Mental Health Survival Kit, Chapter 2: Is Psychiatry Evidence Based? (Part 3)

Peter C. Gøtzsche, MD
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Editor’s Note: Over the next several months, Mad in America will publish a serialized version of Peter Gøtzsche’s book, Mental Health Survival Kit and Withdrawal from Psychiatric Drugs. In this blog, he discusses the science behind psychiatric drugs and the flaws and bias that corrupt drug trials. Each Monday, a new section of the book will be published, and all chapters will be archived here.

Flawed trials have led the psychiatrists astray

The rating scales used in placebo-controlled trials of psychiatric drugs for measuring the reduction of symptoms have made the psychiatrists believe that the drugs work and that the effect is specific for the disorder being treated. However, such results do not say anything about whether the patients have been cured or can live a reasonably normal life. Furthermore, the effects measured with these scales are unreliable. Virtually every single placebo-controlled drug trial in psychiatry is flawed.4,54

Since the trials are flawed, systematic reviews of trials are also flawed, and guidelines are flawed. Even the drug approval process is flawed. The drug regulators don’t pay enough attention to the flaws. They don’t even ask the drug companies for the many missing data or appendices which, according to the indexes the companies provide, should have been included in their applications.55

Cold turkey in the placebo group

In the vast majority of the trials, the patients were already on a drug similar to the one being tested against placebo. After a short wash-out period without this drug, the patients are randomised to the new drug or placebo. There are three main problems with this design.

First, the patients who are recruited for the trials are those who have not reacted too negatively on getting such a drug before.52 They will likely therefore not react negatively to the new drug, which means that the trials will underestimate the harms of psychiatric drugs.

Second, when patients who have tolerated a psychiatric drug are randomised to placebo, they will likely react more negatively to this than if they had not been in treatment before. This is because psychiatric drugs have a range of effects, some of which can be perceived as positive, e.g. euphoria or emotional numbing.

Third, the cold turkey withdrawal that some patients in the placebo group go through harms them. It is therefore not surprising that the new drug seems to be better than placebo. Introducing longer wash-out periods does not remove this problem. If people have been permanently brain damaged before entering the trials, wash-out periods cannot compensate, and even if that is not the case, they could suffer from withdrawal symptoms for months or years.7,56,57

Thousands of trials of neuroleptics have been carried out, but when my research group recently searched for placebo-controlled trials in psychosis that only included patients who had not received such a drug earlier, we found only one trial.58 It was from China and appeared to be fraudulent. Thus, all placebo-controlled, randomised trials of neuroleptic drugs in patients with schizophrenia spectrum disorders were flawed, which means that the use of neuroleptic drugs cannot be justified based on the evidence we currently have.4

The first trial that was not flawed was published on 20 March 2020,59 70 years after the discovery of the first neuroleptic, chlorpromazine, that Rhône-Poulenc marketed in 1953 with the trade name Largactil, which means broad activity. However, even 70 years wasn’t enough for the psychiatrists to come to their senses. They were not yet ready to draw conclusions from their results, which their abstract demonstrates:59

“Group differences were small and clinically trivial, indicating that treatment with placebo medication was no less effective than conventional antipsychotic treatment (Mean Difference = -0.2, 2-sided 95% confidence interval -7.5 to 7.0, t = 0.060, p = 0.95). Within the context of a specialised early intervention service, and with a short duration of untreated psychosis, the immediate introduction of antipsychotic medication may not be required for all cases of first episode psychosis in order to see functional improvement. However, this finding can only be generalised to a very small proportion of FEP [first episode psychosis] cases at this stage, and a larger trial is required to clarify whether antipsychotic-free treatment can be recommended for specific subgroups of those with FEP.”

I have translated what this means for those of us who do not have guild interests to defend:

“Our study was small, but it is unique because it only included patients who had not been treated with a neuroleptic before. We found that neuroleptics are not needed for patients with untreated psychosis. This is great progress for patients, as these drugs are highly toxic and make it difficult for them to come back to a normal life. Based on the totality of the evidence we have, the use of neuroleptics in psychosis cannot be justified. Neuroleptics should only be used in placebo-controlled randomised trials of drug-naïve patients.”

