Welcome to Planet Psychiatry

Editor’s Note: This piece is an edited excerpt from the author’s 2020 book, Butchered by Healthcare.

Most physicians view psychiatrists as somewhat feral animals. We suspect—with some justification—that many of their ideas are hot air. Unlike any other specialty, psychiatrists take care of people with normal labs and radiologic tests. They keep only patients with purely subjective problems. Psychiatrists pass patients with “organic” issues such as thyroid disease to others. These are the ones with identifiable physical signs, symptoms, and tests. Likewise, psychiatrists base treatment outcomes solely on their theories and observing patient behavior rather than on measurable, objective results.

No other specialty has a sizable group of protesters who oppose their legitimacy. These include not only Scientologists, but psychologists, scientists, journalists, and a few renegade psychiatrists. These “psychiatry deniers” believe that most psychiatric drugs used today are harmful, ineffective, and vastly overprescribed. They question the specialty’s power to lock people up and force them to take damaging medications based only on their opinions.

Most of the public, however, sees psychiatry as valid, sensible, and scientifically based. Patients expect health insurance to pay for it.

Mainstream psychiatrists believe the four primary drug categories they use—the stimulants, the SSRIs (Selective Serotonin Re-uptake Inhibitors), the benzodiazepines, and the antipsychotics—are effective, beneficial, and cause little harm. Citing their close-range experience treating mental illness, they claim that these diseases are under-treated and that even patients with mild symptoms should take medications. Their studies and standards support this. But these are so structurally compromised and biased with industry money that they are useless.

These “psychoactive” medications influence sleep, wakefulness, mood, behavior, and so forth. Unlike most drugs, they enter the brain by crossing the blood–brain barrier, which is a natural microscopic defense against toxins. Drugs that behave like this can alter or damage the entire central nervous system. Although these medications are commonly used and casually prescribed, taking them is a trap because addiction is common and frequently irreversible.

As you read the following, contemplate:

1. Mental health is America’s most expensive medical sector, estimated to be $213 billion in 2018 (cardiology and cardiac surgery combined might be in second place, at $143 billion).
2. A 2016 Scientific American source said one in six US citizens takes psychiatric medication. The Wall Street Journal said this is one in five, and the US Centers for Disease Control and Prevention (CDC) claims that one in four of us have a mental illness.
3. Thirteen percent of all US citizens age 12 and over received an antidepressant in 2017.
4. In the US, 9.4 percent of our children get diagnosed with hyperactivity (CDC, 2019) and about half get medication (The New York Times, 2013).
5. Antipsychotics are considerably overused for nursing home residents. The vast majority of patients with dementia get them, mainly for the convenience of the caregivers and in order to cheaply decrease staffing levels.

“PSYCHIATRY IS IN DEEP CRISIS”

Psychiatry is the drug industry’s paradise, as definitions of psychiatric disorders are vague and easy to manipulate. Leading psychiatrists are…  at high risk of corruption and, indeed, psychiatrists collect more money from drug makers than doctors in any other specialty. Those who take the most money tend to prescribe antipsychotics to children most often. Psychiatrists are also “educated” with industry’s hospitality more often than any other specialty. This has dire consequences for the patients.

Peter Gøtzsche, Deadly Medicines and Organized Crime (2013)

How modern psychiatry developed: A few decades ago, psychiatrists were losing their status. Then, the fabrication of new diagnoses along with the invention of medications to treat them saved them economically. First the antidepressants, and then the newer antipsychotics came to the rescue. This moved the specialty into the medical mainstream because the psychiatrists were the only ones who purportedly understood it all.

The novel diagnoses—some say concoctions—were enshrined in the psychiatric manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Pharmaceutical companies played a huge role in its creation.

The American Psychiatric Association (APA) started aggressive disease-mongering of the new ailments. They hired ad agencies to produce “public service” drug advertising. The corporations marketed the new supposed cures alongside.

By 2008, 28% of the APA’s income came from drug companies. According to influence theory, this made the APA virtually a subsidiary of the companies. Senator Chuck Grassley (R, Iowa) publicized the story in a congressional investigation.

