I have over four decades of experience in psychiatry, most of it at the rough end of the scale, including prisons, military, isolated areas, minorities and post-traumatic states. I have also published extensively in the area of the application of the philosophy of science to psychiatry. This is a rather strange combination as philosophy is usually considered very erudite, quite the opposite of scrabbling around in the dirt and mud of Northern Australia, but it’s actually very important. It concerns the question of whether a topic is or is not science — essentially, how much credibility it should be given. Because that’s what science is about, credibility. So the question becomes: how much credibility should we give modern, mainstream psychiatry?
You will be aware that there are people who claim that there is no such thing as mental disorder; that anybody who claims to be mentally troubled is simply making it up. I don’t believe that. When people say they are in such terrible mental distress that they don’t believe they can go on, I believe them. Nobody, for example, willingly gives up a successful military career to become a lonely and miserable pensioner. Now mainstream psychiatry also claims that mental disorder is a reality, and all that counts is the nature and origin of that disorder. For modern, orthodox psychiatry, the answer is very clear: all mental disorder is just a variant of a brain disorder of some sort.
Specifically, mental disorder is a biological disturbance of brain function, presumed to be at the level of neurotransmitters and caused by genetic disorders. Thus, the treatment of all mental disorder, as a physical disorder of the brain, is necessarily physical in nature: chemicals to correct a chemical imbalance, you could say, or if that fails, electrical currents to induce seizures, implanted electrodes, powerful magnetic fields, hyperthermia and, in the extreme, neurosurgery to disconnect parts of the brain.
This is the standard view of psychiatry as it is taught in all medical schools in the world and adopted by all major professional psychiatric bodies throughout the world. Mental disorder, they say, is biology, and the correct approach to understanding all mental disturbance is via a detailed understanding of brain function. A full understanding of the brain will tell us all we need to know about mental disorder with no questions left unanswered. Practically the whole of the psychiatric research budget of something like $2.5 billion a year is directed at this end.
You can see this message a dozen times a day on TV, spread far and wide on the internet, in every newspaper and women’s magazine, even on posters in public toilets. This is true: you can stand at the urinals in Sydney Airport and be told that if you’re depressed, you should see your doctor. The subliminal message, of course, is that you will get drugs. Critics of this view don’t get much airtime these days. Mainstream psychiatry is very effective at shutting down alternate points of view, mainly because it claims to represent the “science of mental disorder.” All other explanations, they say, are not scientific and therefore shouldn’t be heard.
Essentially, biological psychiatrists deal with all criticism with a resounding blast of “We’ve got the science. Our view is supported by a wealth of scientific detail. Due to rapid advances in modern technology, we are on the verge of major breakthroughs in the diagnosis and treatment of mental disorder. We know what we’re talking about so don’t listen to anybody else, just line up and take your tablets.”
However, because it is such an important question, because people’s lives depend on this and psychiatry has a record of getting it seriously wrong, we need to be sure we can trust their claim. In practice, is it true that biological psychiatry has the science? Let’s look at some figures.
At present, 10% of the Australian adult population takes antidepressants. In the US, it is 13%. In the UK, the number of prescriptions of antidepressants doubled between 2005 and 2015, from 30 to 60 million. Yet 30 years ago, well within my career in psychiatry, that figure was about 1%. Are we any better off? Despite massive increases in the prescription of psychiatric drugs, there is no evidence to suggest it is effective. There is ample evidence to indicate the problem is actually getting worse.
In 1974, when I started psychiatry, the incidence of what was then called manic-depressive psychosis was 0.1-0.2% of population, meaning 1-2 per thousand. In 1980, with the advent of DSMIII, the name was changed to bipolar disorder and the diagnostic criteria were substantially loosened. In 1984, Nancy Andreassen, later editor of the American Journal of Psychiatry, said it was 1% of the population. In 2005, Lewis Judd, former president of the American Psychiatric Association said it was 5.4%. In 2008, Phillip Mitchell of Sydney University said it was about 11%. That is, the rate of diagnosis of this allegedly genetic disease increased 110 times, or 11,000%, in just one generation. That is not genetic diseases as I understand them.
In some parts of the world, up to 40% of boys are taking stimulants for a disease called ADHD which didn’t exist when I began psychiatry. This so-called epidemic has only ever been reversed in Western Australia, just by making it more difficult for psychiatrists to write prescriptions for stimulants. One psychiatrist in Perth started 2000 people on the drugs in 20 months. Miraculously, by forcing psychiatrists and pediatricians to spend an extra five minutes getting an authorisation to start the drugs, suddenly, all these young people didn’t have the “disease” after all. It is now clear that something like half the prescribed drugs were leaking onto the black market, and a very high proportion of people started on them legitimately became addicted in adulthood.
Psychiatric drugs are held to be effective, safe, cost-effective and non-addictive. As a matter of empirical fact, nothing could be further from truth.
