Overprescribing Madness

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Editor’s Note: The following is an edited excerpt from Martin Whitely’s book, Overprescribing Madness: What’s Driving Australia’s Mental Illness Epidemic.

Australia should be a country in which it is relatively easy to be happy and feel safe, affluent, and secure. Its five largest cities are all ranked in the 22 most liveable cities in the world. Australians enjoy abundant sunshine, clean air, sensational beaches and open spaces, great food, longevity, a world-class universal access health-care system, robust democracy, rule of law, political and religious freedom, relative economic equity, and a high standard of living following 28 years of unbroken economic growth before the COVID-19 recession.

Clearly these positives are not enough to make many Australians ‘relaxed and comfortable’. In 2018, over 1 in 6 Australians took at least one mental health-related drug, with roughly 1 in 8 taking an antidepressant. Since then, prescribing rates have continued to rise.

Many take multiple psychotropic medications. For example, many elderly Australians are prescribed antidepressants for anxiety or depression, along with antipsychotics to control agitation. Similarly, children prescribed amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) are sometimes prescribed clonidine, or other downers (depressants) to help them sleep.

The willingness of Australians to take pills, and give them to our children, to ease perceived unhappiness, dysfunction, and distress, is not new. Comparisons of 30 OECD countries in the year 2000, and again in 2015, both found that Australians were the second largest per-capita users of antidepressants. Only tiny Iceland (population 340,000), with its frozen, dark, miserable North Atlantic winters, had a higher per-capita antidepressant prescribing rate in either year. The propensity for using antidepressants is consistent with a 2017 World Health Organization (WHO) publication that reported that Australia was the second most depressed country in the world.

But are things really that miserable in the lucky country? These disturbing statistics have nothing to do with Australians being disproportionately mentally ill. Rather, a combination of slick salesmanship, dishonest and incompetent medical practice (overlooked by timid regulators) and cultural, commercial, and political drivers now see Australians hooked on a cycle of over-diagnosis and over-medication.

Medicalising Misery At the heart of the problem is how we have come to define mental health and mental illness. Anything that causes us to be sad, stressed, anxious, or even bored is now regarded as a threat to our mental health, and therefore a potential source of mental illness. If you lose your job, are grieving a death or a relationship breakdown, or are experiencing any of life’s inevitable vicissitudes, then it is very human to be deeply unhappy or anxious and some may even fleetingly consider ending it all. But we have come to regard these normal, although troubling, human reactions as compelling evidence of mental illness.

Australia has blindly followed the flawed lead of the American Psychiatric Association, which has progressively medicalised normality. In effect, Australians have outsourced our definitions of mental illness to the USA – a country that spends the most per-capita on mental health but achieves appallingly poor outcomes.

While many Australians decry the effects that Hollywood, Coca-Cola, and McDonald’s have on our culture, most are completely ignorant about the dominant role American psychiatry plays in contemporary Australia. They have no idea that we have let the Americans define sanity and madness for us. This outsourcing has a massive impact on millions of Australians and their families. It is hard to think of a more powerful example of cultural capture.

What is even more disturbing is that this corrosive Americanisation of Australian psychiatric practice is officially endorsed by government. In 2017, the Australian Commonwealth Government and all state and territory governments agreed that mental illness is defined as a ‘clinically diagnosable disorder’ that significantly interferes with a person’s cognitive, emotional, or social abilities. Of course, individual ‘clinically diagnosable disorders’ are defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

The main problem with DSM-5 is that normal human suffering and frailty is classified as disease. The complexity of human behaviour is reduced to a tick box list of behaviours, devoid of empathy for individual differences in disposition and circumstance. Misery is medicalised, and claims of massive unmet mental health need become the orthodoxy.

Very high estimates of the prevalence of mental illness are accepted by most Australian decision makers, including governments, who fail to understand the significant flaws that lead to massive overestimation. For example, the Australian Parliamentary website contains a webpage titled, Mental Health in Australia: a quick guide that reports approximately:

  • 45% of Australians have experienced a mental disorder in their lifetime, with 20% experiencing a mental disorder in the previous year.
  • 14% of young people aged 4 to 17 years experienced a mental disorder in a year.

These – and other even more inflated figures – are used to argue that mental illness is being left unrecognised and untreated with disastrous consequences and that governments must support universal mental health screening in schools and in the workplace.

Alarming figures about the cost to the economy of unrecognised and untreated mental illness are also frequently cited. For example, in October 2019 there was widespread media coverage of a draft Australian Government Productivity Commission report that estimated that as many as one million Australians are going untreated for mental health conditions and these ‘illnesses’ are costing the economy $500 million every day.

This represents well over 10% of Australia’s GDP, yet, despite the astonishing size of the estimated cost, it and similar claims rarely get challenged. Instead, it is assumed that massive economic benefits are available if we just address unmet mental health needs. This analysis and other similar claims are based on two flawed assumptions. The first is that we can accurately identify who needs help (without massive false positives) and the second is that the help available (primarily drugs) fixes the problem.

More is Less In Australia we have come to believe as an article of faith that spending more on mental health interventions improves outcomes and has economic benefits. However, too often the drugs that are the first-line treatment used to treat psychiatric disorders create new disorders that are managed with other drugs. Often the withdrawal effects from psychiatric drugs are worse than the initial problems they were supposed to treat.

