Thou Shall Not Criticize Our Drugs

Robert Whitaker
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One of the hallmarks of institutional corruption is that an institution will regularly act in ways that promote its own interests, even if that means betraying the principles that are supposed to govern that institution. In the world of medical journals, the public assumes that the journal will seek to publish research articles that report on the safety and efficacy of treatments, regardless of whether the findings support common beliefs and practices. In addition, the public assumes that a journal will publish letters-to-the-editor that, when written by knowledgeable people in the field, raise questions about a recent article the journal has published.

Such are the dictates of science. A medical journal is expected to promote an open-minded discussion of treatments, even if findings—or criticisms—threaten conventional beliefs.

In a blog published on September 21, Peter Gøtzsche detailed a letter that he and I had submitted to World Psychiatry, related to an article on the 10-year outcomes of 281 Norwegian patients following a first episode of psychosis. The death rate in that study was quite high (11%), and we thought the authors should have reported in some detail on those deaths in their published article.

I wasn’t surprised by this rejection of our letter. As a non-academic, I really don’t have standing to write a “letter to the editor” of a medical journal, and although Peter Gøtzsche certainly has such standing, I thought there was little chance our letter would be published. There is a long history of editors of psychiatry journals rejecting articles that challenge the merits of psychiatric drugs in a fundamental way, or only accepting such articles if the damaging results are downplayed or presented in an obscure way. In psychiatry journals, the abstracts are nearly always written in a manner that ensures that the conventional wisdom about psychiatric drugs isn’t unduly threatened.

Now we have a new, powerful example of this institutional corruption at work.

As regular readers of Mad in America know, Donald Goff, Jeffrey Lieberman and others recently published a review of the long-term effects of antipsychotics in the American Journal of Psychiatry. Their conclusion was that while there is no good evidence that antipsychotics worsen long-term outcomes, there is good evidence supporting their long-term use. Joanna Moncrieff wrote a blog for MIA criticizing their study, as did Miriam Larsen-Barr, and I wrote a long “MIA Report” on how their review—given their biased presentation of study findings, their cherry-picking of studies, and their dismissal of evidence that told of long-term harm—served as a case study of institutional corruption. Their review was clearly designed to defend their antipsychotics, as opposed to truly investigating their long-term effects.

Their study also triggered the submission of at least two “letters to the editor” to the American Journal of Psychiatry that were critical of the study, one written by Moncrieff and Stefan Priebe, and the other by Robin Murray and five colleagues. While Moncrieff may be known in the world of psychiatry as a “critical psychiatrist,” which might make the editors of the American Journal of Psychiatry eager to reject her submission, Murray is known as one of the foremost authorities on schizophrenia in the world. As such, it is difficult to imagine how the letter he and his colleagues sent could possibly be rejected by the editors at the American Journal of Psychiatry.

But it was rejected, and so was the letter submitted by Moncrieff and Priebe.

I have to confess, this did surprise me. The rejection of Murray’s letter revealed institutional corruption in such stark fashion: Thou Shall Not Criticize Our Drugs. At least not in the pages of the American Journal of Psychiatry.

The American Journal of Psychiatry is published by the American Psychiatric Association. As the journal’s website states, it is the “official publication” of the association. The website boasts that it is  the most widely read psychiatric journal in the world.

As such, this is the journal that perhaps has the greatest impact on thinking about psychiatric drugs. Yet, if you look up its mission statement, you find that the journal’s purpose is not, in fact, to provide a scientific review of the merits of psychiatric drugs. Here is what the editors write: “The American Journal of Psychiatry is committed to keeping the field of psychiatry vibrant and relevant by publishing the latest advances in the diagnosis and treatment of mental illness.”

The journal is committed to “keeping the field of psychiatry vibrant,” and to do so by telling of “advances in the diagnosis and treatment of mental illness.” Their stated mission is to advance the guild interests of psychiatry, and from that perspective, it makes perfect sense that the editors rejected Murray’s letter and Moncrieff’s too. The rejection of such critiques serves the journal’s stated mission.

I read the journal’s mission statement while writing this blog, and it made for an “aha” moment for me. I hadn’t realized before that the American Journal of Psychiatry so bluntly confessed to this guild purpose, but at least we now know, with this rejection of Murray’s letter, that the editors’ protection of this mission is absolute. They will not find space for criticism even if it comes from one of the best-known psychiatrists in the world.

Both Murray and Moncrieff have given Mad in America permission to print the letters submitted to the American Journal of Psychiatry. Here they are:

The letter submitted by Robin Murray and colleagues

Don’t dismiss the adverse effects of long-term antipsychotics in animal studies.

Robin M Murray, Anthony C Vernon, Sridhar Natesan, Jim Van Os, David Taylor, Marta Di Forti

There is almost universal agreement that antipsychotics are useful in the acute care of people with schizophrenia, and that many patients will have to continue to take them for prolonged periods. However, recent evidence indicates that a significant proportion of patients will be able eventually decrease their medication to a minimum or come off the drugs without detriment to their mental health (1).