Are they effective? Psychiatric drugs are only marginally more effective than placebos, sugar pills. Over seven years, it has been shown that people with the diagnosis of schizophrenia do better without drugs.
Are they safe? They are most definitely not safe. In Australia, people taking psychotropic drugs in the long term die on average 19 years younger than undrugged controls. In the US, that figure is 25 years, mainly because they use larger doses and mix drugs more than we do. The drugs cause massive obesity and all its complications, but drug companies do everything they can to suppress this information. If people are given a list of the side effects of antidepressants, my experience is that they won’t take them.
Are they cost-effective? They most certainly are not — this is wholly a marketing ploy, but from the point of view of the drug companies, it is brilliantly successful. As prescription rates rise, so too do rates of pensions for psychiatric disorders. So-called second generation antipsychotic drugs are ridiculously expensive, sometimes costing hundreds per month when much cheaper alternatives are available.
Are they non-addictive? This is absolutely false, but mainstream psychiatrists believe it as an axiom of practice. By any definition of addiction, psychiatric drugs are among the most addictive chemicals known. Withdrawal symptoms are severe and can last two years. However, for the manufacturers, this is a godsend. Every time anybody tries to get off the drugs, he becomes disabled by symptoms. He will be told “Aha, that’s your mental illness coming back again, you need to stay on drugs for life.” So now you see why the consumption of psychiatric drugs doubles every ten years: nobody can get off them. Once you start, you’re hooked for life. But remember that the drugs were never tested for long term use. Practically all the trials that are used to test them are short term, very often six to eight weeks. I routinely see people who have been taking them 25-30 years. Massive weight gain of 30, 40 or 50 kg is inevitable for anybody taking these drugs more than two years but after two years, you’re addicted.
Let’s look at the science behind ECT, or electroshock treatment. In 40 years, practising psychiatry in the roughest and toughest parts of the country, most of it entirely alone, I have never used it. However, the Position Statement on ECT issued by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) says it is “a valuable and essential form of treatment” which should not be withheld. The facts are quite clear. The state of Victoria uses as much ECT as the entire British National Health Service. In Queensland, from 2014 to 2015, use of ECT jumped from 16000 to 19000 episodes. Japan and Italy, of course, hardly use it. The two times I was appointed head of psychiatric units, it was used before I arrived. It was not used while I was in charge but as soon as I left, it started again. In both cases, during my tenure, the admission rate dropped, the duration of stay dropped and the bed occupancy rate in the units halved. In one hospital, we were able to close a ward. So the facts are crystal clear: ECT is most emphatically not essential. It is an option, and an expensive option at that.
The rates of involuntary treatment and incarceration vary dramatically from state to state, Qld being among the worst in Australia. Mental health acts are acts for incarceration, not treatment. In the Kimberley Health Region of Western Australia, I had no authority to detain people but just by being there, I was able to reduce the numbers of people sent south to the mental hospitals by 96%. There is absolutely no reason to believe that having quasi-judicial hearings before tribunals to determine involuntary treatment has led to any change or improvement, or anything except dramatic deterioration in efficiency, endless delays, and massive additional costs. The Qld Mental Health Review Tribunal costs about $11 million a year, not including all the time people spend sitting around while it deliberates. It achieves nothing except to spread responsibility around the bureaucracy until patients feel they are caught in a legalistic limbo. Many patients, if not most, don’t bother attending their hearings because they know the outcome in advance. The money would be better spent on public housing.
The costs of biological psychiatry are completely out of control. There is a government mental health clinic in the working class suburb where I work in my practice. Anybody referred there will face a 4-6 week delay in getting an appointment and a great deal of inconvenience. Patients mostly seen by nurses, psychologists or junior medical officers. Using Qld MHS figures, it costs $275 per half hour consultation. In my practice, which is 400m down along the road, new referrals face a 2-4 day delay but are sometimes seen on the same day. A half hour consultation with a very experienced psychiatrist costs a grand total of $73.50. That is, the public system takes 10-25 times as long to get a quarter of the service at four times the cost. But if they see me, it is extremely unlikely they will get any drugs. I prescribe antidepressants for no more than about 2% of my new referrals, yet I know my working class, public patients have exactly the same demographic profile as the public clinic along the road.
Is biological psychiatry cutting edge science? At the security units 2 km from my office, patients are admitted for many years at a cost of $4-6 million but routine search of their files reveals no history, no plan, no nothing. Certainly, they have no hope. There have been patients on that site for 150 years — it was once the biggest mental hospital in the country, with 2500 inmates, but there are no occupational therapy facilities. Patients simply lie on chairs under the trees or pace up and down. All of these figures have been handed to chief psychiatrist of Qld and to the Qld Mental Health Commissioner but they were totally ignored.