This iatrogenic suffering (harm caused by treatment) is often blamed on the patient’s re-emerging mental illness, and doses are increased and/or new medications are added. The result is that the patient gets locked into a vicious cycle of drugs creating harm, with more drugs added to address that harm; meanwhile, medication sales soar and Big Pharma rakes in iatrogenic profits (profits caused by creating harm).

This suffering is avoidable. Governments, doctors, patients and their families need to resist the sugar rush temptation of relying on pharmaceutical quick fixes for complex mental health and social problems. Ironically, the increasing use of psychotropic drugs temporarily takes the political pressure off governments to provide more resource-intensive but safer, and in the long term more effective and less expensive, interventions.

Governments must recognise the harm caused by the over-prescription of the psychotropic drugs that they often subsidise. Otherwise they will continue to misallocate resources to options that superficially appear to address mental health need at minimal cost.

Non-expert dumbed down psychiatric practice Another obstacle for achieving safe and effective psychiatric practice is the dominant role that non-expert mental health practitioners, particularly general practitioners, play in the delivery of Australian mental health services. In 2018/19, according to the Australian Government, ‘86.3% of mental health-related prescriptions were prescribed by general practitioners; 7.7% prescribed by psychiatrists; 4.5% prescribed by non-psychiatrist specialists’.

So even if the Australian psychiatric profession miraculously got its act together overnight and only prescribed psychotropic drugs within genuinely evidence-based parameters, this would have minimal effect. Sadly, non-expert, dumbed down, cookbook, DSM-5 based biological psychiatry has become the dominant model of psychiatric care in Australia, and it is going to take a revolution to change that.

There is no doubt that there are new challenges to the mental wellbeing of Australians. We have designed our suburbs, houses and society with too much concern for privacy and too little concern about loneliness. Increasing materialism, the loss of low-skill jobs, and the casualization of the workforce, have also had an impact on our wellbeing. However, there has also been many changes for the better. Prejudices about, sex, race, religion, sexual preferences etc. have diminished, making Australia a much more inclusive society.

The evidence suggests that taking prescription psychotropic drugs in such large and increasing numbers is not helping us face new challenges or embrace new opportunities. Surveys suggest that Australians are relatively content and functional people. However, they also suggest that we are slowly going backwards in terms of happiness, social isolation, rates of psychosis and in international comparisons of numeracy and literacy – the very problems these ‘treatments’ are supposed to address.

Not all the responsibility lies with doctors or the ‘system’. Many patients demand pills. They want a quick fix and are not open to other options. If they are fully informed about the true benefits and risks of treatments (which very often they are not) then that is their choice.

However, parents make these decisions on behalf of their children. Many are attracted by the promise of immediate improvement in behaviours and do not pay proper regard to the long-term effects of medication use. Some even seek out clinicians who will tell them what they want to hear and prescribe the drugs they want for their children.

Much of this prescribing is ‘off label’, i.e. for conditions and/or populations that it has not been approved for, even if this contravenes the manufacturer’s recommendations or product warnings. Off label prescribing occurs so regularly that it has, in many cases, become the norm. It does not necessarily result in adverse outcomes; sometimes patients benefit. But off label prescribing is unregulated and outside safety parameters established through the licencing process.

This should not be acceptable. Psychiatric practice should be based on robust independent evidence. Yet, collectively, Australians seem determined to spend even more on dubious treatments and overhyped programs, sometimes to fix problems in part created by dubious treatments and overhyped programs.

Australia’s home-grown mental illness scientist/salesman Many of the factors driving this escalating madness are identical to those in other developed nations. However, the influence of some home-grown key thought leaders, who have dominated the debate about the future of service delivery in Australia, should not be underestimated. More salesmen than scientists, these mental health gurus/entrepreneurs have secured hundreds of millions in taxpayer funds for their pet programs. They have massively overpromised and under-delivered, and yet to date they have not been held to account.

Successive Australian Governments have unquestioningly accepted the hype and rhetoric around these programs and failed to thoroughly evaluate their outcomes. Worse still, these Governments have failed to carry out one of their core functions – ensuring that medications are used within robust evidence-based safety and efficacy parameters – in these services and elsewhere.

Big Pharma and their paid associates are incredibly good at gaming the systems of drug regulation and subsidisation. They charm, bamboozle and manipulate hapless politicians and limp regulators by creating the illusion that their products are supported by robust science. They are so good at manipulating research as a marketing tool that we should stop expecting the regulatory system to protect our health and well-being.

We should also stop being shocked by stories of 93-year-olds in nursing homes being drugged into a stupor with life-shortening heavy doses of antipsychotics, or of 7-year-olds given amphetamines, antidepressants, and antipsychotics and wanting to take their own lives. We must change the system, or at least wake up to the fact that evidence-free psychiatric prescribing is normal.

The most damning example of this failure is the wholesale off label prescribing of antidepressants to children and adolescents, despite FDA and TGA warnings that antidepressant use increases suicidality in young people. As detailed in a 2020 article in Frontiers in Psychiatry, Australian child, adolescent, and young adult antidepressant prescribing rates have soared over the last decade, and so has the rate of suicide among young Australians. From July 2017 to June 2018, at least 101,174 Australians aged 0 to 17 years (1.8% of the total number) were prescribed an antidepressant, despite the fact that no antidepressant is approved for the treatment of paediatric depression.

