Exploiting The Placebo Effect:  Deceiving People For Their Own Good?

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Readers may remember that a few weeks ago I became involved in an online debate with the very eminent and scholarly psychiatrist Ronald Pies, MD.  That exchange was initiated by a post I wrote concerning a paper on the chemical imbalance theory that Jeffrey Lacasse, PhD, and Jonathan Leo, PhD, had published in the Behavior Therapist in October 2015.  In that paper, Drs. Lacasse and Leo had drawn attention to certain aspects of Dr. Pies’ work, but they had also focused some attention on Daniel Carlat, MD, psychiatrist, and author of Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis.

The subsequent issue of the Behavior Therapist contained replies from Dr. Pies and Dr. Carlat, together with a counter-response from Drs. Lacasse and Leo.

There was nothing new in Dr. Pies’ letter, so I won’t dwell on that here, but Dr. Carlat’s letter warrants, I think, some discussion.

As mentioned above, Dr. Carlat is the author of Unhinged (2010).  This is an interesting work: a kind of “confessions of a reformed psychiatrist” book.  I read it when it came out, and was impressed by Dr. Carlat’s candor and courage.  I wrote a review on the work on October 30, 2010, and have quoted from it on a number of occasions in the subsequent years.  I had formed the opinion that Dr. Carlat was a psychiatrist who had recognized the hoax, and was doing what he could to expose it.

Carlat’s Interview on NPR

In July 2010, Dr. Carlat gave an interview on NPR concerning his book, and it was on comments that he had made in that interview that Drs. Lacasse and Leo had focused in their original article.  Drs. Lacasse and Leo provided three quotes from the interview.  Here’s the full passage from which they quoted.  (The interview was conducted by Dave Davies):

DAVIES: How much do we know about how psychological medications actually work?

Dr. CARLAT: Well, we know both a lot and very little, and the way in which we know a lot is that through clinical trial studies, in which patients are randomly assigned to a medication versus a placebo sugar pill, we know how effective these medications are, in other words how much of an advantage medication has over a placebo.

And that varies from medication to medication. It tends to be a very minimal advantage for antidepressants when treating depression. It tends to be a higher advantage when treating schizophrenia.

But on the other hand, what we don’t know is we don’t know how the medications actually work in the brain. So whereas it’s not uncommon – and I still do this, actually, when patients ask me about these medications, I’ll often say something like, well, the way Zoloft works is it increases the levels of serotonin in your brain, in your synapses, the neurons, and presumably the reason you’re depressed or anxious is that you have some sort of a deficiency.

And I say that not because I really believe it, because I know that the evidence isn’t really there for us to understand the mechanism. I think I say that because patients want to know something, and they want to know that we as physicians have some basic understanding of what we’re doing when we’re prescribing medications.

And they certainly don’t want to hear that a psychiatrist essentially has no idea how these medications work.

DAVIES: But that’s pretty close to the truth?

Dr. CARLAT: Unfortunately, it is close to the truth. We’re in a paradoxical situation, I think, where, you know, we prescribe medications that do work, according to the trials, and yet as opposed to essentially all other branches of medicine, we don’t understand the pathophysiology of what generates mental illness, and we don’t understand exactly how our medications work.

DAVIES: And it can be reassuring if you’re prescribing a medication to tell someone, well, there’s really a biological origin of your difficulty here, and we can treat it with – by treating the biology.

Dr. CARLAT: Right, which is exactly why I still tell patients that at times. But I think, you know, one thing that has happened is that because there’s been such a vacuum in our knowledge about mechanism, the drug companies have been happy to sort of fill that vacuum with their own version of knowledge so that usually, if you see a commercial for Zoloft on TV, you’ll be hearing the line about serotonin deficiencies and chemical imbalances, even though we don’t really have the data to back it up.

It becomes a very useful marketing line for drug companies, and then it becomes a reasonable thing for us to say to patients to give them more confidence in the treatment that they’re getting from us. But it may not be true.

DAVIES: Right. Well, I certainly want to talk a lot more about what drug companies do to market their products, but, you know, help us understand the distinction between the kind of scientific knowledge we have about the brain and its reaction to psychological medications, as opposed to, you know, treatments for cardiac disorders or vascular disease.

Dr. CARLAT: Sure. And – so for example, I’ll take the example of a medication like Zoloft, which is in the class of SSRI, which is specific serotonin reuptake inhibitor.

