Thomas Insel and the Future of the Mental Health System

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Thomas Insel, who directed the National Institute of Mental Health (NIMH), is busy promoting his new book, which carries the odd title of Healing: Our Path from Mental Illness to Mental Health. It is a curious title and a curious endeavor, given that his thirteen years in charge of the nation’s mental health research produced such uniformly dismal results. When the New York Times recently interviewed him about the book, the headline spoke of him as “the Nation’s Psychiatrist.” If he is that, the outlook for those with serious mental illness is a dark one.

Thomas Insel

Having overseen the expenditure of more than twenty billion dollars during his term of office, Insel confesses that none of that money has produced any clinical advances that help patients, and that is an understatement. And yet he has the chutzpah to promote himself as having the answer to the country’s mental health problems—which turns out to be more of the same singular emphasis on neuroscience and genetics that characterized research at NIMH under his leadership. As the cliché would have it, repeating the same behavior that has proved counterproductive in the past is the very definition of insanity.

NIMH was born in the aftermath of the Second World War, a conflict that showed, once again, that modern industrial warfare is inimical to mental health, with hundreds of thousands of troops succumbing to combat-related mental disorders. For the first three decades of its existence, the new institute pursued an eclectic approach to the problems posed by major mental illness, funding social and behavioral research alongside biological and pharmacological studies. That broad-spectrum approach was abruptly abandoned under Reagan’s presidency. Research that suggested connections between mental illness and social factors was distinctly unwelcome politically, and faced with threats to the organization’s funding, the leaders of NIMH embraced a research agenda that focused narrowly on biological psychiatry.

In many ways, Insel’s time as director of NIMH thus followed what had been its standard approach for more than two decades. But the shift from what one president of the American Psychiatric Association called a bio-psycho-social approach to the problem of mental illness to a bio-bio-bio approach was particularly marked under Insel’s leadership, and has been continued under his successor, Joshua Gordon (whose own research prior to his appointment was on neural activity in mice). Funding genetics and neuroscience has become the Institute’s mantra, regardless of its failure to deliver positive results.

Since the appearance of the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, American psychiatry has been fixated on defining mental illness on a purely symptomatic basis. The presence of a certain number of symptoms in a tick-the-boxes fashion is supposed to result, in a purely mechanical fashion, in a diagnosis of schizophrenia, major depression, or bipolar disorder (not to mention a host of other mental disorders). It was an approach that, in the face of a parade of embarrassing studies that showed the profession could not agree on diagnosis, tried to ensure inter-rater agreement while quite deliberately ignoring the issues of whether psychiatrists’ labels corresponded to real diseases in nature.

When the American Psychiatric Association contemplated a fifth revision of this elephantine manual at the turn of the century, its proponents boasted that the new edition would break from this model. With the backing of the neuroscientific research NIMH had been funding under Steven Hyman, the director who preceded Thomas Insel, and with Insel’s renewed commitment to this line of research, the expectation was that DSM-5 would transform psychiatry’s whole approach to diagnosis, using neuroscience to classify mental disorders on the basis of what caused each of the mental disorders it distinguished.

But the science that would permit this simply didn’t (and doesn’t) exist.  We remain almost wholly in the dark about the causes of mental illness and the task force charged with constructing the new manual was forced back on the same symptomatic approach the profession had embraced in 1980. None of the hugely expensive neuroscience NIMH had funded had shown what the etiology of mental illness was. It was more than slightly ironic, then, that it was Insel who took the lead in denouncing the new DSM as a monstrosity. In interviews at the time, he voiced his disgust in no uncertain terms.

On April 29, 2013, a week before DSM-5 was officially published, Insel complained publicly that “the final product involves mostly modest alterations of the previous edition.” That was not intended as a compliment. “In the rest of medicine,” he suggested, “this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. . . symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best course of treatment.” DSM-5 set itself up as psychiatry’s Bible, he reflected, but “Biology never read that book,” and “Patients with mental disorders deserve better.”1

It was simply astonishing, he averred, that psychiatrists should practice in this fashion. Most of his psychiatric colleagues “actually believe [that the diseases they diagnose using the DSM] are real. But there’s no reality. These are just constructs. There is no reality to schizophrenia or depression.”2 Henceforth, Insel announced, NIMH would alter its approach to studying mental illness, since “we cannot succeed if we use DSM categories as the ‘gold standard’…That is why NIMH will be re-orienting its research away from DSM categories.”3 In particular, he suggested, “we might have to stop using terms like depression and schizophrenia, because they are getting in our way, confusing things.”4

One sees what motivated such a statement (and it must have been greeted with glee by the Scientologists), but the phrasing was distinctly unfortunate. The labels may need to go (with who knows what consequences for psychiatry’s reputation). Yet the distress and pathology those traditional labels seek to capture will not disappear with them.