It is highly plausible that this failure of government to ensure evidence-based prescribing has contributed significantly to Australia’s epidemic of youth suicide. Yet our political leaders have continued to seek advice from the same failed suicide prevention gurus who obstinately deny the possibility that antidepressant use maybe part of the problem. If insanity is doing the same thing over and over again and expecting different results, then clearly Australia’s mental health system has gone barking mad.

Politics – Where is the conflict when you actually need it? Unlike the USA, many aspects of Australian public policy benefit from a bipartisan approach (e.g. gun control and universal healthcare). However, Australian mental health policy is suffering from a lack of competition between political parties.

Perhaps this is understandable. For most politicians, mental health is a mysterious issue, and the simple option of subsidising the quick application of diagnostic labels and prescription of pills has superficial appeal. In addition, when charismatic mental health entrepreneurs claim to have 21st century solutions, many politicians clearly think: Who am I to argue? But there are sound reasons why both the Right and the Left should be suspicious of the direction of Australian mental health policy and practice.

Conservatives should be concerned about overreach by Big Government interfering in the lives of citizens by applying a permanent disability model of mental illness that robs us of our individual autonomy and self-reliance. The Left should be concerned about the influence of Big Pharma corrupting our regulatory processes and selling us products that are bad for us and make us sicker and more reliant on their products. The Centre should be concerned about both. But there is effectively no competition of ideas regarding mental health among Australian politicians. The only competition appears to be squabbling about who can give our high-profile mental health entrepreneurs the most money for their pet projects.

Time for our elected leaders to stop following – If we are to achieve better mental health outcomes, our elected leaders need to stop following failed experts. Australians need our nation’s leaders to take the time to consider the independent, robust evidence and not be swayed by those with programs to promote, and empires to build.

Perhaps the bravest thing that politicians need to do is to own up to the limitations of government and the limitations of mental health interventions. They need to challenge the expectation that governments can alleviate, and even prevent, persistent unhappiness, anxiety and distress. Instead they are enabling unrealistic expectations of the capacity of government by engaging in bidding wars for the support of mental health gurus with insatiable appetites for taxpayer’s dollars. Even governments of the Centre Right are buying into the nonsense that it is their job to spend taxpayer’s money achieving the unachievable.

Of course there is a role for government, but good governments know their limits. Good governments foster tolerance and inclusion and help the disadvantaged live dignified lives, with the opportunity for improvement. Good governments also make sure that those with real debilitating mental illness get support that helps them recover, or at least live their best lives. Good governments are concerned about the long-term wellbeing of people, not quick (political or treatment) fixes.

Governments concerned about long-term patient wellbeing need to recognise there are three superficial reasons drugs appear more attractive than psychosocial treatments. First, psychological interventions are often more resource intensive in the short to medium term. Second, drugs usually alter behaviour much faster than non-drug treatments, and trials most often measure improvements in short-term symptom management (often for no longer than a few weeks). Third, the vast majority of psychiatric treatment research is funded by drug companies, with the emphasis on short-term effects rather than lasting benefits and harms. Consequently, pharmaceutical interventions are seriously over-rated and over-utilised.

To address this imbalance, Australian Governments, primarily the Commonwealth Government, but also state governments, should initiate multiple reforms.