And as the name implies, what we think these medications do is they prevent the neurons of the brain from sort of vacuuming up the excess chemicals and neurotransmitters that the neurons generate so that if the depression or anxiety disorder is due to a deficiency of a chemical, a reuptake inhibitor would act by pumping out or allowing the neuron to pump out more neurotransmitter, thereby famously balancing the chemicals.

And the problem is that we don’t have any direct evidence that depression or anxiety or any psychiatric disorder is actually due to a deficiency in serotonin because it’s very hard to actually measure serotonin from a living brain.

And any efforts that have been made to measure serotonin indirectly, such as measuring it in the spinal fluid or doing postmortem studies, have been inconclusive. They have not shown conclusively that there is either too little or too much serotonin in the fluids. So that’s where we are with psychiatry.

And then your other question was: How does that differ from some of the other medical fields? Well, for example, in cardiology we have a good understanding of how the heart pumps, what electrical signals generate activity in the heart.

And due to that understanding, we can then target specific cardiac medications to treat problems like heart failure or heart attacks, again based on a pretty well-worked-out knowledge of the pathophysiology – not perfect, but pretty well worked out.

DAVIES: Whereas – to draw an analogy to psychiatry, it might be like saying, well, if nitroglycerin eases your chest pains, then we conclude that your heart problem is a deficiency of nitroglycerin.

Dr. CARLAT: Exactly, or if we find that opiate medications treat pain in general, we might conclude that pain is a opiate or narcotic-deficiency illness, whereas in fact we know that pain is not an opiate-deficiency illness. It’s a symptom that can be caused by many, many different pathologies throughout the body.”

The Critique from Drs. Lacasse and Leo

Drs. Lacasse and Leo challenged some of the statements Dr. Carlat made in this interview, and pointed out:

“So Carlat is aware of the clinical trials, which essentially refute the serotonin theory, yet still tells patients that they have a serotonin imbalance.”

and

“The simple alternative would be to tell patients the truth—that the pathophysiology of depression is unknown and that we have no idea how SSRIs work.”

In the NPR interview, it is clear – or at least is seems clear to me – that Dr. Carlat admitted that he routinely deceives his clients on these issues, and in that regard, the assessment and suggestion put forward by Drs. Lacasse and Leo seem correct and appropriate.

Carlat’s Response

But in his response in the Winter issue of the Behavior Therapist, Dr. Carlat denies any deception on his part.  Here’s a quote from his letter:

“In one section of the article, they accuse me of making deceptive statements to my patients about how antidepressants work. I deny this accusation. In talking to patients  I simplify neurobiological concepts, using a shorthand to describe, in a simplistic way, some common theories of mental illness. I do this to enhance the placebo effect—which accounts for a significant portion of the overall effectiveness of antidepressants.  Two of the most crucial components of the placebo effect are fostering positive expectations of success and reinforcing the medical ritual of pill-taking (Kaptchuk et al., 2010; Leuchter, 2014). In order to augment my patients’ response to antidepressants, I will say something like, ‘This is a very effective medication, you should take this pill every morning, and you will begin to feel better within a couple of weeks.’ If a patient asks me how the medication works, I will respond with, ‘We’re not completely sure, but it has something to do with increasing levels of neurotransmitters like serotonin or norepinephrine—basically, these pills rebalance certain chemicals in the brain.’

There is nothing deceptive about such statements. While we don’t understand exactly what serotonin’s role is, we have some educated hypotheses. A recent review of serotonin and depression identifies 14 known serotonin receptor subtypes. When antidepressants bind to these receptors, a variety of chemical processes unfold, affecting levels of dopamine, norepinephrine, acetylcholine, cortisol—and yes, serotonin. While it isn’t clear exactly how these chemical cascades alleviate depression or anxiety, it is clear that effective antidepressants exert their actions via shifts in the brain’s biochemical milieu—and that serotonin is one of the central players in the drama (Kohler et al., 2015).

The authors, unfortunately, do not seem to be interested in scientific evidence.  In their role as the serotonin thought police, they brook no uncertainty: the serotonin theory is discredited, full stop.”

Counter-Response from Drs. Lacasse and Leo

In their response, Drs. Lacasse and Leo pointed out very clearly that in the NPR interview, Dr. Carlat had admitted that he deceived his clients:

“…we don’t believe we’re alone in thinking it’s objectionable to tell patients something you don’t believe yourself.”