Ben Furman, MD, a psychiatrist in Finland, explained how it happened in a 2018 blog:

The psychoanalytic belief system was thrown out and replaced with the DSM and the biomedical doctrine: everyone should have a diagnosis, and everyone should have medication. The psychiatrists now treated all the conditions that had been treated with therapy with medication. This became the treatment of choice for almost all mental health conditions regardless of whether the patient was an adult, teenager or child. A patient without medication became a rarity. The data system of mental health services required clinicians to diagnose anyone who sought help.

The psychiatrists and corporations ignored studies showing damage from long-term drug use. They left disparaging critics out of the debate and out of the textbooks.

Finally, long after the science matured, a few of the doctors are telling the truth. In 2012, an editorial in the British Journal of Psychiatry said the psychiatric medication revolution was at an end. Others now echo this sentiment.

The DSM is a kind of chaotic bible used to promote mental diseases. With its code numbers used for insurance, some call it the billing bible. Created primarily by psychiatrists on industry payroll, it mutates and metastasizes every few years through a vote of the APA members. In 2017, after many editions, it was 947 pages long.

Insiders have decried its intellectual disarray for decades. It has become the perverse standard in the service of drug marketing. The following are a few inside opinions about it:

There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous. I think the majority of us recognized that the amount of good, solid science upon which we were making our decisions was pretty modest.

Christopher Lane in Shyness: How Normal Behavior Became a Sickness (2007),
quoting one of the DSM’s contributors

I pictured all these normal-enough people being captured in DSM-5’s excessively wide diagnostic net, and I worried that many would be exposed to unnecessary medicine with possibly dangerous side effects. The drug companies would be licking their chops figuring out how best to exploit the inviting new targets for their well-practiced disease mongering. I was keenly alive to the risks because of painful firsthand experience—despite our efforts to tame excessive diagnostic exuberance, DSM-IV had since been misused to blow up the diagnostic bubble.       

Allen Frances, lead psychiatrist, DSM IV, author, Saving Normal (2013)

The National Institute of Mental Health (NIMH) in 2013 finally tossed the DSM—psychiatry’s diagnostic system—into the wastebasket.

Bruce E. Levine, psychologist and journalist

Of the 170 contributors to the most recent edition of the …  DSM…  ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia…  Not only did the DSM become the bible of psychiatry, but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions. That is an astonishing omission.  

Marcia Angell (2011), former editor-in-chief of NEJM

The DSM’s diagnostic categories lack validity, and the NIMH will be re-orienting its research away from DSM categories.

Former NIMH Director Thomas Insel

To understand the DSM-5 better, scan the following excerpt:

Criteria for Oppositional Defiant Disorder: A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. Angry/Irritable Mood: 1. Often loses temper. 2. Is often touchy or easily annoyed. 3. Is often angry and resentful. Argumentative/Defiant Behavior: 4. Often argues with authority figures or, for children and adolescents, with adults. 5. Often actively defies or refuses to comply with requests from authority figures or with rules. 6. Often deliberately annoys others. 7. Often blames others for his or her mistakes or misbehavior.

Parents of boys need no other commentary unless they support using medications with pernicious side effects to suppress normal, but somewhat irritating behavior.

The DSM has worldwide influence. It is the ultimate resource for courts, doctors, prisons, hospitals, and insurance companies. These diagnoses lock people into legal and therapeutic boxes, but they are of dubious benefit since the drugs work poorly and promote chronicity. Since withdrawal from these medicines is severe and mimics the conditions treated, long-term use becomes almost inevitable.

The corporations blatantly falsify research to get psychiatric drugs approved. Studies that show drugs do not work get concealed. Positive reviews get published multiple times, and the journals mostly only print the data that show the drugs work. These last two tricks are such standard practice that the drugmakers have internal nicknames for them: “salami-slicing” and “cherry-picking,” respectively.

Another often-used fraud is to compare massive doses of an old drug such as Thorazine with standard doses of a new medication. This makes the side effects of the new one look modest.

In proper drug studies, patients who take a placebo are compared with those consuming the genuine thing. However, in some psychiatric research, the people chosen to receive the sugar pill recently discontinued an older antipsychotic such as Thorazine. They are having withdrawal effects such as severe restlessness (akathisia) and anxiety. Placebo patients should not have any reactions. When such a trial is over, the lie is told that the treatment group using the drug had fewer ill effects—fewer side effects—than the sugar-pill group, which is absurd.