Fifteen reforms needed in Australia to improve mental health outcomes
  1. Public disclosure of safety and efficacy data. Massive reform of our system of regulating medical product safety and efficacy is required. The Australian Government, through the Pharmaceutical Benefits Scheme, has powerful levers to pull. It should make it a condition of licencing and subsidising pharmaceuticals and medical devices that there is full public disclosure of all safety and efficacy data held by product manufacturers (with protections for intellectual property and commercially sensitive costing information). There should be very heavy penalties, including immediate removal from market and massive fines (and possibly jail time for directors), for failing to disclose relevant information. Only product manufacturers who are not confident in the safety of their products would choose to take them off the market rather than expose the truth to public scrutiny.
  2. Prevent cherry picking of favourable results by requiring pre-registration of all new research that may be later used to support the TGA licencing and PBS subsidisation of pharmaceutical products in Australia. Obviously this system would only work prospectively, and would not enable access to studies already concluded. To address this shortfall, details of all research conducted on a particular drug should be provided to the relevant regulator for consideration and made available for public scrutiny. This would help to address the problem of a narrow base of selective research used to licence and subsidise drugs. Regulators would have access to all related research.
  3. Freedom of Information Reform. Commonwealth Freedom of Information legislation must be amended to end the entitlement of corporations to rely on privacy provisions originally intended to protect the health records of individuals.
  4. Make adverse drug event reporting for a specified range of serious reactions (suicidal ideation, strokes, psychosis etc.) mandatory, and regularly publish full details on the TGA website. Voluntary reporting means that only a tiny fraction of adverse events ever get reported. Arguably, reckless prescribers may be less likely to report serious adverse events than cautious prescribers because they may be concerned about acknowledging the consequences of their prescribing practices. The public has a right to know, and policy makers need to know about the frequency of adverse events, so they can make informed decisions about the risk-benefit profile of medications.
  5. Full public disclosure of pharmaceutical industry funding sources for clinicians, researchers, patient groups, advisory board members and members of committees involved in regulatory and policy development processes is also required. The Commonwealth Government should look at the US Physician Payments Sunshine Act, passed in 2010 and co-sponsored by Republican Senator Chuck Grassley and Democrat Senator Richard Blumenthal. The goal of the Physician Payments Sunshine Act was to increase the transparency of financial relationships between doctors and other health care providers and drug companies. Potential conflicts of interest should be made public. It was not perfect legislation, but at least it was a start.
  6. Consumer medicine information leaflets. In addition, the Commonwealth Government should also strengthen Consumer Medicine Information (CMI) requirements, so that:
    • Every warning currently included in information to prescribers is also on the CMI. (Currently warnings are often only highlighted on information made available to prescribers and are not seen by consumers.)
    • It should also be mandatory to include a CMI inside medication packaging.
    • A brief summary of the most serious safety warnings is written on the outside packaging of drugs, so consumers are aware of very significant risks.
  1. Off label prescribing is another massive issue the Commonwealth Government needs to tackle. It should, over time, encourage off label prescribing to become ‘on label’. This could be achieved by gradually restricting the government subsidisation of medications to only those prescribed within the approved guidelines.
  2. Without further delay, implement real-time electronic monitoring of pharmaceutical dispensing. The Commonwealth and State Governments need to roll-out, without further delay (originally planned for 2012), the Electronic Recording and Reporting of Controlled Drugs (ERRCD) initiative. ERRCD would provide a mandatory, real-time, electronic tool for all pharmacies dispensing Controlled Drugs. Pharmacists would have real-time information from a database about previous dispensing episodes, enabling them to detect doctor shoppers.
  3. Coordination of Commonwealth and State Government Spending. In total, Australia will spend roughly US$7 billion on mental health services in 2020 (about $300 per Australian). The State governments and the Commonwealth Government will contribute roughly equal proportions, with private health insurance providing the remaining 5%. We can have little confidence we are getting value for money. The Commonwealth and the States need to sort out the mishmash in service delivery. The practice of successive Federal Governments going it alone by directly funding mental health services, without robust supporting evidence, or regard for how these services integrate with state government services, should end. Too often, funding for these services has been based on short-term political considerations and personal relationships with charismatic mental health gurus. This is just not how good public policy is done.
  4. Replace DSM with ICD. One of the simpler reforms governments could initiate is to restrict financial support (including Medicare co-payments and PBS drug subsidisation) for the treatment of mental health disorders to those diagnosed using the World Health Organization’s (WHO) ICD criteria. While the ICD is far from ideal, research indicates that diagnosis and prescribing rates are usually lower using ICD rather than DSM criteria.
  5. Protect the human rights of involuntary patients. State governments need to increase the protections for involuntary patients. Involuntary patients have, in the vast majority of cases, not committed any crime. Too many are detained and drugged against their will on a flimsy basis. Yes, it is legitimate to protect the public from dangerously psychotic individuals and self-harming patients; however, too often, patients are detained and drugged on vague grounds (e.g. to protect their reputation).
  6. Prohibit pharmaceutical company donations to political parties and candidates and compensate if necessary through increased public funding of political parties. Governments are responsible for multi-million-dollar decisions about which drugs get approved and subsidised, and must make these decisions without fear or favour. There is currently only retrospective partial disclosure of political donations. While there is no evidence of direct corruption, there has been very little scrutiny of pharmaceutical company operations by parliamentarians. Although a similar case could be made for a range of industries, the pharmaceutical industry is unique in that it produces mind- and body-altering chemicals that are ingested by children – a particularly vulnerable consumer group. Some of these chemical interventions are lifesaving; many are warranted, but many are harmful (e.g. the use of amphetamines to ‘treat’ ADHD). Government must be free from improper influence by the pharmaceutical industry.
  7. Address the inequity of resourcing of competing perspectives on controversial mental health and health policy issues by direct government funding of independent non-government pharmaceutical and medical/psychiatric watchdogs. The pharmaceutical industry has demonstrated that it has sufficient resources to effectively organise, lobby, and market to enhance its own economic interests. However, there is no significant counterbalancing economic interest that supports those concerned about the inappropriate and unsafe use of pharmacological interventions. Industry domination of notional consumer support groups further exacerbates the problem by creating the false impression of independent consumer-driven advocacy. Governments could address this imbalance by funding independent non-government watchdogs specifically tasked with critiquing research and clinical practice in the medical/psychiatric and pharmaceutical fields.
  8. Ensure diverse views are robustly represented in health and mental health policy and regulatory process. In many cases, these types of processes (e.g. treatment guidelines development and drug prescribing oversight processes) are dominated by like-minded, industry friendly ‘experts’ who develop consensus (often unanimous outcomes). These processes should be open and contested, with a range of views competing to influence outcomes. Very often ‘experts’ in a single condition or disorder have significant financial or even intellectual and ideological conflicts of interest. If medical knowledge is required to evaluate evidence of the safety and efficacy of treatments etc., this can generally be done by medical practitioners/researchers who don’t specialise in the condition or disorder.
  9. Stop schools demanding that students be medicated as a condition of attendance. There are too many disturbing reports of schools suggesting that a child has a psychiatric disorder, particularly ADHD, or, worse still, demanding that a child be ‘medicated’ (i.e. drugged with amphetamine) as a condition of attending school. This is a child rights abuse. It is particularly disturbing because all around the globe many children are drugged because schools and teachers mistake age-related immaturity, among the youngest in class, for a psychiatric disorder i.e. ADHD.

