What Would Real Informed Consent on Psychiatric Drugs Look Like?

Robert Nikkel, MSW
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1710

I’m excited to announce a new series of Mad in America Continuing Education webinars for 2019. They focus on what I believe is a central issue—what does a true informed consent process look like for the prescription of psychiatric drugs? This is a leverage point for changing the paradigm of care by starting with how people are informed about what psychiatric drugs do.

I believe that righting this ship is largely going to be up to non-medical mental health professionals and persons with experience in having been through a system that fails miserably to provide real informed consent. Since we are a continuing education program, our courses are designed primarily for the first group: psychologists, social workers, nurses, licensed professional counselors, and marriage/family therapists. We will continue to apply for continuing education credits (CEs) and at some point recruit more interest from physicians so it would be worthwhile to apply for the more expensive continuing medical education credits (CMEs).

We recognize that our webinars are attended by three main groups—not just clinicians but also persons with lived experience and, increasingly, family members who have become discouraged with the poor progress their loved ones make over time in the era of long-term prescriptions and polypharmacy. And they are more and more frustrated with too much of their advocacy movement having been tainted by corporate influence. We definitely need peers and family members to participate, because change in clinical practice will not take place without the urgency and pressures initiated by those with personal knowledge of the current problems with poorly constructed informed consent processes.

I know from my experience as a state mental health commissioner that making these kinds of system changes requires a combination of great ideas, partnership, and taking advantage of opportunities. Reforming the process of real informed consent is one of those opportunities that we can bring to the horizon sooner rather than later if we have a much clearer product, i.e., a solid idea of what the provision of truthful, unbiased research-based information about psychiatric medications should look like. This upcoming series of webinars will take a meaningful step forward.

We have planned the series starting on January 22 with a panel of four people who have had personal experience in being informed or not when prescribed drugs. They will discuss their experiences: good, bad and indifferent. All of the presenters are also engaged in peer-delivered services and advocacy so their perspectives will be shaped by both kinds of roles. They will also conduct the concluding webinar in June in which they will reflect on what they heard in the four intervening sessions to further refine ideas and to stimulate more interest and advocacy efforts for change.

The second session will be taught by one of the leading conceptual experts on this issue, UCLA’s Dr. David Cohen, who will present his views on the concept and history of informed consent processes. This webinar will be on February 19.

Next, Dr. Sandra Steingard, medical director of a community mental health center in Vermont, will describe what a well-constructed informed consent process looks like in a real life mental health program—she will address challenges, perceived risks and benefits. She will add to her several well-received webinars on psychiatric drug withdrawal in our previous courses on this important and obviously very closely connected topic. Her webinar is scheduled for March 19.

On April 16, Erin Barnett, a child/adolescent psychologist with Dartmouth, will discuss the issues of informed consent in working with children and youth. Much of this process focuses on the information that must be provided to parents and, where necessary, to legal guardians or others who are responsible for approving or not approving the use of psychiatric drugs.

The last of the presenters, James Toews, will discuss issues on a topic that we have not really touched on enough: that of what informed consent must look like when a person who is being prescribed these drugs has extremely limited cognitive capacity, such as people with developmental or other intellectual disabilities and seniors who are increasingly prescribed more and more medications. Mr. Toews is a longtime colleague who most recently served as a highly respected national consultant, and before that for more than two decades as a powerful advocate and director of senior and developmental disabilities at a state level.

You can register for the entire series here.

The fee for the six-webinar course is $75, with an “Early Bird” registration discounted to $40 for those who register by DECEMBER 1. We also provide a limited number of scholarships to all our courses for those in financial need.

We look forward to your participation.

43 COMMENTS

  1. ‘A Model Consent Form for Psychiatric Drug Treatment’ is reprinted with permission from MIA Blogger David Cohen, PhD and David Jacobs, PhD. For original and reprint publication info, please see the bottom of this post in the link https://www.madinamerica.com/mia-manual/model-consent-form-psychiatric-drug-treatment/

    For a long time my posts on informed consent psychiatry that included whats on the MIA link above showed up first page search results. Now the search algorithms favor the ‘mainstream’ and bury the truth just like with news.

    They still don’t warn people about ‘side’ effects but I know in alcohol/addiction ‘dual diagnosis’ treatment unlike 10-15 years ago the word is mostly out that psych meds are a screw over. They still try them but people are more careful and much less trusting.

