One of the first duties of the physician is to
Educate the masses not to take medicine.
– Sir William Osler
Peter Gøtzsche’s new book, Deadly Psychiatry and Organized Denial brings up an important and complex issue. How do psychiatrists get up in the morning and damage people all day long while pretending to help them? The book is elegantly referenced – and I encourage everyone who practices thoughtful psychiatry to read it, because you need to be much better educated to practice high-quality mental health than you do to act as a dispensing machine. Gøtzsche is absolutely right; on all levels psychiatrists are in denial about the damage that they are doing to patients.
The area of denial most interesting to me is at the level of the practitioner. This is where the rubber meets the road. It is one thing to be high in the academic tower, selling misinformation. It is a totally another thing to be its excretory organ. The statistical analyses showing lack of effectiveness and numerous adverse effects noted in Deadly Psychiatry are not just abstractions; this is obvious to the casual observer, and should be painfully obvious to the psychiatrist.
Even taking cognitive dissonance into consideration, psychiatrists can surely see what is in front of their eyes. I remember years ago when Risperdal – the new miracle antipsychotic came on the market. The first patient I gave it to gained about 60 pounds in just six weeks. I have never seen anything like it before. It was hard to believe that this was the same person. He was a man in his early 20’s. His mother showed up with him at the visit, in tears over how he looked.
I have never prescribed Ritalin or other stimulants for children, but have been asked to give second opinions, particularly in cases in which parents are divorced and one parent wants the medicine and another does not. How can a doctor fail to notice stunted growth that makes a 12-year-old look like a 9-year-old? How can a doctor fail to notice all the tics and twitches?
Early in my career I treated a successful song writer who developed florid mania. Of course, I started him on lithium. He also put on a lot of weight, was mentally slow and he couldn’t write songs anymore. Hard to miss that this guy was a shell of his former self.
Patients complained all the time about sexual dysfunction continuing long after stopping SSRIs. Pharmacists know about this problem. Patients are well aware of this problem.
I recall an attorney who was having mild depression related to financial difficulties. He was given samples of Paxil for a month or two, until I ran out of samples. He was unable to afford the prescription. Three days later he attempted suicide.
One patient of mine in therapy for panic attacks with no depression was convinced by her daughter to get an SSRI from her family doctor. She hung herself from a stairway in her house a few days later.
This is not to say that the medications have no place at all in mental health care, but other psychiatrists have to be looking at the same frequent adverse consequences.
There are limits to cognitive dissonance. There are limits to self-deception. While there are times that medications appear to be very helpful, it is impossible to ignore how often they are damaging. Kirsch’s analogy of the emperor’s new drugs is apt, but doesn’t go far enough. I think the emperor knows he has no clothes on, but is scared to admit it. I think that psychiatrists in private practice lead lives of quiet desperation, torn between what they see and what they do.
I think that the situation is more like the famous Milgram experiments. The Milgram experiment on obedience to authority figures was a series of social psychology experiments conducted by Yale University psychologist Stanley Milgram. They measured the willingness of study participants — mostly young male students from Yale — to obey an authority figure who has instructed them to perform acts conflicting with their personal conscience. The experiment found that a very high proportion of people were prepared to obey — albeit while experiencing emotional distress — even if they thought (mistakenly) that they were causing serious injury and distress to another person.
The authority figures in this case are the bought-off academics, their teachings compounded by the nature of medical school and residency training. When entering medical school, and later starting training, the amount of information to be mastered seems massive. Early on, when the damage is new and most noticeable, it is difficult for a student or trainee to point out the problems with damaging treatments. There is a sense that one needs to study more and gather more information before becoming critical. How can a lowly resident question the work of the next-to-God professors (as Biederman described himself, under oath)? Of course, 7 or 8 years later, the young doctor is so embedded in the system that questioning it is likely seen as a form of professional and financial suicide. So, despite personal conscience, psychiatrists continue to drug people ever-deeper into illness. They are following orders. This is Gøtzsche’s organized denial.
Perhaps the twisted experience of causing visible harm just because you are told to do it explains why so many psychopharmacologists appear eccentric. When I see patients for second opinions about what is usually an unnecessary cocktail of drugs for a diagnosis of bipolar disorder, despite the fact that the patient never had a manic or hypomanic episode, I often ask a Socratic question. I ask them to visualize their psychopharmacologist, and ask themselves whether they would buy a used car from this person. Most patients laugh – and say that they would not. So why trust your life to this person?