In their review published on-line in this journal (2), Goff and colleagues downplay the potential harms of long-term “prophylactic” use of antipsychotics. For example, they minimise the formidable evidence that most second generation antipsychotics increase risk of obesity and the metabolic syndrome with all its consequences (3). Furthermore, they dismiss those studies which show that administration of antipsychotics induces brain volume losses in rodent (4) and primate (5) models. Goff and colleagues claim that the relevance of such findings “to the treatment of psychosis is uncertain, both due to species-related differences and because animals lack the pathophysiology of schizophrenia. It is possible that antipsychotics may have deleterious effects on normal brain but protective effects in the presence of schizophrenia-related neuropathology.” This explanation ignores the similarity of the brain changes induced in animals to those seen in patients following long-term antipsychotics (6). Furthermore, it invokes the extraordinary assumption that there exists a “schizophrenia-related neuropathology” which responds to D2 dopamine blockade in the opposite manner to that of the brains of the remainder of humankind.

Goff and colleagues only briefly touch on the extensive evidence that in animals, long-term antipsychotic administration induces supersensitivity of the D2 dopamine receptor. They ignore the detailed studies of Seeman, Kapur and their colleagues (7,8) who noted that on-going antipsychotic exposure in rats and cats induces an increase in D2 receptor numbers, and that the resultant dopamine supersensitivity causes antipsychotics to lose their efficacy in suppressing amphetamine-induced locomotion and conditioned avoidance responding. Once again Goff et al avoid the obvious conclusion that D2 dopamine blockade is likely to have a similar effect in the human brain. Furthermore, they fail to cite the recent reports that some partial dopamine agonists such as aripiprazole have less propensity to cause dopamine supersensitivity, and therefore may have clinical advantages in this regard (9).

In pharmacology, animal studies are considered a valuable indicator of what to expect in terms of the effects of a drug in humans. By arguing that those of us who treat patients with antipsychotics have nothing to learn from animal studies, Goff et al appear to have adopted the Creationist creed that humans and animals were created in an entirely separate manner without overlapping neural systems. The wise psychiatrist will take a more balanced view, and work with their patient to slowly reduce the dose of antipsychotic to the minimum level compatible with the patient’s continuing mental health: in a minority, but an important minority, this level will be zero.

References:

1. Murray RM, Quattrone D, Natesan S, et al. Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics? Br J Psychiatry 2016;
209, 361–365.

2. Goff DC, Falkai P, Fleischhacker W, et al. The Long-Term effects of antipsychotic medication on clinical course in schizophrenia. Amer J Psychiatry, AJP in Advance (doi: 10.1176/appi.ajp.2017.16091016)

3. De Hert M, Detraux J, van Winkel R et al. Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nature Rev. Endocrinology, 2012, 8, 114-126

4. Vernon AC, Crum WR, Lerch JP, et al. Reduced cortical volume and elevated astrocyte density in rats chronically treated with antipsychotic drugs – linking magnetic resonance imaging findings to cellular pathology. Biol Psychiatry 2014; 75, 982–90.

5. Dorph-Petersen KA, Pierri JN, Perel JM, et al. The influence of chronic exposure to antipsychotic medications on brain size before and after tissue fixation: a comparison of haloperidol and olanzapine in macaque monkeys. Neuropsychopharmacology 2005; 30, 1649–61.

6. Vita A, De Peri L, Deste G, et al. The effect of antipsychotic treatment on cortical gray matter changes in schizophrenia: does the class matter? A meta-analysis and meta-regression of longitudinal magnetic resonance imaging studies. Biol Psychiatry 2015; 78, 403–12.

7. Samaha AN, Seeman P, Stewart J et al ‘‘Breakthrough’’ dopamine supersensitivity during ongoing antipsychotic treatment leads to treatment failure over time. J Neurosci 2007; 27: 2979–2986.

8. Ginovart N, Wilson AA, Hussey D, et al. D2-receptor upregulation is dependent upon temporal course of D2-occupancy: a longitudinal 11C- raclopride PET study in cats. Neuropsychopharmacology 2009; 34: 662–71.

9. Tadokoro S, Okamura N, Sekine Y, et al. Chronic treatment with aripiprazole prevents development of dopamine supersensitivity and potentially supersensitivity psychosis. Schizophr Bull 2012; 38: 1012–20.

Conflicts

R.M.M., J.v.O., and DT have received speaker honoraria from Janssen, Lilly, Otsuka, Servier and Lundbeck, and M.D.F. has received honoraria from Janssen and Lundbeck. D.T. is on the following advisory boards: Servier, Lundbeck and Sunovion, and and has received research funding from Janssen, Lundbeck and BMS. ACV has received research funding from Roche.

The letter submitted by Joanna Moncrieff and Stefan Priebe

Patients deserve more evidence

A response to “The long-term effects of antipsychotic medication on clinical course in schizophrenia” by D.C. Goff, P. Falkai, W.W. Fleischhacker, R.R. Girgis, R.M. Kahn, H. Uchida, J. Zhao, J.A. Lieberman

Goff et al’s recent article highlights that the full risk-benefit ratio of long-term antipsychotic treatment remains uncertain (1). All trials of long-term treatment involve withdrawal of previous treatment, yet antipsychotic withdrawal may induce psychotic symptoms and increase risk of relapse, thus confounding outcomes. Long-term follow-ups and data on other outcomes are also limited. Only six of the 65 trials in Leucht et al’s 2012 meta-analysis lasted longer than one year (2). The only long-term follow-up of a randomised cohort suggests that gradual and supported antipsychotic reduction may lead to better social functioning, with no long-term increase in risk of relapse, although numbers were small (3).

