How Well Do Neuroleptics Work?

Sandra Steingard, MD
73
1407

I recently received an email from Psychiatric Times highlighting current articles. Psychiatric Times is a newspaper that is distributed for free to psychiatrists in the US. To put this in context, the paper appears to be heavily subsidized by pharmaceutical company advertising, and its former editor, Ronald Pies, is a psychiatrist who has been critical of views expressed on Mad In America.

It caught my eye when the first article mentioned had the title, “Antipsychotic Discontinuation: When is it OK?” I clicked on the link to find a slide show authored by Brian Miller, M.D., P.D., M.P.H. which was titled, “Antipsychotics – To Respond or Not to Respond?

This was intriguing but confusing. Dr. Miller’s slides reviewed a paper just published in Schizophrenia Bulletin titled, “How Many Patients With Schizophrenia Do Not Respond to Antipsychotic Drugs in the Short Term? An Analysis Based on Individual Patient Data From Randomized Controlled Trials.” As pointed out in the slide show, the paper reported on a meta-analysis of 16 randomized controlled studies of antipsychotic drugs over the first 4-6 weeks of treatment. The authors found that a significant number of people do not respond or have relatively poor responses and the majority do not experience a remission of psychotic symptoms. While important, this article addressed short-term rather than long-term care. It is, nevertheless, informative. [Editor’s note: click here to see the MIA research news report on this paper.]

The senior author of the paper, Stefan Leucht, is a well-known and highly regarded expert in meta-analysis. As noted in the disclosures, he is also well-connected to many pharmaceutical companies. Meta-analysis is a statistical technique that allows for investigation of multiple studies. This provides a broader view of the available data in the field.

Since this was a study of response to drugs, it is important to understand how researchers define that term. When drug studies are conducted, subjects are assessed via rating scales which address the presence and severity of symptoms. A person is asked about a variety of experiences, such as hearing voices or feeling sad, and their responses are scored according to a predetermined rubric. Scores will thus fall on a continuum. The Positive and Negative Symptoms Scale (PANSS) is commonly used in antipsychotic drug trials. It includes 30 items and each can be scored on a scale of one (absent) to seven (extreme). Scores can therefore fall anywhere from 30 to 210.

There are many ways that researchers can analyze the myriad bits of data that are collected in these studies. Researchers are required to determine in advance how they will analyze their data, including what change would allow them to classify a person as a “responder.” Researchers can also define what would be considered a “remission.” To be counted as a responder, a person needs to have a certain percentage drop in the rating scale score from beginning to end of study. To be considered in remission, a person’s final score needs to fall below a set point on the scale. Unless one reads a study carefully, these distinctions can be missed and the notion of “response,” often cited in promotional material, can be misleading. Many studies consider a 20% reduction in score as a response. For some people, this can be a clinically insignificant change in symptoms. When large numbers of people are included in a study, it is easier to detect small differences among groups and these differences can reach statistical significance. A drug may be promoted as effective when what has been found is that the group of people who took it had a clinically minor reduction in symptoms as compared to the group on placebo.

The authors of this study, recognizing some of these challenges, set out to look more carefully at the range of response in the studies under review. They did this by not only reporting on the common 20% reduction often used as a marker for “response” but also 25%, 50%, and 75% reduction in the ratings.

The authors also analyzed the percentage of subjects who reached remission. In this case, remission was defined as not scoring above the “mildly present” rating on 8 key items of the PANSS.

The results:

  • Those who had no change or worsened – 19.8%
  • Less than 25% improvement – 43%
  • Less than 50% improvement – 66.5%
  • Less than 75% – 87%.

For those who were listed as “non-remission” – 66.9%.

To put this another way, only 33.1% of those in the studies were in remission. Only 33.5% had more than a 50% reduction in the rating scale.

The authors offer some insights into what I consider the paradoxes of common psychiatric practice as well as the problems with the way many research studies are conducted.

They begin their paper, “A considerable number of patients with schizophrenia do not respond to antipsychotic drugs.” They go on to cite what they describe as “vague statements” that “can be found in other reports and textbooks such as ‘most controlled trials continue to find a subgroup of 10-20% of patients who derive little benefit from typical neuroleptic drug therapy.’” They offer similar quotes from a variety of texts and conclude that “all of these statements are not based on firm evidence.”

In their discussion, the authors provide insight into the current state of pharmaceutical studies as well as offering their thoughts on why the response rates are so low:

“Pharmaceutical companies are trying to conduct large trials to assure statistical significance which leads to more recruitment pressure; the ‘patient clock’ is running down, thus patients are recruited quickly by professional centers; most of them are improved and stabilized on antipsychotics and enter an RCT after a short wash-out phase of a few days. As most of the antipsychotic effect occurs early on, further response may not be observed which could, at least partly, explain the relatively low number of responders. The increased ‘relapse’ rates on placebo also point to the direction that previous antipsychotics were beneficial.”

I found this rationale to be somewhat tortured. A major issue not addressed is that if people who are stabilized on neuroleptics are withdrawn abruptly and then restarted on drug or placebo, this would favor the drug since those given placebo would be experiencing withdrawal effects. But the authors bring up important issues about who gets recruited into studies these days and the extent to which they mirror the experiences of most people who are offered these drugs in clinical practice. Carl Elliott has written about this problem and it is critical to understand the context in which many drugs studies are conducted.

I still work as a psychiatrist and I know people who appear to benefit from these drugs. However, I want to use them in a way that is most helpful and minimizes harm. I also want to share the available data since this is what constitutes informed consent. What seems equally important is to provide this information to the public, including policy makers, since common misconceptions have had great influence on the structure of our system of care. Deinstitutionalization was driven by many forces but it is sustained by the notion that most people have robust responses to these drugs. We have a system of care and a societal expectation that these drugs are highly effective. When people are struggling in the community, the common response is that we need to adjust “their meds,” even though this is only likely to be helpful in a minority of cases.