Insel’s comments incited a furor, with both medical and scientific journals and the mass media hastening to report his skepticism.5 He had hoped to use the controversy to advance his own pet project, something he called Research Domain Criteria (or RDoC), an attempt to install a research framework based on biology, and more particularly on a nebulous notion that related mental illness to a mysterious something called “brain circuits.” But RDoC was not ready for prime time. No other entity engaged in psychiatric research endorsed his hobby horse, and it has faced fierce criticism since Insel stepped down as NIMH director in 2015.6

In 1886, the American alienist Pliny Earle had lamented that “In the present state of our knowledge, no classification of insanity can be erected on a pathological basis, for the simple reason that, with but slight exceptions, the pathology of the disease is unknown… Hence…we are forced to fall back upon the symptomatology of the disease.”7 Nearly a century and a half later, and despite billions of dollars devoted to neuroscience, nothing, it seems, had substantially changed.

The other major hobby-horse Insel funded during his years as director was the study of genetics. It seemed, on the surface, a promising bet. Dating all the way back to the late nineteenth century, psychiatrists had speculated that mental illness had strong genetic roots. Till the closing years of the twentieth century, such claims rested on evidence from family studies, most notably studies of fraternal and monozygotic twins. These were often plagued by methodological problems and rendered suspect by the ideological commitments of some of the central researchers, but better-conducted studies toward the end of the twentieth century and a greater distance from a prior association with Nazi researches led many biological psychiatrists to expect that imminent scientific advances would uncover strong genetic links to major mental illnesses.

The discovery of the PCR (polymerase chain reaction) technique in 1983, which allowed researchers to make millions to billions of copies of a specific DNA sample, was the first of two major breakthroughs on this front. A year after Insel became NIMH director in 2002, this breakthrough was followed by another major scientific advance, the decoding of the human genome. Taken together, these developments fueled expectations that the genetic underpinnings of disorders like schizophrenia and bipolar disorder would soon be uncovered, and NIMH poured resources into such studies.

Confounding researchers’ expectations, the expected genetic connections have essentially failed to materialize. In the words of two leading psychiatrists, Rudolf Uher and Michael Rutter, “molecular genetic studies of psychiatric disorders have done a lot to find very little. In fact, in the era of genome-wide association studies, psychiatric disorders have distinguished themselves from most types of physical illness by the absence of strong genetic associations.”8 The field as a whole, as the eminent geneticist Kenneth Kendler puts it, has had to absorb some “painful lessons” and acknowledge that “despite our wishing it were so, individual gene variants of large effect appear to have a small to non-existent role in the etiology of major psychiatric disorders.”9

Given the results of nearly twenty years of work, it is now clear that there is no Mendelian gene or set of genes that explain schizophrenia. As that reality became apparent, researchers more and more relied upon an approach called genome-wide association studies (or GWAS). It is an approach that makes no assumption about where genetic associations might lie, but simply scours hundreds of thousands of sites looking for possible linkages and does so for a whole range of psychiatric disorders. The result has been a muddle, one that has disappointed the hopes and expectations of these researchers that a clear picture of the genetics of mental disorder would appear. Studies examining many tens of thousands of patients and controls have failed to show clear genetic links, and even aggregating hundreds of genetic sites, each of which are individually of small effect, explains less than eight percent of the observed variance. Worse still, an individual can harbor many of these genetic variations without ever developing mental illness. Various genes had been hypothesized to be particularly likely to be linked to particular forms of mental disorder. But these so-called candidate genes have been shown to have no closer relationship to the development of schizophrenia than random sets of control genes. That has proved to be as true for bipolar disorder as for major depressive disorder and schizophrenia.

Indeed, these GWAS studies have produced a still more confounding result than these. For rather than revealing one set of vulnerabilities for schizophrenia and others for bipolar disorder or major depressive disorder, most such risks as it identified seemed common to a whole range of mental disorders.10 “The high degree of genetic correlation…among attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder (MDD), and schizophrenia,” the international Brainstorm Consortium reported, provides important “evidence that current clinical boundaries do not reflect distinct underlying pathogenic processes. . . This suggests a deeply interconnected nature for psychiatric disorders.”11

In the abstract, negative scientific findings can be seen as just as valuable as positive ones, acting as correctives to one’s original hypotheses and suggesting the need to reappraise research strategies. That is not the message Dr. Insel seems to take from these results. If anything, he suggests, the United States “should double down on brain research.” His successor as director of NIMH, Joshua Gordon, seems to be of the same mind, insisting in the pages of the New York Times that researchers, having identified hundreds of relevant genes, are “starting to understand those genes in the context of the brain,” promising in a decade or two to provide a pathway to better therapies.”12

Psychiatry has been offering promissory notes of this sort for well over a hundred years, and has consistently dishonored them. There are ample grounds for skepticism about these latest assurances from Dr. Gordon and the man who dubs himself “America’s psychiatrist.” The more sensible conclusion to draw from the absence of progress either in understanding the etiology of major mental disorders or in advancing therapeutics is that putting all one’s eggs in the biological basket is a dangerous gamble. If genetics were the royal road to comprehending where mental illness comes from, its effects would have to be exceedingly powerful, and the research of the past twenty years makes that an extremely difficult position to sustain.