Finally, I recently had a contract with a government department to provide care for their “customers.” The average costs among other psychiatrists seeing their patients was about $5-10000 per patient, although this is a guess based on other reports because the actual figures are a closely guarded secret. Over two years, my costs for 311 patients amounted to $1012 per patient, or 80-90% cheaper. However, my contract was abruptly terminated with no audit of any sort, no warning and certainly no thanks, apparently because I didn’t admit them to private hospitals. I had cost the private hospitals in that city anything up to $3 million over two years and they didn’t like it. But if treated properly, there is little or no need to admit people to private mental hospitals. We could close almost all private hospitals in the country and the standard of mental health would go up.
So let’s go back to the claim that modern mainstream psychiatry is a valid scientific field. I deny this. I have argued at great length that orthodox psychiatry breaches all standards of what constitutes a science. In particular, it fails the essential test of not having a model of its field of study. That is correct. In an extensive survey of eleven years of the 13 major English-language psychiatric journals, I looked at something like 18,000 original papers, reviews, editorials and the like, covering some 175,000 pages. Believe me, it wasn’t fun. But it showed that no psychiatrist in the world has ever referred to or provided a justification of the claim that mental disorder is a biological disorder of the brain. Nothing. It doesn’t exist. In this case, absence of proof definitely amounts to proof of absence, because if they had it, they would flaunt it — they would shove it down your throats, maybe even put it on posters in public toilets. Modern psychiatry is not a science of mental disorder, it is an ideology of mental disorder.
When I see medical students or registrars in training (residents), I ask them the following question. “On your first day in psychiatry, your first lecture, when the professor came in and began his lecture, what was the name of the model of mental disorder he said he would be addressing?” Invariably, the answer is something like “He didn’t. He just came in and started talking about genes and neurotransmitters.” That, ladies and gentlemen, is not an education in mental disorder, it is an indoctrination in an ideology of mental disorder.
The psychiatric publishing industry is a story of its own. One of the most important features of any field claiming to be scientific is that criticism of the status quo, of the mainstream theories and ideas, is mandatory. There is no choice in this — if you don’t criticise your field, you have a political party, or a religion, or a football club, anything but a science. Yet orthodox psychiatry is violently allergic to criticism. Some years ago, I surveyed ten years of the Australian and New Zealand Journal of Psychiatry. Of 1184 papers, reviews, editorials and commentaries, only seven could be deemed critical. Four of these were trivial. Of the remaining three, two were by overseas authors and only one by a member of the College. That was my paper, which showed that the widely-revered biopsychosocial model didn’t exist. It was never written. So that amounts to somewhat less than one critical word per member per year, which is hardly in keeping with the spirit of the injunction to criticise your professors. That’s lucky for the professors, because they react very, very badly to criticism.
While we’re on the spurious biopsychosocial model, I should point out that mainstream psychiatry has assiduously ignored my paper showing that it is a fantasy. These days, there are about 150 papers published each year on something that doesn’t exist, which must be some sort of record for self-deception. How the editors manage to excuse themselves we don’t know because they are immune to criticism.
You have heard many references to the DSM system, the Diagnostic and Statistical Manual of the American Psychiatric Association. While this is sometimes described as the “bible” of psychiatry, I should point out that science doesn’t have bibles, only religions do. The current version, DSM-5, hasn’t had quite the impact its authors hoped. I say that this is because it is based on a false model of mental disorder, the notion that there are separate and distinct categories of mental disorder. There is no truth in this — even the APA itself experimented with an alternative model but it became too threatening so they dropped it. When you consider how much money they make from their DSM, you can understand, but I certainly don’t sympathise with their plight.
The DSM is based on the idea that all mental disorders can be mapped to specific “chemical imbalances in the brain.” You will hear this trope all the time but there is no evidence to support it. The only “chemical imbalance” in the brains of mentally-troubled people are caused by the drugs they take because that’s what psychiatric drugs do, that’s their role, that’s their function. Any chemical that doesn’t affect neurotransmission at some level doesn’t have an effect. However, we don’t know what those changes mean except for one thing: those changes cause the addiction. If there are no brain changes, there’s no addiction.
Finally, psychiatrists are now deskilled. Modern psychiatrists have practically no training or practice in taking proper history or in psychotherapy. This is why they have to resort to drugs for everything, because they don’t know what else to do. Anybody who uses ECT is only saying he has reached the limit of his skill set, mostly because he hasn’t taken a proper history. As a living, breathing, functioning human being, the distressed patient is a closed book.
My conclusion is that the widely-trumpeted claim that orthodox psychiatry is justified by science is false.
If you say to a person, “You have a mental disorder,” without yourself having a model of mental disorder, that is not science.
If you say to a person, “You must take these drugs,” knowing they are dangerous and will shorten his life, that is not science.
If you say, “It is essential you have ECT,” knowing full well that other psychiatrists manage identical patients without using it, that is not science.
If you lock people up on the basis of an alleged “chemical imbalance of the brain,” for which there is zero evidence, and then give them drugs that produce unknown chemical imbalances and addiction, that is not science.