Many of my colleague tend to focus on the need to find better drugs or design better studies as a way to address this problem. We tend to overlook so-called “alternative approaches,” such as the Hearing Voices Network. Oddly, given the context of this blog, these approaches are often discounted because they lack an evidence base. Sadly, adequate money to develop an evidence base is not offered because, well, they lack an evidence base. I suspect there is another bias at play.

In another recent email, this time from Medscape, there was a link to a video, “How to ‘Brand’ Psychiatry Today.”  In the video, Dr. Stephen Strakowski, chair of the Department of Psychiatry at Dell Medical School at the University of Texas in Austin, proposes this definition of the specialty: “Psychiatry is a medical specialty that studies and treats disturbances in brain function that predominantly affect behavior — behavioral brain disorders.”

I appreciated Dr. Strakowski’s attempt to define our profession and I think he captures the way most psychiatrists conceptualize the field. This is informative. He both touts but then acknowledges the risks of the medical model: “We need to be careful to not confuse the medical model with using only medication for treatment. Rather, the medical model uses the medical approach to define the treatment evidence base and decide on the treatment.” Dr. Strakowski also suggests some limits to what psychiatrists should be doing and urges psychiatrists to let others work at the top of their expertise, “to allow those who are the best therapists to be the therapy providers, for example.” My major disagreement with him is that he does not challenge some of the negative consequences of applying the medical frame so broadly; even when he suggests that we consider social factors and invite others to offer psychotherapy, it is all done in the context of a medical conceptualization of the problems at hand. But that is a subject for another time.

For now, I would call upon physicians who claim to value the medical frame “to define treatment evidence and decide on treatment” to do just that. The evidence base suggests that it is time for us to reappraise the effectiveness of these drugs and shift our practice patterns accordingly.

73 COMMENTS

  1. I do appreciate the question of “effectiveness of these drugs”, questioning the science.

    ____________
    Why is that guy yelling at strangers on the street?
    “The Contest” was the 51st episode of the NBC sitcom, Seinfeld. The eleventh episode of the fourth season, it aired on November 18, 1992.[1] In the episode, George Costanza tells Jerry Seinfeld, Elaine Benes and Cosmo Kramer that his mother caught him unaware while he was masturbating. The conversation results in George, Jerry, Elaine and Kramer entering into a contest to determine who can go for the longest period of time without masturbating.

    ….

    The contest affects their sleep, and the remaining contestants suffer insomnia, while only the people who were eliminated can sleep peacefully.

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    JERRY: I don’t keep real coffee in here, I get my coffee on the outside! (Intercom buzzes. He answers it) Yeah?!

    ELAINE: (Through intercom) It’s Elaine.

    JERRY: (Shouting) Come on up! (Opens his door for Elaine)

    GEORGE: Where did you get those socks?

    JERRY: I don’t know.

    GEORGE: I think those are my socks!

    JERRY: How are these your socks?!

    GEORGE: I don’t know, but those are my socks! I had a pair just like that with the blue stripe, and now I don’t have them anymore!

    JERRY: (Sarcastic) Oh, yeah, that’s right, well, you fell asleep one day on the sofa and I took them off your stinkin’ feet. They looked so good to me, I just had to

    have them!

    GEORGE: Yeah, well, they’re my socks!

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    (A brief moment passes as they look at each other)

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    JERRY: What are we doing here..

    GEORGE: ..Oh boy.

    JERRY: This is ridiculous.

    GEORGE: Do you believe this? We’re fighting. We’re fighting.

    JERRY: I haven’t been myself lately. I’ve been snapping at everybody.

    GEORGE: Me too. I’ve been yelling at strangers on the street.
    ___________________
    testosterone in the male over time http://www.mhhe.com/socscience/sex/common/ibank/ibank/0088.jpg

    schizophrenia age of diagnosis, http://www.schizophrenia.com/photos/szage.onset.gif

  2. I’m a surviving victim of the pseudoscience drug racket and means of social control known as psychiatry. Psychiatry is 21st Century Phrenology, with potent neuro-toxins. Psychiatry has done, and continues to do, far more harm than good. The DSM-5 is in fact a catalog of billing codes. All of the supposed “diagnoses” in it are bogus, and they were all invented, not discovered. Think about the key difference there. So-called “mental illnesses” are exactly as “real” as presents from Santa Claus, but they are not more real.

    Consider the “mind”, which psychs believe can be/have an “illness”. Did YOU create your mind all by yourself? Or is it the fact that your mind is a social construction. How did you teach yourself English, before you learned English? Or were you taught English by others? Therefore, so-called “mental illness” must be something that either ALL of us have, or else NONE of us have. Each person is a unique human being, but psychiatry believes there are arbitrary and clearly defined categories of “mind” which can be defined and identified. That’s a form of group delusion.

    As for this so-called “stigma”, which must be “defeated”, how can you propose to “defeat” something which you continue to perpetuate, having created it in the first place? I say you can’t. There ARE some identifiable, biological, physical brain conditions which can mimic many so-called “mental illnesses”, and those are the province of neurology, not psychiatry, as clearly stated in the video. So-called “stigma” is in fact an artifact of psychiatry. Psychiatry created stigma, and psychiatry perpetuates it.