Quite unexpectedly, under the weight of the genetic evidence, existing distinctions between disorders are crumbling, and the notion that such artificial constructs identify distinct diseases has become ever-more implausible. The enlightenment genetic researchers have produced threatens to undermine the standing and legitimacy of the “diseases” that psychiatrists had believed in for more than a century—concepts that have woven themselves deeply into the ways the lay public had been taught to view mental illness. To acknowledge that the distinctions between schizophrenia and bipolar disorder may be spurious, and that those constructions might have to be abandoned—but with what to put in their places?—threatens the very foundations of the psychiatric profession’s claims to expertise. If such fundamental building blocks of the psychiatric universe crumble on close inspection, what is left?

Two years after denouncing DSM-5, Insel stepped down from his position as director of NIMH. In the aftermath, he gave an interview to an online MIT magazine. He was asked to summarize his accomplishments while heading the institute, and responded insouciantly, “I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded in getting lots of really cool papers published by cool scientists at fairly large cost—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”13

The current situation is even more dire than the one Insel conjures up here. People with serious mental illness live, on average, fifteen to twenty-five years less than the rest of us, and that gap seems to be widening, not narrowing.14 While genetics and neuroscience have flourished within the confines of universities, their therapeutic payoff has been minimal or non-existent. This may change, but it is equally possible that those sponsoring these programs may tire of funding investigations that show few signs of producing practical advances. Meanwhile, advances in psychopharmacology since the introduction of the first antipsychotics and antidepressants in the 1950s have essentially stalled, and the major drug companies have largely abandoned research in this area. 15 In the words of the former head of neuroscience at Eli Lilly and Amgen, “Psychopharmacology is in crisis. The data are in, and it is clear that a massive experiment has failed: despite decades of research and billions of dollars invested, not a single mechanistically novel drug has reached the psychiatric market in more than 30 years.”16 Steven Hyman, Insel’s predecessor as the head of NIMH and now director of the Stanley Center for Psychiatric Research at Harvard has made the same point: the discovery of chlorpromazine and related compounds in the 1950s seemed to promise “both therapeutic progress and significant probes of brain function. Looking back, the picture is painfully different. The efficacy of psychotherapeutic drugs plateaued by 1955.”17 And that efficacy is limited indeed, with none of the drugs helping much with the devastating negative symptoms of schizophrenia, and the drugs’ side-effects remaining as troublesome as ever.

In the face of this damning record accrued during the period he oversaw the country’s basic research into the causes and remedies for serious mental illness, Insel is unrepentant. He and his successor continue to fixate on biology and biology alone. In my judgment, that is a profound error, and it threatens to undermine still further the prospects for progress in the mental health arena. The foolish monism that NIMH has embraced has meant that the phenomenological and social dimensions of mental illness have all but disappeared as questions worthy of serious and sustained attention.18 That is an imbalance that has had profoundly negative effects on psychiatry, and more importantly, on the prospects of advancing the clinical care of patients. Given Insel’s role in these developments, I suggest that his is the last voice we should be listening to when we ponder how to deal with the devastation mental illness brings in its train.

