A few weeks ago on the MIA site, Robert Whitaker analyzed a recently-published review of studies of antipsychotic use. The review concluded that there’s not much evidence that antipsychotics help much in the short term. Since they’re so commonly used, you’d think that the evidence would be pretty strong backing up their use. You might also think that anyone reading that review who prescribes antipsychotics ought to start re-thinking what they do. We’ll see about that.
Whitaker’s article generated a variety of comments, including one from me, my first contribution to MIA. There were several responses to my comments, and I found these exchanges challenging and thoughtful.
I’ve practiced psychiatry for over 4 decades, mostly in outpatient settings, and I’m firmly convinced that scientific approaches to psychiatry (and medicine in general) are helpful and necessary. But science is far from being some revealed truth that should be worshipped, so we have to figure out where it belongs in mental health care. I’m also convinced that both psychiatrists and others have all kinds of misunderstandings and biases about what science says. That is one of the important obstacles to working in a collaborative way. My goal here is to shed some light on how psychiatrists try to use science. Some of that helps patients. Some of it doesn’t. I also want to say some things about what makes for good science. Good science wants to move us closer to truth, and understands that even being proven wrong is a step forward.
Full disclosure, I don’t consider myself a scientist in the usual sense, but I know a lot about what makes scientific findings more valid and useful. Oddly enough, some findings may be valid but not useful. People are complicated and nobody wants treatment that is dictated by science alone (the human connection is essential). Besides, that’s a very boring and unsatisfying way to practice psychiatry!
No doubt science is not the only way we know things. Some things we know using logic. Some things we intuit or just have a feeling about. Some things we’re taught and we accept them as knowledge. Some things we can know using our five senses. Some may come from religious training.
For some things, using a scientific approach is best. The big question is what are those things. Sherlock Holmes said that if you rule out all the other possibilities, then the one that’s left must be the truth. The hard part is how do you rule out those others, and can you be sure you’re not missing still others? All the other ways of knowing are more based on our individual experiences. Science tries to say—not always successfully—“let’s not make this personal and let’s try to agree on a way to narrow down our question”. If person A had a terrible experience with an antipsychotic, and person B had a wonderful one, what can we conclude? Only that antipsychotics can do good and bad things. It’s not much help to person C. The more experiences with antipsychotics we can collect, the stronger conclusions we can draw. So what’s the best way we know to collect that information?
The randomized, double-blind, placebo-controlled trial (RDBPCT) is the best way we know of to try to isolate one factor from the others. It’s not the only way, but other ways make it harder to draw valid conclusions. Back in the early 20th century, they were doing political polling by calling random people and asking them questions. Seems unbiased and fair, right? But back then, not everybody had a telephone at home, not everyone could afford them. So the “random sample” was biased—and not on purpose—to get opinions from people in better financial shape. What about other people? They were left out, so all you could say is that richer people tended to support candidate X. But that’s all you could say. You couldn’t say anything about the whole population.
Studies that aren’t randomized, or double-blind, or placebo-controlled can still shed light on things, but you have be even more cautious about drawing conclusions. Same applies to case studies, or other reports of individual experiences with psychiatric care.
Back to antipsychotics. I’m not going to re-analyze either the specific studies reviewed by Whitaker, or the original authors’ conclusions here. I am going to say a few things about what goes into doing a good study, and the importance of interpreting studies in an even-handed way. I’ll refer to Whitaker’s report at times here.
A study that compares 2 treatments, or a treatment with placebo should strive to compare apples to apples. This is harder than it seems. How similar or identical do the apples have to be? What differences can we assume don’t matter?
A designer of a RDBPCT says “let’s (1) find a group to study that are a similar as they can be, (2) divide them in half randomly, and (3) give each half either treatment or placebo, (4) be sure no one knows who got treatment or placebo, and then (5) measure to see if there’s a difference or not.” Seems simple enough, but let’s go through these factors a little.
If we want to study a population of people with schizophrenia or schizoaffective disorder ( like the study we’ve been referring to), we need to be sure the diagnosis is accurate, meaning that we trust someone to make the diagnosis, including not missing other diagnoses that might muddy the waters. The more people you have making diagnoses, the more the chance that errors are being made, that the diagnostic process may vary. (That’s even more of a concern with studies collecting data from different countries and cultures.) I know we have the DSM, but even that leaves room for interpretation. We can either trust the “apples’ designation fully, partly, or not at all.
And it’s not just collecting people with that diagnosis. It’s being as sure as you can that those people are similar in some other ways, because some of those other ways might affect how they do with treatment or placebo. Because we know that socioeconomic, medical and ethnic factors impact schizophrenia, we’d like to have all of these “apples’ similar in that way. Some factors we can think of might not matter; we probably don’t need an equal number of right- and left-handed people. And they don’t need to have the same religion, as far as we know so far.
Some people might be recruited for the study but decide not to participate. Might they be different in some important way from those who opt in? Could be.