      • I have been following the latest in censorship and as a Youtube commenter put it critics of government abuse of power the ‘police state’ are the real targets. https://www.madinamerica.com/forums/topic/stop-internet-censorship-writetrump-com I included a big list of censored alternative news sites too.

        Its not left or right politics like fake news would like you to believe, the websites getting censored are the ones against abuse of power. Mike Adams Natural News a huge critic of the psychiatric drugging of children they pulled out all the stops to put him down the memory hole.

        Psychiatry is a favorite tool of oppression, they will protect it.

        • Oppression is not a left-right issue. The sooner we peons realize this, the sooner we can stop buying into the idea that voting in a new set of oppressors will solve the problem. Not that I’m against voting, mind you, as some oppressors are objectively worse than others, and there are still a few bright lights out there in the darkness of politics, but it should be clear now that direct and unified action is the answer, and left-right politics is a divide-and-conquer tactic that serves all the elite from whatever side of the aisle.

          • left-right politics is a divide-and-conquer tactic that serves all the elite from whatever side of the aisle.

            Steve, your liberalism is showing I’m afraid. True left-right politics involves the struggle to overthrow capitalism. What you are referring to is “liberal”-“conservative”/Democrat-Republican/”good-cop-bad cop” so-called politics, where there are are not really “two sides” but variations on the style of capitalist rule. The false “sides” you mention DO divide people, but not in the sense you seem to think; a conscious populace united against capitalist oppression would be considered fully “left” under the current definitions. But given the FALSE divisions that such terminology seems to encourage, we may do well to eliminate the “left-right” verbiage entirely until and unless the meanings of these terms are more clear and mean the same thing to everybody.

          • I mean “left-right” politics as described and played out in today’s media and public conversations in the USA. It’s a long time since the USA has an actual “left” in the old 1930s “let’s organized and take on the capitalists” sense. When Bernie Sanders is considered a radical leftist and Hillary Clinton is called a “socialist,” the term “leftist” has long since lost any rational meaning in the USA. So perhaps “Democrat/Republican” is a better description, but in truth, that’s what the vast majority of US citizens think of when someone says “left” and “right” these days, at least over here.

          • Here’s how I put this is a recent letter I sent to someone (and I agree the term may have had its day):

            I remain a revolutionary socialist of some sort, which is decidedly left. But the idea is to articulate and communicate principles that unite people in defeating the system, not divide people who are equally powerless in the system into warring camps shouting one another down over “isms.” That’s a gift to those who want to divide & conquer…

            In my book you aren’t a leftist unless you oppose capitalism. There is no category of “liberal/leftist”; the two should be recognized as in opposition. And capitalism is not just another “ism,” equal to “ableism” or “looksism”; it’s up there somehow intertwined with racism and sexism as the “mother of all isms.”

          • Are you familiar with Slavoj Zizek? He is a prolific writer, not a fan of capitalism, AT ALL. His writing can be very dense, but provocative. Very interesting person. I’ve waded through some of his books. Zizek is a philosopher and also trained in Lacanian psychoanalysis. I’ve dipped my little toe in Lacanian psychoanalytic theory and decided that I’d have to learn French before I could really get into Lacan’s work.

            Yanis Varoufakis is another “real” socialist progressive who is an excellent writer. He was the finance minister of Greece during the period when the EU was destroying Greece’s economy, so he writes from a different perspective than Zizek, but equally provocative. If you haven’t read “Adults in the Room”, it is a real life, true story about the absolute destructiveness of capitalism. You can’t help to see the parallels with what’s going on in the US.

    • Yes I think its going to be difficult to come up with a consent form as well, but something has to be done.

      In the UK the bare minimum should be:
      1. “is this prescription in accordance with NICE guidelines?” In some cases this actually REQUIRES written consent, but it is not followed.
      2. “is it off-label?” Again, this is not always disclosed.
      3. “is the person in possession of the patient leaflet and has this been explained to them?” Extraordinary to think that you might not get a patient leaflet isn’t it? But it happens.

      I would also LIKE the person to be informed of published efficacy and what it means.

      Lots of people are not fans of the NICE guidelines and I understand that you can argue about them, but they at least represent a protocol, even if its too pro-drug.