Show 18 footnotes

  1. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
  2. Quoted in G. Greenberg, The Book of Woe; P. Bellick and B. Carey, “Psychiatry’s Guide Is Out of Touch with Science,” for the Bible quotation. Steven Hyman had earlier expressed similar incredulity that “grant reviewers, journal referees, editors, and regulatory agencies (all) acted as if DSM criteria…pick out real human diseases.” S. Hyman, “Cognition in Neuroscience,” Trends in Cognitive Sciences 16, 2012: 4.
  3. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
  4. Quoted in G. Greenberg, The Book of Woe New York: Blue Rider Press, 2013.
  5. See, for example, “The NIMH Withdraws Support for DSM 5,” Psychology Today, May 4, 2013; Gary Greenberg, “The Rats of NIMH,” New Yorker, May 16, 2013; “Psychiatry in Crisis! Mental Health Director Rejects Psychiatric ‘Bible’ and Replaces with Nothing,” Scientific American May 4, 2013; “NIMH and APA Clash Over Upcoming DSM-5,” Medscape May 7, 2013; “Psychiatry Divided as Mental Health ‘Bible’ Denounced,” New Scientist, May 3, 2013; “Director of Top Research Organization for Mental Health Criticizes DSM for Lack of Validity,” British Medical Journal 346, May 8, 2013; P. Belluck and B. Carey, “Psychiatry’s Guide Is Out of Touch with Science,” New York Times, May 6, 2013.
  6. Christopher Ross and Russell Margolis, “Research Domain Criteria: Strengths, Weaknesses, and Potential Alternatives for Future Psychiatric Research,” Molecular Neuropsychiatry 5, 2019: 218-235 argue that the whole approach is “fundamentally flawed.” See also D.R. Weinberger et al., “Whither Research Domain Criteria (RDoC)? The Good, the Bad, and the Ugly,” JAMA Psychiatry 72, 2015: 1161-1162.
  7. Pliny Earle to Clark Bell, April 16, 1886. Pliny Earle Papers, American Antiquarian Society, Worcester, Massachusetts.
  8. R. Uhler and M. Rutter, “Basing Psychiatric Classification on Scientific Foundations: Problems and Prospects,” International Review of Psychiatry 24, 2012: 594. See also M. Henriksen, J. Nordgaard, and L. Jansson, “Genetics of Schizophrenia,” (Frontiers in Human Neuroscience 11, 2017: 322) who note ruefully that “if common genetic variation implicates an intractable amount of genes of only very small individual effect alleles, we may find ourselves in a situation, where, as Goldstein put it, ‘in pointing at everything, genetics would point at nothing.’” They are referencing here D.B. Goldstein, “Common Genetic Variation and Human Traits,” New England Journal of Medicine 360, 2009: 1696-1698.
  9. K.S. Kendler, “Psychiatric Genetics and the Nature of Psychiatric Illness,” Molecular Psychiatry 18, 2013: 1065.
  10. S.M. Purcell et al., “Common Polygenic Variation Contributes to Risk of Schizophrenia and Bipolar Disorder,” Nature 460, 2009: 748-752; S.H. Lee et al., “Genetic Relationship Between Five Psychiatric Disorders Estimated from Genome-Wide SNPs,” Nature Genetics 45, 2013: 984-994; M.J. Gandal et al., “Shared Molecular Neuropathology across Major Psychiatric Disorders Parallels Polygenetic Overlap,” Science 359, 2018: 693-697; Cross-Disorder Group of the Psychiatric Genetics Consortium, ‘Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms Across Eight Psychiatric Disorders,” Cell 179, 2019: 1469-1482; Alastair Cardno and Michael Owen, “Genetic Relationships Between Schizophrenia, Bipolar Disorder, and Schizoaffective Disorder,” Schizophrenia Bulletin 40, 2014: 504-515.
  11. Brainstorm Consortium, “Analysis of Shared Heritability in Common Disorders of the Brain,” Science 360, 2018: 1313. As they note in the accompanying research paper, this situation contrasts markedly with what one finds for neurological disorders like Alzheimer’s and Parkinson’s diseases. The consortium is a cross-national collaboration among researchers at Harvard, Stanford, Oxford and Cambridge, among others.
  12. Ellen Barry, “The Nation’s Psychiatrist Takes Stock, With Frustration,” New York Times February 22, 2022.
  13. Antonio Regalado, “Q. and A. with Tom Insel on his Decision to Join Alphabet,” MIT Technology Review September 21, 2015.
  14. S. Brown, “Excess Mortality of Schizophrenia: A Meta-Analysis,” British Journal of Psychiatry 171, 1997: 502-508; S. Saha, D.Dent and J. McGrath, “A Systematic Review of Mortality in Schizophrenia: Is the Mortality Gap Worsening Over Time?” Archives of General Psychiatry 64, 2007: 1123-1131; T.M. Laursen, “Life Expectancy Among Persons with Schizophrenia or Bipolar Affective Disorder,” Schizophrenia Research 131, 2011: 101-104.
  15. Sten Stoval, “R&D Cuts Curb Brain-Drug Pipeline,” Wall Street Journal, March 27, 2011. Steven Hyman suggests that this abandonment of the field “reflects a widely shared view that the underlying science remains immature and that therapeutic development in psychiatry is simply too difficult and too risky.” Steven E. Hyman, “Psychiatric Drug Development: Diagnosing a Crisis,” Cerebrum 5, April 2013 PMC3662213. See also David Nutt and Guy Goodwin, “ECPN Summit on the Future of CNS Drug Research in Europe,” European Neuropsychopharmacology 21, 2011: 495-499; Colin Hendrie and Alasdair Pickles, “The Failure of the Antidepressant Drug Discovery Process is Systemic,” Journal of Psychopharmacology 27, 2013: 407-416; and Peter Tyrer and Tim Kendall, “The Spurious Advance of Antipsychotic Drug Therapy,” Lancet 373, 2009: 4-5.
  16. H. Christian Fibiger, “Psychiatry, the Pharmaceutical Industry, and the Road to Better Therapeutics,” Schizophrenia Bulletin 38, 2012: 649.
  17. Steven Hyman, “Cognition in Neuropsychiatric Disorders,” Trends in Cognitive Sciences 16, 2012: 4.
  18. N. Andreasen, “DSM and the Death of Phenomenology in America,” Schizophrenia Bulletin 33, 2007: 111.

***

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.

41 COMMENTS

  1. Thank you for your excellent article. It says everything that needs to be said about psychiatry and it’s clumsy DSM with clarity, deftness and subtle humor.

    It’s articles like this that make me believe it’s possible for people’s awareness of and attitudes towards psychiatry to eventually be illuminated.

    Thank you again for so skillfully pointing out psychiatry’s almost comical fecklessness in their efforts to defend their imaginary turf, be it biology, neuroscience or genetics, not to mention the hilarious hollowness of their spectacularly stupid DSM –

  2. I don’t exactly know what “Schizophrenia” is as I have never had a breakdown. (I was poisoned in Amsterdam in 1980 and made Recovery in Ireland in 1984 as a result of stopping psychiatric drug treatment – which was a very difficult thing to do).