Are the subjects for the study being paid? If you’re paid, perhaps you’re more likely to want to not only complete the study, but also to give answers that you think might make the researchers happy (even if you’re only guessing about that). We’ve known for a long time that research subjects are prone to this ( even if not purposely).
True randomization ought to be pretty neat and clean, but what if, once randomized, some people drop out of the study? This almost always happens to some degree, and it’s going to affect the results. Let’s say we study 100 people, 50 in each group. Suppose we find group A has better outcomes than group B, but half of group A dropped out and only 3 did in group B. That’ll need an explanation.
It may be the case that no one knows who got placebo or active drug, but we know that drugs often have side effects. Placebos can, too. How can we be sure that side effects don’t affect the outcome measures? If I’m getting side effects and I think that means I’m getting “the real thing,” I’m likely to let that affect my view of how I’m doing when the researchers ask me. Also, how do the researchers know if I’m really taking the treatment in the prescribed way?
And who decides what outcome measures to use? There are oodles of validated, standard rating scales for almost all kinds of psychiatric disorders, including schizophrenia. And measures to identify side effects, too. Both provide a way to collect information researchers hope will show the pros and cons of the treatment. But a rating scale might not capture what is meaningful to a patient with a given condition. It might, say, show that a person’s hallucinations are decreased, but maybe that doesn’t matter to that person as much as whether, say, they’re getting along better with their family. To the researcher, the person is better, but the patient, if asked, might say they see no difference. But that will go in the “benefited” column.
Oh, and who is paying for the study? A big pharmaceutical company? Are they putting their thumb on the scale in some way? Maybe we should say that any study funded by them is automatically one we should ignore. I wouldn’t say that so absolutely, but I do want to know that from the get-go. And we know that drug companies have been known to prevent publication of negative studies of their drugs; there are some ways around that, but it’s complicated and beyond the scope here.
Someone might read this and understandably conclude that doing RDBPCTs are so full of problems that even trying them is doomed. I know I can find flaws in just about any study I see. And I’ve not listed here every kind of flaw I can think of.
So here’s where I come down on this. What follows applies to other studies that are not RDBPCTs. I think it applies also to other medical and psychotherapy studies.
We—all of us—in every part of our lives—have to decide who’s trustworthy and who’s not. Some of us are trustworthy about some things, but not so much about others. The more someone (or some part of society, like psychiatric care) gives you reasons not to trust them, the more you either have to erase them from your life or take some time with that person (or that psychiatric study) to decide if you can trust them in that instance. If you like your psychiatrist, but s/he doesn’t return your call in a timely way, you can get a new one, or decide that the benefits of that person outweighs this flaw. And so it is with research. If finding a flaw is only about a “gotcha” moment, take a step back.
Very few people are really skilled in making sense of published psychiatric research. It’s probably an open secret that that applies to most psychiatrists (therapists, too). Few would admit it, but I believe the vast majority of us read relatively few studies from beginning to end. And all of those statistics will make most eyes glaze over. Most will either read the introduction and the conclusion to get the gist of it, trusting that the study didn’t have huge flaws. Most will trust the editors of the journal to have done that work for them. If I’m familiar with one or more of the researchers, or the place where the study was done, that’ll affect how much faith I have in the study.
But what about non-psychiatrists who are trying to make sense of RDBPCTs and other research? A few things to think about:
(1) Never rely on the title of the article alone. This also applies to headlines in social media, TV reports, and any other shorthand story. They’re too often after your attention, not about educating you.
(2) Think about how much you trust the source of the information about the study. Your psychiatrist, or therapist, or family doctor may—or may not—be a reliable interpreter of some seemingly important research. If you read Whitaker’s analysis, how much did you trust him? How much did he trust the article he analyzed?
(3) I said earlier that every study has flaws. Don’t let that be an automatic disqualifier of its findings. Many important and patient-helpful studies have flaws, and if we just ignored them because of that, there’d be more suffering than there is now. Ditto for a Pharma-sponsored study. We all have our own flaws, and we’d not take it well if our own work or words were discounted because of that.
(4) Some people, based on their experiences, have some powerful criticisms of psychiatry, and some are cynical, too. Fair enough, and so to think that that might make someone more likely to see (and perhaps magnify) flaws in research shouldn’t be a shocker. We are all prone to see what we want to see and not see what goes against what we already believe. Just human nature.
(6) It’s not often noted, but almost every study I’ve ever read has a section in which the authors discuss (a) what they already know to be some of the flaws in the study (b) how those flaws limit the strength of the conclusions they draw and (c) that their study is not definitive and how it should stimulate more studies. I can’t think of another line of work where the workers routinely include some self-criticism and humility about what they’ve done. I think that’s praiseworthy, and you won’t hear about that on TV or in social media posts about these studies.
(7) It’s pretty hard to do good scientific research. Imperfect but good research has gone a long way, in my view, to make things better for many people. I wish it were even more helpful, but I think that reflects, mostly, how hard it is to understand humans and the tedious detail involved in doing any good work. And I’m not so naive as to think that research can’t be misused, or that some make a lot of money doing it. They don’t have to be saints, but then again, thankfully, neither do you or I.