    And I haven’t even gotten to the unholy marriage of psychiatry and PhRMA. Psych drugs are far less safe, much less effective, and much less necessary than your PhRMA paymasters would have you believe. The so-called “medical model” is both an aberration, and an abomination. It’s the tool of oppression which psychiatry wields to inflict the carnage it does. Among my friends are far too many who suffered under psychiatric care. Many, if not most, were also victims of physical, mental, emotional, verbal, psychological, and sexual abuse as children. I know 3 women, – ironically all Catholic, – who were raped by their fathers when they were girls, and who were then taken to psychiatrists for labelling and drugging in their teenage years, all so they would not be believed when the spoke out about the truth. So, yes, psychiatry is complicit in covering up rape. The unmitigated and unacknowledged arrogance and intellectual conceit of psychs such as in the video continues to appall me. The worst mistake I ever made was going to a psychiatrist, and taking psych drugs. The best decision I ever made was to stop both. And so I will live out my years, in increasing good health and happiness psychiatry-free. And I shall speak out every chance I get at the pseudoscience lies of the drug racket and means of social control known as psychiatry. There’s a damn good reason for that “shortage” of psychs, – people are waking up to the delusions, to the lies. You really need to spend a few hours at .madinamerica.com., reading some truth, and hearing other surviving victims tell their true stories. My only conflict of interest is the truth of my own reality, which psychiatry cannot explain. Gee, Doc, what happened to my “mental illness”?

    • Dr. Steingard includes a link to a video on “Medscape”, by a Dr. Strakowski, who wants to do a better job at “Branding” psychiatry today. The longer comment above, from myself, is what I posted on “Medscape” in their comments section. But it *looks like* “Dr. sandra steingard” left herself logged in to that site. So I *think* that my comment there looks like it was posted by Dr. Steingard and not myself. I couldn’t see how to log in to “Medscape”. I’m sorry for any confusion, and I’m sure that regular readers of the MiA comment section will recognize my usual comment style and content.

    • “… psychiatry is complicit in covering up rape.” Yes they are, Bradford, and big time. As a matter of fact, covering up child abuse is the number one primary actual function of today’s mental health industry, according to their own medical literature.

      Today over 80% of those labeled as “depressed,” “anxious,” “bipolar,” or “schizophrenic” are misdiagnosed child abuse survivors. Over 90% of those labeled as “borderline” are misdiagnosed child abuse survivors.

      https://www.madinamerica.com/2016/04/heal-for-life/

      Why all this misdiagnosis of child abuse survivors? Because NO mental health professional may EVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER, without first MISDIAGNOSING the child abuse survivor with one of the billable DSM disorders. Child abuse is listed in the DSM as a “V Code,” and the “V Codes” are NOT insurance reimbursable disorders.

      https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

      So basically, today’s mental health industry is a multibillion dollar, iatrogenic illness creating, primarily child abuse covering up, system. (See my comment below for the medical proof that the antipsychotics create the schizophrenia symptoms.)

  3. “I still work as a psychiatrist and I know people who appear to benefit from these drugs.”

    Given that the human body is in perpetual struggle against these drugs, and reacts to them as poisoning, it is difficult to say that some patients “benefit” from this treatment.

    It is not because the patient says he has a benefit of the treatment that this is true.

    Neuroleptics are primarily chemical lobotomizers: Dorph-Petersen (2005) found that haloperidol and olanzapine reduced the brain mass of monkeys by 8 to 11% in 17 to 27 months.

    The mass of the human brain is about 1500g. 8 to 11% of the human brain corresponds to 120-165 grams of fresh mater. It’s the equivalent of a steak (100-150g).

    Go and remove 120 grams of a man’s brain. Would you do it? It will be necessary to push the scalpel deeply into the brain, and to go on several times.

    It is not ethical to practice any treatment – even when the patient requests it or seems satisfied – especially in the case of lobotomized patients who lack 120 to 165g of human brain.

    Psychiatrists who maintain a patient on neuroleptics – with or without their agreement – must be regarded as practitioners of the chemical lobotomy.

    If you refuse to start or maintain a patient on neuroleptic, it would be a progress.

    Dorph-Petersen, K. A., Pierri, J. N., Perel, J. M., Sun, Z., Sampson, A. R., & Lewis, D. A. (2005). 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, 30(9), 1649. https://www.nature.com/articles/1300710

    • I was told by a self professed expert on psychopharmacology (on a psychosis website managed by psychiatrists that I won’t mention) that studies of neuroleptics on animals is in no way comparable to the effect on humans. Also, the main action of any neuroleptic is sedative (according to him), whatever that means. A first generation antihistamine is also a sedative, I suppose it could also be considered an antipsychotic, by that logic.

  4. Sandra Steingard, I’m curious, how do you see an improvement in your patients on neuroleptics that can’t be done any other way? If you could explain that in some detail, I would appreciate it. I gather, maintaining them on the drug is also necessary to sustain this improvement. Or is it just as a temporary measure to calm someone down?

  5. hi. I always enjoy Dr.Steingard’s posts.

    I take an “atypical” neuroleptic. Probably sort of like taking a low dose of Haldol, but with less muscle stiffness. I also take a lot of vitamins (Orthomolecular). I’ve taken benzodiazepines in the past, and they only suppressed voices to a point. Same thing with neurontin, sedating antihistamines, even a number of anti-seizure drugs. sedation only goes so far.

    am I a “voluntary” patient? Not exactly. If I don’t take the tranquilizer and I relapse, I could end up hospitalized, which would mean costs and (in all likelihood) a more noxious, densely sedating drug. Do I have “Schizophrenia” ? I doubt there is any such entity as a disease, in the same sense as say…lung cancer or arthritis.