    But, I believe people that hear voices can often develop tactics to quieten them, or they can alternatively learn to live with their voices.

    I believe people that suffer from extreme anxiety can often learn to stand off their anxiety – and approach their problems without fear.

    I also know that preoccupations and delusions, can often disappear of their own accord.

    Irelands main export is pharmaceuticals – so we have a terrible Mental Health problem in the country, with Homicides and Familicides that are completely unexplainable.

    • Fiachra,

      I know you already know that the “schizophrenia” treatments can create both the negative and positive symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome, and anticholinergic toxidrome. So it’s no wonder that being weaned off the psych drugs was beneficial for you, and all.

      And I agree with you that “people that hear voices can often develop tactics to quieten them, or they can alternatively learn to live with their voices.” In my case, what was wrongly called, in my medical records – a “Holy Spirit voice” – was actually just a dream query.

      But I personally have no problem with the Holy Spirit and God being in charge of – as opposed to the dumb men and women, particularly the omnipotent moral busy bodies of the Holy Spirit blaspheming “mental health professions” – judging all.

      What’s sad is America, too, is controlled by big Pharma’s lies, propaganda, and greed. So we too, have a “terrible Mental Health problem.” For goodness sakes, the APA’s DSM “bible” was debunked as scientific fraud back in 2013.

      http://psychrights.org/2013/130429NIMHTransformingDiagnosis.htm

      Yet those industries that bill by it / worship from the DSM “bible,” have still not acknowledged this reality, almost a decade later.

      • Thank You Someone Else,

        “Anticholinergic Toxidrome” is well recognised.

        I notice also a number of Celebrities in the UK that have acknowledged taking antidepressants have developed Parkinsons Disease in Older Age.

        Use of antidepressants and the risk of Parkinson’s disease: a prospective study:-

        “…Our study shows that the risk of PD increases during the first two years of use of antidepressants, whether they are tricyclic antidepressants or SSRIs. The increased PD risk that follows initiation of antidepressants was greater among individuals with recent history of depression than among the others…”

        I would imagine that there could be some anticholinergic influence involved here as well.

  3. Nice article Andrew – a keeper. I was put in touch with Ivan Illich’s paradoxical counter-productivity reading this – Illich of course was writing about several institutions in modern society where as they poured more money into them there was greater negative effect at the other end – which of course then demands more resources to tackle the problem – and the result is even greater harm – which of course then demands… You get the picture! One of the things I’m increasingly attracted to is depsychiatrization – which is not and can be distinguished from anti psychiatry. Foucault traces the commencement of depsychiatrization to the 19th century when they started filtering out dementia etc as belonging more in the department of neurology. I think most doctors outside of psychiatry are recognising that what’s left does not belong in medicine. Now psychiatry came about when the doctors put up their hands in the 19th century to answer the magistrates question of who can predict dangerousness. We now know that claim was false – and still is – no profession has more claim on the prediction of dangerousness than any other. Now I am proposing that this task should fall back on the police, the traditional dealers of dangerousness in society. Currently police forces around the world are attempting to adopt a “policing by consent” policy where they can, which would humanise policing (US policing is seen as the anti-thesis to this). Police are employing social workers with greater frequency. Other social agencies, especially public welfare, are picking up on many people who had previously been dealt with by “mental health” services – most not requiring the debilitating requirement of a diagnoses.

    • “Police [and schools] are employing [scientific fraud based, DSM “bible” believing] social workers with greater frequency. Other social agencies, especially public welfare, are picking up on many people who had previously been dealt with by “mental health” services – most not requiring the debilitating requirement of a diagnoses.”

      Yes, this is a problem. The “mental health professions” do need to learn the concept of “live and let live.” Since they are the “omnipotent moral busy bodies,” about whom C.S. Lewis forewarned us.

  4. Thank You Andrew

    “SUICIDE”

    “…I don’t think we moved the needle in reducing suicide…”

    My Disability and Suicide Attempts were caused by the drug (below) :
    Suicide associated with akathisia and depot fluphenazine treatment
    M K Shear Allen Frances et al. J Clin Psychopharmacol. 1983 Aug.

    I asked for ADR Warning to be included in 1986, and strongly complained about this drug in 2012. The 1986 Requested Warnings though guaranteed were deliberately OMITTED by Doctors at Galway Ireland.

    THE IMPACT OF FLUPHENAZINE DECANOATE DISCONTINUATION –A RETROSPECTIVE COHORT STUDY

    NUI GALWAY 2021 (Copy and Google Heading to get Study)

    Theres also NO Warning Whatsoever in the above Study of the present day Dangers of this Drug – though this drug has killed vulnerable people in Ireland over the years – Left, Right and Centre.

    The Drug is out of Patent so if it was continued it would most likely be continued in the 3rd World.

    My Experience of this drug is that it causes it’s own type of “Schizophrenia” through its Withdrawal Syndrome.

    OPINION
    The Authors I believe take it for granted that it’s okay to kill a certain amount of people with this drug and that prescribing doctors are better off not knowing about the dangers.

  5. We need to move BEYOND holding people in a kangaroo court and putting them through the ordeal of proving they are not A LIAR!!!

