the importance of gut flora. They don’t need a lecture on how “autism” is not a neurological disorder, and be forced into family therapy, if they want to pursue holisitic medical approaches instead.

            An elderly person in early Alzheimer’s doesn’t need a lecture on how *dementia* is caused by unresolved trauma, any more than a woman in middle years needs to be coerced into seeing a shrink, after she begins to experience post-menopausal depression – due to hormonal changes in her body.

            And veterans do not need to be told that they have PTSD before a doctor has taken time to search for organic injury – possibly caused by IED’s in cobat zones. Explosions in a war can cause as much physical brain trauma as emotional trauma… hyperbaric oxygen therapy helps with TBI.

            And we neeed to begin to appreciate healing – in many forms – not just *talk therapy*. Some people who have been through trauma do much better with neurofeedback or mindfulness activity; or a host of therapies that utilize meridians – EFT, NET, EMDR.

            I don’t mean to be the bearer of bad news, but it seems to me we have yet to really decide who we are and what we’re all about… much less, what it is we want to do…

            IMO, whether someone has a “chemical imbalance” (neither side will ever be able to prove their point)or not pales in comparison to the question of whether that same person has a right to say what *treatments* they are interested (and NOT interested) in pursuing.,, and whether they will have the opportunity to fully recover.

            Duane

  17. I position is that too much of neuroleptics and SSRI’s are being prescribed, though in some cases they may be useful. If I went around telling, too much neuroleptics are being given for wrong reasons! .. then a great number of psychiatrists would nod in agreement -“Those other doctors sometimes give these drugs for wrong reasons.” – and go on with their work.

    • Yes, I really agree with this. Being nuanced gives professionals who have staked their education and their livelihoods an opportunity to evade responsibility. Being nuanced provides a loophole, for which those who must inevitably be accountable are grateful.

  18. I think we’re a movement about freedom of choice, and about liberating the search for truth from the crushing grip of corporate power. I also think that the truth is messy, and complicated, but that we should not reject it because it does not make for a good hot sound bite … like “antidepressants save lives!” Or “antidepressants are poisons!”

    I have gained a lot of respect for Dr. Breggin’s courage and persistence in standing up to power. But I also have to say that his books helped me keep taking my goddam pills for several more years than I otherwise would have. I would sit and read them in bookshops, looking for answers to my plight, and finally toss them aside in frustration. “There’s no such thing as mental illness. Medications are poisons that cause brain damage, pure and simple. ECT is an electrical lobotomy. (I have had ECT and would not recommend it to anyone with any other alternatives. But it’s not a lobotomy. I have met a couple of older institutionalized persons with lobotomies and will never forget the experience.) A really magical, skilled therapist (like me) can set everyone free.” Etc., etc. Maybe because I remembered so much of the bogus encounter groups and therapy cults of the seventies, I knew that therapists could make big money and cause big harm too. If this is the opposition, I thought, maybe I’d better stick with “mainstream science.”

    It was only when I encountered some people on the internet who could break it down like Ken and Corinna are doing that I was able to see what was happening to me … and what social and economic forces had gotten me on all these meds, and why I felt as bad as I did. And had the confidence to get off the goddam Cymbalta, etc. And in many ways, began a new life. And finally arrived here. Might never have gotten here otherwise. Might be on SSDI by now and taking 5 or 6 meds, because that is where I was headed.

    My experience in various fights against the establishment has been that when you are the underdog, you have to be twice as smart and have twice the respect for the truth as the establishment’s smartest people. And that the messy messy truth will set you free.

    I am not in favor of censoring anyone’s viewpoint! And happily I don’t see it happening here. And fear not, there is no school of thought on this board that is about to make peace with Big Pharma, the American Psychiatric Assn. or any of their apologists. Rest assured, they hate all of us.

  19. Do we here even fully agree on what “this” movement is, what “our” movement is?

    “Anatomy of an Epidemic” focuses mostly on the ideas that psychotropic drugs don’t work nearly as well over the long run as previously believed, are probably sometimes harmful over the long run, then asks a bit about alternatives to long-term psychotropic drugs.