The authors of a 2011 Cochrane systematic review of neuroleptics for early episode schizophrenia pointed out that the available evidence doesn’t support a conclusion that antipsychotic treatment in an acute early episode of schizophrenia is effective.60 This is one of the very few Cochrane reviews of psychiatric drugs that can be trusted.4,54 There are huge problems with most Cochrane reviews, e.g. Cochrane reviews in schizophrenia routinely include trials in a meta-analysis (which is a statistical summary of the results of several trials) where half of the data are missing.4 This is garbage in, garbage out, with a nice little Cochrane logo on it, as Tom Jefferson said in an interview in the article, “Cochrane – a sinking ship?”61

To find out for how long patients should be advised to continue taking their drugs, so-called maintenance studies, also called withdrawal studies, have been carried out. These studies are highly misleading because of cold turkey effects. A large meta-analysis of 65 placebo-controlled trials found that only three patients needed to be treated with neuroleptics to prevent one relapse after one year.62 This looks very impressive, but the result is totally unreliable. The apparent benefit of continued treatment with neuroleptics decreased over time and was close to zero after three years. Thus, what was seen after one year was iatrogenic harm, which was described as a benefit.

When follow-up is longer than three years, it turns out that discontinuing neuroleptics is the best option. There is only one appropriately planned and conducted maintenance trial, from Holland. It has seven years follow-up, and patients who had their dosages decreased or discontinued fared much better than those who continued taking neuroleptics: 21 of 52 (40%) versus 9 of 51 (18%) had recovered from their first episode of schizophrenia.63

Leading psychiatrists interpret the maintenance studies of neuroleptics and depression pills to mean that these drugs are highly effective at preventing new episodes of psychosis and depression, respectively,4 and that the patients should therefore continue taking the drugs for years or even for life.

Danish researchers tried to repeat the Dutch study, but their trial was abandoned because the patients were scared about what would happen if they did not continue taking their drugs. A psychiatrist involved with the failed trial told me about another, recent withdrawal trial, carried out in Hong Kong.64 The researchers treated first-episode patients with quetiapine (Seroquel) for two years; discontinued the treatment in half of the patients by introducing placebo; and reported the results at ten years. They found that a poor clinical outcome occurred in 35 (39%) of 89 patients in the discontinuation group and in only 19 (21%) of 89 patients in the maintenance treatment group.

I immediately suspected that the trial was flawed, as this result was the exact opposite of the Dutch result, and that they had tapered off the neuroleptic far too quickly, even cold turkey. As there was nothing about their tapering scheme in the article, I looked up an earlier publication, of the results at three years.65 They didn’t taper at all; all patients randomised to placebo quit their neuroleptic cold turkey.

The ten-year report was highly revealing: “A post-hoc analysis suggested that the adverse consequences of early discontinuation were mediated in part through early relapse during the 1-year period following medication discontinuation.”64

The investigators defined a poor outcome as a composite of persistent psychotic symptoms, a requirement for clozapine treatment, or death by suicide. They called their trial double-blind, but it is impossible to maintain the blind in a trial with cold turkey symptoms, and it is highly subjective whether there are any psychotic symptoms and whether clozapine should be given.

I’m much more interested in whether the patients return to a normal life, and a table showed that after ten years, 69% of those who continued taking their drug were employed versus 71% in the cold turkey group, a quite remarkable result considering the iatrogenic harms inflicted on the latter group.

I consider this trial highly unethical because some patients commit suicide when they experience cold turkey effects. Robert Whitaker has demonstrated that this trial design is lethal.1,66 One in every 145 patients who entered the trials for risperidone (Janssen), olanzapine (Eli Lilly), quetiapine (AstraZeneca) and sertindole (Lundbeck) died, but none of these deaths were mentioned in the scientific literature, and the FDA didn’t require them to be mentioned. The suicide rate in these clinical trials was 2-5 times higher than the norm.