My bottom line echoes what you might remember Ronald Reagan saying in a very different context: “Trust, but verify.” I presume a researcher or research team is motivated more by trying to do good than to do evil until I have evidence—more than a gut feeling or a general distrust—otherwise. I expect to find flaws, and then I need to discern if the flaws are minor or worse.
Usually, what I want to know in these studies are these: (1) how close to apples vs apples did they get? (2) are the outcome measures meaningful and did they look at function, not just symptoms? (3) how bad were the downsides of the treatment? (4) were there a lot of dropouts—and why? (5) was the study done for a long-enough time? Depending on the study, I probably will wonder about other things, especially whether it should change something about how I work with patients.
The most important thing to know about a study is where the funding came from. Good research is expensive – getting enough people, making quality controls, following up.
One research paper I remember coming from the tradition of the replication crisis is that the biggest correlation to the result of a paper is who funded it. Sometimes this is covert – if a therapist runs their own study on their proprietary technique, that’s a funding bias too. And big pharmaceuticals currently don’t have an obligation to published failed trials, so they could run 20 and only publish the 2 whose results benefited them.
As you said, it’s a murky field. I have a math degree and my mind still goes muddy at messy statistics. I think in the future we need to build more trust in science, which means removing as much bias as possible. I hope RFK Jr and Dr Bhattacharya move in this direction at least.
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Hi Richard Moldawsky… Your article seems to be about “not offending anyone, not hurting anyone.” I understand what you mean. Your article is very well written. Thanks.But you seem to be ‘undecided’ about the ‘harms’ and ‘not being prescribed to anyone’ of psychiatric medications.
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My call to all psychiatrists is here: Stop prescribing toxic psychiatric medications that are ineffective in treating mental illnesses and are extremely dangerous and lethal to both brain and physical health. Even famous psychiatrists, doctors and/or journalists such as Robert Whitaker, Joanna Mouncref, Peter Gozche, who have revealed the harmful effects and lethality of psychiatric drugs, can say that “some psychiatric drugs may be beneficial for some people” (even though they know that psychiatric drugs are lethal).
This is actually an illogical theory. On the one hand, you’re going to expose the harmful effects of psychiatric medications… and on the other, you’re going to say, “They might be beneficial for some people.”
I now understand perfectly well why mainstream psychopathic psychiatry has survived until now and continues to poison and kill people. If you expose the harms of something… if you claim that it is beneficial for some people… then no one will believe you. This approach is the biggest trump card in the hands of mainstream psychopath psychiatry.
There is something I learned. So. One thing I’ve learned: Prof. Dr. Peter Breggin, the world-renowned psychiatrist who has been given the title “the conscience of psychiatry,” never prescribed psychiatric drugs to his patients again after exposing the horrific harms of psychiatric drugs.
This is the definition of an “HONEST PSYCHIATRIST.” Peter Breggin was a psychiatrist who was well aware of the deadly harms of psychiatric medications and who served as an expert witness in court for years. No one knows the current state of health of Peter Breggin, now in his 90s.
If you’re looking for an “honest psychiatrist,” you can find Peter Breggin and others like him who don’t prescribe psychiatric medications to their patients. No psychiatrist who prescribes psychiatric medication is an honest psychiatrist. They can whine and sweet-talk all they want, but the outcome remains the same.
1) None of the psychiatric medications can or do cure mental illness. And it doesn’t cure anyway.
2) All psychiatric medications produce effects similar to those produced by illegal street drugs. They numb the brain.
All psychiatric drugs do is numb ‘healthy brains’. They then (usually after long-term use over months and/or years) inflict damage (chemically induced brain damage) on the healthy brains that have been ‘numbed’.
Every psychiatrist knows how psychiatric medications work. They work by numbing healthy brains. This numbness causes individuals to calm down. This calming process then translates into the lie that psychiatric medications treat mental illnesses and are beneficial for some patients.
This is a massive (huge) deception. Because of this massive deception, people’s healthy brains are being deliberately damaged (chemically induced brain damage). The claim that “some psychiatric medications are beneficial for some people” is a deception. This deception is something mainstream psychopath psychiatry enjoys. It suits their interests. Because… they prescribe toxic psychiatric medications to their patients in large quantities. And to be able to inflict damage (chemically induced brain damage) on their healthy brains… that would be another step forward.
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All psychiatric medications are LEGAL DRUGS. They are ‘pillified’ versions of illegal street drugs like marijuana, heroin, and cocaine. They are sold LEGALLY in pharmacies. Indeed, just as we combat illegal street drugs, we must also combat psychiatric medications, which are “legal drugs.”
‘Psychiatric medications are more dangerous than illegal street drugs.’
Because they easily enter every home. It can be purchased from pharmacies with a psychiatrist’s and/or doctor’s prescription. And people are being poisoned by these toxic psychiatric medications. Both mentally and physically.
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The best (or worst) thing psychiatric medications do is… damage (chemically induced brain damage) to people’s healthy brains. Not to mention the various fatal diseases and deaths.