    I’d like to taper off the neuroleptic, eventually. How? I don’t know. My dose is moderate in “atypical”-land, and that beats a high dose or (worse yet) a massive dose of the older stuff, state hospital-style. and yet..

    there is 0 support around here for tapering. everything and everyone reinforces the need for “medication.” I have a remarkably supportive family and yet…they too tell me “take the medicine.” The clinic is worse. All meds, all the time. And then if you’re on too many meds, that’s regarded with suspicion. And if you manage to get a psychiatrist to reduce the neuroleptic…that raises eyebrows, and…

    yeah, OK. Let’s just say…based on my “real life experiences,” I find Dr.Steingard’s approach appealing, far more humane, and…just more acceptable, from a moral standpoint.

    🙂

    • Which makes it ultimately more dangerous than Torrey.

      This is disappointing, this continued legitimizing of drugging under the aegis of “medication” by someone who is considered progressive regarding these matters. Not addressed in the least is the very idea of dealing with distressing thoughts and emotions by distorting and/or suppressing them chemically, which is based on a philosophy of denying the organism’s ability to sense and communicate impending danger. People are not designed to be in a perpetual state of bliss or even tolerance when the environment does not correspond.

    • My heart goes out to you. No support around here either.

      I went off with online support from SA. I was already on disability. I stayed on my parents’ farm, getting my drugs from a GP for tapering and the placebo effect (on Mom.) I pretend to have Fibromyalgia to this day and many of my withdrawal symptoms are the same as FM.

      Out in Indiana everyone touts the “chemical imbalance” myth like the latest, most up-to-date medical discovery. I have printed a copy of the article where Dr. Pies puts his foot in his mouth about this “metaphor.” Yet he goes on to argue how his “science” (of destroying random parts of the brain) is so darn effective.

      Tell a lie often enough and you’ll believe it long after others wise up.

  6. I always enjoy reading Sandra’s work. She is thinking!
    I think as survivors we can’t always make all professionals whipping posts for our very justified anger and rage.
    This WHOLE movement is a process and there are fits and starts and fits and starts.
    As much as the Nazi’s in Germany and other repulsive regimes with their minions are completely reprehensible to me. I also know there were those who tried to help. Some did amazing things and were killed, others did little and still were killed, and others lived on.
    Every time we blanket our thinking it stops as Leonard Cohen put it so well we need to acknowledge that it helps that other humans let the light come in through the cracks.
    And I will stand my ground with stating every every corrupt system has cracks.

    The other issue is there is no good alternative yet. If you are rich maybe but jus maybe because professionals can take advantage of the rich.
    Who btw is “ treating” Kayne West?
    Hell of a job?
    Where is a person who cares about the little boy that he was and what he lived through? No language but a cry that is unheard and labeled mental illness.
    So there are few open doors and windows which makes the field like living in Germany knowing about the camps or just after the Allies came in and what does one do?
    The ability for funding and creation of true supports is ALWAYS iffy.
    British Military Medical Staff knew about trauma because they had no choice but to return soldier suffering from battle faitigue to the front. It worked but after the war ended- No more soldiers needed at the front lines do it was all forgotten to the detriment to all of us.
    So while we are in movement and there still is no way to Adequetely heal from the malpractice and abuse we suffered we have to slug on and anger even the best and most justified can end up a burden. MLK Jr. and Ghandi and Vera Britten and others knew rage and because they knew it so very well they choose the nonviolent path.
    So don’t stop wring criticisms just maybe doing something somehow. May not be realistic but I speaking for me, can’t totally turn off others when they are trying. If we do turn off others we are uncomfortable about or maybe they are a trigger- so many ways of walks
    I don’t want to be as rigid as the Nazis and other tyrants my way or the high wayor for many in contact with them
    death. Or the parents who says when I say jump the only question you can ask is how high?
    Allies are important even if you don’t totalky see eye to eye.

    • I really appreciated this comment. It is important that we don’t allow ourselves to deteriorate into labeling and dismissing, as that is the tactic used by “the system” to keep dissenters down. We need to recognize the humanity of everyone we encounter, even if we have to decide to keep someone’s views or behavior in check due to the damage done to others. There is no telling which antagonist might at some time have “the scales fall from their eyes” and start to see things differently.

      Psychiatry’s biggest crime, in my view, is undermining and defeating people’s hope. We have to continue to have hope that people are human and are never entirely hopeless.

      • Gandi is no different than any other person. We are all full of these contradictions. He was a born Hindu, with many of the prejudices of his religion, although he was greatly enlightened in other areas. Claiming he was terrible because of his views on caste paints him as a very black and white individual, stripping him of his humanity and making him into a paper caricature of a person.

        You can find the very same thing with Jesus of Nazareth. He was born and raised a good Jew, although the Jews of Judea didn’t recognize anyone from Galilee, or Northern Palestine, or Israel, to be a good Jew. They thought that the Jews of Galilee were not true Jews because they had contact and relations with Gentiles. Anyway, both the Jews of Galilee (Northern Palestine) and of Judea all looked down on anyone who came from Samaria, which was the middle province of Palestine. The reason for this was that the Samaritans had polluted the Jewish religion with pagan beliefs, creating a syncretized religion that wasn’t Jewish. Everyone hated Samaritans. Usually, people traveling from Judea to Galilee and from Galilee to Judea traveled out of their way to avoid going through Samaria because to travel through there would pollute them, making them unfit to worship in the Temple in Jerusalem until they’d gone through lots of purification rites. Jesus is very unusual because he travels through Samaria with little concern for propriety and custom.