Many of the fifteen suggested reforms would require courageous political leadership, something we have not seen in Australian federal politics for a long time. A significant barrier to these necessary reforms will be the influence of the pharmaceutical industry. Big Pharma’s enormous economic resources and political skills have enabled them to dominate, virtually uncontested, the processes of licencing and subsidising their products in Australia. Without political leadership on these issues, Australians will continue to be denied fully informed consent and be exposed to unnecessary risks.

For their part, doctors, other mental health professionals and policy makers who genuinely want to see better sustained outcomes Australia’s mental health system, need to restrict psychiatric practice to robust evidence-based parameters. This will require the Australian medical and psychiatric professions to acknowledge how little they actually know about the interplay between brain, body, biochemistry and behaviour. This in turn requires far greater respect for just how difficult it is to be a competent, empathetic psychiatrist, who knows both their patients the relevant science.

Psychiatry is an exceptionally difficult and complex profession that must be done by highly skilled specialists. Non-expert practitioners, especially general practitioners without extensive psychiatric and psychopharmacological training, should not be able to initiate psychotropic drug treatments. Most importantly, if a doctor is not capable of helping people withdraw from a mental health drug (usually by tapering), they should not be allowed to prescribe them.

Government and the psychiatric and medical professions and even the media need to lift their game. But ultimately the Madmen marketing us our epidemic of mental illness couldn’t sell their products if consumers were not buying.

If Australians want improved mental wellbeing, the most obvious change that needs to happen is that patients need to stop believing in ‘quick fixes’. Pills may work in the short term, and for a minority of severely ill patients they may be required for extended periods, but very often they do much more harm than good.

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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.

15 COMMENTS

  1. Well, I was with you in the first half of this, with the dismay over the American exportation of mental illness and psychopharmaceutical prescribing habits. However, I’m kind of concerned that the steps outlined to address this are solely focused on changing prescribing habits and admonishing folks for wanting to take the drugs when the drugs are all that are available to most people.

    If we are to truly revolutionize the way we approach distress, we must start from a preventive model and not just a response model. A preventive model would begin from the ground up. It would address all the factors that are contributing to increasingly distressed populations. It would address climate change (and consequent weather instability and disasters), the food supply (prioritizing nourishing foods rather than cheap profitable foods), social conditions and community structures (the breakdown of families and communities), the economic policies that produce great GDPs while increasing inequality between the haves and have nots. As Peter Sterling said in his interview, we’d redesign our education systems to meet the developmental needs of children rather than demanding children fit into poorly designed schools that exist to meet the demands of constantly growing economies. We would, in essence, put people and planet before profit.

    We don’t need to revolutionize prescribing habits – we need to revolutionize our entire planet to be people friendly! This won’t stop bad things from happening and resultant distress or the need for caregiving. It won’t stop abuse or illness or disaster or the grief that comes from loving and being loved. But it will provide a much better grounding for acquiring and holding onto the emotional resilience required to survive and thrive in relationship with each other.

    When we realize that multinational conglomerates do not exist to fulfill actual human needs and that nobody should ever have to get stuck in revolving menu hell when calling customer service to the point where they’ve been on the phone for hours and end up screaming at the automated voice on the other end before hanging up in disgust, then we might begin to understand what actually needs to change about modern life to start dialing down the level of stress we are almost all living with and reacting to in some way or another.

    We live in a disabling world because it is profitable. And as we need fewer bodies to perform labor that machines can do more efficiently, it is increasingly profitable to “disable” ever larger percentages of the population through drugging them into complacency with the system and accepting their distress as a personal illness instead of an affliction.

    It shouldn’t be necessary to protect ourselves from algorithms designed to identify and then play on our fears and insecurities, to reward us for clicking, to sell us happiness in the form of things, and to convince us to change ourselves to fit in.

    People didn’t fall into the trap of demanding to be drugged out of their misery because they just want a quick fix! This is literally baked into the design. Misery is extremely profitable and generations of people have been propagandized to believe that competing with each other for more stuff is the definition of a good life.

    • It is a chicken and egg type situation. Psychiatry in part prevents society from solving issues such as poverty, pollution, discrimination and so on. It does this by labeling those who are suffering as “mentally ill”. The result is that poverty isn’t viewed as the problem, it is the impoverished people’s defective brains that needs “fixed”. A common comment on the topic of homelessness is that homeless people are “mentally ill”. What this comment does is transform the problem from a lack of housing to defective brains. A lack of housing is solved by providing housing; “mental illness” is “solved” with drugs and electrocutions of gray/white matter.

  2. Hi are you sure? With this pandemic all the experts are talking about epidemics of Mental Illness. I don’t know if this will mean more talking therapy or more medication or both.

    [Though, when I interact with family members in Ireland – they sound quite happy with their circumstances].