Drs. Lacasse and Leo also cited a passage in Dr. Carlat’s book Unhinged where he made similar admissions.  They then concluded their response to Dr. Carlat with a  paragraph that ought to be carved in stone and displayed prominently in every psychiatric training center in the world:

“We don’t think scientific truth is so flexible, and disagree with shaping it for purposes convenient to the prescriber (e.g., to get patients to take medication, or to reassure the patient of the prescriber’s expert knowledge). Dr. Carlat also writes that he boosts the placebo effect by telling patients that SSRIs are ‘a very effective medication’ (Carlat, 2015; this issue, p. 262). Fournier et al. (2010) demonstrated a Number-Needed-to-Treat (NNT) of 11 for severely depressed patients. In other words, when prescribing to 11 severely depressed patients, a prescriber would expect 1 to have an impressive short-term response as compared to placebo. Given the existence of such data, we question the accuracy of claiming that antidepressants are ‘very effective’ (see also Weitz et al., 2015).”

And to which I would add the following observations:

  1. It is clear that, at least in Dr. Carlat’s practice, the chemical imbalance hoax is still alive and well.
  2. Deceiving clients “to enhance the placebo effect” betrays an extraordinary level of condescension, and a fundamental misunderstanding of how best to help people who are experiencing problems of thinking, feeling, and/or behaving.
  3. In the absence of evidence of efficacy, “fostering positive expectations of success” is a sham, essentially similar to the kind of hype used by traveling snake-oil peddlers in the late 1800’s.
  4. “Reinforcing the medical ritual of pill-taking” is a euphemism for drug-pushing.
  5. The notion that antidepressants “rebalance certain chemicals in the brain” is a hoax. It is just as likely  – in fact, arguably more likely – that these drugs disrupt the normal chemical functions in the brain.  Cocaine is a serotonin reuptake inhibitor (SRI), but I have never heard claims that it rebalances brain chemicals.  In fact, in most contexts, such a claim would be considered ridiculous.
  6. Dr. Carlat’s characterization of Drs. Lacasse and Leo as “the serotonin thought police” is just one more example of entrenched psychiatry’s marginalization of its critics. They can’t gainsay our arguments, so they resort to personal attacks.  In addition, there is an enormous irony in a psychiatrist using the epithet “thought police” to express censure, when it is psychiatry itself that routinely incarcerates and forcibly drugs and shocks people on the grounds that their thoughts and speech don’t conform to psychiatry’s standards of normality.

***

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.

23 COMMENTS

  1. I can possibly see telling a patient that taking an innocuous sugar pill will help them in order to make use of the placebo effect. Possibly. I’m really not sure. But antidepressants are not benign. So it is malpractice (or should be malpractice) to deceive a patient by telling them that an antidepressant will be effective when its side effects include sexual dysfunction, insomnia, weight gain, suicidal ideation, and who knows what else. Does the good doctor inform his patients that trying to get off the drug if they do have adverse effects could be problematic? The arrogance of Dr. Carlat’s position is stunning.

    • “They can’t gainsay our arguments, so they resort to personal attacks.” Basically, just like children do right, Philip? And that largely describes my dealings with psychiatric practitioners, in general, they behave like children. They call people names, then bullying and lie to people, to get them to take drugs, while hypocritically claiming to be doctors who “know everything about the meds.”

      My psychologist, according to her medical records, ran off to child abusers, got a list of lies and gossip from them, including gossip that had originated with 6 year old children. Then she took this list of lies and gossip, utilized it to delude, and defame me to, my husband. Then she deluded psychiatrists with the lies and gossip, too.

      In the end, once my family’s medical records were finally handed over by some decent and disgusted nurses in my PCP’s office. I confronted my psychiatrist with all the misinformation in his medical records, and informed him that the medical evidence of the child abuse had been handed over. He declared my entire life a “credible fictional story.” Really? Was I supposed to believe that? He wanted to drug my child, who’d largely healed by that point. He tried to convince my husband I needed to be re-tranquilized. As we walked out, he tried to get me to sign a sheet of clear stickers that stated, “I declare this is true” on them.