William Osler, who founded the residency training program, wrote in the 1800’s that the first duty of the physician is to educate the masses not to take medicine. If I were in charge of the APA this would be my primary directive. I would instruct the members not to use any psychiatric drug for which the original, raw data was unavailable, including unpublished studies, for association review. I would not let the companies pay for the review. The pharmaceutical companies can have their “proprietary” information, but the doctors would not prescribe the drugs to patients without knowing the absolute value of the medications. This would benefit patients and doctors alike.
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.
The pressure to be part of the club is as great among shrinks as for fraternity pledges. Since nobody’s patients ever get any better, it’s easier to presume they’re all miscreants looking for some kind of free ride.
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Beautifully put, Stuart!
I take it this book is not being put out and advertised by a major publishing house. Too bad.
My shrink certainly doesn’t have any awareness he does harm every day. Makes him all the more frightening.
Well put, Dr. Shipko. And I do so hope the psychiatric community changes it’s current ‘bipolar’ drug cocktail recommendations. Currently, they recommend combining the antipsychotics, antidepressants, and benzos. Despite the fact it’s already medically known that combining these drug classes can make a person “mad as a hatter,” via anticholinergic toxidrome.
And the central symptoms of anticholinergic intoxication syndrome look like “the classic symptoms of schizophrenia,” according to my former psychiatrist’s medical records. And in actuality, the only difference between the symptoms of ‘schizophrenia’ and the central symptoms of poly pharmacy induced anticholinergic toxidrome is “inactivity” vs. “hyperactivity.”
I do so hope the psychiatrists stop harming and killing patients soon.
I suspect Dr. Shipko was writing this article when I went to see him last month. While he probably waxes eloquent re: nuances of getting off medication (so there is a need for his expertise), he is incapable of treating a severely depressed person who is already off meds. I sent him an email after seeing him the first time, in the hopes that he might have some ideas. Plan A was getting help. Plan B was Gravitas, in Switzerland. The depression was THAT bad. I thought that, by emailing him just how bad things were (vs. verbalizing them on the spot) he could “prepare” for the appointment, much like we teachers “prepare” lesson plans.
He immediately called me. I should NOT be emailing such info. (He had just told me contact is done via email!) Even threatened to call 911. Not good, when suicide ideations are essentially rebuffed rather than listened to. After all, we know they are too intense for even a good friend. Besides, Gravitas needs an application, a current passport, an airline ticket… none of which I had done. He knew that.
I truly hoped he’d “hear me”. That somewhere in his expertise he’s worked successfully with people like me. That if he saw the downside in medication, he was aware of complementary protocols and could HELP me.
He told me (1) the mental health system was all messed up. (2) that I knew more about resources than he did. And… (3) go to a movie.
I have since found there ARE suicide ideation treatment protocols. Dr. Shipko, you failed to use one when I really needed it. I’m sorry if my deep despair bothered you. I thought that perhaps you were sufficiently knowledgable to handle it. Or at the very least, to refer me to someone who could.
Now I know the truth re: people who reach out when feeling suicidal ideations. There is no safety net. It’s truly a free fall.
Hi goodie, I am sorry you didn’t find good direction in that appointment. I have healed from profound long term depression and PTSD, including suicide attempts, homelessness, drug and alcohol addiction, and huge cocktails of psychiatrist medications, using energy medicine, mind body healing like yoga, guided self healing, tong ren, shamans, reiki, good food choices… many paths and solutions are out there. I only meet with one person who is technically a mental health clinician but he works so far outside the box regular clinicians may not want to claim him! 🙂 because he works in the higher spiritual realms, through the body and with energy medicine. Please know there is a way for you to heal, be open minded and look for direction from others who have walked your path and can recommend things or help you directly. Also listen to your own intuition as to what direction will be good. Whatever attracts you will likely be good for you, so listen to that. And pray for guidance, our thoughts and mind are powerful.
I think Dr. Shipko did hear you. You must have said in your email that you were thinking about suicide. In his clinical wisdom, training, and knowledge of the law, the correct thing to do to save a suicidal patient’s life is to call an ambulance.
He did not ignore you; he phoned you right away. He was within his rights to tell you what kind of information you should not email him. Did he mean that you should call him, or 911, when things are that bad, instead of emailing?
I guess you expected a different reaction to your email. It’s hard to tell. But sometimes an ambulance is in order. I collapsed to the floor in my first and last non-epileptic non-syncope “seizure” when I went to see a new psychiatrist after the first one had trashed my brain. I was mystified. I asked her what it was (my collapse). She said “I’ve seen that before.”