It is no wonder that AstraZeneca (seller of quetiapine) was happy to fund a trial in Hong Kong that was seriously flawed in favour of their drug.64

The investigators’ attempt at explaining away what they found is breathtaking. They wrote that their result in the third year raised the suggestion that, “there might be a time window or critical period during which a relapse might be course-modifying.”

The plausibility of the existence of such a time window between year two and three is zero. As it is highly variable when or if a patient relapses, there cannot exist any such time window. The psychiatrists deliberately harmed half of their patients, but they concluded they did nothing wrong and that their patients, or their disease, or a “time window” are to blame.

Lack of blinding

Because of the conspicuous side effects of psychiatric drugs, trials labeled double-blind are not double-blind. Quite a few patients—and their doctors—know who is on drug and who is on placebo.4 It takes very little unblinding in a trial before the small differences recorded can be explained purely by bias in the outcome assessment on a subjective rating scale.4

In trials supposed to be double-blind, investigators may report positive effects that only exist in their imagination. This occurred in a famous trial funded by the US National Institute of Mental Health in 1964, which is still highly cited as evidence that neuroleptics are effective. It was a trial of 344 newly admitted patients with schizophrenia who were randomised to phenothiazines such as chlorpromazine, or to placebo.67

The investigators reported, without offering any numerical data, that the drugs reduced apathy and made movements less retarded, the exact opposite of what these drugs do to people, which the psychiatrists had admitted a decade earlier.3 The investigators claimed a huge benefit for social participation (effect size of 1.02) and that the drugs make the patients less indifferent to the environment (effect size 0.50). The drugs do the opposite.

They also claimed, with no data, that 75% versus 23% were markedly or moderately improved and suggested that the drugs should no longer be called tranquillizers but antischizophrenic drugs. Their study contributed to shaping the erroneous beliefs that schizophrenia can be cured with drugs and that neuroleptics should be taken indefinitely.1

Neuroleptics do not have clinically relevant effects on psychosis. Despite the formidable biases—cold turkey, lack of blinding, and industry funding that involves torturing the data till they confess,4,51—the published outcomes have been very poor.4 The smallest clinically relevant effect would be a change of about 15 points on the Positive and Negative Syndrome Scale (PANSS)68 commonly used in the trials. Yet, what was reported in placebo-controlled trials of recent drugs submitted to the FDA was only 6 points69—even though scores easily improve when someone is knocked down by a tranquillizer and expresses abnormal ideas less frequently.9

Depression drugs don’t work either. The smallest effect that can be perceived on the Hamilton scale is a 5-6 point change,70 but a change of only about 2 is obtained in flawed trials.71,72

Some meta-analyses have found that the effect of depression pills is larger if the patients are severely depressed,71,73,74 and the pills are generally recommended for severe and sometimes also for moderate depression. However, the reported effects are very small for all depression severities, e.g. 2.7 points for patients with a baseline Hamilton score above 23 which is considered very severe depression,74 and 1.3 for milder degrees.71

Moreover, it is likely just a mathematical artefact that the effect seems to be slightly larger in severe depression.75 Since the baseline scores for severe depression are larger than for mild depression, any bias will influence the measured result more in patients with severe depression than in those with mild depression. If we assume the unblinding bias is 10% when estimating the effect in the drug group and, for the simplicity of the example, that there is no bias in the placebo group and no improvement between baseline and the final visit, then a Hamilton baseline score of 25 would still be 25 after treatment. But because of the bias, there would be a 2.5-point difference between drug and placebo. If the baseline is 15, that difference would only be 1.5.

The small effect of depression pills measured in flawed trials disappear if the placebo contains atropine, which has similar side effects as the pills, e.g. dry mouth.76 Such trials were done many years ago when the depression pills were tricyclics. Many psychiatrists say that these are more effective than newer depression pills (but also more dangerous, which is why they are rarely used). Despite this, the effect in seven trials with atropine in the placebo only corresponded to 1.3 points on the Hamilton scale.76 The “effect” of the newer drugs is around 2.3, or almost double as much.71,72

It is very easy to make almost any substance with side effects “work” for depression, including stimulants.77 Three of the 17 items on the Hamilton scale are about insomnia, and that issue alone can yield six points on the scale,53 or three times as much as the “effect” in biased trials. And if a person goes from maximum anxiety to no anxiety, eight points can be earned.