      • Forced treatment should be abolished, however, if you’re going to “detain” people against their will and wishes, a no drug treatment option should be provided. Ditto a no shock option. No amount of information is going to make drug treatment or shock treatment harmless procedures. I can’t say for sure that I know what “voluntary” treatment in these cases means any more than I know what “informed consent” means. What does it mean? We made a “plea bargain” and we handed somebody a printed form to sign? You watch TV, and on TV you get a string of ads, drug ads, and these drugs ads are followed by a listing of adverse effects, that seems to drone on forever, but the idea is to get people to be mesmerized by the ad, and to tune out the adverse effects. Nobody is even saying, here, you shouldn’t take these things, but since you’re going to do so anyway…. No, they’re going to be saying, read the print out, and then do what you will. Honesty would mean saying, straight up front, this is a drug nobody should be taking long term, and if it’s a drug nobody should take long term, maybe it’s a drug people shouldn’t even be taking on a short term basis. I just wonder and worry about the number of times “informed consent” might mean “misinformed non-consent”. We know some treatments are supposed to be harmful, but still, you’re hoping to get a “sane” person out from their usage in the end. When it comes to weighing risks versus benefits, somebody could still be tampering with the scales.

  2. “If a child had an allergic reaction to selective serotonin re-uptake inhibitors”

    More nonsense from the psychiatrists that needs to be challenged. ‘Allergic reaction to SSRI’s in children’. It is NOT an allergic reaction, it is because children do not have fully developed metabolising enzymes and will all have different phenotypes (strenghs, expressions of) therefore can not metabolise the drugs correctly and become toxic. All of this can be predicted with a gene test that no one gets.

    https://www.theguardian.com/society/2018/nov/21/children-under-10-among-those-given-strong-antidepressants-in-uk

    “Theodosiou said: “If a child had an allergic reaction to selective serotonin re-uptake inhibitors (SSRI), it’s not worth running the risk of trying another SSRI, so you may say let’s then try venlafaxine instead. But you would need to know that it may increase thoughts of suicide and in that situation would make sure medication was locked away … give prescriptions on a weekly basis and increase reviews.”

    So they are – in a sly way – trying to shift blame to saying suicide ideation and suicide is being caused by an ‘allergic’ reaction.

    • @streetphotobeing Absolutely true! Thanks for the link – I am keeping tabs on what is being spread in the media by members of the Royal College of Psychiatrists – this bit is of particular interest…

      Theodosiou said she did not think there was overprescribing of antidepressants. “The debate about the use of antidepressants is good but … it’s really important that people are not frightened of the prospect of medication. What we wouldn’t want is a situation where people thought these medications were inherently dangerous.”

  3. We can talk all we want about informed consent and how important it is but this is not going to accomplish a thing. How are you going to force the psychiatrists in places like where I work, a state “hospital”, to truly inform people about the effects of the drugs that they’re forced to take? If they truly informed people of such effects there would be a huge rebellion on every unit where people are held because the truth is that these drugs are harmful. Some people might choose to take the drugs anyway rather than deal with the voices or visions, but my suspicion is that most would push back about taking them. One of the big reasons that informed consent is nonexistent in such institutions is to keep people from fighting back. Informed consent would change the entire paradigm of how these institutions would be forced to run and this would be problematical for clinicians. So, how are you going to force psychiatrists to truly inform people about the drugs that they force people to take? You can work with social workers and psychologists and the like but they’re not the ones making people take the drugs.

  4. I have mixed feelings about this. I guess it’s a start, but I don’t see how “informed consent” can work in any realistic way. It doesn’t work with non-psych medication prescriptions, and in psychiatry there is the additional problem that anyone who has been given a psychiatric diagnosis is assumed by many psychiatrists and other doctors to be incompetent in some way and therefore not capable of making rational decisions about their own healthcare. Very convenient, eh?

    The real problem I have with this, though, is that it proceeds from the premise that psychiatric diagnoses have something to do with real illnesses that can be treated with medication. That is absolutely false. Psychiatric medications do have a function, or actually several functions, none of which are related primarily to helping the targeted individual. First and foremost is that these drugs make MONEY for the pharma companies and other businesses downstream from the pharma companies: drug reps, magazines & journals that advertise the drugs, medical associations, prisons and other quasi-governmental agencies that need to control people, and of course, psychiatrists and other doctors who prescribe them. That function is so overwhelmingly powerful that any attempt to limit or control the use of these drugs will fail.