    “Anatomy” itself doesn’t focus as much on forced medication, forced hospitalization, the traumatization often caused by these things, or civil rights issues. Nevertheless, many people who feel strongly about these issues have gravitated to this website. Other people with strong feelings about long-term drugging, and wanting to see better alternatives offered, nevertheless might not feel as strongly about each of these additional issues. Does that make these people “heretics” in the eyes of other commenters here?

    There seem to be multiple potential movements afoot (sharing an anger with various facets of mainstream psychiatry), overlapping to considerable degrees. But I worry that we’re sometimes tripping over each other, as we assume that if someone else agrees with us on one facet, they must necessarily agree with us on a different facet. And we feel so strongly about our beliefs (many of them burned in by painful experiences of personal trauma and violation) we tend to become angry that our own viewpoint is not equally apparent to everyone else.

    Just as one example, I personally don’t know what to make of the posed question: “Is behavior medical or not medical?” Maybe I’m being too pedantic, but I have to ask: What does one mean when you say “behavior”? What does one mean when you say “medical”? What would “not medical” look like to you? Then what can we envision about what follows from that?

    I’m a science geek, and I like the idea that smart people can get together and devote their lives and careers to learn more about human suffering, and find compassionate non-traumatizing ways of individually and societally reducing some of that suffering (as many have already done in various ways). I know that dealing with people in great distress is itself often stressful, and not everyone has the chops or the skills or availability to offer it. Some of those skills could probably be taught, how to really “be with” someone in distress in ways that help facilitate the healing process. I don’t have to call these people “medical” people. But in a more fair universe, I can imagine a better system with people and processes and bodies of expertise who are much more compassionate and skilled and effective and non-traumatizing in helping us facilitate our own healing processes.

    I’m appalled at instead how badly the researchers went off-base and screwed things up. A personal beef is that in the name of a certain style of “science” (as well as corporate influence, etc.), most researchers have forgotten how to simply ask us about our own first-hand experiences, what is it really like, what kinds of things have helped us, what kinds of things have harmed us, etc. They’re too busy noodling over their favorite closed-ended hypotheses and having us fill out their closed-ended questionnaires, ignoring several elephants in the room when we’re sitting right over here ready to tell them more of our experiences about what helps most.

    But if I’m busy denouncing the stuff that I feel most strongly about, and someone else is busy denouncing some slightly different stuff that they feel most strongly about, how do we even figure how best to come together to decide which “our movement” or “this movement” it is that we’re talking about?

    – Phil

    • Philroy,

      You make some great points.

      “What” movement may be the best question at this point.

      Re: Heresy

      I may be one of the biggest heretics on MiA, because I don’t believe we can *dis-prove* chemical imbalance, anymore than psychiatry can prove it.

      I find it amazing that many folks are convinced that brain chemistry can *never* become imbalanced – never.
      To believe that prolonged stress, trauma, lack of sleep can cause bodily chemical imbalance – hormonal, adrenal,cortisol, etc… but never, never effects the brain. This seems like quite a hypothetical stretch.

      It seems to me that the *last* thing we need to do is toss out good science, research and *medicine* that helps people learn to overcome trauma, deeply calm their neurological system, heal their bodies, including their *brains*.

      But hey, what do I know?
      I’m just the guy who needs to develop a more nuanced approach to rat poison (neuroleptics)… Hardly the spokesperson for an unknown *movement*.

      “What” movement?

      Duane

      • OK, I love speaking the truth and holding NAMI’s feet to the fire, too.

        The problem is not just in mental health, it’s in all parts of medicine and many other industries where rich people make money off hurting poor people.

        But the solution for mental health is the same as the solution for all the other industries – create a new way to solve the problem. The new way should be much much cheaper, and one that doesn’t harm poor people, the evironment, or the producers of the new product (or service). Then the poor people will drown out the lies told by the rich people.

        It’s much much harder to lie than it used to be. We are winning. That fact that so much ugliness is coming out right now doesn’t mean the world is starting to fall apart. It means we’re just now starting to look for solutions to what’s been wrong for a long time.

        • Corinna,

          It’s obvious to me that you’ve got a great heart, and that you’re doing all you can to make the world a better place.

          I’m not a person who is down on free markets (free enterprise, dare I say, *capitalism*?)

          I think free markets have brought a lot of good to the world – allowed people to dream, create, be their best.