        So, we have the story of the Samaritan (or Canaanite) woman who asked Jesus to heal her sick child. Jesus’ first response to her was not very nice at all because he essentially asked her what she was doing, a Samaritan, asking him, a good Jew, for anything. It was like he said, “How dare you even speak to me!” And then she zinged him with the line about even the dogs get to eat the crumbs from under the master’s table This is a play on words since Jews referred to Samaritans as sychars, or dogs. And as we know from the story, Jesus is taken aback and has to rethink things and then responds in a truly human and kindly manner. Jesus was a product of his times and society and had the very same prejudices as all the rest of his culture. This is one of the most interesting stories in all of the four gospels that we have and yet you never hear it preached about from the pulpit on Sundays, probably because it shows a very prejudiced and human Jesus. This story is important because it shows why Jesus was truly a great person. He could rethink things, even things that he’d always held as gospel truth. This is the mark of an amazing person, at least in my humble opinion.

        All this business with the Samaritans is why Jesus used a Samaritan as the hero of one of his best known parables. Up to the time of his telling of this parable he had lots of followers but after he told it all but the twelve left him. Everyone thought he was crazy because he even told such a story. In one gospel version even his family thought he was crazy and they went to get him. It was an affront to their religious dignity. This is why, in the gospel, that Jesus turned at this point and asked the twelve whether they were going to leave him also. There was no way in the world that there could ever be a good Samaritan! I believe that this is one of his greatest parables and, in my own belief I think that he was only able to tell such a remarkable story after his encounter with the woman about her sick child.

        Well, I digress but my point is this; all of us have our issues and our inconsistencies in thinking, even Gandhi and even Jesus of Nazareth.

        • Oh, stop. Gandhi lived in the 20th Century, so it’s easier to discern what he actually did. Your Jesus of Nazareth was born of a virgin, what does that tell you of the accuracy of the stories about him 2000 years later, or even 200? What makes you even think this story you are telling isn’t made up? Who was narrating it? The BBC?

          Gandhi wasn’t born anything, I didn’t say he was terrible, I said he was repulsive, repulsive to the people he excluded. It was his choice to exclude. And he exerted power.

          • It could just be that the story about the Samaritan was part of a plan concocted by a rival group to undermine the Jewish faith. As could be the whole narrative in the New Testament. History of the Catholic Church does tell of persecution of Jews.

        • Gandhi has been object of “cult of the personality” like Stalin, Mao or Steve Jobs. The opposite of “cult of the personality” is the “demonization”. As much the cult of the personality as the demonization obscure the intelligence. But in the case of Gandhi, it is rather the cult of the personality which has maintained incredible myths.

          For example, Gandhi was not at all non-violent, far from it. He has participated in many wars: against the Zulus, against the Boers and against Germany on the side of the United Kingdom, but also against the United Kingdom on the side of Hitler (Gandhi, op cit, vol 78, p. 386 “460. TO EVERY BRITON” July 2, 1940.). Gandhi’s position on violence would be better defined as follows: you must not use violence against powerful governments like those in the United Kingdom or the Third Reich. On the other hand, when these same governments order you to slaughter your neighbor in an imperialist war, you must do it, otherwise you are cowards and effeminate (Gandhi, op.cit., Vol 17: p 83 “67. APPEAL FOR ENLISTMENT “, June 22, 1918).

          So no, I do not think Gandhi was “no different than any other person”. He had a very special personality, made of oportunism, religious fanaticism and racism. People with such a high level of duplicity are rare, even among politicians.

  7. Amen to that Steve.

    My experience is that the psychiatrist will try to lower your expectations and indoctrinate you with “it’s biological, it’s not curable as such , it’s treatable with chemical but you may never be fixed, it’s psychiatric not psychological, it’s an imbalance that only drugs can reverse”. These are the messages I got from the NHS and it’s shocking. I had to call time once saying we just don’t have time for dogma we have to work on getting better.

    When all hopelessness is being heaped on you, just believe in the power of human recovery. Believe in this person , they can and will do it if the people they trust don’t undermine them.

    For me, apart from deliberately undermining hope so as to engender dependence, psychiatry’s other biggest sin is to deny the evidence that there is no chemical pathology we can find, no brain disease we can identify, but are there certainly psychological causes for extreme mental distress.

      • @despondent: “extreme mental states are not solely psychological in origin.” That’s a interesting question. Have you any examples? I think that might be right, but I can’t actually think of any at the moment that aren’t psychological in their root cause. I think even enlightened biological psychiatrists are coming round to the idea that it doesn’t start with chemistry, I’m thinking of Sir Robin Murray. We can at least identify highly correlatable psychological factors, but there isn’t any other possible cause that has any evidence at all, is there?

        Oh, and Steve: in the UK , I don’t think the driver is money, I think it’s job security and toadying up to your professional leaders. You won’t get fired for doping someone so much they can’t function for years, but if you don’t drug I think that could cost you your job, I thought I saw an example of that .

        • Thanks for that inside information about life in the UK. I know things are different in different countries. I’d have to say, though, that sounds like the facts on the worker level. I am guessing that someone higher up the food chain is still making a lot of money or it wouldn’t be so important to make sure workers are prescribing.

    • “there is no chemical pathology we can find”

      Hate to say this, but there is. You see gamma-Aminobutyric Acid (GABA) is synthesized from glutamate by the use of an isoform of the enzyme glutamate decaboxylase: GAD 65 and the active form of B6 (P5P). Enzymes are encoded by genes and if the phenotyope of the enzyme is poor and an individual can’t adequately make that conversion to GABA you will have a chemical imbalance. But there is a partial fail safe being as the NMDA receptor is a voltage gated ion channel. Now to be sure I’m not on the side of the psychiatrists and their drugs… that is very harmful fraud. If the ion isn’t present to gate the channel you will have excess transmission of the glutamate neurotransmitter. What does that mean ? Well anxiety, insomnia, mania, aggression, anger, migraine possible violence, seizures.