Irrelevant outcomes

What do doctors want to achieve with drugs? Above all, to avoid suicides and deaths from other causes. Moreover, to get the patients back to a normal life, with good social contacts.

Sometimes, this cannot be obtained. Most patients who get a diagnosis of depression live depressing lives, e.g. are married to the wrong person, have a bullying boss, a tedious job, or a chronic disease, and it is hardly the job of doctors to try to get them out of this predicament. Moreover, there are no pills for this, but these people are nonetheless routinely prescribed depression pills, which are seen as the “solution” to life’s troubles.

A score on a rating scale doesn’t tell us whether the patient is well. Over a thousand placebo-controlled trials of depression pills have been carried out, but I have not seen any that measured whether the patients were cured by a drug, i.e. whether they came back to a normal productive life. If any such trials existed, we would have known about them. Unless they showed that the drugs made the situation worse and were therefore buried in company archives.4

According to the American Psychiatric Association’s disease manual, DSM-5, major depression is present when the patient exhibits 5 or more of 9 symptoms that “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” Given how the disorder is defined, it makes no sense that drug trials don’t use these outcomes.

One trial with such outcomes was not appropriate, as it was a withdrawal trial that only told us that the cold turkey withdrawal harms that the psychiatrists inflicted on patients were bigger for some drugs than for others.78 Unsurprisingly, patients on fluoxetine (the sponsor’s, Eli Lilly’s product) could endure a short treatment interruption where the patients got placebo because this drug has an active metabolite with a very long half-life. Paroxetine has a short half-life, and even after missing just one dose, a statistically significant increase in harms occurred, which worsened during the next five days.

Lilly’s trial was grossly unethical. The abstinence symptoms after paroxetine withdrawal were severe, which was expected based on clinical observations and a previous, similar study also sponsored by Lilly.79 The patients experienced “statistically significantly worsened severity in nausea, unusual dreams, tiredness or fatigue, irritability, unstable or rapidly changing mood, difficulty concentrating, muscle aches, feeling tense, chills, trouble sleeping, agitation and diarrhoea during placebo substitution.”78

In Lilly’s previous trial,79 roughly one-third of the patients on paroxetine or sertraline experienced worsened mood, irritability and agitation, and had an increase in the Hamilton score of at least eight, which is the difference between being mildly depressed and severely depressed.74

Lilly sacrificed the patients for a marketing advantage. Many patients suffered from an abstinence depression caused by the cruel trial design, and the various harms they experienced increase the risk of suicide, violence, and homicide.4 This was known long before the trial was carried out.2,4,80

Unsurprisingly, “Patients treated with paroxetine reported statistically significant deterioration in functioning at work, relationships, social activities and overall functioning.”78

  1. If you are being asked to participate in a clinical trial with a psychiatric drug, you will need to investigate very carefully what it is about and whether it is ethically acceptable.
  2. Ask the doctor for all documentation, including the full trial protocol and investigator’s brochure, which might be the only place where the harms have been listed, also from animal experiments.
  3. Pay attention to conflicts of interest. Will the doctor or the department benefit financially from conducting the trial?
  4. Will the raw data in anonymised form be made available to the investigators and to independent researchers, allowing them to do their own analyses? Will all patients who ask for these data get them?
  5. Ensure you get written confirmation before you make a decision. If the data will not be made available, or your doctor becomes uncomfortable when you ask, you should refuse to participate and publish your experiences as a deterrent for bad research practice and to warn other patients.

 

To read the footnotes for this chapter and others, click here.

 

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

31 COMMENTS

  1. If you are being asked to participate in a clinical trial with a psychiatric drug, you will need to investigate very carefully what it is about and whether it is ethically acceptable.