Goff et al. refer to evidence using percentages and group means but doctors are confronted with individuals. Even ignoring the problems with existing studies, numbers needed to treat with antipsychotics suggest individual patients are more likely not to benefit than to benefit. In Leucht et al’s review, three patients need to receive maintenance antipsychotics for one to have a lower chance of relapse attributable to treatment. How do doctors provide the evidence to patients in this situation? How should the possibility of positive effects be balanced with the probability of serious adverse effects and the indications—even if not confirmed—of brain shrinkage, impaired cognition and lower social functioning ?

Patients’ decisions will be influenced by the probabilities of different outcomes and by their personal appraisals of these outcomes. A patient might accept the risk of re-hospitalisation in exchange for the higher chance of a satisfying sex life, for example, and appraisals can obviously change over time. The challenge for research is not to arrive at a generalised recommendation for or against treatment with anti-psychotics, but to provide more detailed evidence to facilitate the informed choice of individual patients. If doctors support patients to take such decisions a more open and trusting therapeutic relationship may be established, making it less likely that patients stop medication on their own.

The United Kingdom’s National Institute for Health Research has funded the first large trial of gradual antipsychotic reduction and discontinuation in people with recurrent psychotic conditions, which will measure social functioning and quality of life as well as relapse (4). This may clarify some questions about long-term antipsychotic treatment. Yet more studies for different patient groups are required to provide the data patients and doctors need to make informed and collaborative decisions.

1. Goff DC, et al. The Long-Term Effects of Antipsychotic Medication on Clinical Course in Schizophrenia. Am J Psychiatry 2017 May 5;appiajp201716091016.

2. Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Davis JM. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev 2012;5:CD008016.

3. Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ. Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy: Long-term Follow-up of a 2-Year Randomized Clinical Trial. JAMA Psychiatry 2013 70:913-20.

4. RADAR trial ISRCTN (International Standard Randomised Controlled Trial Number) 2017 Feb 7. http://www.isrctn.com/ISRCTN90298520

Conflict of interest statement:

Both authors are investigators on a research programme funded by the UK’s National Institute for Health Research entitled Research into Antipsychotic Discontinuation and Reduction (RADAR). Details are described in the text, and a reference to the trial registration is supplied.

Neither author has any financial conflicts of interest.

 

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51 COMMENTS

  1. “… it invokes the extraordinary assumption that there exists a ‘schizophrenia-related neuropathology …’”

    Thank you for pointing out the “extraordinary assumption” that there even is such a thing as “schizophrenia.” As you are correct, this is a largely disproven assumption at this point. And when we “ass u me” we make ….

    “The wise psychiatrist will take a more balanced view, and work with their patient to slowly reduce the dose of antipsychotic to the minimum level compatible with the patient’s continuing mental health: in a minority, but an important minority, this level will be zero.”

    Today, “the prevalence of childhood trauma exposure within … individuals diagnosed with psychotic or affective disorders … reaches 82% (Larsson et al., 2012).” This means that 82% of people diagnosed as “psychotic” today are actually legitimately distressed child abuse victims, as opposed to people with brain diseases initially.

    The neuroleptic/antipsychotic drugs are known to be able to make a person “psychotic,” via anticholinergic toxidrome.

    “The symptoms of an anticholinergic toxidrome [can] include blurred vision, coma, decreased bowel sounds, delirium, dry skin, fever, flushing, hallucinations, ileus, memory loss, mydriasis (dilated pupils), myoclonus, psychosis, seizures, and urinary retention. Complications include hypertension, hyperthermia, and tachycardia. Substances that may cause this toxidrome include the four “anti”s of antihistamines, antipsychotics, antidepressants, and antiparkinsonian drugs[3] as well as atropine, benztropine, datura, and scopolamine.”

    The neuroleptics can create symptoms which mimic the negative symptoms of “schizophrenia” as well, via neuroleptic induced deficit syndrome.

    “Neuroleptic induced deficit syndrome is principally characterized by the same symptoms that constitute the negative symptoms of schizophrenia—emotional blunting, apathy, hypobulia, difficulty in thinking, difficulty or total inability in concentrating, attention deficits, and desocialization. This can easily lead to misdiagnosis and mistreatment. Instead of decreasing the antipsychotic, the doctor may increase their dose to try to ‘improve’ what they perceive to be negative symptoms of schizophrenia, rather than antipsychotic side effects.”

    Given the reality that the neuroleptic drugs can, in fact, create symptoms that mimic both the negative and positive symptoms of “schizophrenia.” And given the fact that most people labeled with the “psychotic” disorders are, in fact, legitimately distressed child abuse victims initially. I believe it is logical to conclude that “schizophrenia,” and “bipolar” and all the so called “psychotic disorders,” are primarily iatrogenic illnesses used to silence, defame, and torture child abuse victims.

    And, “Individuals with psychiatric illnesses and a history of trauma also appear to display significantly higher functional impairment than the remainder of the sample (Cotter, Kaess & Yung, 2015).”

    Antipsychotics do NOT cure concerns or symptoms of child abuse.

    Thus, I believe it is the majority of those labeled as “psychotic,” who were likely made “psychotic” with the antipsychotics, in other words the 82% of child abuse victims, and any concerned parents who were also defamed and force fed the antipsychotics today, that should be completely weaned from the antipsychotics. As opposed to a “minority” that should be completely weaned from the antipsychotics.