      What I’m stating is hard science biology.

      https://www.ncbi.nlm.nih.gov/pubmed/9777629

      https://www.ncbi.nlm.nih.gov/pubmed/9871412

      https://onlinelibrary.wiley.com/doi/full/10.1046/j.1471-4159.2003.01910.x

      Glutamate is the major excitatory neurotransmitter in the CNS. GABA is the major inhibitory neurotransmitter in the CNS.

      How do you know if you are low in the ions necessary to regulate the NMDA? well migraine/anxiety is a sure sign.

      I sincerely hope that helps. Running to my bunker now.

      • “if the phenotyope of the enzyme is poor and an individual can’t adequately make that conversion to GABA”

        IF. If, if, if…

        Do you know some living human with genetic deficiencies that prevent the correct synthesis of GABA?

        Many genetic deficiencies lead to a non-viable embryo and therefore to a miscarriage or stillbirth.

        You have to prove that a human being with such a deficiency is viable and exists before making the assumption that a skull ache could be caused by such a deficiency.

        In the first article, the researchers describe the process of GABA synthesis and its genetic origin. Unless I am mistaken, they do not describe a pathological condition where a genetic defect would hinder the synthesis of GABA. Unless I am mistaken, they do not mention any subject having such a defect.

        Can you cite more specifically a study (with quotation) in which a genetic defect is linked to a defect in the synthesis of GABA and that the cause has been formally identified and observed on living human beings?

        In this case, it should be possible to detect a group of human beings with this genetic disease which would cause above-average anxiety. As an individual, I have never heard of such a genetic disease.

      • Not sure if the bunker has WiFi but when you surface again…..

        “How do you know if you are low in the ions necessary to regulate the NMDA? well migraine/anxiety is a sure sign.”

        Isn’t that BS of the kind we are all railing against? Sorry if that seems strong, please prove me wrong!

        It’s an interesting theory streetphoto, alongside all the other chemical imbalance theories. But where’s the evidence it exists and causes mental “disorders”? Not in those references I don’t think .

        • SPB is excellent at the science part but still apparently fails to grasp that correlation is not causation. He still tends to “diagnose” people, and ascribe their feelings to biochemical causes, and seemingly hasn’t grasped the idea that “mental illness” is impossible, instead focusing on “alternate” ways to cure “it.” I think he should focus on helping people withdraw from neurotoxins instead of contributing to the same myth that psychiatry is based on, i.e. that there can be such animals as “mental illnesses.”

          • Pharma/psychiatry corrupted the science for profit. The science is good and shows not only partial solutions to these problems but also the corruption. Am all for helping people withdrawal and exposing this vile fraud that has killed and harmed so many. I certainly do disagree with you that conditions called anxiety, depression, mania and psychosis do not exist. But I’m not going to go a step further on it. We have much more in common than not.

          • @streetphoto, I hope the bunker is agreeable, I’m thinking of going down to mine when Storm Callum hits.

            Don’t you think the GABA theory should be put in perspective? It is a theory where there is some interesting research, stimulated by the increasing doubt over the dopamine theory. It is not yet a cause that has evidence to back it up. It may well go the way of the seratonin theory (always BS) or the dopamine theory (jumped the gun, it might be a pathway but probably not causal). But it might just turn up something, open mind and all that.

            So as yet there is no chemical pathology we can find and no brain disease we can identify, and psychiatrists, in the name of their own ethics, should stop telling their patients this until something is found where the weight of evidence is compelling. It does no good whatsoever because the patient feels broken, debilitated and then angry as he/she does their own research – the psychiatrist then loses all credibility and is exposed as a charlatan (strong word but strictly accurate).

            Jumping to conclusions is psychiatry’s biggest intellectual failing, ironic since this can be a failing in their patients – I’m sure you agree. I think you could even say that the GABA line of investigation is promising and might yet prove to be part of the puzzle, which is quite something in a research landscape littered with failure, but surely it is no more than that, don’t you think?

            A GABA drug supported by 2 flukey unblinded studies is just what we need to muddy the waters. Drugs to down-dopa, up gaba, up sera, up noreph, up adren all based on theories and giving rise to an chronic over-medicated mess. Already the research is massively complicated by universal overprescription of antipyschotics so you can’t work out what’s what.

            Off to bunker but have a bit of battery left on the laptop.

            Agreed that we do have alot in common, except you have a tin hat.

          • SPB: “Ask Aunite, I’ve just spent the last year engaging with her on this precise matter.”

            Yes, and it has been quite a revelation.

            Oldhead says… “[SPB] still tends to “diagnose” people, and ascribe their feelings to biochemical causes, and seemingly hasn’t grasped the idea that “mental illness” is impossible, instead focusing on “alternate” ways to cure it. I think he should focus on helping people withdraw from neurotoxins instead of contributing to the same myth that psychiatry is based on”

            You couldn’t be more wrong – SPB is NOT “contributing to the same myth that psychiatry is based on” – far from it. His knowledge is pivotal to exposing psychiatry as a pseudoscience and helping people withdraw to neurotoxins.