  3. What is interesting about this article is that it points out how America exports everything (knowingly and unknowingly) and of course, the good, the bad and the ugly to very ugly. Our “mental illness system” seems to be one of the ugliest. There are some ideas in this article that could be applied to the States, however, it is questionable if ever would. Unfortunately, there is still too much reliance on treatments, specifically drug treatments for people just acting normal. Taking these drugs out of the schools would be very fantastic, but in the US, you would have to confront the ever powerful Teachers’ Unions. But, perhaps, we will need to confront these Teachers’ Unions on many fronts as I see the schools, the educational system as the launching pad for necessary change. It begins with honoring each student as a unique individual with unique gifts and talents, etc. It also begins with an honest approach and a free approach. We need to stop lying to ourselves, our children, and each other. And, above all else, we need to educate all, including the parents, about the evils of these drugs and the accompanying droning, repetitive evil of therapists, etc. We need to let people be people and let each person do and be as he or she is meant to do and be; that which can not be done, etc. by anyone else. We need to stop forcing people into doing and being whom they are not and could not ever do and be. It’s just useless and humiliating to feel the need to only go to the clothing store to only try on the clothes that don’t fit and/or look just plain awful on you. A few are necessary to make a comparison against those clothes that are perfect and right. But, to spend the whole shopping trip trying on the wrong clothes for us is humiliating, debilitating, and worse. In the end, it can cause unneeded suffering and sadly, even premature death. Thank you.

    • The Soviets had a similar “mental health” system as our current American one. In the Soviet Union psychotic and delusional people who openly opposed the Soviet “Utopia” were fixed and treated with neuroleptic drugs. The American system is more subtle where those who don’t appear happy, productive and properly sociable under the American “utopia” are fixed and treated with the same drugs.

      Neoliberalism is influenced by the Protestant Prosperity gospel which started in Europe. The prosperity Gospel basically states that the rich are blessed by god and the suffering masses are sinners being punished by God.

  4. Gentlemen, but after all, everything we write about the harmfulness of psychiatry, about the monstrous results of “treatment” has been known for a long time! All this has been written on the same pages for decades! But the world from this does not come close to getting rid of such evil. Rather, on the contrary, this evil is deepened.
    Just informing is not enough. It is necessary to present a demand to the authorities. Any public, social groups have achieved their rights exclusively in this way. – Providing joint, solidary pressure on the authorities. For some reason, only victims of psychiatry are unable to rise to such a level. We continue only to inform humanity. Probably we relying on someone else to defend our rights. Alas, such hopes are vain. “Rescue of the drowning, the work of the drowning themselves” This is the awful reality of the world we live i

    • Lametamor,

      Largely agreed. This is one reason, as you hint at, why political and legal solutions will be (have been) needed as well, in all their breadth and depth. Unfortunately, many politicians are often last to either know or do something, especially since ‘they’ so often must act as a group or sub-groups. But to the extent that participatory democracy is real, the attitudes and acts of citizens should ‘trickle up’ or be installed in political positions. As always, individual acts and attitudes are still required. I believe there are more than the ‘victims’ working on this, and there are also ‘friends in high places’, all not necessarily mutually exclusive. Often, even those that are not hardcore victims are victimized or at least good listeners and connect a few dots. One thing about criminal injustice systems and mental hell systems (and politics!): overall, they must abide by ‘the law’ — not only the laws they are accustomed to manipulating, but the laws which could make ‘them’ imprisoned, unemployed, or bankrupt….new laws, stricken old laws, or simply understanding and enforcement of existing laws — especially when citizens know how, and do, use their rights and liberties. Or something like this.

      BTW: (Gentlemen?)

    • Lametamor,

      I’d probably reword/analyze my comment on victims not being the only ones working on this. Your emphasis was on the publicity and solidarity of certain social groups (previously marginalized but gaining political power and recognition). Reminds me of how homosexuals and non-‘traditional’ sexual orientation and gender identity have quite an oppressive history in psychiatry. Much progress, much more needed.

      It is interesting to me when different marginalized, minority, or otherwise civil rights/liberties groups could team up to strengthen political change and social realization. Sometimes our identities and niches both empower and divide agendas, including within single individuals.

  5. I like your robust article Martin. It is detailed and clear. And I like the great points made by @Kindredspirit also.
    Sometimes I feel it would be good to not only have in depth articles that year after year splendidly illuminate the debacle but…

    “DO SOMETHING”

    I think of creative campaigns like extinction rebellion. Whether you think they flopped or flaunted, they at least made the years and years of unheard reams of data spewing forth about climate change feel less like a paralysing roll calls of the dead icebergs and more like actual activism. Great articles on climate change change nothing. Not until people fling a cup of frustration at the television and go and bodily lie down in a car factory. It is important to read up to date articles but what they outline is…
    A. there is a huge problem.
    B. faceless industries should be persuaded to change.
    C. nobody knows how you the reader can do that.
    D. so sit with your impotent knowledge and despair.

    At least Martin’s fine article outlines some key steps.