    I have a better idea. The original Madness Network News (not the “new” version) used to have a “shock doctor roster,” which was just what it implies, i.e. “doctors” who used shock on their “patients.” Maybe in this case MIA and others could institute a “Mengele roster” listing shrinks who push “experimental” psychiatric procedures on their supposed “patients.”

    Psychiatry is fraud by definition, based on the absurd concept of “mental illness,” so distinguishing between “legitimate” and “experimental” is meaningless.

    • According to psychiatric measurements of psychosis (PANSS) you disagreeing with psychiatry so adamantly, and being so hostile towards psychiatrists means you are psychotic and need to take neuroleptic drugs to fix your defective brain. Since you are mentally ill you are dangerous and they can with the aid of the police throw you in a hospital and force the drugs on you.
      Psych supporters flat out say that It is very stigmatizing if we do not tell people they are genetically/biologically/mentally defective and are second class citizens. Psychiatry is working very hard to reduce discrimination and stigmatization by insulting and drugging more and more people.

  2. Another brilliant piece!
    Having been at death’s door with Neuroleptic Malignant Syndrome from an antipsychotic, I was concerned recently to hear that there seems to have been an increase in this syndrome linked to covid 19. The cytokine storm of severe covid is much like the cytokine storm of Neuroleptic Malignant Syndrome (or NMS). Covid and NMS can lead to pneumonia, heart inflamaton and kidney failure and death. On intensive care wards it would be difficult to tell apart symptoms caused by covid or NMS. And since severe covid can lead to a few weeks of delirium that may require treatment for hallucinations, apparently on an intensive care ward an antipsychotic is sometimes used on ventilated patients to make the patients more “comfortable”. My near fatal NMS only took two weeks on an antipsychotic to produce a cytokine storm. I can imagine that if I already had severe covid 19 and a covid caused cytokine storm, it might have been curtains for me if an NMS cytokine storm, from say a delirium treating antipsychotic being given, occurred on top of that. And how would a busy intensive care nurse or doctor know to stop an antipsychotic if they thought the symptoms were only covid. They probably would keep giving the antipsychotic, worsening the cytokine storm to its natural conclusion. There have been over two million deaths from covid…and counting. Were a fraction of those down to NMS making covid worse? Are intensive care staff of the opinion that antipsychotics might be risky? And what of those patients put on them for over a month or so, maybe to also “treat” ptsd? Do they have suicidal moods upon trying to discontinue them, and does that get met with yet more psychiatric medication? It would be interesting if someone could contact the Neuroleptic Malignant Syndrome organization to enquire about these concerns.

  3. The measurements used in psych studies to determine “improvement” are subjective personal reports not only from the users but the psychiatrists making money off the drugs.

    In depression scales used for psych drug studies a person gaining weight has achieved more benefit than people taking the drug. The psychiatrist reporting the person fidgets less has achieved more benefit than those taking the drug.

    It is also interesting how many of the measurements consist of how much the person complains. In essence if the drug silences someone by causing mental decline psychiatry considers it a benefit.

  4. How can psychiatry be “evidence based” when it blatantly ignores, dismisses, or contradicts people’s truth about themselves, as well as with their experience of psychiatry? There is an enourmous amount of very obvious evidence that psychiatry has done profound harm to countless people and continues to do so, yet it will continue to deny the evidence in order to continue business as usual, based on judgments and personal opinions rather than anything even remotely scientific.

    Psychiatry is not at all evidence based, but rather it is *fear* based. Fear is what makes people vulnerable to being controlled.

    • Not to mention denying the evidence from their own researchers: that “ADHD” is 30% more likely to be “diagnosed” if a child is a year younger, that there are no long-term outcomes that are improved by stimulants for “ADHD”, that “antidepressants” increase the likelihood of aggression and/or suicide rather than decreasing them, that taking “antipsychotics” for more than a brief time dramatically DECREASES the likelihood of recovery, that countries with less “antipsychotic” use have better outcomes, that the likelihood of “psychosis” is strongly affected by social conditions, in particular, migration, urban living, and childhood sexual abuse, that genetics contributes little to nothing to the probability of any psych “diagnosis,” that “antipsychotics kill people decades earlier than the general population… I could go on.