    The psychiatric industry’s primary actual function in our society today is covering up child abuse, by turning child abuse victims into the “mentally ill” with the psychiatric drugs en mass. This is shameful. We are living through an American psychiatric holocaust of child abuse victims.

    And in case the psychiatric industry, who was miseducated and deluded by your belief in your now debunked DSM “bible” and lots of fraudulent pharmaceutical funded research, hasn’t heard. It is now all over the internet that the “elite,” who funded your miseducation, are “luciferian pedophiles.” Please wake up. You’ve tortured and killed too many already. The primary etiology of “schizophrenia” is iatrogenic, NOT “genetic,” in nature. You need to swallow the “bitterest” of pills, take the “red pill,” wake up!

    “The measure of a civilization is how it treats its weakest members.” Please stop torturing child abuse victims, psychiatry.

  2. If you are a MH patient and make a complaint about a psychiatrist, or pretty much anything else and keep on about it, quite literally you can be sectioned, and this has happened. Imagine you writing these letters and a few weeks later the heavy mob come round and section you ?

    This man tries to record his sectioning and is stopped. He had sent an email letter of complaint to the council about the activity of his neighbours:

    https://www.youtube.com/watch?v=TaExut-MeAk

    The next day at the psychiatric hospital, his sister confirms his story and describes the sectioning as: “horrifically done”

    https://www.youtube.com/watch?v=lABi4jwiEJ8

    As far as I know, he was put on Olanzepine, and of course that would be by force. I’m not saying he doesn’t have problems. But as the sister says.. it is horrific.

  3. Loved the first letter, and shocked to find this reluctance to acknowledge it by the journal. It shows how statements made in the initial report fly in the face of logic. Apparently guild interests mean more to the publishers of American Journal of Psychiatry than reasoned responses.

    I think the end of that letter itself bears repeating….

    “The wise psychiatrist will take a more balanced view, and work with their patient to slowly reduce the dose of antipsychotic to the minimum level compatible with the patient’s continuing mental health: in a minority, but an important minority, this level will be zero.”

    If only more psychiatrists felt the same way, there might, in fact, be a lot less iatrogenic damage in the world than there is today.

        • The “wise patient” might be characterized as a non-patient (ex-patient), at least, non-compliant, ditto, “the wise psychiatrist”, “critical” or unorthodox in his case, but since we’re realists here, and the “mental health” treatment bubble is a long ways from popping, I would imagine it’s the human being who wises up to all the contrivance in the drama taking place around him or her.

          As for the “good therapist”, Thomas Szasz recognized a great need for more psychiatrists for the defense of the interests of the patient/client as there is presently an overabundance of psychiatrists for the prosecution of such patient/clients in the interests of the state.

  4. Strictly speaking, Goff does not deserve an “answer” but a denunciation of his scientific negationism, the evidences of the deleterious effects of long-term neuroleptics are overwhelming, and long ago.

    However, I am surprised by the letter from Joanna Moncrieff and Stefan Priebe:

    “Patients’ decisions will be influenced by the probabilities of different outcomes and by their personal appraisals of these outcomes.”

    Do the psychotics in your country really have the choice to take neuroleptics or not?

    • Sylvain:

      No, they do not. From experience. In the U.S. itt is very easy to get a court order forcing someone to take neuroleptics. If a hospitalized person in the U.S. refuses to be drugged, a ‘medication over-ride’ can easily be activated by the treating physician if he/she obtains the signatures of two, addition colleagues. To get a discharge, a patient will often have to sign a ‘conditional release’ form. This form often contains the conditions of their discharge (known as a conditional discharge). If they fail to comply with the conditions of their release, they can be rehospitalized. If a person is involved in the corrections system, even for say, a non-violent misdemeanor, taking medication can be written into the requirements of a person’s parole (breaking conditions of parole can make a person subject to incarceration). Medication compliance can be written into a person’s conditions of parole by a law enforcement officer or parole officer who has absolutely no knowledge of the risks and harmful effects of medications. Judges, who also no next to nothing of the risks of psychiatric drugs, can order that a person participate in an ‘Assisted Outpatient Treatment’ (AOT) program even if individuals are living peaceably in their own homes. AOT is a euphemism for forced drugging. In other words, a low wage mental health worker comes to a person’s house on a daily basis to witness a person taking his/her meds. My friend has a son who is labeled with schizphrenia and who was living with her. He was on probation for a non violent misdemeanor and a psychiatric nurse come to her house accompanied by an armed law enforcement officer to administer a depot injection of neuroleptics. It is a flagrant abuse of individuals rights.

  5. Great article. Thank you. It is interesting, however, when people are surprised by the corruption of psychiatry. Psychiatry has been corrupt since its inception. The drugs are just a more recent symptom of that corruption. What next? More pseudo-scientific tinkering with the human brain in the name of “medicine” and “treatment”? More brain scans? More so-called “early prevention”? Every psychiatric “treatment” that has gone into disuse was once considered to be on the cutting edge of innovation. The same is true of the poisonous psychotropic drugs. As the truth about psychotropic drugs comes to light, which “innovations” will psychiatry come up with to replace them? O brave new world!

    • “CBT” is not a “Cure All”, BUT It can work effectively with Withdrawal Syndrome.

      The “mind” doesn’t operate in the same way after taking psychotropics as it did before the exposure, and this can present serious problems.

      “CBT” can offer alternative regulatory approachs, and after a while the techniques can become second nature.