I told Dr. Shipko that short story. He said he would have called an ambulance. If Dr. Airbrain had, I might have been rescued from her ineptitude instead of losing the next 4.5 years of my life and much that I held dear in her “care,” or chemical assault program.
She turned out to be the partner of Dr. Idiot, which neither disclosed to me. He had told me he thought she’d be great, even after I emailed him to say I had arranged to see an MFT/PsyD who’d helped me in the past. I said I didn’t think drugs were suitable for me.
He emailed me soon after, told me he had made an appointment for that very afternoon, and that Dr Airbrain already had his notes. Like a Stockholm-Syndromed sucker, I went to see her. If I had known they were partners (or seems their airbrain-idiotic web site), I would not have.
I hope you made your way through the pain you were experiencing this spring, and found the kind of help that works best for you.
While Dr. Shipko may have been within his legal rights, he failed in knowing how to help a deeply depressed person.
(1) At the very least, at a deeply human level, he needed to be cognizant of how to use empathy or human connections in recognizing the intensely frayed emotions being cautiously and fearfully shown him. He made no attempt at inferring compassion or concern. None. This is at the heart and core of Emotional CPR and other peer-based interactions. Something that inferred he cared and understood/believed me.
(2) At a basic level of being in mental health as a psychiatrist, he – more so than ANY other professional/peer/agency in the entire “mental health industrial complex”… as someone who blogs here about what’s missing in psychiatry… he’s absolutely missing the key ingredient – PEERS. Dr Shipko knew NOTHING about mental health resources. He explicitly told me this when we met. I have since then found a veritable treasure trove of local, regional, national resources. I, as a patient, naively assumed he, as a professional in mental health, knew of them. He knew nothing. In fact, he even told me he knew nothing much about Mad in America.
I’ve found the local leaders in mental health recovery to be deeply insightful of experiences such as these, for they’ve had theirs too. I deeply wish that I had connected with the local peer run agency at the start rather the end.
If he doesn’t think he can help you at least he’s being honest. Why do you hold him responsible for your feelings of despair? Maybe he was looking out for you by telling you not to put personal stuff in an email. Anyway, the best response to an unhelpful shrink is to stay away. Can’t you find a support network?
1- He is a practicing, licensed physician in California. A psychiatrist. He runs a statistical risk (especially when his practice focuses on taking patients off of medication) that he will see patients with suicidal ideation. This, to a psychiatrist, is like something needing immediate attention in an ER. ITS HIS JOB.
2- Google “suicide ideation treatment” and the non-informed layperson can read a wide selection. It’s already there. He wouldn’t have to create one.
3- He WASN’T honest. He didn’t say he couldn’t help me. His “plan” was seeing me in a week.
4- HELLO? And your knowledge regarding suicide ideation is…? Would you believe that “this” (talking about feeling this bad) is something people don’t want to hear? Imagine having breast cancer… yet no one wants to hear about it. http://melissainstitute.org/documents/35_Years_Suicidal_Patients.pdf
Dear Goodie–A few things I think are worth doing when really tormented by suicidal thinking:
1) Try to identify one person in your life you can at least talk to. They don’t have to have answers, or even be able to spend hours discussing it. But ideally they should be able to hang out with you for awhile when you are feeling shaky and/or let you stay on the couch for one night. It can be hard to identify such a person and get up the nerve to ask them for support. A doctor or counselor could help you work it out.
2) I heard one good tip from a woman who had called a suicide hotline: They told her to put together a “first aid kit” of things that reminded her of reasons for living. It could be pictures of people you love, things you’ve accomplished, dreams for the future … This woman kept hers on her smartphone and said it helped her talk herself down several times.
3) The Scarlett O’Hara strategy: “I’ll think about it tomorrow.” In a way I think that’s what you were doing by thinking of an “exit strategy” that would take weeks of work to complete–going to a euthanasia clinic in Europe. I did a similar thing in a period of crisis by deciding I had to insure that I could donate my organs–which ruled out the simplest option of OD’ing on pills at home. It was only years later I realized that had been my way of resisting my own suicidal thoughts.
4) If you can’t yet find a supportive friend, at least look for ways to be in public or not alone. Going to the movies ain’t the best but it might work. So could going out for a cheap dinner, running an errand or just browsing in a bookstore.
One reason healthcare workers call 911: Even if they don’t truly believe you will get effective help, they’re under pressure to protect themselves. If someone contacts them talking suicide and they DON’T call 911, they might be sued or disciplined if the person does take their life. It’s a damn shame that pressure exists, because the Emergency Room experience can end up being more traumatizing than anything else.