      I agree, the most fundamental evidentiary problem is ignoring the actual experiences and feedback from those they are supposed to be helping. You’d think that would be the MOST important data, and it is considered the least. But even without that vital consideration, the profession’s ability to ignore cartloads of inconvenient evidence disqualifies them for even the vaguest consideration of being “scientific!”

      • Yep, also disqualifies their “expertise,” given that people are the experts only of their own experience. As you say, they’re tossing the most vital evidence of all! Which explains the mess of it all, I think. That particular piece of evidence is exactly where the ever elusive truth of the matter resides. And it’s many truths and voices of experience in the world, not just one.

        • Indeed it does! But apparently, they don’t even respect their own “experts” when they come up with the “wrong answer!” These are not people who are going to suddenly say, “Gosh, we seem to have gotten it wrong – maybe we should listen to our clients in the future.” They are dogmatically committed to their worldview and to taking down anyone who dares to challenge that view. I want to extend my love to such people and hope for their transformation, but we can’t allow such people to decide what is “helpful” for the people they truly don’t give a crap about!

          • “we can’t allow such people to decide what is “helpful” for the people they truly don’t give a crap about!”

            I had to come to that conclusion for myself and then I had to finally make the leap and choose a better healing path, which amounted to learning how to find my own answers instead of relying on others. This is when the internet was just firing up, not really a resource at that time, so this took a lot of hard knocks for me to get to this self-agency. I had no notion of this, and had not realized the extent to which I had surrendered this to people about whom I can very honestly and assuredly say did not know what they were doing, not one bit.

            Eventually, after years of consulting one kind of counselor or another for guidance out of chronic anxiety, I learned to be my own counselor and guide at every turn, having learned to tune into and absolutely honor my own intution and impulses, which of course had been rendered dormant under psych drugs and multiple social programming influences (family, academia, “the system,” etc).

            I might have helpful conversations along the way with insightful people, but at the end of the day, I am the one sorting through the information and making my own decisions, so at least if I make an error in judgment, it is my doing and I can’t blame anyone else. That makes it actually possible to correct.

            I had all kinds of healers and teachers after leaving behind the mh world to help me straighten out all of that nonsense programming I had taken on, along with the post traumatic stress from it all, a lot of stuck negative energy, as we say in the healing world. That was such better and relevant information–the authentic healing work–and it got me moving forward in a new way, once and for all as my brain and other ograns were healing along with my spirit, learning to hear and trust my own inner voice over those of others, first and foremost.

            But I can’t say they all cared too terribly much about me, although I felt seen and understood because these were smart and competent healers, they’d been through their journey and were paying forward from their experience, based on energy work and perspective, and knew how to teach tools and alignment. I moved on from that more whole and with a new paradigm in tow.

            Took a few years to integrate all of this, and even longer to heal from the harm that psychiatry had done to me, as is all-too-common of course; which, more than healing, it actually is transformation because I had to adapt to new ways of doing things based on new information along all that awakening.

            But that is coupled with an entirely new perspective, and together–new actions and new perspectives–these create a new life experience, new unfolding of reality, core change. So it would be the point of it all. Hard journey at first, but then it becomes interesting and then clarifying and relieving, and then amazing in all sorts of ways, and it gets easier, change is always happening. That’s how it worked for me.

            I offer new perspectives and help people who are ready to make that transition to self-healer, that’s my contribution, to heal the program of having to depend on others, if that is what people are ready for. Some are not, which is natural, we’re all at different stages and have different needs at different times.

            Either way, fighting others only brings it all back, can’t do that anymore. We have to find a space of inner peace in order for our self-healing to work, which would be supported by a harmonious and nourishing environment. Energy moves fluidly like this, which is how healing occurs naturally, through co-creation. This is the kind of stuff I learned over the years after I abandoned psychiatry, and all of the system in general.