Psychiatric drugs are disasters. For example, Hengartner and his colleagues did a 30-year prospective study of 591 depressed Swiss adults at the University of Zurich. They found that no use of SSRIs (Prozac-class medications) had better patient outcomes than some use, which in turn had better results than long-term use. After nine years, they reported that the SSRIs cause more depression rather than less.

The benzodiazepines (Valium-class drugs) relieve anxiety for a few weeks. But after about a month, they stop working. After this, patients require higher dosages to produce the same effects. Later, if the drugs are discontinued, months of agonizing dread, sleeplessness, and crippling nervousness commonly occur.

The original studies of Xanax for anxiety were for 14 weeks; after four weeks, it was working; after eight weeks, it was not; and at the end of the study, as the experimenters withdrew the drug from the patients, they got much worse.

The psychiatrists and the drugmaker ignored the longer-term results and claimed there was a net benefit based on the first four weeks. (See Robert Whitaker’s explanation of the study on YouTube.) The FDA approved the drug, and it became not only the most commonly prescribed benzodiazepine but the most frequently prescribed psychiatric medication. But Xanax is addictive, and most physicians are well aware of it by now.

Other benzodiazepines are also hard to stop. Klonopin (clonazepam) is a chemically similar drug. One patient I worked with had used this 17-hour benzodiazepine to sleep every night for a decade. He decided to stop it. I wrote a compounding pharmacy prescription for smaller and smaller doses, so he tapered it over three months. He suffered with anxiety and sleeplessness the whole time, but felt better at the end. He said his energy and creativity both improved.

Another example: bipolar patients’ outcomes are profoundly worse in today’s medication era than they were before. Prior to the drugs, the disease often went away on its own. But now, we treat children who have psychological ups and downs with a stimulant or antidepressant before their first severe mania develops. The ones treated with antidepressants have four times increased chances of becoming “rapid cyclers,” which means they have frequent recurrences.

Robert Whitaker, a distinguished journalist, summarized the horrific medication problems in Anatomy of an Epidemic (2010):

Given what the scientific literature revealed about the long-term outcomes of medicated schizophrenia, anxiety, and depression, it stood to reason that the drug cocktails used to treat bipolar illness were unlikely to produce good long-term results. The increased chronicity, the functional decline, the cognitive impairment, and the physical illness—these are usual in people treated with a cocktail that often includes an antidepressant, an antipsychotic, a mood stabilizer, a benzodiazepine, and perhaps a stimulant, too. This was a medical train wreck…

Whitaker learned that most patients in emerging countries could not afford psychiatric drugs. Doctors there may even leave psychotic people unmedicated. The result is much less chronicity and some spontaneous cures. Almost half of the people with schizophrenia recover if they never get antipsychotics, but in the US, with treatment, this happens rarely or possibly never. History is also encouraging: before the drugs were developed, some studies showed the same thing. But since Americans now medicate practically everyone, comparison with placebo has become impossible.

In the US, mental illness, disability, and drug prescribing rose in tandem. Our psychiatric disability percentages have grown over tenfold during the modern medication era. Whittaker built a cautiously stated and well-referenced case that the medications were the cause. He also reported studies showing that within a few years, antipsychotics caused brain shrinkage in both monkeys and humans.

Psychiatrists have pressures to pass out medications. I interviewed one who said, “We cannot support our families unless we see a patient every ten minutes and give them the latest drug. Most of us know these are unproven, ineffective, and sometimes harmful, but people will not pay us just to talk with them anymore.”

David Healy further describes this circus in Pharmageddon (2012). The industry’s interest in funding psychiatry picked up when Prozac became available in 1987. As these SSRIs and other inventions became lucrative, corporations spared no expense for psychiatrists. They cater food, pay for meetings, arrange free hotel rooms, and sometimes provide first-class plane tickets for them. Lectures, trinkets, social events, limousine service, and massive exhibit halls are all available courtesy of the drugmakers.