          Greed and the *love* of money (not money, but *love* of money) is at the root of much of the evil we see in the world. Along with *crony* capitalism.

          We see it with drugmakers and the NIMH – the federal governmentt chooses to partner with specific industries, rather than regulate, protect the states and the *people*.

          We may disagree on some of this. That’s okay, because I have *no doubt* that your heart is in the right place, and I think it’s fair to say that we both (along with many others) want to make a better world.

          Duane

  21. To Duane re: chemical imbalances and proof: I think it is important to remember that in science, it is the person making the claim that has to submit the proof. The basic assumption in science (often called the “null hypothesis”) is that the theory in question is false until proven otherwise, and then is only true until enough evidence accumulates to call it into doubt. Real science is inherently skeptical, and requires very high standards for accepting a theory as fact.

    So our inability to prove that “chemical imbalances” are NOT the cause of mental distress is of no consequence. Those who claim that there is a causal relationship have 100% of the burden of proof, and they have failed.

    We have to go forward with the assumption that chemical imbalances are not a causal factor until proven otherwise. This is why I find the psychiatric world so completely disingenuous. They pretend to be interested in science, but they don’t apply real science – they assume the conclusion is true and then challenge anyone opposing them to prove that it is not, when the shoe should be on the other foot. I have heard this argument used again and again – “Well, you know, it COULD be caused by a chemical imbalance, otherwise, why would the drugs work?” But people have ALWAYS used drugs and herbs and substances to alter their consciousness and emotions and behavior. The fact that drugs can do that proves nothing at all.

    It also begs the very important question: what if different people have different brain chemistry for a good reason? What if our species survival depends on having a range of behavioral/emotional/intellectual styles, and that suppressing these chemically is damaging our survival as a species? I would submit “ADHD” as the perfect example of a “condition” that is created by assuming that a certain set of behaviors is necessary, when it’s really only necessary to please the teachers in school or your parents who can’t figure out how to handle you. And I speak from experience, having raised two of these marvelously challenging kids and having worked with many more. My kids have incredible talents and skills, but they don’t fit into school. Why is that an “imbalance” in them, even if they are genetically or chemically “different,” which they very well may be? Maybe their particular chemical makeup gives them talents and abilities that are very beneficial to the species, once you stop trying to force them to sit down and do things that they have no interest in doing.

    Or maybe our emotional/mental reactions are a warning about the nature and direction of our society and culture. Assuming for a moment that depression and anxiety are caused by “chemically different” states of mind, maybe those states are a function of this being’s reaction against a social system that is out of balance. Maybe their reaction tells us important information about the world they are in.

    These “theories” I have just proposed are only theoretical – neither has been proven scientifically. But why should I have to disprove the “chemical imbalance” theory any more than a psychiatrist should have to disprove my “states of mind” theory that proposes that chemical changes accompany reactions to adverse circumstances? Just because they’re doctors?

    You see what I mean. If there is no proven theory, then we are all free to engage in our best creative thinking and come up with whatever theory works best in moving us forward in life. We don’t have to disprove anything. They have to quit pretending they have proven something that they have absolutely failed to prove after 50 years of effort.

    Until we see the gene(s) that is/are directly linked to and responsible for a specific and repeatable set of chemical responses, and until it is proven that these responses represent a true disease state and not an adaptive response, the chemical imbalance theory is scientifically NOT TRUE. And the more efforts have been made that failed to support it, the more scientifically untrue it is. I’d say the overall evidence is pretty strong that repeated efforts to prove this theory, even by those who are strongly biased to find it its favor, have failed miserably. The theory should be scientifically dead, without any efforts from me or anybody else to show otherwise. Repeated failure over time to prove it true proves the theory worthless, at least in the world of real scientists.

    —- Steve

  22. Steve,

    I have a hard time telling you from Stevie and I know one of you might be Dr. Moffic and neither of you might be. Do you think you could change your user name to include a last name? Or upload a picture to gravatar.com? There’s where the pictures for commenters who have pictures are coming from.

    • Sorry about that confusion – you’re not the only one who has been confused. I’ll see if I can figure out the Gravitar thing.

      But I’d say all you need to do is read my comments and you should be able to tell the difference. Can you imagine Dr. Stevie writing what I just wrote? I sure can’t!

      —- Steve

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