      I’ve never met more insecure, immature, disingenuous, deceitful, disrespectful, delusional, and insanely childish people in my entire life as those working within today’s psychiatric field. “The arrogance of Dr. Carlat’s position is stunning.” Seems like typical childish, psychiatric “professional” behavior to me.

      Thanks as always for speaking the truth, Philip. And let’s hope the psychiatrists grow up some day, and learn everything is not just about them and their, and their friends’, pocketbooks. We all need to work together to bring about a better society. But today’s psychiatrists seem to want to halt all progress within humanity, because currently they’ve been given too much power, by our current run amok government, and it’s fiscally irresponsible banking masters, and the evil “corporations that have grown up around them,” like big Pharma.

    • Hello Dr. Hickey ,
      Long time no hear lol , anyways have been going to my weekly Syracuse hutchings appointments and sorry to see Dr Sunny to have left our Mad in America talks !Last time I was on here I was censored for being politically incorrect , so I quess I will have to mind my placebos versus my SSRIS ! Anyways I also have post concussive syndrome from 8 years of middle school to high school to one year of college before I decided , not the local doctor who was god , told me to stop .Funny because now my university is losing quarterbacks to concussions quicker than they can recruit them .Anyway it is way to late for me , I had atleast 4 or 5 concussions a game , playing tailback for tailback u is a 35 plus a game carring the ball plus playing defense and punt and kickoff return , well at 170 lbs versus 230 to 250lbs , that kinda makes you a little punch-drunk .But all the kings doctors and all the kings boosters put humpty dumpty back together again , yea sure they did ! and they call these people DOCTORS…PROFFESSORS…ADMINATRATORS….BUSINESS LEADERS…SPORTS WRITERS …THE LEADERS OF THE SOCIETY .But in essence they are just living there roman gladiator lives thru the players , who aren’t smart enough or old enough or believe there elders would do such harm to them ! But when the establishment sees there golden goose being fleeced , they will do just about anything to keep there standings ! Whether it be for money , excitement , fantasy or just plain kicks …they will argue its for the young adults best .Yes men work better in business situations because they play sports , sure they learn self abuse , cheating , drugs , lying and whos the big shot .well that’s how life works , as my billionaire boss in florida said , if you take abuse ,,you either have to , or you would move on , cost of doing business , or you like it ! Easy for him to say as he was the one dishing it out .Same year I was at a south Beach Bar , Pearl/Niki Beach , and a Miami Football Player named Junior Seau came by , he and I had a couple of heated words over something stupid , then we started bonding over booze , women , and football .Well we went out to the beach , much quieter there and he started talking to me like I was his priest or something .He said he felt down , didn’t feel like playing football was fun anymore and he wasn’t playing up to his All-pro self .He had MOODS , even felt like suicide some days !Well I said I had that feeling years ago and that’s why I stopped , of course I never played pros , let alone made all-pro , but I understood .We chatted a bit and then he went upstairs to his Miami players , and I though ..god ..if he isn’t making it ..with millions , family , doctors , famous , people etc ..I quess I shouldn’t worry so much ! Funny thing …Will Smith was there , the guy that plays in the new NFL concussion movie , I don’t wanna see it because I now they had to politicalize it , the real truth who be to end it or start wearing leather helmets again .Anyway as most of you know he really tried killing himself twice , once he ran his SUV of the road on a hill , didn’t work , then he shot himself in the heart , so his brain could be examined ..and yes he did have the disease , as probably half do .Now I get to the article at hand with my background of having meningitis and almost dying , but nobody knows why , hepatitis from a football related blood transfusion , diabitis form being over weight from depression and lack of sleep , I sleep every third day no matter what , colitis , arthritis , leg pain , back pain …migranes and I take 20 some pills a day which is now shutting down my kidneys ..and you know what ..I have made my peace ..dying doent scare me anymore ..it is just how I go that scares me , and in that I have to be my own doctor .You ask why , well here goes just one incidence , I had just moved to Miami after my younger wife of 12 years had gone thru a 6 year TBI injury from a car accident , so I was already up on nuerology and drugs and phsych as she had , a young model with a masters , tried in the second year of recovery to kill herself , ironically I ended up in the same clinic 12 years later , if would of thought it ! Well she had gotten used to pain killers , and when we left Syracuse after a terrible legal and medical ordeal , she got hooked I quess on recreational opiates , she just couldn’t resist after 6 plus years on scrips , but my story is she went manic , all week all the time parties , Miami is a bad town for after parties and drugs , and I lost her , I had become an alcoholic to deal with the men , drug dealers , cops her etc and when we went on a 21 day carnival cruise for a second honeymoon and to get her out of the clubs , well she was just setting me up for a divorce .and when we got off the boat ,I soon found out I was excess baggage , the years of marriage and all we went thru she said led her to leave , she didn’t want to remember the accident the pain the lost 20s .Sorry she said , but just because you saved my life doesn’t mean I have to be with you for ever