If you don’t criticise what you are doing and you actively suppress criticism, that is not science.
If you indoctrinate your students and trainees, and don’t educate them to criticise the status quo, that is a disgrace.
I will no doubt get lots of criticism from other psychiatrists for daring to air these matters in public. I have been told by a president of the RANZCP that it is inappropriate to discuss them in public, that they should only be seen in the College journals. However, he was on safe ground there as he knew his close friend, the editor, never publishes anything critical. But they’ll have to wear the criticism because modern psychiatry is now beyond the point where normal courtesies apply. In plain language, if you have mental problems these days, you live in dangerous times.
So we can go back to my original question, of how much credibility we should give modern, orthodox psychiatry. The question of whether psychiatry has a rational basis is now settled. It doesn’t. But don’t wait for psychiatrists to suddenly develop a conscience and start a process of critical self-examination. After waiting 43 years for the day, I can tell you it won’t happen.
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.
“Specifically, mental disorder is a biological disturbance of brain function, presumed to be at the level of neurotransmitters and caused by genetic disorders. Thus, the treatment of all mental disorder, as a physical disorder of the brain, is necessarily physical in nature: chemicals to correct a chemical imbalance, you could say, or if that fails, electrical currents to induce seizures, implanted electrodes, powerful magnetic fields, hyperthermia and, in the extreme, neurosurgery to disconnect parts of the brain.
This is the standard view of psychiatry as it is taught in all medical schools in the world and adopted by all major professional psychiatric bodies throughout the world.”
And that has to change.
Psychiatry has been torturing, disabling and killing people for centuries. Perhaps the most barbaric practices have been abandonned (shoving icepicks through the eye socket into the brain, insulin shock therapy, pulling teeth and excising vital organs etc etc…) however more victims than ever are targeted, maimed and killed today than ever before in human history. At Children’s Hospital in Vancouver, BC there is now a psychiatric unit for 0-5 years olds and 1 in 4 nursing home residents is given a neuroleptic despite black box warnings (fondly called “the 5 o’clock OUT”). The chemical imbalance theory of mental illness has been repeatedly disproven by research but every day, neurotoxic “medications” are given by psychiatrists to their “patients” without informed consent. There is no hope for a reform of psychiatric practice because the number one agenda of psychiatry is to expand its turf and increase drug sales by any and all means. So the only way forward is through the anti-psychiatry movement, the goal of which should be the complete eradication of psychiatry from the face of the earth.
Agree with everything you have to say about the dangerous pseudo science that is psychiatry, but have a concern with the following statement:
“So the facts are crystal clear: ECT is most emphatically non-essential. It is an option, an expensive one at that.”
An “option”?? When should a lunatic bogus “procedure” that is an electrical lobotomy that causes brain damage (memory loss, cognitive dysfunction, personality changes, despair at lost function leading to suicide) be characterized as an “option”??
It is clear it needs to be banned, now. The “expense” is not the issue. First do no harm is the issue.
Anything less than a total rejection of this barbaric human rights abuse is unacceptable.
I whole heartedly agree with you. First do no harm IS the main issue with psychiatry. No psychotropic drug is safe or effective and “treatment” without informed consent is a human rights violation. The use of electroshock therapy in 2017 is truly barbaric. Patient confidentiality is abused and used as a means of isolating a “patient” from their family, friends and social supports and as a cover for their abusive practices, literally to screen psychiatrists from malpractice suits. Committal and extended leave orders are also human rights violations that have no place in medicine. Psychiatry is really a plague on society that needs to be wiped from the face of the earth.
“You will be aware that there are people who claim that there is no such thing as mental disorder; that anybody who claims to be mentally troubled is simply making it up. I don’t believe that.”
Two terms, not necessarily synonymous, are “mental disorder” and “troubled”–“mentally”, socially, or however one might view “troubled”.
The problem is that psychiatry is a branch of medical science, and, therefore, the presumption is of a physical basis for “mental disorders” (a way of not saying “illness”) or whatever you want to call them. Otherwise, why do psychiatrists have medical degrees? Couldn’t another profession attend to your “troubled” souls with equal or better facility? Psychiatrists are doing an atrocious job, as a rule, anyway, and so much of this atrocious behavior is based upon the view that confused or troubled people suffer from a physical condition requiring the services of a physician.
Real is a relative term. When we say “mental disorder” or “troubled”, are we saying that the person so described has a disease? If we are implying as much, and it is not true, we are being deceptive, lying. We are not dealing with an actual disease. The reason there has been so much iatrogenic damage done in the field of psychiatry is because psychiatrists are presuming they have a physical disease when actually they have no physical disease. Take the case of cancer, an imaginary tumor is not a “real’ tumor, however chemotherapy for an imaginary tumor is certain to harm the patient. It would harm the patient even if the patient had a real tumor, but if the patient had a real tumor, the hope is that the treatment will relieve the patient of that tumor. In psychiatry you have medically trained doctors treating people for diseases that quite literally don’t exist, and through this treatment they’ve created their own epidemic of physician induced injury. Injury that they are calling treatment.