    In fact, it could be argued that any other function of these drugs is related to this primary function, although there are non-monetary functions as well. These drugs function to promote the belief that mental illnesses are biochemical illnesses, thus alleviating anyone outside of the “designated patient,” including society in general, of any responsibility in creating the distress in individuals. This function is required by psychiatry because it justifies the continued existence of the field itself, within the current medical model that all illnesses are of biochemical origin. (Note that I am not denying the existence of biochemical factors in illnesses, but the sole focus on inherent biochemical defects has obliterated any alternative discussions about the origin of illness, to the detriment of everyone.) Psychiatry does not have to justify its existence in this way, but it has chosen its own fate. Psychiatrists used to be the primary providers of talk therapies for distressed people, and a small minority still do that, but greed, laziness, and other corrupting factors pushed the field into this fake biochemical model and now it’s stuck with this albatross.

    Within the much larger perspective, societies have a need to control their members. This is true in ALL social structures, not just human social structures. This function has evolved with life itself as a way to protect and promote the continued existence of species. This is true for both plant and animal life. For Homo sapiens this function has led to the development of agriculture, governments, organized religions, etc. The concept of “mental illness” is a recent “invention” that has evolved as a way to marginalize and control individuals that don’t conform to societies’ designated norms, and therefore are considered “dangerous”.

    Although society itself has created the distress that individuals experience, the designation of illness makes “mentally ill” people disposable, especially those who are so disabled by their distress that they can no longer contribute (economically, in a capitalist society). But wait! Society has created a way for mentally ill people to contribute! Mentally ill people are consumers of drugs, thereby contributing income for many, many other members of society. This allows society to continue to avoid acknowledging its own brutality. Society gets to pat itself on its back proclaiming “Aren’t we kind and compassionate to take care of our members in this way!”

    This function of the designation of “mental illness” and the important role it plays in society is rarely acknowledged, or even made conscious. As content on this website clearly indicates, though, there are severe downsides to this concept of mental illness for both individuals and society itself, but the concept has taken on a life of its own because of the economic drivers in the equation.

    Is it possible to change this grindingly huge monster?? Pecking away at peripheral factors, like suggesting that there can be “informed consent” for these drugs falls way short of the mark. Really, at least in my view, the only “informed consent” would be: “You don’t need this drug. Don’t take it.” But that is also incredibly naive because so much of society is unconscious of the bigger picture. So, what’s the answer??

    “The greatest and most important problems of life are all fundamentally insoluble. They can never be solved but only outgrown.” Carl Jung

    Each individual must do the hard work of becoming conscious of what society does not want to be made conscious. Of course, that makes one even more of an outcast, even more dangerous. It’s a desperate dance.

      • I’m not sure that eliminating the term (mental illness) will solve the problem. Psychic dis-ease does seem to exist. Really, the whole concept of illness needs to be exploded. It is confined in the straitjacket of biochemistry, imposed, ultimately, by capitalist interests. Capitalism eliminates creative thought. Thinking takes time and energy away from producing and consuming–the only things that matter in a capitalist society.

        Medical technology has taken on god-like proportions: drugs, diagnostics, bionic parts, artificial intelligence, robotics, and on and on. All the shiny new toys have so limited our concept of humanity and life in general that we can’t even imagine something greater than an assembly of bits that ultimately can be thoroughly described, understood, replaced, perfected. This is what the field of medicine has become. There is nothing of Healing left in medicine today. It’s just another industrial process. The field of psychology is no different, although there are perhaps more independent thinkers who are psychologists than medical doctors.

        But again, as I’ve said before here and elsewhere, banishing the term “mental illness” or destroying the field of psychiatry won’t change anything unless we acknowledge that there is a systemic defect that allows–or requires–these things to be created in the first place. If society needs a subcategory of people to bear the burden of society’s inability to take responsibility for the harm it causes individuals, it will continue to create that. Just read history! Witches, sorcerers, practitioners of black magic, etc.: categories of people who were misunderstood, feared and persecuted.

        It’s easy for those of us in the current version of the “misunderstood, feared and persecuted” subcategory to get mired in our own pain and fear and to try to lash out and destroy that which hurt us. But we are the ones who have to take the conversation to the next level and insist that the focus be broadened and deepened to include scrutiny of the defect in Homo sapiens that allows individuals to shirk responsibility when functioning as part of the “herd”.