          • I needed to read that last part. I think I need to stop fighting so much and let people be where they are in their journey. Yelling at them or being disgusted with them does nothing to help, and damages my own peace of mind. Not that I’m not ready to take to the streets when the time is right, but I don’t see that happening any time too soon.

          • I think that’s true, Steve, that our judgments are what undermine any sense of peace, inside or out. We are human so judgments won’t always fall by the wayside, we do exist in a highly judgmental world. We can work to influence more compassion and less duality in the world, but right now, it is what it is.

            And by the same token, we have ample opportunities daily to become aware of and own what our habitual judgments are and whether or not perhaps it’s time to update a belief and get a new perspective on things, exactly as you are exemplifying in your above post. That’s always an option which personally I, too, have found to be extermely beneficial in all ways, moves things right along from wherever we are at that moment, toward new expansion.

            When we work though our own judgments to find compassion instead, then we have healed something significant which will ripple outward. It is a relief to drop a judgment, helps one and all, leads to new clarity. Ultimately, it is freeing.

          • @Steve — What are you planning to do in the streets? How will you know when it’s time? Just make sure you don’t get hurt. 🙂

            Actually the time never “comes” until we decide to seize it. Meanwhile the whole country can be in the streets “demonstrating” and “protesting” — but to whom and why, if everyone already agrees?

            “Protesting” is essentially a demonstration of weakness, pending the attainment of the power to make and enforce structural changes.

          • You really know how to ruin a figure of speech! So what are you “seizing” right now? How many “seizers” does it take to “seize it?” And if everyone agrees, why is there any need to “seize?”

            Only fair if I ruin your figure of speech in return…

      • Psych doesn’t just ignore any personal experiences that disagree with their interests, they flat out insult, stigmatize, and forcibly drug/hospitalize those whose experiences don’t fit with their dogma. Anyone who has a psych label should be aware that a common response if people know they do not take psych drugs will be increased stigmatization, insults, and blame. They will be pressured and/or harassed if they don’t take them drugs. If they refuse anything bad that occurs will be blamed on their refusal to use the drugs.

    • Fear is what makes people vulnerable to being controlled.

      Scratching my head for a current example of that, I must be blocking it…or locking it down…

      Any evidence you’ve seen in your travels lately that psychiatry might be a legitimate branch of medicine? (I’m building my own evidence base.)

      • Right now, I don’t consider anything we’d call “mainstream” to be terribly safe. We have to find our own innate sense of safety these day. There is so much anxiety in the collective at large, of course, which would be understandable at this time.

        I consider psychiatry to be highly detrimental to society. However, I recognize that it is part of many peoples’ belief system, and that it creates dependence, as it once had with me. I had to get out from under a lot of rubble, look at my own dynamics, and shift my thinking quite a bit about myself in order to banish it from my own life. Biggest gift I ever gave myself, and I got better.

  5. Dr. Gotzsche and all other people in roles of mental health professionals on this website,

    First of all, I respect the work that you have done in bringing information to people. It is appreciable, but it is in many ways still of not much use to individuals who end up in this place. For years and years, suffering people from various countries have written on this website. People afraid of psychiatrists, and even ordinary medical doctors because of their psychiatrically labelled status. People afraid of their families and of society. I have not seen any practical action to help anyone who posts in the comment sections here (or anyone at all?). Simply, publishing papers, blog posts and writing books solves nothing.

    Where is the real life help? I myself have begged for it in my life and my life has gone to the dogs and it is affecting my state of mind and my work. I have to make a career for myself, put food on the table for myself and the people I care about. The same applies for everyone. Where is the legitimate real life help? Where are the real life changes? And not that which is given, but that which is actually needed.

  6. Also, Dr. Gotszche,

    MIA team, please make sure the author of the article reads this comment.