            Up until December 2017, I had spent over 20 years frequently pole-axed by migraines. My GP provided me with repeat prescriptions for sumatriptan, a powerful serotonin agonist. I was effectively hooked on the sumatriptan, reaching for it every time a migraine threatened to develop. This drug “saved my life!!”… it was like magic. Before I started taking it, I would spend several days each month completely incapacitated by crippling full-blown migraine – sumatriptan, taken in the early stages, stops it in its tracks by constricting the blood vessels in the brain and damping down the inflammation. But after a couple of years, the frequency of migraines increased and I was relying more and more on the sumatriptan. I didn’t realise this was due to rebound from the drug until SPB pointed it out. I had deliberately avoided researching sumatriptan because I didn’t want to face up to having to stop taking it (spellbinding), I was scared of the return of full-blown migraine. I was kidding myself that migraine drugs were not psych-drugs, and I fell for the medical industry propaganda that “there is no cure for migraines.” But by the end of 2017, I was spending nearly all my life either drugged up and “spaced out” on sumatriptan, or in pain because of migraine. I was also taking daily propranolol (80mg sustained release), and even occasional tramadol – all courtesy of my GP. I later found out that he was following NICE guidelines to the letter. The drugs were only just keeping the migraines at bay, I was on a hellish treadmill.

            SPB has guided me to a migraine-free, drug-free life. I took my last dose of sumatriptan on 5th May, and I am successfully tapering off propranolol. The thought of taking tramadol horrifies me, I won’t be doing that again.

            SPB has opened my eyes and mind to the importance of understanding basic neurochemistry – in particular the role of intracellular Magnesium – I have most certainly had a deficiency of this all my adult life. Doctors do not have this basic knowledge, and that’s partly what makes them so dangerous – they are intelligent and intensively educated, but susceptible to being manipulated and falling for the ultimate hoax… Psychiatry.

          • SPB is NOT “contributing to the same myth that psychiatry is based on”

            Yes he is, unfortunately. We are talking about the myth of “mental illness,” recognition of which is the cornerstone of an anti-psychiatry analysis. Again: a) correlation is not causation; b) “mental illness” is impossible if we are still using the English language, or any language really; c) good nutrition is important, just like brushing your teeth, but it does not “cure mental illness.”

            “Mental illness” REMAINS a myth, and I don’t see how you cannot see the dangers (and fallacy) of maintaining otherwise, or how this sort of logic can be used to oppress us. It doesn’t matter how well magnesium meshes with your system. If you continue on this path your only logical conclusion would be “mental illness exists and can be cured through nutrition.” Is this really where you want to go?

            It is irresponsible, given what is at stake here, to use terms like “anxiety,” “depression,” or “psychosis” with a straight face. They are disease terms which lead people right back to psychiatry. Additionally, if one understands the depth of alienation created by capitalism and its effect on people’s lives, there are no “mysteries” to solve here.

            So let’s separate the issues. Be healthy, everyone, and take your vitamins and minerals if you need them. We need to be healthy — and migraine-free — so we can continue to show the world that “mental illness” is a hoax.

            This sort of validation of psychiatry, while unwitting, is so frustrating coming from people who should understand the way “mental illness” labels continue to be used against us.

            (An addendum to Auntie — have you ever considered changing the cartoon in which you recommend “zopiclone”? It’s about the only serious contradiction I have ever noticed in your published work so far.)

          • His knowledge is pivotal to exposing psychiatry as a pseudoscience and helping people withdraw to neurotoxins.

            The latter, yes, absolutely, the former not at all. Psychiatry has already been exposed as a pseudoscience, and a knowledge of biochemistry, while helpful, is not necessary to understand that psychiatry is a hoax; Szasz demonstrated that decades ago. If people don’t want to see what’s right in front of them all we can do is wait for them to make the connections.

          • I certainly do disagree with you that conditions called anxiety, depression, mania and psychosis do not exist.

            Let’s examine this more closely bit by bit:

            — It is true that states of mind are “called” such things, but it is not true that these labels are valid;

            — Assuming that “anxiety” (a form of fear) or “depression” (extreme sadness or despair) have the same origins from person to person and can be categorized as such is mistaken;

            — Such emotional states serve a function and the goal should not be to suppress or eliminate them prematurely;

            — Interpreting the biochemical processes which facilitate the communication of such emotions throughout the organism as the cause of those emotions is equally invalid.

            So, again, these emotional states do “exist,” as people experience them. However they are not disease symptoms, nor do they represent flawed or “disordered” responses of the individual’s brain to the life circumstances he or she faces.

            For the vast majority of the psychiatrically labeled, the solution lies in overcoming the objective sources of suffering, which are almost always to be found in material reality — not in trying to simulate the biochemical correlates of such resolution. Reordering the body’s synapses, etc. via extraordinary measures should be reserved for actual neurotoxic damage induced from without, not the body’s natural responses to a toxic culture, and I would encourage SPB to make this his niche. I think it would be far more useful and productive than attempting to validate the bankrupt concept of “mental illness” then promoting nutritional “cures.”

        • CC – The glutamate/gaba science is not wrong, but the solution is only partial, for some it would be very significant. I came to this conclusion through an indept experience/understanding of migraine long before my experience of psych drugs. The NMDA (glutamate) receptor is central to the transmission of migraine pain and central to long term potentation (memory). btw the migraine business is also sickeningly corrupted.

          • @streetphoto: Well, OK, but please god lets hope psychiatrists don’t start running round with this notion, which is still just a theory.

            As a matter of interest, the main drug class that affects gaba is (gasp) benzos, is it not? I think Peter Goetsch said that short term crisis use of benzos has been undervalued. What do you think of that?

            With migraine, are you saying that Triptans are not as effective as we are led to believe?

          • @ConcernedCarer: “As a matter of interest, the main drug class that affects gaba is (gasp) benzos, is it not?”

            Yes. Also alcohol.

            “I think Peter Goetsch said that short term crisis use of benzos has been undervalued. What do you think of that?”