        Developing better Informed Consent forms is a version of micro-managing the defect. Yes, in some respects, it is necessary because the abuse has become so critical and people are suffering and dying. But micro-management without the macro-view is destined to fail. Who is having this discussion on a larger scale–a more visible public forum? I honestly don’t know. Like everyone else, at least part of me lives in my own personal bubble of fear for my own safety and the daily grind of survival. Online forums, like this one, are a good start, but they become too insular and only offer an illusion that the discussions here matter to anyone outside this tribe.

        If you do a broad internet search on “the meaning of illness” you get mostly dictionary definitions! There is a paper published in The BMJ in 2011 that touched on the problem of medicalization of conditions not previously perceived as “illnesses” and the economic factors driving this. But that is still only a part of the larger concept of “dis-ease”, whether or why we need that concept, and the various forms of value (not just economic) that flow from having this concept.

        Maybe it’s just too big a chunk to bite off…

        • The real problem I have with this, though, is that it proceeds from the premise that psychiatric diagnoses have something to do with real illnesses that can be treated with medication. That is absolutely false.

          Psychic dis-ease does seem to exist.

          OK these two statements are essentially contradictions.

          Apparently you are unfamiliar with Dr. Szasz, who has already done much of your work for you. Mental or psychic “disease” can never be more than a metaphor.

          Psychiatry does not have “defects”; it IS defective in its basic premises, i.e. a house of cards.

          • well, no, not contradictions. Maybe I should have been more clear, but I’m using the term “dis-ease” in a way that is not at all the same as a medically diagnosed “disease”. My definition of dis-ease flows from Jungian analytic theory as a state of being in which there is incongruence between the overall “Self” and one or more parts of the Self, one of which Jung called the ego, but there can be many others. Actually, I don’t know if that would be “standard” Jungian analytic theory. I don’t claim any expertise, just some familiarity and fascination with his ideas. However, that is how I experience what I call psychic dis-ease.

            Here’s an example: Ego: “We need more money!” Self: “No, we have enough.” Ego: “How do you know?? We might run out of money!!” Self: “No, we’ll be fine.” Ego: “But we might END UP HOMELESS!! We might STARVE TO DEATH!!” Self: “We’ll manage.”
            Note: histrionic, fear based ego, anxiety driven behavior leading to over-working, physical symptoms, obsessive compulsive kinds of behavior, poor decision making, etc. In this example, the whole premise of not having enough money has no basis in objective reality, but the ego doesn’t see it that way. Other times, Self may agree with ego, saying “yeah, we should probably either make more money or spend less.” Then the ego is HAPPY because it gets to go into executive mode and organize, plan, and make things happen!

            In the first case, the behaviors and symptoms generated by the unhappy ego might receive a diagnosis of “mental illness” by a shrink requiring medication or worse, whereas a good psychotherapist might help sort out what’s generating the unhappiness and then help to unravel it.

            Of course, things can get a lot weirder than that, but it always seems to be some kind of incongruence between what the Self knows and what some part (complex, according to Jung) thinks it knows, leading to uncomfortable emotions, unhelpful behaviors, various physical symptoms, etc., any or all of which could receive medical diagnoses.

            That was a long-winded explanation of how I view two separate concepts: disease vs dis-ease.

            I am familiar with the writing of Dr. Szasz; again, not in any expert way, but I read a lot. I think that much of what he wrote is interesting and has merit, but his ideas are not universally accepted, or maybe I should say that not all of his ideas are universally accepted.

            I am, happily, not an expert in any of these ideas of mind, psyche, psychopathology (for those who believe that exists), etc. My research training is in behavioral neuroscience, very much the nuts and bolts of the brain, with occasional forays into mind stuff. But as my life unfolded into the brutal world of psychiatry, “mental illness”, psychosis, and every bad thing that happens when those 3 come together, I struggled a long time to make sense of what was happening and what it meant. Nuts and bolts explanations just didn’t cut it for me.

            I have read and continue to read a lot. All these great thinkers have contributed ideas to help make sense of the human experience. Some things I don’t agree with, some things I do, but it’s all valuable. All of it helps me make sense of my own experiences, although there are some experiences that will never make sense. I’ve also learned that sometimes there are genuine reasons to be paranoid. There is evil in the world.