    I am the son of a surgeon too. My mother’s husband has been an associate professor and a Head of Department of Urology in several institutes in India. While he was an abusive bastard, I used to enjoy going to hospitals and watching surgeries. I watched dozens of them even before the age of 10. I was even taught to use a manual sphygmomanometer by the attendant anaesthesiologist as a kid. I have seen proper medicine up close and it is a fascinating and essential subject.

    I have had multiple root canals, an implant, an appendectomy, bronchitis and various other problems. Never have I once been confrontational with a doctor. In fact, I am kind to them, and if they are young doctors, I try to be polite and gentle with them, so that even they feel comfortable and don’t make mistakes.
    The only doctors I start screaming at are my mother’s husband and shrinks.

    I do NOT enjoy insulting anyone. If I’m doing so, it is out of utter anger after many years of absolute rubbish.
    You were a former Director of the Nordic Cochrane Collaboration. You know the the psychiatrists in the South Asian Cochrane collaboration and the dunces in that CMC Psychiatry Department. And not just that. All of them. NIMHANS, PGI-Chandigarh, JIPMER, AIIMS, KMC, how many ever psychiatry departments you can get your hands on in India and various other places.

    Instead of merely writing blog posts here, use your authority as a renowned doctor and beat some sense (at least intellectually) into these fools. Drill it into their heads, that their psychiatric labelling is damaging people, and stigmatising them for life. Drill it into their heads that their labels are used as weapons by friends, family, even themselves sometimes to gaslight people. Drill it into their heads to not convince suffering people who come to them for help because they don’t know what else to do and have very little power, to not whisper sweet-nothings into their ears and act like everything is fine. Just like they force some things onto others, they have to be forced into dialogue and be confronted about what they are doing.

    Many of these individuals in Indian Departments of Psychiatry neither tell the individuals what consequences the drugs have or don’t have. When they prescribe SSRIs, they do not tell them that they would likely cause sexual dysfunction and tremors, and in some cases mania and delusions. They say nothing about the withdrawal effects of any drug. Hell, I am not even fundamentally AGAINST the use of drugs if they are helpful to some (but voluntarily, and the control should ideally be in the hands of those who use them), but people should have information.

    Worst of all they pretend like things are fine and dandy with their profession (and I’m not talking simply about the drugs). When these things cause us social problems and legal problems, they run away like cowards. Please don’t be a coward like them. Also, they say nothing about the damaging impact of psychiatric labelling which can occur 5 years or 10 years down the line.Don’t just look to publish books. Do something with your power.

    If things here proceed the way they are, things will become just like western psychiatry. They don’t even NEED to use DSM labelling here because many people pay cash. They still do it. Do you think if a new individual who goes to them says “Sir/Ma’am please don’t label me, I do not want to be labelled”, any of these individuals will listen? Very few would. A lot of them would put on a pompous demeanour and ask “why?”. Even if the opposite party gives valid reasons, they will rubbish his fears as, protect themselves and talk about how many patients there are living happy lives with their methods.

    The internet is FULL of people who weaponise psychiatric labelling. You can see them on Reddit, on chatrooms, and on many forums. Every year more people are taking up MD courses in psychiatry and giving rave reviews to each other. If their methods are not changed and the public does not have sufficient information about what their “help” is or even how terrible some of the patient population (and their family members) can turn out (totally indoctrinated), more people will sink into the depths of horse manure the size of Mt. Everest.

    You must also educate ordinary doctors, cardiologists, neurologists, internists/general medicine doctors, anesthesiologists, gastroenterologists and everything in between about these problems. And also, not to screw with already terrified patients who have labels showing up on charts and who isolate themselves in fear and don’t even seek medical help for ordinary problems.

  7. I don’t think this is a fair comment.
    In my experience the greatest obstacle are the users themselves, who prefer a parentlike figure waving a magic wand or giving a portion, so all problems are solved.
    There is a minority, who want to face their issues and work them through.
    For them this website and above book provide enough information to realize that pills are not a solution.
    What I am missing in this website and discussion is however the insight, that just stopping the drugs neither solves anything.
    The only option is to tackle the issues causing the crisis and find one’s own way.

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