    • Some of us can’t stand “mindfulness” meditation. Brings back nasty memories of some Kindergarten style “case worker” reading mantras and other stuff to us in a soothing voice while we empty our minds. As though the drugs had not already sufficiently emptied them. Between these interminably dull sessions–two hours with a short break between–we were talked down to like dumb bunnies or preschoolers. Typical of “Adult Day Treatment.”

      Oh, yes. None of us were supposed to be developmentally delayed either. Supposedly we all had normal or above normal IQs.

  6. Occasionally I’m surprised by something but nothing here does the trick.

    Let me just repeat that to be guilty of “corruption” an institution first needs to serve a valid purpose. If its basic tenets are invalid there’s nothing to “corrupt” in the first place. What is being described here as “corruption” is simply more of the same repression in the guise of medicine.

  7. Ho hum…
    Pseudoscience principles:
    1 – Hostile to criticism, rather than embracing criticism as a mechanism of self-correction

    2 – Works backward from desired results through motivated reasoning
    
3 – Cherry picks evidence
    
4 – Relies on low grade evidence when it supports their belief, but will dismiss rigorous evidence if it is inconvenient

    5 – Core principles untested or unproven,
    6 – Utilizes vague, imprecise, or ambiguous terminology, often to mimic technical jargon

    7 – Has the trappings of science, but lacks the true methods of science
    
8 – Invokes conspiracy arguments to explain lack of mainstream acceptance (Galileo syndrome)
    9 – Lacks caution and humility by making grandiose claims from flimsy evidence
    10 – Practitioners often lack proper training and present that as a virtue as it makes them more ‘open’
    We could perhaps add – desire to mislead for financial purposes.

    • You know, frankly, the term “science” is used way too much these days to justify an ideological position of “we are correct and you are not”. I feel, it is an unhelpful term, that only leads to endless mental masturbation and pointless intellectualisation. The “scientific nature of psychiatry” is a pseudo-problem that obscures the truth.

      Building a car engine is different than observing the trajectory of a planet. Studying the structure of a leaf is different than writing a computer program to accomplish a specific task. These are different activities, and consist of different set-ups and different people (and different infrastructure) with different mental states, environments, motivations and objectives working on them. No point obfuscating the truth by putting it all under the banner of “science” and engaging in argumentation of whether it is “science” or not.

      The more pertinent question is, what is the truth about psychiatry? What is the nature of these truths? What are the contexts of these truths?

    • A Profession in Denial: Psychiatry’s 6 head-in-the-sand responses to criticism

      1. The critic lacks expertise or objectivity
      2. The harm is a result of the underlying illness, not our treatments (Brain Shrinkage)
      3. We are on the cusp of a major scientific breakthrough
      4. The damage is justified
      5. Our treatments save lives
      6. We never really believed that (chemical imbalance myth)

      http://www.talesfromthemadhouse.com/a-profession-in-denial-psychiatrys-6-head-in-the-sand-responses-to-criticism-part-i/

      • 6. If they never really believed that, this shows them more disgusting and morally depraved than many thought. In essence the “well informed” psychiatrist is a card carrying liar who will say anything to sell his drugs and convince the public of this nonsense as well as his hapless “consumer” victims!

  8. Papers written for science, for the efficacy of electroshock are junk science when they leave 50% of the source patient/starting number out of the calculations. There is no Internal Affairs division in psychiatry like the police have to keep bad police in check.

    “Sixty patients, who had completed at least one course of ECT”
    + “At the end, our final study sample constituted 30 patients.”
    Leaving out 50% of the source. http://onlinelibrary.wiley.com/doi/10.1002/pnp.466/epdf

    • Whats termed “Severe Mental Illness” is supposed to be a long term condition – but this longterm idea comes from Psychiatry itself.

      I notice that most people that depend on Psychiatry remain “mentally ill” and that most people that recover – recover as a result of leaving Psychiatry. So I would have to ask what a Psychiatrist does to justify their existence.

  9. The madness of psychiatry itself! Suffering from severe delusions it sifts through what suits it best rejecting anything that can question its sense of righteousness and pseudoscientific beliefs, blithely twisting evidence into lies and money. Working closely with its chemical factories it continues to delude and poison its patients as the only medical specialty that actively does more harm than good breaking the Hippocratic oath every single second around the world.

    When will this dangerous delusional pseudoscientific thing called psychiatry be stopped?

  10. Dear Dr, Whitaker
    I am writing this comment without any malice towards you or the psychiatry critical psychiatrists you cite in this blog. I am simply asking questions which I hope this website still promotes and allows.
    “There is almost universal agreement that antipsychotics are useful in the acute care of people with schizophrenia”
    Is it not true Dr.Whitaker that most of the evidence you’ve gathered in your books and articles are based on people who have NO exposure to antipsychotics? Isn’t it true that there is evidence that people with ZERO exposure to so called “Antipsychotics”/scientific non pharmaceutical name neuroleptics can “recover” from what is referred to as “psychosis” or ‘schizophrenia?”
    Isn’t it true that most of the worst aspects of “psychosis” or “schizophrenia” come from withdrawing from “antipsychotics” which cause extreme psychotic symptoms that would’ve never occurred without them? Isn’t therefore logical that we should be promoting a system of care that avoids NEUROLEPTICS whenever humanly possible?
    Isn’t it true Dr. Whitaker that the same flawed “Science” behind the promotion of “Antidepressants” is also at hand in the “almost universal agreement that antipsychotics are useful in the acute care of people with schizophrenia”
    Isn’t it true that for most people(especially those who are having a drug reaction) their “psychosis” is temporary? Isn’t it true that the “recovery” seen in these people could be falsely attributed to “Antipsychotics?” That it’s basically a placebo effect? Isn’t it true that the “science” of “almost universal agreement that antipsychotics are useful in the acute care of people with schizophrenia”involves removing studies with negative results?
    All I’m asking Dr.Whitaker is that you not let yourself be manipulated by people who’s jobs, wealth, and status depends on their ability to continue to make people take “Antipsychotics” and to sometimes ask questions about their motives.