Would welcome any comments from practicing “mental health workers” of any stripe!
Some thought was put in to your response, and for that, I thank you.
Perhaps the most important concept that psychiatrists (no matter how pro, or con, re: meds) need to embrace is that psychiatric things inextricably link body/mind; and it’s most likely nearly impossible for any professional to wear the dual hats of overseeing the body’s needs while understanding the deep chasms brought on by the mind itself. So when a patient is “stable”, s/he can independently access friends, acquaintances, hobbies, jobs, etc. And Dr. Shipko helps people reduce amount of antidepressants in a way that hopefully maintains that balance. He tapers them off meds and they remain stable. A Win Win. That’s the kind of work setting we all want (i.e., a calm day as a cop or firefighter, no major traumas in the ER, a typical teaching day, etc.)
But psychiatrists, like cops, firefighters and teachers, in the real world, occasionally are challenged by unfortunate realities, We see what happens when we aren’t prepared. Cops shoot mentally ill. Teachers physically restrain kids. Psychiatrist mishandle problematic patients. No, it doesn’t make the headlines but it’s a big deal to the patient, nonetheless.
My thought as that ‘mishandled’ patient? That ‘we’ develop a sound program so that psychiatrists literally have a brochure with names/contact info for local peer driven groups that are specially trained in connecting with deeply depressed people. Massachusetts RLC has a training program so that peers can communicate with people in these dark places. Perhaps it’s time that local psychiatric associations network with peer groups in order to create brochures that local psychiatrist could literally give to patients as a “supplement”. Dr. Shipko told me I knew more about MH resources than he did. (??? While I know of MIA, etc.) I’ve not “networked” with confidence and assurance… remember, I’m dealing with depression…)
There needs to be open, candid, talk here, between the folks who carry the Power (psychiatrists) with those who carry the Knowledge (us). When I’m wearing my non-suicidal ideation hat, I can see what I’ve accomplished in life. But when I’m wearing that hat… that ideation hat… all bets are off. I suspect that there are many folks who’ve also worn these two hats and gradually one is worn more than the other. AT THOSE TIMES, I truly need to connect with folks who deeply “get” that reality. People who ***know*** how dark (!!!!!) that place gets over time. This just isn’t understood via coursework, no matter how well directed.
Please, all who work in psychiatry… soberly know where your lived experiences end and ours begin. Our experiences have come from both living in your abilities and ours… and living in an experience defies book learning. Perhaps, if you were forced to hold a hot cup of coffee (for the next week) you might understand how a ‘pain’ X ‘time’ = ‘deeper pain’. It’s a nuisance, then a bother, then denial and nuisance, then denial, then deadening, then…
NETWORK WITH US. Find the folks who’ve “been there/done that” re: living with mental ‘illness’. Develop a mutually respectful yet separate relationship. Then, “next time”, when you have a ‘patient like me’ (one whose alleged problems would make Donald Trump look presidential)… just give them the brochure.
Have you ever considered that psychiatrists may simply not the best people to go to for help in circumstances such as yours? Complaining about their being unhelpful doesn’t change much and seems like a waste of time. Building alternative support resources and techniques such as mentioned by Ms. Ryan above seems like a far more productive approach. But if you insist on shrink-shopping, let the buyer beware.
Me thinks you didn’t read what I wrote, old head. Please read it again. I specifically mentioned alternatives. No one is “shrink hopping”. That demeans anyone who lives with a complex ‘anything’. (Just look at what happened to Justine Pelletier and her family when they went to Boston children’s hospital. In essence, the hospital alleged they were guilty of medical child abuse …)
Again, I am saying that while I am sure Dr. Shipko is entirely knowledgable re: getting off meds, patients can and do present more complex pictures. At the very least, the local psychiatric community should forge relationships with the local peer movement and local parent/family movement to create some ‘tool’ regarded as generally useful/a starting point for people seeking support/help. Create a brochure… something… that lists local groups and contact information. Update it periodically. People just don’t know these things thru osmosis.
Fine. We just have much different perspectives. I don’t believe in “psychiatric communities,” I think there are few things I would attempt to avoid more.
Me thinks that that was suspicious.
Applause for your well reasoned and persuasive arguments from this choir member Dr. Shipko. Organized denial indeed. It aught a be illegal to poison people. Oh wait, it is illegal to poison people. I keep getting up in the morning and forgetting that after I was almost poisoned to death- repeatedly- for no reason.
You get my vote for director of the APA.