Psychiatrists are well aware that they are physicians. This is one of the reasons why the critical attitude in psychiatry is not predominate. Psychiatrists know where their interests lie, and they don’t see those interests as lying in the self-destruction of their chosen profession. People outside of the field, in particular victims, have much more reason to oppose the profession which presumes that some kind of innate biological inferiority is found in them, and then proceeds to debilitate them through injurious maltreatment.
Liah Greenfeld’s “Mind, Modernity, and Madness” has a very detailed repudiation of the notion that depression, bipolar, and schizophrenia are primarily biological. She constructs a compelling account of the mind and its structure based on meaning and identity to explain these phenomena,
TLDR all of it, but to retain your values, surely resignation is in order…
Or publishing articles like this.
Resignation is often a weak tactic. People are merely politly ignored while those in power carry on.
It feels better actually to practice without an all or nothing mentality.
What I mean is you prescribe medicines at same rate as the stats you showed on your article from the 1980’s.
It’s pretty obvious that medicine helps only a minor percentage and logic shows this is probably when the cause is neurotransmitters. It helps but does not cure.
Using logic it also shows that most of the time the mental health challenge is caused by something else. This could be a separate biological function unrelated to neurotransmitters (central nervous system) or a social factor like mental abuse.
The DSM-5 diagnoses behaviour not diseases and is a behavior control system. https://www.youtube.com/watch?v=10ZVZbm9e7c
I have read almost every article on this website for the last few years, the Zypexa , Risperdal , Paxil crimes. Sane story over and over with all of the drugs, its crooked studies, then market to children and when the lawsuits come cause of the sick and dead people it’s use a little profit to settle the lawsuit and admit no guilt.
PSYCHIATRY WILL NEVER CHANGE TILL THE PEOPLE COMMITTING CRIMES GO TO PRISON.
People from Eli Lilliy and J&J should be in prison for what they did.
“A Small Price to Pay for The Molecule”
To be clear, no Big Pharma executives, who slither around making decisions that harm and even kill people are ever being prosecuted. These fines are occasional, set aside, and a cost of doing business and nothing more. https://shadowproof.com/2013/12/18/over-easy-a-small-price-to-pay-for-the-molecule/
The science in psychiatry comes out of business schools. It is applied not in the development of so-called “diagnoses” and “treatments,” but in the brilliant non-marketing marketing of the profession and the products it sells. First it was sold to the medical profession (doctors and the self-protective associations they shield in) and governments (state and federal). The medical profession and the “authorities” (which operationalize as gun- and Taser-wielding dog-catchers of man) have sold it to the people. Some of us want our money – our personalities, IQs, friends, families, careers, homes and money, that is – back, is all.
and it wouldn’t disappoint me at all if *someone* would finally acknowledge that long-term/permanent damage occurs after withdrawal…not just ‘2 years’.
I am so discouraged, my friends keep trying to ‘fix’ me by recommending this supplement, that mediation technique, to correct my ‘attitude’ (where have I heard *that* before??) and imply that I’m just not trying hard enough. I should be good to go after 39 months of this hell!…I must be ‘exaggerating’ or faking it!
It would be so much easier for me if this PAWS/ID thing was recognized. AND COMPENSATED for!! But there’s the catch, huh?
Resignation is often a weak tactic. People are merely politly ignored while those in power carry on.
Just wondering how much a dissenting shrink would cost tax payers over forty years with that big fat pension n all- how much do u have Niall for your ‘career’? The tie looks cool…
Why do we need more articles asking rhetorical questions? We KNOW there is no legitimate science behind psychiatry, and have known for some time, there’s no purpose in continually parsing the matter. What to do about it would be a more appropriate topic for discussion.
I agree. What is being done? What can be done? How can it be done?
The anti-psychiatry movement is the only way forward. Psychiatry needs to be exposed for what it is, public awareness must be raised and people must learn to protect their children and their elderly parents from victimization. “Mental health awareness campaigns” need to be stopped (and other means of targeting victims). Mental health programs need to be removed from schools, colleges and universities. Psychiatrists should not be considered legitimate authorities on mental health issues. Governments should be lobbied so funding is cut for in-house psychiatry. Psychiatrists should not be viewed as authorities on mental health nor consulted or given any legitimacy. Funds should be re-allocatied to other disciplines like neurology and psychology with a focus on unbiased research as psychiatry’s entire database is illegitimate.
Is it a rhetorical question? The author is a psychiatrist. He seems to think the science is unsound to the strictly biological approach. He has done some things differently. Non-biological approaches present us with another problem. What business do medical doctors have in counseling anybody about anything other than medicine? He has the power to do things differently, but this doesn’t resolve the basic issue of a psychiatrist’s role. “Real sickness”, if that’s what one means by “mental disorder” or “troubled”, is neither “sickness” nor “real”. Seeing it as such has become an excuse to injure people by way of treatment, maltreatment in actual fact.