in return .So I drank 2 bottles of jack daniels with her friend next door at the house , and we talked about me talking her diet pills and ending it all .Well I did , I took 50 barbs and went nuts , the cops came and I was flying and they arrested me and put me in the squad car , then I said good because by the time I get to jail ill be dead , and they thought I was just drunk , hell my heart was racing so quick I could feel it coming out of my chest !then my wife came home , I fiqure the neighbor must have called her after he called the police to score points with her , she all pissed off , she hates scenes , but goes into the house and sees all her bottles empty and comes out and says if hesays he took pills I believe him , you better call the EMT .So they do , and the EMT comes , and they say I have like minutes to live , and the cops still wont uncuff me , I am kinda of laughing because I had it in with this on maimi-dade cop om the take 3 months before this and he just wanted to throw me in jail , well the EMT, give me anti whatever and iv and oxygen etc and rush me off to the hospital ! I wash there for 2 weeks until my heart stopped going so weird .But my wife already had divorce papers and wiped me out financially and had her new husband , a famous relative of a wealthy family picked out and I was totally depressed and manic like Sylvia plathe in the Bell Jar .It was the final straw in my physcy that put me in final unbreakable depression .I had stood up in the past with at 20 a dead father dying in my arms from a heartattack in the doctors office and having the doctor wisk me out because I was disturbing his nurses work .My aunt burning up in front of me at 6 years old while babysitting me and lighting herself on fire instead of the grill .chased by killers at 8 .almost drowned as a child and the multiple operations and the depression from football concussions I didn’t even know at the time I had , just that I didn’t remember things in school as well and was sick with a headache , I was 5th in a class over 600 in highschool and made varsity sports as atrue freshman !
      Now we get to drugs and depression , well after I got out of the hospital I was incredible mentally sick , I was sent to a Miami doctor who put me on a quick high dose of lithium and said straighten out your wife going to clean your clock ..this just upset me more and I took the lithium like I was supposed to , by the second day iwas not only suicidal but homicidal , I never , ever was one to hurt another person or think of really hurting someone else .I found myself loading a shotgun a had and never used and was going out to shoot all the drug lords that got my wife into it .I laoded the gun then ..I wave of ..call it childhood catholism came over me , I flushed all the pills down the toilet , rushed into my truck and speed down us1 to keywest .just hauling ass to the end of the world . So what did this doctor do , almost turn me into a columbine murderer , just like that , if it wasn’t for mystrong upbringing everthing in me was saying kill ..get even . later that year aread about a young boy the same doctor prescribed the same thing on the first visit and he committed suicide , but the doctor strongly argued that he had saved many more then he had lost , and he was suicidal to begin with , how do you prove a negative , he killed himself because he was suicidal , I saved them because they didn’t kill themselves .During my crazy sick years , I drank to self medicate , over ate , gambled , played the field like never before and generally didn’t sleep much ..I never did any of these activities before , I found out latter that ambein cause all these symptoms amd my Miami behavioral doctors probably knew it , they where one of the largest hospitals in us .anyways I lost everything and gained 80lbs .None of the pills worked , the zolofts , paxils ,Lexapro , antavan ,wellbutrin ,and 10 other crap …I always said if you have to wait 2 to 3 months for a pill to work , if you had a headache or a toothache would you wait 2 to 3 months for it to work ? and whenit didn’t it they would say things like don’t you feel a little better or youarent tring hard enough , just like when they used to tell you to take steroids to gain weight ..what bs ,just agree to make them feel better not you !So know I talked to that clinic in Chicago , the one that puts the funny metal hat on you and turns on the magnets and gives you special K or Ketamine .funny my friend died of a overdose from it , it was a real favorite rave drug in some of the miaimi clubs , I quess those guys cant begoing to jail anymore , they should just get there PHD for curing all those unhappy teenagers and making them into allnight dance parties , what was it the 50s lobotomies , the 70s lithium , the 80s SSRIS , the 90s your guess with shock therapy.
      When are these doctors going to stop going onlong with the drug companies in off brand use , who are they kidding ,killing unborn babies ,gambling loses ,suicidal effects in what 20% of ussers .They actually make there patients feel bad , they say you got to feel better , I am treating you aren’t I , which only causes more depression and frustration .Nobody really wants to her your suicidal .its like cancer used to be , or hiv , or a bad knee on a football team , your the person to avoid at all costs , and the only people who will listen are the ones as bad as you , and when you put two whatevers together , alcoholics , druggies , gamblers , sex addicts ,you just multiply the effect , so when your mentally depressed and you don’t have a somewhat normal person to lean on ..you better pray a lot even if you relly don’t believe , as my Miami doctor used to ask me in the unit , is so and so found god yet , because if he hasn’t we better medicate him some more …god seems to be the biggest placebo of all !
      Well we will see who actually reads this third day no sleep rant lol