These companies give some working psychiatrists $300,000-$400,000 per year. This creates the desired effect; for example, one group from the American College of Neuropsychopharmacology published a claim (2004) that SSRIs did not cause youth suicides. They were discredited after the discovery that nine of the ten doctors on the panel had a financial relationship with the industry.

The psychiatrists have credible excuses. The phenomena they treat are chronic and poorly understood. No labs, physical testing, or examination findings help make the diagnosis. Studying treatment is difficult because every detail is subjective. I felt sorry for them until I read about their misbehavior.

Since nothing seems to help, in their frustration, they have historically tried about anything. Ice-water baths. Electrical brain shocks—electroconvulsive therapy (ECT). Overdosing with insulin to crash the blood sugar. Even a destructive brain surgery called lobotomy, for which the inventor received the 1949 Nobel prize in medicine. These were all discredited. ECT, for example, is no longer believed to be effective and at least a third of treated patients suffer substantial memory loss. Worse, the fatality rate is 1/1000.

Psychiatrists customarily use medication combinations. They prescribe Topamax and Lamictal, which are unpleasant anti-seizure medications, to treat various symptoms and side effects. Depression, drug abuse, anxiety, and bipolar disease are all treated off-label using these. Military psychiatrists are fond of giving these seizure treatment drugs to combat troops. They often throw antipsychotics into these “drug cocktails.” The side effects of all these medications include fever, hair loss, nausea, mood changes, dizziness, diarrhea, double vision, loss of appetite, and suicide.

Brexanolone is a steroid hormone approved in 2019 for postpartum depression. It requires sixty (60) hours of medically supervised intravenous injection costing $34,000.

Progesterone, a female hormone that rises during pregnancy and goes nearly to zero postpartum, can ease these symptoms. The 100 mg dose is a patent drug, but compounding pharmacies can inexpensively provide the larger doses required for this condition. There is little interest in this because there is no huge price tag.

Hallucinogens such as ketamine or LSD are recurrent fashions in psychiatry. Recent trials are underway to treat depression, anxiety, and post-traumatic stress disorder using small doses of these, and there is a lot of enthusiasm in some circles. LSD has been considered disreputable and classified Schedule I since the war on drugs in the 1970s, even though it has no fatal dose and its toxicities are modest compared with many prescriptions. Although these therapeutic uses may have merit, I fear they are further abuses, even though there is no patented way to profit from these older drugs—yet.

The mental health industry’s ambition—now mostly realized—is to be the universal solution for every problem, and to use the drugs for nearly anyone. The National Institute of Mental Health says one in five US citizens “live with a mental illness.” Wikipedia (2020) noted that: “Worldwide, more than one in three people in most countries report sufficient criteria for at least one [psychiatric disorder] at some point in their life. In the United States, 46% qualify for a mental illness at some point.”

They were citing (respectively) the Bulletin of the World Health Organization and a 2005 paper by Ronald Kessler in Archives of General Psychiatry. He is the most widely cited psychiatric researcher in the world. He said in his paper: “Interventions aimed at prevention or early treatment need to focus on youth.”

Industry financing pushes this narrative. The money passes back and forth, and it is hard to tell what is industry propaganda and what comes from legitimate psychiatric sources—if there is such a thing. For example, MentalHealthfirstaid.org says: “In the United States, almost half of adults (46.4 percent) will experience a mental illness during their lifetime. Half of all mental disorders begin by age 14 and three-quarters by age 24.”

They emphasize that besides 50% of adults, children, who are traditionally off-limits, should be drug candidates as well. The following chapters explain how 17% of the entire US populace came to be using psychiatric drugs.

SSRI PSEUDOSCIENCE

The Selective Serotonin Re-uptake Inhibitor (SSRI) name was pseudoscience dreamed up in the marketing department of SmithKline Beecham.  The “chemical imbalance in the brain” idea was the brainstorm of a sales copywriter. Knowledge of serotonin and other neurotransmitters was even more sketchy when Prozac was invented than it is now. Today, this seductive but mythical gibberish embarrasses researchers.