What business do medical doctors have in counseling anybody about anything other than medicine?
The answer is obviously NO. Science, for starters, needs to be self-skeptical, needs to test and re-test its own assumptions in the search for new knowledge. It also needs to have clear definitions that can be verified by external observer. Neither of these most basic assumptions of science are even vaguely attended to by psychiatry. They invent unverifiable categories based on untestable criteria, and insist on the correctness of their theoretical framework despite any and all evidence to the contrary. Those who challenge them from within are ostracized, those who challenge them from without are ridiculed and attacked. They have no interest in advancing their understanding of the people they are trying to help. They use technology and shiny lights and biochemical smoke and mirrors to obfusticate and distract from the fact that they don’t have the first idea what causes ANY of their spurious “mental illnesses” nor what anyone could do to actually “cure” their “diseases.” It is, in fact, the antithesis of science, with much more in common with a religious practice than a medical one.
Excellent article Niall. Love how you tell it is like it is.
It is probably stated elsewhere – but what model does dr. McLaren have of mental disorders? I’ve read a bit about his biocognitive model, which still appears to base disorders on a biological basis – although it suggest a move to a non-dualist position, which is generally a good thing. But it does not appear to be a coherent framework for talking about ‘mental dis-ease’ and he still points to psychiatrists as the main actors in mental health – but how is this supported?
I’m skeptical if the solution we need is a new and improved bio-model that includes cognition. A problem with the individual-brain-centered view is that it disregards context and culture, and then assumes they can easily be added later on – which is like… studying dead fish in a desert without even a concept of water. I think we need to reconfigure the starting-point in a more radical fashion. Culture, feedback-loops, embodiment and experience seems like important concepts.
I think dr. McLarens point about psychiatry’s extraordinary lack of self-criticism is spot-on.
Nice article Jock – any chance of getting it published in a peer review journal – perhaps one of the English critical psychiatry ones?? I came upon this article of yours whilst out hunting for those elusive outcome statistics for mainstream MH – we have great stats from Seikkula – but I would be nice to be able to compare them with other clinics – it would make his findings more newsworthy. You’ve got some here – but also you need to tie down the figures to location – like when you say $2.5 billion in psychiatric research – where? – this is an international forum – is that 2.5 Oz or international or what?
For a nation first settled by convicts, the psych authorities are sure bound by convention- I know they were regularly after Chris Reading for years (is he still alive?). He frequently had to publish his stuff in the Canadian-published Journal of Orthomolecular Medicine and its predecessor, the Journal of Orthomolecular Psychiatry.
Psychiatry in Queensland, a State of Australia, with around 4.8 million residents called “Queenslanders” is certainly violently allergic to criticism. It is quite a backwards State, with a history of dreadful corruption in its Health System, Government Departments, and Statutory Bodies. Consultant psychiatrists in Queensland really are the bottom of the barrel of the medical profession – they all look after each other and cover-up for each other. The problem is they are handed absolute power under the Mental Health Act 2000, now the new Mental Health Act 2016, and there is no one to monitor their conduct or to report them to who will do anything. They simply detain residents with the flick of a pen and place them under Involuntary Treatment Orders, as a “safety net” – this means that it’s the consultant psychiatrists who are looking after themselves, and looking after Queensland Health, in case anything goes wrong – and it does, every day – it is extra-judicial incarceration. The legal profession stands by and does nothing because the legal profession and psychiatrists are very close, and lawyers require the services of psychiatrists – so no one will ‘rock the boat’. Consultant psychiatrists, psychiatric registrars, psychiatric nurses, and the clinical psychologists and psychologists, and other staff are so incompetent, heavy-handed, poorly trained, and of such low intelligence, that they cannot tell the difference between symptoms caused by physical medical conditions, symptoms caused by withdrawal or allergic reactions to major psychotropic medications, normal human distress and emotions, misdiagnosis, and more serious situations. Medical records take on a life of their own. When this is reported to Queensland Health or the specific Health Service Provider, it is ignored or great lengths are taken to cover it up – complaints processes are dragged out for years. The Office of the Health Ombudsman, under Mr Leon Atkinson-MacEwen is corrupt and will cover-up medical errors – misdiagnosis and adverse reactions to medications, unlawful detainment, abuse and neglect of patients, and when the complaints are transferred to the Queensland Ombudsman under Mr Phil Clarke, they work together to quash the complaints. Successive governments do nothing – for the past few decades there has been a Labor government, except for three years of the Liberal National Party – and while Labor likes to see itself as progressive and dedicated to social issues – it stands by and allows this corruption and abuse to continue – these are human rights violations of the worst type. Mental Health Services is a law unto itself, and allowed to be. To my delight it was recently reported in the media that the Mental Health Review Tribunal was referred to the Crime and Corruption Commission, names were even mentioned – there had been a fake lawyer appointed as a Legal Member to the Tribunal for many years – Anne-Marie Roche, who made thousands of decisions including approvals for ECT, and wrote Statements of Reasons – the questionable response of the Palaszczuk Labor government was to rush through legislation to validate these decisions. There had been another fake lawyer employed as the Legal Officer, while the regular Legal Officer was on leave. The President, Mr Barry Thomas, and the Executive Officer, Mr Robert Troy, had wives appointed as Community Members, so there was a referral for nepotism. The Minister for Health, Cameron Dick MP, will not investigate serious medical errors, and will leave it with the Health Ombudsman and the Queensland Ombudsman. The whole system needs a good clean out – it is nothing more than a cesspool. No one should ever go anywhere near a consultant psychiatrist in Queensland or Mental Health Services.