A) Probably… EVERY DAY, hundreds of millions of people around the world… are subjected to chemically induced brain damage (chemical lobotomies) from psychiatric medications.
B) And probably… Of these hundreds of millions of people —at least more than 1 million— EVERY YEAR get caught permanent chemically induced brain damage from psychiatric drugs.
It’s also important to know this fact. Probably… Today, there are individuals with intellectual disabilities who must spend the rest of their lives in mental health facilities such as mental hospitals, psychiatric hospitals, nursing homes, retirement homes, and rehabilitation centers. It’s important to know that psychiatric medications may be what enabled the vast majority of these individuals to undergo chemical lobotomies.
And also in the psychiatric outpatient clinics and wards of state and university hospitals… and in community mental health centers… subjecting people to ‘chemical lobotomies’ with psychiatric drugs continues apace.
Do you know how terrifying this situation actually is? We can safely say that psychiatric medications are/could be the reason why most, if not all, of these people are in this situation (causing them to suffer permanent chemical-induced brain damage).
And because psychiatric drugs are still widely used… it’s not difficult to predict who will be affected by the chemically induced permanent brain damage (chemical lobotomy) caused by psychiatric drugs.
Today, anyone taking psychiatric drugs… is a to catched candidate for the chemically induced permanent brain damage (chemical lobotomy) caused by psychiatric drugs tomorrow (usually in the long term). It’s only a matter of time before they get a chemical lobotomy.
And it will be inevitable for them to end up like the millions of other innocent mentally disabled individuals who end up in mental hospitals, psychiatric hospitals, nursing homes, retirement homes and rehabilitation centers.
And those responsible for this are the mainstream psychopath psychiatry gang. And so are the psychiatrists who prescribe psychiatric drugs. Furthermore, those who remain silent about these issues will be doctors (the mainstream medical community), governments, states, mainstream media, politicians, and society itself.
As a final word, Psychiatry is an industry, not a medical field. It is a money-making industry. The harm it inflicts on humanity is countless. Psychiatry should be prosecuted for the harm and genocide it has inflicted on humanity. Psychiatry should be removed from medical schools…
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Richard Moldawsky, thank you for your article. It contains information that will be helpful in my own work. I will try to evaluate it. Thanks again. Best regards.
With my best wishes. 🙂 Y.E. (Researcher Blog Writer (Blogger))
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No offense, Richard, but psychiatry is an iatrogenic illness creation Ponzi scheme. The ADHD drugs and antidepressants can create the “bipolar” and “schizophrenia” symptoms. And the antipsychotics can create “psychosis,” via anticholinergic toxidrome, and the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.
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Reading this blog lulled me into an almost drug-like sense of feeling “What’s all the fuss about? Everything seems just fine in the land of psychiatry…”.
But then I woke up and realized that the author’s seemingly impartial, sing-song approach is probably the way most psychiatrists soothe themselves from having to repeatedly pretend to know more than they actually do.
And if I were he, I would allow myself to entertain the possibility that maybe my own “patients” are the most reliable research subjects of all.
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Clarification: The author’s seemingly impartial, sing-songy approach is probably the way most psychiatrists lull themselves into believing they know more than they actually do.
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“Good science wants to move us closer to truth, and understands that even being proven wrong is a step forward.”
So the so called “mental health professionals,” whose DSM “bible” was debunked as “invalid” in 2013, need to garner insight into reality.
“No doubt science is not the only way we know things. Some things we know using logic. Some things we intuit or just have a feeling about. Some things we’re taught and we accept them as knowledge. Some things we can know using our five senses. Some may come from religious training.”
So the Holy Spiritual blasphemers of the “mental health industries” may want to repent, and change from their “unforgivable” ways?
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I think the author of this blog needs to face the fact that psychiatry is glorified drug pushing—no matter how many research papers he reads.
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In my opinion the really crucial thing is to respect patients’ autonomy, to treat everyone as a unique individual and not to be pessimistic.
I was diagnosed with paranoid schizophrenia in 2012. I decided to come off the prescribed neuroleptic (against psychiatrists’ advice) because I saw absolutely no point in “maintenance treatment” (my psychotic symptoms had disappeared) and the side effects were horrible in my case. Since that time I have never had a relapse. I am happy and able to work at a job which requires a high level of knowledge and skills (my employers have no idea about my diagnosis).
I am sure that I did the right thing when I decided to come off my neuroleptic. Psychiatrists who wanted me to keep taking it did not think about the impact of the neuroleptic on my life, brain and health. They also wrongly assumed that every patient had the same priority – to minimize the risk of a relapse (though there are even people on neuroleptic injections who have relapses) and to hide any possible sign of being different from “normal” people.
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What you say Dr is very reasonable. It makes me ask—how do you said justify treatment without consent?
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Thank you for bringing up the all-important question of consent. Or more specifically, access to INFORMED CONSENT for the people who really matter.
You’ve brilliantly highlighted the way so many supposedly rational people misuse their power of reason.