    From a 27 year old woman with tardive dyskinesia and COPD/heart/lung problems I deal with every day from a common cold 2 years ago which I was unable to fight from a weakened body withdrawing from “Antipsychotics” I was on for a month.

  11. They hear you. They are skilled in un-hearing. They listen and un-hear all the time.

    What marks you out as different is that they can’t dismiss you. To dismiss you, they require a pathology.

    In the absence of a pathology, they’ll go on un-hearing you, for as long as it takes. That might be your lifetime.

    That’s also how institutions that have become corrupted operate. They play the long game. Sometimes that works. Sometimes it doesn’t. It almost never endures. People wise up. The institution must save face to survive. It owns up.

    I hope you witness that in your lifetime. If not, your tenacity will endure until the truth breaks out.

    People say psychiatry is on its last legs. What they rarely point out is the regenerative power. Psychiatry is well-equipped to lose its legs. It will lose its legs. And then it grows new ones.

    Banish antipsychotics. Banish these poisons. Let them be gone.

    But who is ready for the next onslaught, for the new legs readying to hit the ground running?

    The new technologies. The fusion of synapse and silicon.

    That’s another battle, for another Mr Whitaker.

  12. World Psychiatry is the number 1 ranked journal in Social Science Citation Index and has a phenomenal impact factor (a rating of how often articles are cited in a particular journal). A journal with this reputation would naturally have a low acceptance rate. Whitaker — or anyone who submits there — shouldn’t be surprised when their work is rejected. Rejection from a journal like World Psychiatry is far more likely to be a function of competition for space than some nefarious plot.

    It’s a bit premature to claim that American Journal of Psychiatry (AJP) is trying to hide anything. The Letters to the Editor on Goff, et al. have yet to appear (the article itself has only appeared in print this month) and while it’s likely that a high-profile article like this will likely generate some response we don’t yet know which (if any) will be accepted for publication. Simply because 2 letters critical of Goff, et al. were rejected doesn’t mean that all such letters have been or will be rejected. In fact, these 2 letters are rather poor and it’s easy to see why an editor would reject them outright. Murrary, et al’s, reliance on animal models to argue for supersensitivity psychosis ignores human data suggesting supersensitivity psychosis appears unlikely to occur in patients (see, e.g., Leucht, & Davis, 2017) and then goes on to belittle any potential critics by equating them with creationists. Similarly, Moncrieff et al’s critique overly simplifies (and confuses) the issue by suggesting that there isn’t enough data to provide guidance to individual patients and then inexplicably notes an NNT of 3 (such a statistic is pretty much meaningless in isolation, particularly with drugs like antipsychotics which have a wide range of potentially side effects). Both of these letters make worthy arguments but such schoolboy errors are more than enough reason for an editor to reject them outright for a high impact journal like the AJP.

    As for the broader point that the mainstream psychiatric journals have a policy of “Thou Shall Not Criticize Our Drugs,” this is demonstratively false. The Wunderink study that is so often cited (as Moncrieff et al does) against antipsychotics was published in JAMA Psychiatry (published by the American Medical Association) and the subject of this blog post, the AJP (the official journal of the American Psychiatric Association), has, for example, previously published articles on adverse side effects of antipsychotics (e.g., Allison, et al. 1999) and very recently published an article by Leucht, et al. (2017b) which suggested that “antipsychotic drug efficacy may have decreased over recent decades and that “only a minority experienced a good response” to antipsychotics. The AJP (and other mainstream psychiatric journals) routinely publish data on antipsychotic drug failure and harmful side effects. One can certainly reasonably argue that there is much that could and should be changed when it comes to mental health research and treatment but overgeneralizations and accusations of “institutional corruption” does not help patients or researchers.

    Leucht, S., & Davis, J. M. (2017a). Do antipsychotic drugs lose their efficacy for relapse prevention over time?.

    Allison, D. B., Mentore, J. L., Heo, M., Chandler, L. P., Cappelleri, J. C., Infante, M. C., & Weiden, P. J. (1999). Antipsychotic-induced weight gain: a comprehensive research synthesis. American journal of Psychiatry, 156(11), 1686-1696.

    Leucht, S., Leucht, C., Huhn, M., Chaimani, A., Mavridis, D., Helfer, B., … & Geddes, J. R. (2017). Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia: Systematic Review, Bayesian Meta-Analysis, and Meta-Regression of Efficacy Predictors. American journal of psychiatry,

    • “World Psychiatry is the number 1 ranked journal in Social Science Citation Index and has a phenomenal impact factor (a rating of how often articles are cited in a particular journal). A journal with this reputation would naturally have a low acceptance rate. Whitaker — or anyone who submits there — shouldn’t be surprised when their work is rejected. Rejection from a journal like World Psychiatry is far more likely to be a function of competition for space than some nefarious plot.”