Great article Jock,
One of the first tenets of pseudoscience is , `hostility to criticism’ so one must assume that if someone is hostile to criticism they are indulging in pseudoscience, and somewhere in their psyche they are aware of it.
However, doctors are doctors are doctors. The long and arduous education process produces a set of beliefs and expressions that is universal and necessary. If you have chest pain and shortness of breath you want someone who can quickly communicate with fellow professionals. Critical thinking is discouraged even if the student has the time to indulge, while concrete thinking is admired. Most of the people who are drawn to medicine have a mindset that embraces rules and things they can see and measure. Also, at the age when most of their peers are talking to each other about how the world, relationships and their place in it works, the medical student is in the library. This is why the treatment of people who are overwhelmed by circumstance does not fit the medical profession. First everyone is different; second, the person in front of you may disagree with you, someone with chest pain won’t do that; third, the need to label the unlabelable will confuse you…etc. But since the doctor has no other terms of reference, has never been encouraged to think outside a very specific box and has a narrow view of the world, he or she will cling to that safe place or risk the pain of cognitive dissonance. And remember, prestige and financial rewards demand certain loyaties as well.
Basically, the medical profession has no place in dealing with emotional states, except to rule out neurological and other physical disturbances. So psychiatry is a non-profession.
But while we rail about the fraud, the pseudoscience of psychiatry our words are rarely if ever seen by the broader public. The mainstream publication feature article after article about this or that new drug, how wonderful the `new’ ECT is, how tragic mental illness can be, the wonder of psychiatric research etc etc etc. But Robert Whitaker’s books are not found in the popular bookshops when Jeff Biederman’s and Allan Frances’ are. Where, other than MIA will you see an article like this, Time Magazine, Washington Post, New York Times, London Times? On TV, too, you will see exposes on prison conditions, orphanages and slums. Occasionally, usually during a `Mental Health Week’ there will be a program about psych wards. The voices will be the psychiatrist, the nurses and a couple of carefully coached patients who aren’t drugged rigid and drooling (they’re hidden behind locked doors), who are so dazed and compliant they look as if they’ve just had ECT. The public nods and says `see, it’s all under control.’ And it is, psychiatry has the ear of government, the press and the people, an MD, DPsych and money will always overcome truth.
Change from the inside? I don’t think so._
“Basically the medical profession has no place in dealing with emotional states, except to rule out neurological and other physical disturbances.” Yes! However, psychiatric consults are made WITHOUT ruling out neurological and other physical disturbances. A neurologist is rarely consulted and the patient is shuffled over to psychiatry, diagnosed and drugged. Psychiatric diagnosis ignore memory loss, cognitive decline and other obvious signs of neurological damage. The focus is not on etiology and the psychiatrist is not trained to diagnose or treat neurological damage. So, yes I agree wholeheartedly “psychiatry is a non-profession”.
Thank you for showing that “Psychiatric drugs are only marginally more effective than placebos, sugar pills. Over seven years, it has been shown that people with the diagnosis of schizophrenia do better without drugs.”
Is it possible to give a rough guess on the damage i. e. long-term effect of antipsychotics on recovery?
Antipsychotic medications are viewed as cornerstones for both the short-term and long-term treatment of schizophrenia. The evidence for symptom reduction will be critically reviewed. Are there benefits in terms of recovery?
Leucht et al has 2009 found (How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials) the effect NNT(Number Need to Treat)=6 for short time treatment (1). However this was looking at 50% or more reduction of symptoms on the Positive and Negative Syndrome Scale (PANSS).
Leucht et al 2012 looks at maintenance treatment with antipsychotic drugs. Between 7 to 12 month are covered. The results published are better but conclude that it is necessary to “clarify the long-term morbidity”.
Bola et al. Cochrane.org 2011 (5) found just 5 studies with real placebo, i. e. RCT (Randomized controlled trial). One of them Rappaport et al 1978 found that umedicated patients managed better, e. g. readmission into hospital. NNH turned out to be 2.9 (NNH= number need to harm).