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Birdsong, I am not sure if you were replying to my comment, but I totally agree with you: informed consent is crucially important! And in my opinion NO ONE (even people who have committed crimes) should be forcibly drugged.
There is absolutely no moral justification for forcing people who have not done anything wrong and who are not violent to be on neuroleptics. Most people don’t realize what effects these drugs have (and some people are particularly negatively affected by them).
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Joanna, I agree. Drugging someone against their will who isn’t violent is very wrong, especially for extended periods of time.
It’s also very wrong how often most doctors are ignorant of the serious side effects common to neuroleptics, something that unfortunately makes their version of informed consent a sick joke most of the time.
Most of the time the use of neuroleptics is unjustified.
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Yes, Birdsong – doctors should actually use these drugs themselves to see their effect. One psychologist in my country has done it and realized how neuroleptics are impacting patients. It’s a pity that there are very few people like him!
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It’s disturbing the way so many psych professionals seem to automatically tune out people who complain about the distressing ways neuroleptics affect them.
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CORRECTION:
You’ve brilliantly highlighted the way so many supposedly rational psychiatrists misuse their reasoning powers, most likely stamped out of them early in their psychiatric residency program by their most likely pharmaceutically-groomed higher-ups who not only “teach” them the ins and outs of “biological” psychiatry, but pretty much control the fates of their so-called “careers”, a process that leaves most trainees with an intractable amount of obsequiousness to what they’re led to believe is actualscience.
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Clarification:
“… a process that leaves most trainees with an intractable amount of obsequiousness to what they’re led to believe is “actual science.”
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As a non medical scientist let me make a few suggestions that may help you.
1. The premise that you are dealing with a medical issue aligns with your position as a medical professional. May I suggest that you start with a more general goal of finding ways to improve your patients. While it is true that patients may lack insight, it is also true that a patient who is recovering has an insight into the factors which are helping this recovery. Doctors used to treat scurvy with citrus fruits as they knew it helped patients although at the time the doctors knew nothing of vitamins. So knowing what helps patients and using it not only helps treatment but also gives you an indicator of underlying causes. By looking at common factors in numerous recoveries you can avoid subjective bias.
2. It has been long speculated that alienation is a factor in mental illness but with no agreement in the source of this alienation. My own personal experience and my experience helping others revealed to me that the source of the alienation is not important as you are dealing with a feeling and not a neurosis. 70% recovery is possible by providing a safe space and an inclusive relationship. A supportive non judgemental relationship reduces feelings of alienation and reverses the patients reaction to this. Further focusing on the source of the alienation risks increasing this feeling as you are serving your Ego needs and not the needs of the patient.
https://psychrights.org/research/digest/effective/APAMonV31No2.htm.
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Thanks, Eric.
I, in spite of being a medical professional, do not believe that all patients I see have ” medical issues.” I agree that the goal is to be helpful, which means I don’t presume that a problem is medical. More important is how the patient views the problem; that is the starting point, and I routinely ask – on day one – how the person thinks about whatever’s going on. S/he could tell me it’s a chemical imbalance; that’s the starting point – not the end – of the conversation. S/he could tell me the problem is a bad boss; again, that’s the starting point. My style is that it’s a longer conversation before we even consider meds ( if we ever do).
2.I agree that many feel alienated. Again, that’s a starting point. Alienated from what? for how long? what does the person mean by that word? Part of creating the safe space is taking the time to be sure I understand the patient’s language as best I can – and that the patient knows I’m trying to do that before jumping to some quick fix.
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Richard thenk you for taking the time to respond and I am glad we agree on the importance of helping.
A wise man once said “the more severe the mental disorder the lighter the touch”. A person diagnosed as Schizophrenic will greatly benefit from a supportive helpful inclusive relationship, which has the potential to reverse feelings of alienation, while intrusive probing of his past has the potential of making him worse.
If you are interested in research into why people recover from regressive psychosis I have experience you might find useful.
Contact me at [email protected]
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Eric, supportive, helpful and inclusive relationships are crucially important, but it can be very difficult to form such relationships. Not everyone diagnosed with schizophrenia has access e.g. to a peer support organization. Not everyone makes friends easily. And poverty often makes it difficult to socialize.
Moreover, people may get trapped in abusive situations precisely because they are isolated and desperate to have a supportive relationship in their life.
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Joanna, I totally agree with all that you said. I had a brief regressive psychotic experience in 1978 and was fortunate to be treated with a brief course of anti-anxiety medications and also escaped the Schizophrenic label. Unfortunately my history was discovered, greatly exaggerated and spread among friends and family. It took me 40 years to completely discredit the rumors and begin to make meaningful relationships. However since the original article was about Psychiatric research my point is that why patients recover is a neglected area of research. Courtney Harding and others have published papers in this area and these have resulted in the recover movement. I personally have focused on this for forty years and along with my own experiences have developed an Existential understanding of what is commonly referred to as Schizophrenia which fits the recovery evidence. It might not fit everyone but by focusing on successful recoveries it holds a lot more promise than chemical straight jackets.