            Yes, I agree, psychiatry IS defective in its basic premises. But more and more, I am coming to believe that all of Medicine is defective in its basic premises. Every illness has a dollar (or euro or whatever currency) value attached! That is so bizarre to me. It evokes images of walking down the breakfast food isle in a grocery store, thinking to myself “there’s nothing to eat, it’s all junk food!”

            How do we know what “illness” is? Is it a commodity? Absolutely it is! The concept that every illness has a currency value is so ingrained in almost all modern human cultures that we don’t even SEE that it’s going on! That brings us back to capitalism, and I think I’d better stop writing!

          • Medicine is flawed in some basic premises too, but in a different way. The focus here is psychiatry however.

            If you are unfamiliar with Szasz to the extent that you simply see him as having some “interesting ideas” you are missing much of the crux of anti-psychiatry analysis. In the end, what you or I personally may come up with as we play with semantics is not overly relevant, as the reigning mythology, which has the force of law behind it, is based on taking the metaphor of mental “illness” and concretizing or reifying it as an actual pathology. A linguistic trick which we can expect to see repeated in other areas I’m sure, it seems to work so well.

          • Re: Szasz…I just didn’t want to write a thesis. As you’ve probably noticed, I tend to get a bit carried away. It’s difficult to do him justice in a blog comment and I’m also tired tonight.

  5. It’s important to try and avoid the sententiousness that always accompanies one persons’ attitudes to someone elses’ drug use.

    If you are going to go ahead with the pompous moralising, then it’s best to do so from a very, very solid position of personal abstention from drugs, including from the most prevalent and damaging of all: alcohol and refined sugar.

    Alcohol alone, is the drug of choice for suicide, homicide, rape, domestic and stranger violence, and child abuse. It is toxic to all of the major organs, including the brain, the heart, the liver and the kidneys. It is attributable to a great many home fires, car accidents personal injuries, and disrupted social gatherings.

    How many regulars on here who castigate psychiatric drugs are using alcohol and sugar?

    How many people on here are well-informed and aware of the risks of alcohol and sugar but go on using them anyway?

    And more importantly, why?

    If alcohol and sugar are anything to go by, people can be repeatedly informed of the risks and the likely impacts on their health, but choose to go on using anyway. They weigh the pros and the cons and for them it balances on the positives.

    The same can be done with psychiatric drugs.

    Some people find solace through using them. They are aware of the pros and cons. Agree that people should be better informed. But force is a human rights issue, an infringement.

    But if bad news about drugs was enough to drive people away from them, then as I say, you don’t have to venture far from your own home to work out why bad news isn’t enough. And that’s true for almost everyone.

    Force. Compulsion. That is the problem that needs to be addressed, and perhaps more people inflicting forced drugging would be less willing to partake in this human rights infringement if they themselves were better informed about the risks.

    • Be careful not to conflate prescription medications that have, as Steve says above, “the veneer of respectability as treatments for pseudo-medical diagnoses”, with over-the-counter substances that one can easily obtain without the blessing (or condemnation) of the medical profession.

      Sugar is a “nutrient substance”; not a healthy one in the quantities that are ingested in the Western world, but it’s not a drug.

      Ethanol certainly could be classified as a drug, and yet for many people, low to moderate exposure does not carry significant health risks. Ethanol abuse certainly does, and what you are describing above are consequences of ethanol abuse. The same argument could be used for cannabinoids, although that’s not a popular sentiment these days. Nevertheless, occasional moderate use by adults likely has no long-term adverse effects. Cannabinoid abuse can have adverse effects.

      Psychopharmaceuticals are targeted specifically to disrupt neurotransmitter systems. They are, in fact, highly toxic, although some people are more tolerant than others. For the most part, they are only (legally) available by prescription.

      There are many substances that are toxic when misused, but can be obtained without the intervention of medical professionals. The point is that society cannot keep people from choosing to be stupid and damaging or killing themselves. But many people, if not most, still trust and depend on the judgement, education and ethical standards of medical professionals where prescription medications are involved. When medical professionals allow financial and other conflicts of interest to get in the way of their judgement and ethics, then there is real cause for alarm.

      • Oops. Yes, sugar has nutritional value and depicting alcohol as a drug is an opinion. Please forgive my poor education.