    This is true for those individuals who know they have been wrongly diagnosed

    AND AND AND AND

    It is true for those individuals who know they have the correct diagnosis.

    What business is it of a cruel business man in a suit to tell a tribe they have a diagnosis they do not have at all.

    What business is it of a cruel pontificating lesson spouting activist to tell a tell a tribe of really ill people they are not ill?

    The Shaman is a lover. The Shaman has NO great interest in weeding out WHY someone says they feel ill. The Shaman does not mock them or hold them in a court and say they must be a LIAR!!!

  6. Ps.

    If the brain can be vulnerable to toxic effects of medication and even trauma, to the extent of iatrogenic harm that RESULTS in brain atrophy….that RESULTS in changes to white and grey matter….that causes psychotic-like harms…and is a brain damage that perhaps has an effect on genetics…since genes are not something invented by psychiatry…then maybe….just maybe…the iatrogenic effects that seem similar to schizophrenia ARE not that far from genetic damage.

    You cannot have it both ways…
    1. The medications cause physical damage to the entire body.
    2. Nothing out of the orindinary is ever having an effect on genes.

    The dandilions in Chernobyl know genetic disruption. We are all of us steeped in a primordial soup of forever chemicals. Do not tell me that ANY part of the body is NOT “genetically modified” by that. And even on the trauma level, it is becoming clear that our bodies are not living in isolation from our environment but that our genes are ALWAYS modifying themselves as part of healthy mutation, that success story of EVOLUTION.

    Genes are not a…

    “PROVE IT”

    “DID NOT PROVE IT” done deal.

    All “DONE DEALS” smack of the worst of “psychiatry-speak”.

  7. Robert may drown out my voice with a stack of winning articles.

    Given that I believe we all are living in a mirage, where NOTHING IS REALLY REAL then neither is “absolute” truth. So how come evidence is being busily stacked up to provide “PROOF” of ANY INDIVIDUAL of “free choice” is being A LIAR when they say they themselves know why they feel ill.

    THERE IS NO EXTERNAL EXPERT PROOF that an INDVIDUAL’s FEELING is “wrong”, especially in a MIRAGE.

    BELIEVING it is ALL a MIRAGE means we ALL begin to respect that NONE OF US ARE “RIGHT” about ANYTHING beyond our own perceptions…And GOD KNOWS what those are. I do not believe there are a convlusive stack of EVIDENCE PAPERS on that one. Penrose himself does not know what conscious existence is.

    If we do not know what conscious existence is then how can we be CERTAIN that genes are real or not real.

    In a dream called reality the ONLY truth that matters is how you yourself authentically FEEL and how your neighbour authentocally FEELS.

    Love thy neighbour!

    Even if they choose to believe in antipsychiatry or genes or philosophy or trauma or hope or drink and drugs.

    Therefore that is the ONLY thing we ought to respect in each other. What we each individually feel and conclude from our OWN FEELINGS.

    Logic is A GREAT BIG BULLY.

    Logic and reason like to pretend to dissect reality in the MIRAGE and tell people why they are not complying with the absolute truth.

    It is logic that makes kangaroo courts and tells individuals that their FEELINGS are LIARS!!!

    Logic does so to make people FEEL nothing at all.

    With all of my powerful free FEELINGS I spit on self righteous pedallers of logic.

  8. “In the words of the former head of neuroscience at Eli Lilly and Amgen, “Psychopharmacology is in crisis. The data are in, and it is clear that a massive experiment has failed: despite decades of research and billions of dollars invested, not a single mechanistically novel drug has reached the psychiatric market in more than 30 years.”……Tough times for the Drugs Racket!
    At what point does marketing hype become FRAUD? When do we realize that psychiatry is basically chemical genocide?….

  9. “We remain almost wholly in the dark about the causes of mental illness”

    I disagree. We know perfectly well what causes depression, anxiety, paranoia, hallucinations, delusions, etc. These complaints are caused (not “triggered”) by abuse, trauma, loss, etc. The correlation is robust, reliable, and dose-dependent, it cuts across income brackets, ethnic identities, and national boundaries, and it has been demonstrated again and again in case-control studies, prospective cohort studies, and cross-sectional studies. an anyone show me a study that looked for a correlation between trauma and so-called “mental illness” and did NOT find one?

      • Along with some colleagues from ISEPP, I have had the privilege of helping design and conduct a study of NIMH grants. Few of the studies are about psychotherapy, and fully half of those are looking for ways to do psychotherapy on the cheap — internet, text messaging, etc.

        Many of the studies propose to systematically terrorize mice or rats in some unspecified fashion and then use all kinds of fantastically expensive technology to study the effects on their brains. I have a better idea: why don;t we just assume that being systematically terrorized is a bad thing, and if mice or rats or people are being systematically terrorized, put a stop to it?

        • Seriously! I always find it oddly hypocritical for the psych professions to claim that all of our “mental illness” is biologically based, and yet create their model animal subjects by scaring the shit out of them! Why don’t they just find some “genetically ill” mice to test their drugs on? Oh, wait, is it because they actually realize that the main cause of “mental illness” is being terrorized, tortured, or ignored or mistreated, and know that there are no “biologically ill” mice (or humans) in the real world?