Congratulations on overcoming your trauma and escaping psychiatric/pharmaceutical complex. I wish you all the best in the future.
https://www.madintheuk.com/2024/08/rethinking-schizophrenia/
[email protected]
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Eric, thank you so much for your reply to my comment, for your heart-warming words and for sharing your own experiences.
I am very sorry to hear that some people decided to use your story to vilify you and damage your reputation. Great to know that you have been able to overcome this experience which must have been very painful.
Fortunately very few people know about my psychotic experience, but I sometimes suspect that it negatively impacts the attitude of some of my relatives towards me. I have also learnt not to share my story with other people, even when I see them as close friends.
Psychosis still tends to be perceived in a negative way and as a sign of lifelong mental illness, unless a person is obviously successful and popular. This is very sad because this means that many people – like me – are literally afraid of sharing their stories in public (I am not using my real surname on this website). People “with lived experience” are encouraged to share their stories at a mental health conference in my country, but the organizers clearly don’t take into account the danger of stigma.
I totally agree with you that there is not enough research on patients’ recovery – and especially on recovery without the “chemical straitjackets”, as you aptly called them.
I am going to read your article and I, too, wish you all the best in the future!
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This blog is a beautiful example of the way most medical doctors rationalize the irrational—the irrational being their urgent need to uncritically believe in psychiatry’s pharmaceutical propaganda, an ailment seemingly common to most psychiatrists, only understandable once you realize it’s a carefully crafted form of self-preservation.
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Dr. Moldawsky finds solace in his field – and enough ambiguity – in the well known vagaries of carrying out minimally biased, unconflicted scientific research and laments the public’s naivete regarding understanding such research. As a practicing psychiatrist, he also represents acceptance of individual rights being involuntarily relinquished, as well as the right to be so personally empowered. However, irrespective of science’s general, eternal and difficult struggle toward truth (which we must certainly applaud), biological psychiatry’s pharmacopeia’s scientific evidence is of the weakest, most ignorable kind, is only autocratically integrated with patient care, and the research outcome for which isn’t remotely productive of patient cure/wellness. The legitimacy/necessity of biological psychiatry, which glorifies (essentially the control of) human “behavior” – at the expense of human subjectivity – remains unchallenged bedrock for Dr. Moldawsky, though his guild has no redeeming therapeutic (much less scientific or even philosophic) understanding of either the word “mental” or “illness”, much less ‘mental illness’. Surely, throughout human history, we humans have persisted struggling (and suffering) meeting life’s challenges through the values of mutual care, compassion, and love – notwithstanding, and even acknowledging through shared sympathy, the profound mystery of our existence about which science hardly scratches the surface. True honesty, including scientific, will recognize biological psychiatry, and the system it tyrannizes with it’s ‘mental illness’ plague, irrespective of undoubted good intentions of any given practitioner, is an invalid, unscientific mythological – though undoubtedly profitable – substitute for such human values, and needs to exit the field of our (very subjective) lives. We can do better.
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I think this article overlooks the most important point: psychiatric protocols and decisions are NOT made based on scientific results! Or to put it another way: there are certain very strong assumptions operating in the psychiatric worldview (the DSM categories are scientifically valid, “mental illnesses” as so described are biological in origin, reduction of “symptoms” as identified in the DSM is the most valid measure of “success,” etc.) and the research, even if it’s otherwise done in a clean and legitimate manner, is automatically biased by these assumptions and therefore leads to wrong conclusions. As an example, if “ADHD” is a “neurological disorder” in all cases, then stimulant “medication” can be shown to “reduce the symptoms” of this “disorder.” However, long-term studies have shown repeatedly that the “treatment” of such children with stimulants does not lead to substantial improvements in any long-term outcomes that most people would value (completion of school, enrollment in college, reduction in delinquency, higher self-esteem) despite the “symptoms” being “reduced” by the drug substantially. I’ll leave the reader to imagine and enumerate the many possible reasons why a child may be seeking attention and stimulation, but I think it’s fair to say in this case that “symptom reduction” serves primarily the needs of the institution (usually schools) who recommend it, and leaves the actual client in no better shape for being exposed to a fairly dangerous brain-altering substance for many years.
So by choosing to measure “symptom reduction” as the main outcome, research favors legitimizing the DSM categories and validating drug “effectiveness.” If different “outcomes” were chosen the results would vary dramatically. But these assumptions are not challenged by the article, and are rarely if ever challenged by mainstream researchers. Those who do challenge them are attacked or ostracized, as Whitaker was from Day One, despite the excellent scientific basis of his theses.
Oh, and there’s also the fact that legit research is intentionally ignored by the establishment. Hard to pretend you are being scientific when you dismiss inconvenient data in order to justify continuing your current practices. I will ask how many psychiatric drugs were said to have “minimal side effects” and “no dependency” only to be later shown to be addictive or cause Tardive Dyskinesia or otherwise do known damage that was denied.