        And yes, it’s very naughty when doctors dish out drugs that drug-seeking individualists go seeking. Very naughty indeed. And those poor-drug seeking people isolated in their desolate villages with no access to information. Those poor serfs being led along by the naughty doctors and the naughty pharmacists and their naughty leaflets.

        I mean, who doesn’t trust a leaflet with massive lists of side-effects?

        And we know alcohol and sugar is okay and much better than the naughty doctors stuff because have you ever been given a leaflet detailing lengthy health risks including death when purchasing alcohol and sugar?

        I should hope not!

        Damn those naughty doctors and hurray to the publican and the sugary food retailer!

        • You misinterpreted what I wrote. Sugar is a nutrient substance. Ingestion is optional because our bodies generate “sugar”, ie, glucose, and-normally-rigorously control the amount that floats around in our bloodstream. So, there really is no VALUE in ingesting various forms of sugar. Refined sugar has no nutritional value. Our bodies can handle ingestion of small amounts, but regular ingestion of large amounts of various forms of sugars, as well as simple starches (grains, potatoes, etc) can lead to metabolic disorders.

          The fact that ethanol isn’t defined as a “drug” is a political and cultural convenience with a long history. I’m neither condoning nor condemning that.

          Also, the fact that nutrition education in this country is wholly inadequate is really irrelevant to this discussion.

          I’m not disagreeing with you that forcing someone to be exposed to a toxic substance is absolutely wrong and is a human rights issue. However, to assume that someone is knowledgeable enough about the effects of a prescription drug, based on the information his or her doctor provides when writing a prescription, is making a huge leap.

          Maybe I’m wrong, but I do not think that most people have an adequate understanding of biochemistry and physiology to allow them to make informed decisions about the risks of taking medications (psych or non-psych). My own experience is that a shocking number of my own physicians do not know enough about the medications they prescribe that would allow them to adequately inform their patients. Studies have shown that on average, doctors’ information is something like 17 years behind the times! Most doctors do not read the medical literature and they do not have adequate training in experimental design and statistical analysis. Doctors rely on “expert panels” of other doctors to tell them what they need to know in their daily practice of medicine. Unfortunately, those “expert panels” can have economic conflicts of interest, and recommendations can end up being very industry-favorable, to the detriment of patients.

          Of course, people can make their own decision whether to take or not take a prescription medication, just as they are free to make their own personal decisions about nonprescription substances they ingest, whether to jump out of airplanes for fun, have unprotected sex with strangers, etc! That does not mean they are adequately informed about the risks of any of that, though. But access to prescription medications is controlled by the medical profession, whereas access to other potentially dangerous substances and activities is not. The medical profession has a burden of responsibility as the gatekeepers of access to prescription medications. That is the issue being discussed here.

          • “[…]to assume that someone is knowledgeable enough about the effects of a prescription drug, based on the information his or her doctor provides when writing a prescription, is making a huge leap.

            Maybe I’m wrong, but I do not think that most people have an adequate understanding of biochemistry and physiology to allow them to make informed decisions about the risks of taking medications (psych or non-psych).”

            A doctor can’t tell you what will happen to you. All they can do at best is express hope that you feel a bit better. Whatever that means?

            Even the world’s foremost biochemist is unable to have an adequate understanding of what will happen to *you* if you take a psychoactive drug. Most of their knowledge is based on what has happened to mice, rats and fruitflies. In *isolated* *controlled* environments.

            And then they are unable to predict what will happen to a specific mouse, rat or fruitfly.

            And even then, no-one has a blinkin’ clue what happens when all these drugs enter the wild, and mix it up with all the culturally okayed shit, and all the environmental pollutants, the chemicalised environment, and plastic particulates in the food chain.

            It’s more complex than the simplifying narratives make it out to be.

            Never trust a simplifying narrative!

            There are expectancy effects and there is the placebo effect and some drugs are downy, and some others are uppy, and some others can be trippy. Beyond that, what does anyone really know about drugs and how can anyone realistically measure the effects of drugs on human beings? Moreso, on an individual?

            How can a doctor be held to blame if someone regularly using alcohol, sugar, aspartame and caffeine comes a-pleadin’ for a fix when their coctails catch up with them? And gives them what they want?