    On a separate note…I can say for myself that sometimes the most interesting and passionate and alive times of my life have been when I have felt suicidal. I think people can confuse suicidality with a sort of empty deadness and numbness that comes from feeling nothing at all. Whilst dead that way I yearned to cease the quality of deadness in a gesture that would “wake me up into life again”. So that sort of bleak act has a striving to live. And in my life, “living” has quite often had someone shouting at me, or a flooding washing machine, or a dangerous protest lighting up my street, or a lover telling me he never wants to see me again….all fantastic, epic stuff!
    So I believe some of the uptick in suicide rates is actually due to wanting a more visceral and dangerous and vivid existence. And loneliness makes that less likely. So cushioning the routinely suicidal on a cocktail of sedative drugs and teaching them to fear feeling any feeling at all is probably unhelpful in the long run. Though I do also chime with @Kindred that our world needs to be way more loving generally. The acutely suicidal need more care not less.

    Could go on but Ive got to listen to moody Max Richter music now. Taraaa

  6. Martin, thank you for contributing this excellent blog post! I look forward to reading your book when it is released. I live in Australia and share your keen interest in these issues. I learned a lot about the political side of this problem from your article. I’d like to share a few thoughts on your commentary.

    You wrote that, “The main problem with DSM-5 is that normal human suffering and frailty is classified as disease.” This leads to understandable psychological struggles in response to bad things happening pathologized as medical illness, leading to medical “treatment” (psychiatric drugs, ECT, etc.). I would argue there is another main problem with the DSM: it is not scientifically credible. The “disorders” therein are not valid, let alone reliable.

    The modern DSM is an invention of the American Psychiatric Association, created out of desperation in the late 1970s to save its image as a credible branch of medicine. DSM “mental disorder” diagnoses have never been scientifically credible but the APA, in partnership with the pharmaceutical industry and other entities, managed to convince the public that DSM diagnoses are “real biological illnesses, just like diabetes.” Australian psychiatry eagerly adopted the American model. As a former American living in Australia, it appears even more entrenched and dogmatic here than in the US, and psychiatry/medicine has no real competition as opposed to the US and especially the UK where psychology is a more prominent critical voice. Historically, Australia has followed what America does based on faith and loyalty. Australia fights alongside the US in wars no matter how unjust or irrelevant to Australian interests. And Australia has adopted America’s uniquely home-grown DSM-based biomedical model for itself. As a bonus, this model is exceptionally useful to the medical profession in terms of power, money, and prestige despite the fact the model is both scientifically invalid and harmful to society.

    There are three additional issues your essay doesn’t emphasize or address that, in my opinion, are crucial in understanding why 1 in 6 Australians take psychiatric drugs. First, psychiatry, in protecting its guild interests, consistently lies about its theories and “treatments,” as Robert Whitaker and Lisa Consgrove demonstrated in Psychiatry Under the Influence. For example, here you can find the official position of Australian psychiatry that its drugs “work by rebalancing chemicals in the brain” (https://www.yourhealthinmind.org/treatments-medication/medication). The Australian Department of Health (https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-c-coping-toc~mental-pubs-c-coping-wha) tells the public, “Depression involves changes in brain chemistry and can change the way people respond to their world. Antidepressant medicines can correct the imbalance of chemicals in the brain until such time as the natural balance is restored.” I have complained to the relevant entities about this misinformation and was blown off. Nobody cares.

    Second, medicine (including psychiatry) is trusted by the public. This means that society, including politicians, patients, and the media, is unable to imagine let alone act on the fact that medicine (especially psychiatry) lies about the nature and “treatment” of “mental health” problems. In Australia, doctors run the healthcare system. Other professions like psychology that might challenge medicine are mere “allied health professions,” clearly subordinate to medicine and less trustworthy and credible in the public eye.

    Your proposed solutions seem focused on making accurate information available to the public. I agree with you that such solutions are necessary. However, I doubt they would make much difference to the “1 in 6 medicated Aussies” figure because of the third issue I discuss below.

    Australians trust their doctors. The Australian healthcare system places general practitioners as the gatekeepers to the mental health system. Every person who wishes to see a psychologist and receive a Medicare rebate must first see a GP. As you noted, GPs are inadequately trained for this task and know little beyond the basic version of psychiatry’s biomedical model. Indeed, 1 in 10 Australians takes an “antidepressant” prescribed by their GP. However, society venerates GPs as THE experts in mental health, certainly more expert than the psychologists to whom they refer clients. Even when they refer a client to a psychologist, the client has to come back after 6 sessions and ask the GP’s permission for additional sessions, and the psychologist has to write a report to the GP to ask for permission. In the Australian mental health system, psychologists work for GPs as much as they do for clients. Fundamentally, the mental health system is run by medical doctors.

    The third issue I speak of is this: doctors are incapable of safely and competently prescribing psychiatric drugs. This fact is clearly demonstrated in the US, UK, Australia, and similar countries that have the highest prescribing rates and worst outcomes in the world.

    Martin, I believe that if every one of your suggested reforms were instituted, the societal effect would be minimal. Doctors will keep doing what doctors do – offering psychiatric drugs to people in distress regardless what the science and guidelines say. Unless their practice is severely regulated and restricted, or they are removed from the equation altogether and people can see a therapist/psychologist directly without having to be exposed to doctors eager to medicalize and prescribe, I believe we’re stuck. And such reforms would require regulators and politicians to recognize that the profession of medicine (psychiatry) has lied to us all in order to protect its guild interests.