  10. A month ago this article might have been reasonably fair. However since then the SCHEMA study has been published which identifies ten specific genes whose disruption substantially increases the risk of developing schizophrenia. It is entirely reasonable to expect that this discovery will indeed lead to useful advances in understanding and treatment of mental illness. I’ve written more about it here:

    Identification of specific genes involved in schizophrenia aetiology – what difference does it make?
    https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/identification-of-specific-genes-involved-in-schizophrenia-aetiology-what-difference-does-it-make/9E78768FDBC5B19D2A921DF541F54429

    • First off, there have always been claims of “causes” for schizophrenia and other DSM-identified “conditions,” and none so far have panned out. These “genes that contribute” will undoubtedly contribute in a small way to a limited number of cases, and such genes will no doubt appear in many in the general population who do NOT “have schizophrenia,” and will NOT be present in many cases who “have schizophrenia.” This is not to say there may be a small subset of people so diagnosed who will have a large genetic contribution to their situation, but so far, we have at best tiny correlations with large sets of genes, all of which overlap to a huge degree with the “normal” population.

      Whereas correlations with events like sexual abuse, early childhood neglect, domestic violence, head injuries, sleep loss and others are much, much higher than any genetic correlation to date. So why are we spending so much time finding tiny correlations with genes when we have HUGE correlations with traumatic events?

        • Oh, believe me, I understand only too well how this kind of study is misinterpreted to indicate causation.

          Here is the operative statement:

          “…which damage functioning are found more often in people with schizophrenia than in controls.”

          Clearly, if these genes are only “found more often” in those diagnosed with “schizophrenia,” there are large numbers of controls who have the same genes, and there are large numbers of people labeled with “schizophrenia” who do not have such genes.

          Further, they state: “… here pathological changes in DNA sequence, can at least sometimes result in a severe illness characterised entirely by abnormalities in mental functioning.”

          Of course, this statement is not a legitimate conclusion from the data presented. All that we know is that a certain genetic pattern is associated to some degree with the probability of developing the subjective set of symptoms that are called “schizophrenia” by the DSM’s authors. Since 1) that set of symptoms does not objectively define any specific “condition” that can be tested for and verified, and 2) the pattern is only ASSOCIATED with increased probability, with a huge percentage of the people having this set of genes NOT developing said “condition,” and a similarly large proportion of those “diagnosed” with this “condition” NOT having the set of genes in question, there is no way to conclude that this genetic pattern is causal.

          There is also no specific evidence that the genes in question are “pathological changes,” since they don’t create any kind of “pathology” in the majority of people who have it. The comparison with smoking is, of course, odious, since we are talking about a carcinogenic agent being ingested vs. a genetic pattern possessed by many “normal” people. To claim genetic causality of “schizophrenia,” either all or most cases of “schizophrenia” must have this genetic pattern present, or an objectively verifiable subset of such cases, which can be unequivocally distinguished from those not so affected, would have to all have this same genetic pattern. It is not proper to assign causality to genes which neither cause most cases of the “condition,” nor which are present in large numbers of people without the condition applying.

          Note that I predicted this would be the case before I even read the article. All recent claims of such “causality” are based on the same flawed “logic,” confusing correlation with causation, I would at this point say intentionally.

          Do you always assume that someone disagreeing with your viewpoint can only do so because they “don’t understand?” I personally found that assumption both condescending and insulting, and I strongly suggest you avoid making such assumptions in the future. I am correctly interpreting the data presented in the study, and comparing it to prior efforts to make the same arguments, all of which fail for the reasons identified above. You may choose to disagree with my evaluation, but I think my reasoning is quite solid and disagreement would be difficult to rationally accomplish given the barriers cited above. You’re welcome to give it a try, but trying to deny the premise that causal conclusions can only be drawn when all or the vast majority of such cases have the specific genetic variations in question seems to be an unconquerable flaw in this and other such claims’ reasoning.

          • “LOL!”….”Substantially increases the risk”….lol. I’m with Steve McCrea 100% on this. I’m seeing a textbook case of the mental illness “confirmation bias”. Like looking at Creation in awe, & exclaiming that there must be a Creator God, just because WOW! SCHIZOPHRENIA! Sounds like a medical FETISH to me….. I no longer believe in such contemporary superstitions as “mental illness”, “schizophrenia”, or “psychiatry”…..
            So go ahead, dude, show me the genes which SUBSTANTIALLY INCREASED MY RISK of losing faith in pseudoscience to 100%….

          • I can see you’re not worth arguing with. I think you didn’t understand the paper but it’s possible that you’re deliberately misrepresenting it. I’ll let others read it and they can make up their own minds.

          • You once again assume the condescending attitude that I somehow “misunderstood” when I have explained myself very carefully. I have misrepresented nothing. I have used quotations from the paper itself. Those who understand the demanding, rigorous logic of the scientific method will know what I’m talking about. And I notice that you did not even bother to try and refute my arguments logically, but resort to ad hominem attacks to try and make your point.