  2. Thanks Dr. Hickey for another enlightening article showing us what psychiatrists are really like. Please don’t compare them to snake oil salesman, however. Snake oil salesmen have been unfairly maligned by the pharmaceutical industry. Snake oil is a very nutritional substance much like fish oil. Pharmaceutical companies have demonized it because it is cheap and they can’t get a patent on it.

  3. Thanks Philip for another well thought out informative article . It should be clear by now that when talking to psychiatrists their underlings and big-pharma reps and executives one must expect to hear words coming out of both sides of their forked tongued mouths at the same time .
    Although our government and others insist on monitoring and thoroughly inspecting nuclear weapons programs of certain countries it’s a huge mistake that the same level of scrutiny is not especially applied to Psychiatry and Big -Pharma . I guess it would be like asking the Therapeutic State to oversee itself instead of totally running amuck with abandon while abandoning the wellbeing of the people.

  4. This is a shocking deception by Carlat. He admitted straight up: “I am deceiving my clients about the efficacy of the drugs I give them.”

    Then after critics call him out, he says, “I deny that I deceived my clients.” But it’s hard to deny what you said when you admitted it previously in a recorded interview…

    It would be funny except for the fact that it’s unethical and potentially harmful.

    Here’s hoping Carlat gets sued by former clients who read this statement and pursue him in court for intentionally misleading them about the efficacy of the drugs. In no real field of medicine would this type of deception be permitted as liberally as it occurs in psychiatry. Psychiatry at this point is so full of lies and deceptions about everything, especially its foundations of illusory diagnoses and “medications” (i.e. central nervous system tranquilizers), that it’s become routine. I imagine it’s hard as a psychiatrist to even know if what you’re saying about diagnoses and drugs has any validity or not anymore.

    In their identity-forming activities of labeling clients with “diagnoses” and prescribing “medications” that barely do anything outside of a placebo effect, psychiatrists have become in essence pathological liars: They routinely mislead patients with unscientific garbage that causes real harm. It’s time for more Americans to stand up and say this:

    https://www.youtube.com/watch?v=76k95Je3daw

    Dr. Carlat: We’re Not Gonna Take It!

  5. It really does seem to me DrHickey that at the point where the defense of the “noble lie” is destroyed (ie that it is not a noble lie because one party suffers harm) these liars rely on the broken record technique as a final self delusion.

    Dulce et decorum est, pro patria mori?

    It certainly seems destined to become another Old lie.

    keep knockin em down Doc 🙂

  6. Dr. Hickey:

    First they ignore you, then they laugh at you, then they fight you, then you win.

    Mahatma Gandhi

    May those who have died from psychiatric harm or neglect, and their survivors, rest in peace. May those who are living with side effects from years of over medication, brain damage from ECT, or the psychological trauma of isolation, restraint, forced medication, and institutionalization experience complete healing and peace of mind. May those who courageously fight for justice in the mental health system realize their dream of a society in which people experiencing mental and emotional challenges are able to receive compassionate support in a dignified, truthful, and transparent manner and plot their own treatment course from a wide array of effective treatment options that ‘first do no harm.’

  7. The entire population could hopefully be educated to “first do no harm ” . Then when some of them come to have extraordinary power over others “first do no harm ” would hopefully be their guiding principal . See the enlightening film “Experimenter” on Netflix for some surprising insights .

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