The Council of Evidence-based Psychiatry exists to communicate evidence of the potentially harmful effects of psychiatric drugs to the people (3).
Nancy Sohler et al. gives 2016 this summary: «For many years, this (…)clinicians’ belief in the need for long-term use of antipsychotic medications strong (Lehmann, 1966) that it has been impossible to design a sound observational study to address the question of efficacy or harm … (O)ur study also could not conclusively evaluate whether long-term antipsychotic medication treatment results in better outcomes on average. We believe the pervasive acceptance of this treatment modality has hindered rigorous scientific inquiry that is necessary to ensure evidence-based psychiatric care is being offered.»
So I understand there are nearly no RCT controlled studies (avoiding «cold turkey» problems) answering my question on recovery.
However is it possible to use other studies to evaluate effects based on other studies and real world results?
WHO Cross-Cultural Studies, 1970s/1980s found (Jablensky, A. 1992, Hopper, K. 2000): 16% of patients in the developing countries were regularly maintained on antipsychotics, versus 61% of the patients in rich countries. 63.7% of the patients in the poor countries were doing fairly well at the end of two years. In contrast, only 36.9% of the patients in the seven developed countries were doing fairly well at the end of two years. In the developing countries, 53% of schizophrenia patients were “never psychotic” anymore, and 73% were employed. In the rich countries, only 37 percent of the patients had good outcomes, and 59 percent had become chronically ill.
Naturalistic studies of e. g. Harrow, M. & Jobe, T.H. (2012), Harrow et al 2014 (11), Wunderink (4,7) and Wils et al 2017 show that patients do better without long-time antipsychotic medication. Harrow, M. & Jobe, T.H. (2017) concludes in “A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia”:
“Negative evidence on the long-term efficacy of antipsychotics have emerged from our own longitudinal studies and the longitudinal studies of Wunderink, of Moilanen, Jääskeläinena and colleagues using data from the Northern Finland Birth Cohort Study, by data from the Danish OPUS trials the study of Lincoln and Jung in Germany, and the studies of Bland in Canada,” (Bland R. C. and Orn H. (1978): 14-year outcome in early schizophrenia; Acta. Psychiatrica Scandinavica 58,327-338) the authors write. “These longitudinal studies have not shown positive effects for patients with schizophrenia prescribed antipsychotic for prolonged periods. In addition to the results indicating the rarity of periods of complete recovery for patients with schizophrenia prescribed antipsychotics for prolonged intervals, our research has indicated a significantly higher rate of periods of recovery for patients with schizophrenia who have gone off antipsychotics for prolonged intervals.”
Jaakko Seikkula et al 2010 (Journal Psychosis Volume 3, 2011 – Issue 3) has reported on long-term outcome of first-episode psychotic patients treated with Open Dialogue Therapy in Western Lapland approx. 80% recovery (6). “Showing the benefit of using not much medication supported by psychosocial care.” 19% were on disability allowance or sick leave with 17% ongoing neuroleptics. Sveberg (2001) reported 62% on disability allowance or sick leave following standard care and 75% ongoing neuroleptics.(11)
The effect of cognitive therapy (8) and psychotherapy (9) is documented.
Bjornestad, Jone et al. 2017 reported “Antipsychotic treatment: experiences of fully recovered service users”: “(b)etween 8,1 and 20% of service users with FEP achieve clinical recovery (Jaaskelainen et al., 2013)” under the profession’s current protocols.
Approx. 60% or so of first-episode patients may recover without the use of antipsychotics (Whitaker 2017).
In order to maintain the narrative of antipsychotis beeing “effective” schizophrenia is falsely declared cronic i. e. drug dependence is preferred over recovery.
Now I know this guess is not exact science, but does it seem that approx. 40% of patients subject to regular medication (e. g. in Norway “National guideline for diagnosis, treatment and follow-up of individuals with psychotic disorders”) loose long-term recovery compared to non-medicated patients?
Would this be a fair guess of the long-term effect of antipsycotics on recovery?
Morrison et al. 2012 (8) concludes «A response rate analysis found that 35% and 50% of participants achieved at least a 50% reduction in PANSS total scores by end of (cognitive) therapy and follow-up respectively» i. e. NNT=2 for «follow-up» with cognitive therapy. Antipsychotic drugs perform NNT=6 according to Leucht et al. 2009. This shows Klingbergs conclusion (9): “In conclusion, psychosis psychotherapy does not have an evidence problem but an implementation problem.”
Patients have a right to know in advance to decide with informed consent the benefit of actual symptom reduction in the beginning at the price of long-term reduction of recovery. Where there is a risk there has to be a choice.
I would appreciate your answer based on your knowledge of studies. Thank you in advance.
Here are the references: http://home.broadpark.no/~wkeim/files/question-recovery.html
Apparently I missed this MiA blog when it came out, wow, great information. Thank you, Niall.