            And how honest are people anyway about their drug use with their doctors? Especially, as you know, most people are necking drugs under the self-delusion that they are non-drug substances.

            “The medical profession has a burden of responsibility as the gatekeepers of access to prescription medications. That is the issue being discussed here.”

            It’s all a bit too much scapegoaty and unrealistic if the broad issue of drugs and self-drugging isn’t included in a more honest and open discussion. Singling out one aspect of this drug opera isn’t getting to the heart of the issue. Which seems to be the way the world turns much of the time.

            I agree that the gate is too wide open. And needs pushing closed a fair bit. But afore that gate aren’t simply the gullible and the desperate. It’s a highly drugged population in disarray in a drug-normalised environment.

  6. Real Informed Consent would scare prospective “consumers” away and spell the end of psychiatry.

    “If you want I can give you a drug to mess with your brain functions and cause TBI. It may work by fooling you or MAYBE sabotaging the part of your brain used to process (bad) emotions, but there’s a greater chance it will do the exact opposite or even turn you into a monster, alienating those around you. It’s mostly miss with an occasional hit that obliterates way more than you wanted. It will also wreak massive damage on every other organ in your body. Oh, and if you don’t already suffer low self esteem this will take care of that when your weight doubles in less than a year.

    “In addition to random acts of brain damage I can assign you a stigmatizing label to ruin your chances of marriage, gainful employment, higher education, or renting anything outside a HUD ghetto. It will also cause doctors to laugh at you if you have a heart attack, stroke, or cancer–not to mention akathisia, and other iatrogenic damage caused by this treatment. Of course we won’t shame the pills. We shame patients instead. Blaming it all on you…that is your horrible illness causing you to suffer.

    “Nobody’s fault. At least not mine.

    “Am I my brother’s keeper?”

    Well, yes you are doc. That’s what you aspired to be, after all.

  7. “Do you think they felt they were murdering people ?”

    “Errr it’s most interesting that two other chiefs here: medical doctors and psychiatrists who were running this place here, kind of got away with it – in 1962 – by saying that they couldn’t see anything wrong with killing those incurable insane, and they had learned this in the medical courses at the universities and so they couldn’t see anything wrong. In fact they got free, and so this went from court to court and in 72 the German supreme court decided that indeed since that they didn’t see anything wrong there was nothing wrong with it and they could be free. So this is about the medical people.”

    Benno Müller-Hill

    https://youtu.be/0uB7S7Ckjvc?t=304

    You will not find the word Akathisia on any psych drug pill insert in the UK.

    Psych-Drugs Harm – 5B: Wendy Dolin – Drug-Induced Akathisia

    https://youtu.be/cvoIFbR9OPk?t=277

  8. After years of trying and failing with what seemed like every SSRI/SNRI/Atypical antidepressant, i was told a DNA test was the answer to my problems (where was that sent to after?), we could figure out the best course of action for me. Of course it told my doctor everything I had previously told him, I metabolize SSRIs & SNRIs too quickly so I get “brain zaps” even though I’m taking them on time every day. He recommended this new medication called Viibryd and said I had the chance at finally feeling better. I took it for FOUR DAYS and had the most intense electrical shocks in my brain I’ve ever felt. They were so painful that i could feel my brain pulsating almost a minute before the big shock. It took me over a month to ween myself off of them after FOUR DAYS. I was taking them for depression and PTSD. The brain zaps continued but with auditory hallucinations, which I had never experienced before. I really think it did damage to my brain. I was in tears and unable to function the entire month. I’m still scared that my brain was capable of going to a breaking place like that. It still frightens me to this day. Anyway- when i finally got another appointment with my doctor and told him about the horror i experienced, i was told (with condescension) “I’ve never heard of that before. This medication works for a lot of people.”

    I just wish i had been warned. I had no idea what i was being given. When I’m being prescribed a medication I want to know what it’s doing to my brain, what three REAL side effects are, what the clinical trials were like, and how is this going to effect me long-term.

  9. The long time issue re Maria Schneider is serious and Last Tango in Paris should not be available and should have been shelved. One can draw correlations in mental health in terms of coercian and informed consent interms of emotional damage. This goes on all the time in mental health situations and as it never left Maria, indeed affected her whole life as is the case with us…many of us have been emotionally and physically (forced drugging) raped by psychiatry. Think about that and then think some more !