The marketers said depression was like diabetes, and SSRIs were an “insulin” for brain disease. However, no clear relationship of depression to serotonin or other neurotransmitters was ever established, and the drugs all work about the same, with a similar lack of benefit. Jill Moncrieff in The Bitterest Pills (2013) confirmed this:

No chemical imbalance or other biological process that might explain drug action in a disease-centered way has been substantiated for any psychiatric disorder … Most authorities now admit that there is no evidence that depression is associated with abnormalities of serotonin or noradrenaline, as used to be believed (Dubovsky et al., 2001). There is also little empirical support for the dopamine hypothesis of schizophrenia.

Despite this consensus, nearly everyone still believes the metaphor and parrots the message. The idea is 1) your brain is damaged, 2) the drugs fix something, and 3) you need to take medications indefinitely.

SSRIs cause substantial harm. A 2017 literature review of randomized controlled trials in Frontiers in Psychiatry said these drugs are ineffective and damaging. It linked them to osteoporosis and movement disorders, including akathisia and tardive dyskinesia. They may double the risks of miscarriage and congenital disabilities. But physicians use them off label for pregnant women and during breastfeeding. Expectant mothers get severe withdrawal symptoms just like anyone else.

Sexual side effects occur in a range from 2% to 59% in various trials. In some studies, they never asked the patients about the issue. When used for premature ejaculation, about a third of men permanently improved, sometimes after just a few pills or even a single dose. This suggests significant long-terms effects that are adverse for most people. Many patients report having long-lasting problems with having orgasms after taking and then stopping these drugs.

In the first nine years of Prozac’s use, between 1988 and 1996, there were 39,000 FDA complaints, a record for any drug. This included reports of suicide, psychosis, abnormal thinking, and sexual dysfunction. Many patients taking the medication have sexual difficulties, are “emotionally numb,” and have “reduced positive feelings.” In October 2004, the FDA introduced a written warning about suicide in children and adolescents treated with SSRIs. The agency extended this in 2006 to include young adults up to age 25.

Antidepressants are touted as preventing depression for people having medical problems. Prophylaxis is a market for nearly anyone.

Industry hid SSRI-related suicides and violence. The manufacturers have always claimed suicide was because of the underlying depression and not the drugs. They altogether avoided addressing violence, and the psychiatrists parroted this.

SSRIs may help for severe depression, but only for a brief time. If your depression puts you in bed full time for months and you can barely resist killing yourself, you may want to risk the drugs. If you do, you must accept the risk that the medications themselves will enable you to get up and commit suicide or harm others. For moderate depression, the drugs work poorly or not at all. For mild depression, which is their current primary use, these medications are ineffective.

Casual prescription of SSRIs is unconscionable. Allowing the pharmaceutical publicity machine to promote them for brief adjustment disorders, mild sleep problems, and even grief reactions is a travesty. I wish I could say that awareness of this situation has percolated through the psychiatrists and primary care physicians. Unfortunately, industry propaganda has overwhelmed all the other narratives. In some years, SSRIs have been the most prescribed drugs, even ahead of blood pressure medications. Between 1996 and 2005, US antidepressant usage rose from 5.8 percent to 10 percent of the population, and by 2017, it was 12.7 percent.

CONCLUSION: LIVING ON PLANET PSYCH

Working psychiatrists address formidable problems, and we must respect their experience treating severely impaired patients. There is a definite place for their drugs, but they should only be prescribed to a fraction of those who take them now.

For more healthy individuals—who are victims of the universal overprescribing—the drugs cause much more harm than good. People seem to forget that life is full of challenges. Long-term use of a pill will not fix these. Even if they were side-effect free, which they are not, these drugs just put issues off.

The atypical antipsychotics, SSRI antidepressants, and stimulants have infested healthcare through a process of industry promotion, physician payoffs, and diagnosis-creep. The antipsychotics are likely the most damaging drugs ever widely used.

With the leadership of industry and their cosseted, lapdog doctors, psychiatric medications are prescribed indiscriminately to nearly anyone entering a physician’s office with a psychological complaint. The short-term benefits of controlling crazy, violent, and antisocial behavior has been indecently extended to decades of expensive, damaging drugging for one in six US adults. Worst of all, we push the medications into the mouths of many of our treasured children under two.

 

Note: The full version of this piece, with references, can be read in the author’s 2020 book, Butchered by Healthcare.