            Meanwhile, it’s clear that you have already decided that you are “right” and are unwilling to accept the most rational possible feedback from me (did you even bother to read and digest my arguments?), so I am not intending to get into further discussion with you about it. The article says what it says, and I have directly responded to the logical flaws and the actual data presented. If that’s not good enough for you, please at least refrain from your condescending swipes at my intelligence and/or integrity. It is not a becoming look on you.

      • Steve McCrae asks, “So why are we spending so much time finding tiny correlations with genes when we have HUGE correlations with traumatic events?” –

        Because psychiatry is nothing more than a pseudoscientific VANITY PROJECT – a project for which these “tiny correlations” get BIG FUNDING – funding that pads their pockets and looks mighty nice on their curriculum vitae. And anyone knows that healing traumatic events doesn’t make the headlines like some nifty-sounding “neuro-scientific discovery”.

        The ridiculous notion that emotional problems are biologically rooted is deeply embedded in a culture built on financial exploitation.

        Will Thomas Insel ever learn? I doubt it – and it wouldn’t matter if he did, as science doesn’t heal trauma.
        So what does heal trauma? Time, quiet, and freely chosen solitude, and best of all, genuine, heartfelt human connection THAT DOESN’T COST A DIME –

    • davecurtis314

      If we already know that People can make full Recovery and return to productive life without Psychiatric Drug Dependency – then this surely is the way forward.

      Irish Psychologist Dr Mike Watts, towards the end of his career, has produced a PHD on how people have successfully recovered (from so called
      “Schizophrenia/BiPolar/Depression”) through Peer Support.

      https://connachttribune.ie/highlighting-power-peer-support-mental-illness-recovery-300/

      He discusses his own MH experience below.

      https://youtu.be/YT2ecA6bJ1c

  11. Schizophrenia is not even a coherent diagnostic category. Two people can have a diagnosis of schizophrenia and have NO symptoms in common. There are no measurable signs of schizophrenia, no common outcome, and no treatment specificity. It is meaningless to talk about a cause for something that does not exist.

    Anyone who knows anything about life as it is lived knows that people vary in their susceptibility to trauma, and sure, genes may have something to do with this. And so what? As I asked in my first book, if a child is being abused, do we stop the abuse, or do we give her a blood test? And if the blood test reveals she has a low “genetic risk score” for schizophrenia, do we leave her in the abusive situation?

    We know the conditions needed for human beings to lead long, healthy, satisfying lives — at least for the vast majority of people. We know this perfectly well. Let’s work on making those conditions available to everyone. That seems to me to be a more profitable course of action than pursuing miniscule correlations mined from colossal data sets.

    • I have used the analogy, “If children are being hit by cars outside of a school, and 20 percent break their legs and 80 percent don’t, do we do genetic testing to see why some of them have ‘weak leg disorder’ because they can’t stand up to being hit by a car? Or do we figure out how to stop cars from hitting kids on their way home from school?”

      • I get your point, Steve, and it’s a valid one. But it seems to me an extreme example, and thus almost irelevant to a more central & basic point. Our pro-genes-cause-so-called-schizophrenia friend here wants to PROVE GENETICALLY that an actual medical disease entity exists, called “schizophrenia”, and “caused” by “genes”. Whew! That’s a lot of quotation marks! Looks like pseudoscience, to me! I say that schizophrenia is EXACTLY as “REAL” as presents from Santa Claus, but not more real. Surely you’ll agree with me so far, Steve? I hope that guy comes back & comments, so we can finish awakening him to real REALITY….

        • I agree completely with you. These attempts to “prove genetic causation” by finding some tiny correlation involving dozens or even hundreds of genetic markers really are a joke and can never prove anything close to what they’re claiming. Especially when we have massive correlations with traumatic events that vastly outstrip the most optimistic (aka delusional) interpretations of the genetics data. Basically, they REALLY REALLY want there to be a genetic basis, they REALLY want it to be true, so maybe if they close their eyes and click their heels together three times and say, “There’s no cause but genes… there’s no cause but genes… there’s no cause but genes…”

  12. There is a long and rich tradition of treating the complaints that now fall under the diagnostic rubric of schizophrenia with empathy and compassion, beginning with Saint Luke’s Hospital in the Eighteenth century, The Retreat at York and the Salpetriere in the Nineteenth, Chestnut Lodge and Soteria House in the Twentieth, and continuing to this day via Open Dialogue Therapy. All this is covered in chapters 10-13 of my first book, Madness and Genetic Determinism: https://www.amazon.com/Madness-Genetic-Determinism-Mental-Illness-dp-3030218651/dp/3030218651/ref=mt_other?_encoding=UTF8&me=&qid=

  13. Article after article on this website. Still the same old commenters. People retiring and people dying. And still. Nothing changes. Nothing. I’ll consider this place a success when none of the old commenters post a comment again. Or maybe post like 4-5 comments a year. Because then, you know that individuals are engaged in life and are doing something worthwhile and actually living. What existence is this otherwise. Marginalised and in pain.

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