I could go on, but I think y’all get the gist. There’s no point in doing “science” if you start with heterogeneous non-scientific groupings, limit your findings to the things you want to find, and deny the reality of research that doesn’t validate your reality. Psychiatry is the farthest thing from scientific, and no amount of double-blind studies can alter that fact.
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I would have to disagree with your approach, particularly your emphasis on randomised controlled trials. The success of treatment for psychological distress is very heavily influenced by the factor unique to the individual – E.g, nature of distress, personal preferences, personality style, life circumstances. RCTs are not very useful in this field, because they involve aggregation of statistics for analysis, and that aggregation erases those individual factors. Consequently, an RCT can say very little whether a treatment would be useful for an individual suffering some form of psychological distress, because it does not analyse the most important factors.
Additionally, I think theoretical problems are another serious issue. To research the treatment of psychological distress, it is critical to have useful theories of psychological distress, which can be measured with useful and valid construct.
I do not think the theoretical models that are currently used in this research are very good. There is a focus on monolithic “disorder” constructs, which are usually questionable and do not effectively model human experiences. The measures also have major issues with theoretical validity. As such, the outcomes of studies are not very useful. Finding a statistically significant reduction in a metric like the Beck depression inventory and concluding this means there has been an improvement in a “disease” called “depression”, does not say very much about actual people’s experiences.
My view is that high-quality qualitative research is needed to create theories of psychological distress that are more accurate and useful, before quantitative research can be productive. Also, I think that research methods that capture individual factors, such as case studies, are more useful for informing clinical practice. I think RCTs are only useful for validating and quantifying subjective drug effects, and are not appropriate for evaluating the effectiveness of treatment.
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Finally some signs of intelligent life.
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Jane, I really appreciate your comment. Yes, statistics don’t reflect factors unique to individuals when it comes to recovery. And I, too, value case studies much more than statistical research.
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Jane DRF –
thanks
I agree with you about some of the limitations of RCTs, which is why I said that science is not to be worshipped and that RCTs are one way to get information, not the only one.
I would add that it’s simply not the case that RCTs are only good for drug studies; there are some others the compare psychodynamic psychotherapy with cognitive psychotherapy for anxiety disorders, just as an example
I think we have to also say that individual factors, important as they are, help us with the person in front of us, but not so much with the next person who has a whole different set of personal situations and problems and strengths.
Personal anecdotes mean a lot, but how do we take person #1’s story and reliably use it for person #2? Maybe we can’t, other than to be reminded that #1 and #2 are different, and there’s not much else to guide us.
I’d be interested to know if you know of the kind of research you think ought to be done. If we all don’t have enough in common, we can’t be studied as a group of any kind.
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We can’t. As Milton Erickson said wisely, we need to reinvent therapy for every client! The idea that there is one “scientific way” to help people who are having emotional difficulties is actually a ridiculous concept! That’s why the DSM categories are a waste of time. What good is a “diagnosis” that tells you neither why the condition arises nor what can reliably be done to resolve it? It’s a farce!
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Steve, you’re talking as if we humans don’t have anything in common. Not sure if you mean that, but the implication of that might be that if a therapist is successful with patient A, it’s random that they’ll be able to help patient B. Ditto for the unsuccessful therapist. We do know that successful therapists have some things in common.
If we have to reinvent therapy for each patient ( and in a sense I agree), it makes me wonder how and who would teach people how to be therapists. I’d be daunted to be a therapy trainee and be told I have to come up with a brand new therapy for each new person. Wouldn’t you? I’d need at least a framework, so I’d be curious to know how you might teach that.
Just for the record, I am not – never have been – an apologist for DSM. I think it, like most things, can be useful if we also acknowledge its limitations.
This problem is not limited to psychiatric diagnoses; two people with diabetes can be in wildly different states of health or disability.
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Richard, you don’t have to reinvent anything. But you do have to know how to leave the preconceived notions psychiatry fills your head with at the door enough to really see and truly hear what the person in front of you is trying their best to say.
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I don’t mean that at all. Not sure where you are getting that. What I mean is that there is no FORMULA we can follow that will help everyone.
As to how we could teach people to be therapists, I agree that this is a difficult, almost impossible task. What the training would need to do is to teach the therapist how to recognize and set aside their own preconceived notions and biases and truly be there to hear what the client has to say. There are certainly situations where past experience helped me know what to do in a current circumstance, but absent the ability to truly connect with the client in their own space, any such experience is pretty much useless. This is why some folks have advanced training (Ph.D. or Masters) in counseling/psychology and are terrible therapists, whereas volunteers at the crisis line I worked at with backgrounds in engineering and/or computer science seemed to be extremely competent in helping out. It is to me an illusion that one can be trained in a particular “school of thought” and apply this thinking universally to all clients with any level of success. My experience is that starting with a “beginner’s mind” and knowing that we DON’T know what to do just yet is the key to success. But this requires a humility and a level of personal security that can’t be trained into someone. Maybe making sure therapists get good therapy before they start is the best chance of creating this. But of course, they’d have to have therapy with a person capable of doing all of the above or their “therapy” won’t make a difference.