    On a personal note, Martin, I would be keen to correspond with you about these matters as I am working in this area as well. Please do email me if you see this at [email protected]. Best, Brett

  7. @DrBrett, the GP presiding over the birth of myself, according to my mother, kept a bottle of whiskey in his leather gladstone medical bag, from which he would offer himself and his patients a wee nip. He was the same doctor who smoked in the treatment room….”can you pass an ashtray?”. And he prescribed for my six months colic a gallon of morphia. But he was a nice doctor and beloved by many.

    But my point here is doctors can be persuaded to slid aside the whiskey glass, and cigarrettes, and noxious sleep aids for howling tots…if they get thoroughly shamed out of such practices. Shame is a powerful reason why we dont see smoking doctors in treatment rooms anymore, or indeed smoking people anywhere.

    But applying shame is delicate task, too much shame and the shamed brush off all sentiment or morality and doggedly assert the noble ediface of their own sentiment and morality. Nobody likes being embarrassed. But until the prescribing of psych drugs becomes as “shameful” and “embarrassing” as offering a patient neat rum or a filter tip, the indifference of doctors will continue in a buisiness as usual mode. But it is also of note that when everyone quit cigarrettes there were “other places” to channel relentless stress, like going to the gym or meditation class. There were places a doctor could “send” nicotine craving, desperate, wits end patients to.

    So as well as shaming doctors for doling out antidepressants needlessly, there needs to be a plethora of alternative places for the upset to go to and get some proper hand holding support. In climate change activism it is the same. Shame the enormous fossil fuel companies and the people squandering plastic packaging, but also build alternatives to current fuel and packaging. And make that double whammy of shame and alternative tightly together. Shame without an alternative becomes mere “bitchin”. And an alternative with no push of shame becomes pie in the sky or “negligence”. But shame is best served up by the masses. A few placcard wavers almost incentivize shameful defiance. For the masses to have knowledge of the shameful stupidity of psych drugs it needs more horror stories coming out from activist camps, like the uptick in lung cancer deaths from smoking. Death is just not sexy. Unless necrophilia is your bag. The public turn to psych pills because their doctors tell them their warts and moles and mysterious lumps are not only nothing but attention seeking, time wasting “shameful” behaviour. The loveless dismissal a patient gets on presenting a sore body finds relief in joining the gaslighting idea that maybe being an odious selfish patient is due to madness. Patient and doctor then become complicit in shoving the patient on psychiatric chemical soothers as a proxy for love and a proxy for respecting the “normal” wish for adequate “bodily centred” medical care.
    Why a patient might so readily agree to the gaslighting tilt into a pill bottle is occasionally because there is a very fine sense of ego identity to be forged from cultivating an air of the tragic. I am not saying there is no underlying actual tragedy. Scratch the surface of ANY life and you will find true accounts that will make you weep. But what I am saying is that like tragic Monroe and tragic Plath and tragic Kurt Cobain, it seems a ticket to greatness and legend in a life that may, for political reasons, have zero props of “identity” in it. And there is nothing a person will take more seriously than their choice “identity” when they finally feel they have seized upon it. And if that identity is the tragic identity that needs a rattling pill bottle to confirm it and bolster it, then the pill bottle will itself be taken terribly seriously. As if it is a bottle of identity, a bottle of tragic “self”. And a “tragic” self is worth dramatically more than a lonely needy “zero self” in our bored to bits society. An air of the “tragic” is a route path to societal love, who like its meaningfulness as an art form and entertainment for them, but an air of the lonely is a route path to utter abandonment and death. Add a whiff of actual depression and we see why the whole population of the West are inching towards psych pills.

    So “shaming” and “alternatives” are two things required to foster change, but I believe there needs to be an illumination about why people need to cling to an air of the “tragic” narrative as their whole “identity” and “only” form of permitted “self love”, given that it jeopardises their very brain in leading them to consume revolting psych medicines. A few decades ago your “identity” was founded and enboldened not by what tragic awfullness you felt but by your gritty deremination to survive anything at all costs. That is so crucial! But because society took advantage of such heroic stoicism and beat it into the uncomplaining shape of poverty and zero hours employment contracts and rubbish relatonships and lousy led local communuties, people have grown disdainful of being abandonned in their stoicism.

    Could write all day but mustn’t…mustn’t.

  8. Dear Martin,

    We ‘all’ need to lift our game.

    Not every pill is a synthetic ‘psychiatric’ drug prescription, nor is every drug from a laboratory that directly or indirectly affects the mind inherently corrupt and valueless, including for the long-term and including for some who are not ‘severely ill [mental] patients’ (and therefore occasionally justified in using them, from what you’ve said).

    The production, advertising, and prescription of pharmaceuticals do not exclusively define, make completely irrelevant, nor corner the market on ‘biological’ psychiatry.

    Please, as I’ve said to another MiA author, stop reinforcing the cliche or stereotype of ‘madness’ by using the tired definition of ‘doing the same thing over and over again expecting different results’, just to describe/diagnose AND ridicule another person/system as ‘gone barking mad’. Not only is this not necessarily logically accurate, but it repeats a probably faulty prejudice while maintaining the faulty premise. Plus, it gives madness, in this case, that style of ol’ moon-howling madness (as luna-tic), a bad name, which isn’t a given and may depend on the context and the one who is perceiving and/or
    interpreting it.

    There is much I agree and resonate with in this article, but I don’t need to flesh out nor reiterate those relevant points here.

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