            I know this was directed at SPB, but I have an opinion on this… In the early 90s I vowed to myself that I would avoid “antipsychotics” at all costs. Since then, in times of crisis, I have managed to persuade GPs to prescribe either Valium, or latterly, Zopiclone. It always “worked” in that it effectively shut down my brain in a way I desperately needed at the time. So, I would agree with Gotzsche… except to say that now that I am taking Magnesium supplements, I’m confident that I will never again have to run the gauntlet of a GP appointment for any more neurotoxins.

          • Its the process of deduction and honesty that matters to me. No-one can say that biochemical imbalances cause mental problems until evidence proves otherwise. And you can’t say a drug reverses an imbalance if it doesn’t or there isn’t an imbalance.

            Psychiatry has to learn to live with uncertainty and be able to hold several theories in mind as possible causes without being definitive.

            Jumping to conclusions has got psychiatry in the mess where its drugs are not effective and in a great many cases makes things worse. The lack of scientific rigour in some quarters has become laughable and that is terribly undermining for a profession that I still think we need.

          • So much to disagree with, so little time…

            Jumping to conclusions has got psychiatry in the mess where its drugs are not effective and in a great many cases makes things worse.

            Which conclusions?

            An alternate perspective: Just imagine for a minute that the designed function of psychiatry was not to help people live better lives, but to mystify people’s dissatisfaction with capitalist society, and put the onus for reacting negatively to an inhuman system on the individual reflecting that dissatisfaction, rather than on the system causing it. Suppose that neurotoxic drugs were actually a form of chemical warfare used to aid that distortion and suppression of people’s natural reactions to lifelong oppression. In that context what would be meant by the drugs “working”? Working for whom, and to what end?

            As the above fantasy is my reality, I think psychiatric drugs work pretty well at doing what they’re supposed to do. Which is why we need to expose them and abolish them.

            Psychiatry has to learn to live with uncertainty and be able to hold several theories in mind as possible causes without being definitive.

            Again this rests on the assumption that there is something mysterious to be explored. In fact propagating the illusion of “uncertainty” is part of the deception. Understanding that people react in a zillion different ways to living in a system where human aspirations have been reduced to dollar values, and our worth is calculated in terms of the profit which can be extracted from us, is not rocket science OR brain science.

            This is all happening at a level beyond the control of “mh professionals,” no matter what their opinions. So this is not a personal statement, CC, and we are clearly in synch on some other things.

          • We are not talking about emotions and it is not a correlation. External inputs directly cause the process of LTP (memory). In this case of anxiety/depression it is the memory of abuse in childhood usually or when ever. The functionality of memory is that of the AMPA and NMDA receptor. And that is where the problems are. The magnesium block of the NMDA and it’s movement generating an electrical field is of absolutely profound importance to humanity. Nothing less. If a person wants to stop their anxiety/migraine attacks, raging insomnia, intrusive thoughts/ memories in the middle of the night, Mg is what they have to do.

            I even suspect that the loss of Mg through stress/abuse may also be involved in anti-nmda receptor encephalitis inducing psychosis.

          • If a person wants to stop their anxiety/migraine attacks, raging insomnia, intrusive thoughts/ memories in the middle of the night, Mg is what they have to do.

            Only if the only reason for the physical symptoms is a magnesium deficiency, which may be one out of endless possibilities. You seem to be assuming, with no evidence that I’ve seen, that this is true for everyone. Additionally, those “intrusive thoughts and memories” have to come from somewhere; I’m sure you’re not claiming that these are created by magnesium deficiencies.

          • The most basic error of psychiatry in the DSM era is the assumption that all people presenting certain ‘symptoms’ have essentially similar needs and causal factors in place. This, of course, could not be more wrong. So it is that some people will do wonderfully with magnesium supplementation, and some will experience no effect at all, and some might even do worse. True, it is much safer and smarter to try nutritional interventions or supplements of this sort, as the consequences of a “no result” are pretty minor compared to “antidepressants” or, Lord help us, “antipsychotics.” But the idea that a person experiencing intense anxiety automatically has a need for magnesium supplementation is just as scientifically wrong as believing that all anxious people need SSRIs. It is dehumanizing to lump people together based on some arbitrary category of emotional “disorder” defined by subjective observation and judgment regarding basic human emotional responses that could literally mean almost anything depending on the person experiencing them.

  8. Well all, of course Ghandi was imperfect as Jesus, as Vera Britten, as Rabbi Hillel,
    Victor Frankel, Corrie Ten Boom, Dorothy Day, . The importance is not their flaws, their importance was/ is that they spoke out. Some better than others, some less hypocritically than others. There are no saints on this earth.
    Some people like Dr Peter Goertze speak out.Some do as Stephan Gilbert has chosen.
    The only option I have found for myself is to tell my story to chosen people and groups. And it was as far as I can tell a random shout in the dark. But I followed what I would tell the kids I worked with to tell and tell and tell until someone listens and hopefully either can or will act. No guarantees just the knowledge that there usually are some sort of good folk around. But luck is a crucial element.
    Oh my Dr Torrey talk about wrong way Corrigan – perfect example of TROUBLE.
    The force that drives the fuse.
    I just hope someday we can have a counter force that drives the fuse of our own.

  9. One of the most devious tactics that psychiatrists and most studies on the efficacy of neuroleptic treatment use is their study of so-called “first episode” patients. They do all kinds of measures and tests when these people are obviously at their most vulnerable. Slap on an antipsychotic, do some more tests and measures after a while, since they become tired and apathetic, at least they are no longer actively psychotic (something that probably would subside in any case). Scans that show increasing brain damage over time are attributed to the illness. Trials on animals are not valid. Trials longer than 2 or 3 years are not popular, as it would probably indicate a paradox. A relapse is called schizophrenia, requiring life-long treatment. Ofcourse, it’s not a failure of the drug.