      Yeah right. And if these “doctors” really have their patients best interest in mind – they would publish anything that warns of potential dangers before they publish anything else. You act as though publishing “the next great drug’s” marketing material deserves equal weight to harm reduction – or even worse they should just print things on some subjective basis other than protecting patients.

      Every single psychiatrist has lied to me. They all have. About the effects of the drug and even that my experiences with these effects were not the drug. When complaining of sexual sides effects these “doctors” are very nonchalant about an effect that is very disturbing. My last “doctor” claimed that it wasn’t the drug but the fact I was overweight. This, even while, the changing of medications modulated the effect. That same doctor then scolded me for not being grateful as she was giving me services “at a discount” and even said that my concern wasn’t hers and had nothing to do with her role in my health. Her role, as she put it, was simply related to and regarding mood. She even, then, implied that my mood was to contributing factor to my distress and symptoms.

      These effects are still lingering months after discontinuing the medication. And if you aren’t depressed or distressed – just wait until you find out that “treatment” may remove you from ever having a family of your own as they destroy your ability to reproduce. Yeah, that’s right – semen production almost completely stops. Not one “doctor” told me about this as a possibility – even while informed consent laws mandate them to do so.

    • Pfff! You quote Leucht & Davis? Seriously? Come on!

      “There is a new debate about long-term treatment with anti-psychotics stimulated by data suggesting a dose-related brain volume loss, supersensitivity effects of long-term treatment with antipsychotics and some follow-up studies showing that patients who do not receive antipsychotics in the long-term have better outcomes than treated patients.

      In this context Takeuchi et al present an analysis of the symptom trajectories in relapse prevention studies over 1 year. In the placebo-treated groups they find a continuous worsening of approximately 50% over baseline of the mean Positive and Negative Syndrome Scale (PANSS)/Brief Psychiatric Rating Scale (BPRS) scores at 1 year, compared with an only 10% worsening of these scores in the antipsychotic group. This finding is important because it means that antipsychotic efficacy is maintained over time and should not be discontinued.”

      Thus, to contradict long-term studies (that of Harrow lasted * 20 YEARS *) Leucht & Davis cite a meta-analysis of studies lasted … 1 year ?! what a light of intelligence! What a brilliant mind! But where do they come from?

      Declaration of interest:
      In the past 3 years S.L. has received honoraria for consulting from LB Pharma, Lundbeck, Otsuka, Roche, and TEVA, for lectures from AOP Orphan, ICON, Janssen, Lilly, Lundbeck, Otsuka, Sanofi, Roche, and Servier, and for a publication from Roche.

      Ho! Ho! Ho! What a fine soldier of the pharmaceutical industry! And Takeuchi, the author of the meta-analysis?

      Declaration of interest:
      H.T. has received manuscript fees from Sumitomo Dainippon Pharma. O.A. has received speaker’s honoraria from Eli Lilly & Company USA, Eli Lilly Canada, Janssen-Ortho (Johnson & Johnson), Lundbeck, Mylan Pharmaceuticals, Novartis, Sepracor Inc. and Sunovion, and consultant fees from BMS, Eli Lilly & Company USA, Eli Lilly Canada, Janssen-Ortho (Johnson & Johnson), Lundbeck, Novartis, Otsuka, Roche, Sepracor Inc. and Sunovion, and research support from Boehringer Ingelheim, Neurocrine Biosciences, Janssen-Ortho (Johnson & Johnson), Otsuka, Pfizer Inc. and Sunovion. G.R. has received research support from Novartis, Medicure and Neurocrine Bioscience, consultant fees from Laboratorios Farmacéuticos ROVI, Synchroneuron and Novartis, and speaker’s fees from Novartis.

      It’s even worse! Soldiers work by squadrons!

      And you could give us an declaration of interest, it could be interesting. Have you received invitations to industry conferences, with free trip, free meal or free hotel? Have you received any money for consulting services? Or gifts?

        • Yes. But you see, Temper, my comment has been removed.

          When Murray compares Donald Goff to a creationist and is censored, it deserves an article on MIA.

          But when I say that Leucht & Davis are idiots because they claim to refute a study that lasted 20 years with a 1-year study meta-analysis, I deserve to be censored on MIA.

          Thus, MIA ridicules itself by complaining on the one hand that American Journal of Psychiatry remove the criticisms of pro-neuroleptic authors, and on the other hand remove my own criticism of pro-neuroleptic authors.

          • @Sylvain

            It should be removed. Precisely for the reason I said. You claimed that this paper should use some other method that paitient safety.

            So why don’t you try a antipsychotic. I mean they are so safe that you can force them down people’s throat over just a bit of psychosis. Now the courts say that you need to demonstrate that a person is a danger to self or others – but all this translates to is psychosis is a danger to self and others.

            Plus, you know if they can give it to kids because they are so safe – then before you continue your crap about how 1 year is long term – when it isn’t and the cry of censorship – why don’t you just put yourself on a life long treatment of an antipsychotic.

            I recommend you try Risperdal. It will ruin your life to the point where even if you were semi charmed – you will be so mad and angry with the world suicide will begin to make a lot more sense. Then after you are taking the drug, blow up like a balloon, and everyone sees how crazy you are-

            Let’s talk. Then you can tell me how safe these drugs are “long term” and how they prevent “psychosis” – like that is the most important thing in the world.

            Then if that doesn’t do it for you – we will immediately remove you from the drug – and watch to see if after even just a few weeks on it if you can maintain your sanity.

            When you can’t we will label you “crazy” and every time the police are called that will be the reason in their mind so you know you’ll get a fair shake as they repeatedly drive you to the hospital in handcuffs even though no law has been broken.

          • Oh and @Syvain

            I have been on Risperdal, Cogentin, and one other I can’t think of – that was one time. When I stopped taking it – it caused an episode.

            Then there was Latuda and Trileptal – ruined my sexuality.
            So we switched to Vraylar – I literally couldn’t stand still or sleep. So, buspar and trazodone – later to be buspar and ambien.
            Then I started getting tardive dyskinesia – so that was changed to olanzapine which had me, a man, growing breasts. This was also in response to me complaining about sexual size effects – like no longer holding an erection and no semen when I did manage to ejaculate.

            So go on.. put yourself on one to prove how safe they are.

          • “You claimed that this paper should use some other method that paitient safety.”

            There must be a misunderstanding. I am not an anglophone and it is possible that I did not express myself correctly.

            No, I think this article is crap, and there is no way to prove that neuroleptics are effective in the long run, since they are not. To my knowledge, all follow-up studies beyond two years prove without exception that neuroleptics aggravate psychosis in the long term, even when relatively little dose is taken.

          • “No, I think this article is crap,”

            Which article?

            ” and there is no way to prove that neuroleptics are effective in the long run, since they are not.”

            So why did you post it?

            “To my knowledge, all follow-up studies beyond two years prove without exception that neuroleptics aggravate psychosis in the long term, even when relatively little dose is taken.”

            So comparing them to creationist is an apt one – no?

          • And @Syvain – the site didn’t moderate you – the users did. Your post was reported for moderation (not by me) and once the site operators get a chance to review it – it very well could come back.

          • > Which article?

            Leucht, S., & Davis, J. M. (2017a). Do antipsychotic drugs lose their efficacy for relapse prevention over time?

            > So why did you post it?

            LOL. Maybe I understand: you did not confuse me with SamSara? It’s SamSara who defended neuroleptics, not me! I harshly criticized SamSara in my censored comment. If that’s the case, it’s really fun! 😀

            But my comment will probably return, you will see what I really wrote.

    • The Leucht et al 2017 study says: “At least a “minimal” response (at least a PANSS 20% symptom reduction) occurred in 51% of the antipsychotic group versus 30% in the placebo group, and 23% versus 14% had a “good” response.” In order to calculate NNT (NNT=Number Needed to Treat) you have to subtract 30% placebo from 51% equal 21% i. e. NNT=5. For “good response” 23% minus 14% equals 9% effect due to antipsychotics i. e. NNT=10. You have to treat 10 pasients to get a good response for one. Leucht et al 2009 and Leucht et al 2012 calculated NNT. However this showed how low the real effect was. Therefore NNT is no longer used. From a pasient point of view the difference is important, because it shows that it is not necessary to medicate so many avoiding side effects and long-term negative affects.

  13. It’s a very interesting article on how difficult it is to get the message out there. It reminds me of the mechanisms in the propaganda model theory of Edward S. Herman and Noam Chomsky to explain systemic biases function in the media. The theory postulates five general classes of “filters” that determine the type of news that is presented in news media. These five classes are: Ownership of the medium, Medium’s funding sources, Sourcing, Flak, and “fear ideology”; quote taken from Wikipedia.

    The other side gets around our common sense filters by telling feel good stories, or putting fear into us.
    Last week on NPR they had a feel good story of a mother who finds help in Zolft to address her panic attacks during her pregnancy, and a researcher whose paper shows that it’s safe to use; very limited metrics were used to come to the conclusion.
    They sugar coat this drug advertisement with a mother’s story.
    As my wife pointed out doctors warn expecting mothers not to eat raw mike cheese, or shell fish, but Zoloft is no problem!?

    Could MIA information be disseminated using a feel good story, to get around the filters?
    There might be less aggressive filters with public media, and they are desperate for material.

    This is how it would play out.
    Sugar coat:
    A feel good story of a likable person who has carefully weaned herself/himself off of xxx, xxx, xxx, and xxx, and is now much happier and healthy; along with their significant other.
    By becoming more mindful, communicative, and engaged with the people around him or her
    And is coming to terms with past issues.
    The message:
    Dr x or researcher x, associated with the x institute, has recently done a meta-analysis of XXX type drugs, where the drugs were shown to be harmful in the long term, and to be no more effective than active placebos.
    Sociologist x has shown that people who are part of supportive communities are more resilient.
    Dr XX or researcher XX has said that in many instances drugs are prescribed to people (like the feel good person of the story) without getting to the root of their issues, which ends up masking their anguish, and causing long term physical and metal damage.

  14. FILE CLASS ACTION SUIT DEA/CDC et. all CHRONIC PAIN SUFFERERS BEING PUNISHED
    Visit the following link to send a message to the Government and file a class action suit against the entities behind this cruel behavior. They have no right to violate HUMAN RIGHTS. Also report your treatment to the UNITED NATIONS and anywhere online that allows you to FILE A HUMAN RIGHTS COMPLAINT!
    Request to start a class action suit and send a message to the GOV via the link below :
    https://www.petition2congress.com/ctas/claas-action-suit-against-fdadea-new-drug-laws