It’s a conundrum. But it’s best we acknowledge the observable truth that training people to “do therapy” doesn’t really work very well.
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And under what circumstances do you see the DSM as being useful?
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Richard, take my word for it:
Insulting people with stigmatizing labels is useful only for people who like hearing the sound of their own voice utter medicalized gibberish.
P.S. Clinging to rigid assumptions builds invisible walls.
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CLARIFICATION:
Insulting others with stigmatizing labels is useful only for those who find uttering medicalized gibberish comforting.
P.S. Listening with an open mind is a much better way of making sense of what seems intolerable to oneself.
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I don’t think you can reliably apply what you learn from one person to another. But I think that by understanding the unique experiences of a large number of people, you can identify patterns and develop useful knowledge about people’s experiences of psychological distress, including an understanding of its variations and nuances. These, in turn, can be used to inform clinician’s efforts to help a person in psychological distress, by applying that knowledge to analyse their situation and gain a better understanding them and their needs. Obviously, that is a process that needs genuine understanding and curiosity – It will always be as much about the therapist’s interpersonal approach as it will about understanding any theory.
As for what research I would want done, it would mostly be qualitative psychological research.
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Thank you, Jane, you said it better than I could have. Experience leads to generalized knowledge that is useful, but there’s no one way to approach everyone that will ‘work,’ and “the therapist’s interpersonal approach” really is the key to success! And I also like the emphasis on “curiosity” – one can’t learn if one thinks s/he knows all about the area before s/he starts!
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I’ve never understood medical doctors’ distrust of anecdotal evidence.
Where on earth do these educated fools think their research data comes from?
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Richard, knowing the difference between cynicism and skepticism is a very useful skill to have when trying to make sense of just about anything.
P.S. Nothing’s more cynical than psychiatry’s DSM.
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I’m glad that my blog has stimulated a lot of comments. It’s tempting to respond to each of them, but an ongoing give-and-take with the commenters is tough to keep up with. I’m going to say a few things here by way of acknowledging what you’ve written; I might ( not promising) to make future ones, so please don’t read anything into what future comments I don’t respond to. I promise to read them all, however.
(1) There’s lots in psychiatry and the mental health field to be critical of, and I have been one of its critics when I’ve seen us fail. I’m not writing to defend it, but, as I see it, trashing the field has limited value.
(2) We all have our biases and blind spots. I know some of mine, but I’m sure not all. That’s true for all of you, too, I bet.
(3) My experience is that most in the field are neither evil nor dupes of Big Pharma, the APA, nor worshippers of the DSM. Maybe you know some who are evil or dupes, and I would join you in saying those people shouldn’t be practicing. I have known a few myself.
(4) The DSM is not a bible. It’s a partly helpful, partly unhelpful way to talk about patients. It’s more helpful with schizophrenia and bipolar and some anxiety conditions than it is with mood or personality disorders, or ADHD. That’s an incomplete list. We are stuck with it for billing purposes until something better comes along. It’s a big moneymaker for APA, which troubles me, and it’s part of why I’ve not been an APA member for over 40 years.
(5) It’s a cliche to say that we are a polarized society in many ways, and I guess one of them includes how we all think about mental health care. Good vs evil, freedom vs totalitarianism, clear-eyed vs naive: I think it’s unhelpful to frame things so simplistically. I know that trying to stake out some common ground, disagreements included, can appear unprincipled or chickening out. I just don’t buy that.
(6) I’d be interested to know if there are things you’d like to have me write about in the future. Please understand that I’m wanting to bring some perspectives to the table that don’t already have voice on MIA. Not promising to respond to any of your suggestions, but I value my audience. Thanks.
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I would like to hear more specifically how you see the DSM being helpful in such situations. I acknowledge that folks acting within the insurance system need to use the codes to get paid, but for my money, that’s about what they are good for. “Diagnoses” never entered into any therapy I engaged in except to tell them I was billing the insurance company or to explain to them what someone else had labeled them so they’d understand the descriptive and subjective nature of the labels.
I’d also love to hear a response to my answer to your question about how to train therapists. Jane also made a fantastic reply which said what I meant even better, and I think it is deserving of a reply, even if it’s “Well, I don’t know how to do that.”
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If I tell a colleague who also treats the same person (like a therapist or a PCP), using DSM provides some ( not complete, don’t go there!) common ground to begin a collaborative discussion. As I said, for some diagnoses, it’s more helpful, and for others, I don’t bother and use other language.
As for training new treaters, you have to define the scope of what your program trains treaters to treat. If you opt not to call them illnesses, fair enough, but you have to somehow be able to say “we’re training people to help with problems like X or Y or Z,” using non-illness language. One could say “problems in living” a la Szasz, which is reasonable. In the world as it is, it would be a challenge to find people or institutions to fund it, don’t you think? Even most current psychology. or social work training programs can’t escape some form of DSM-type targets of treatment.
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The fact that “the system” uses DSM codes for billing is no excuse for giving them more validity than they merit. You’re saying we shouldn’t train people to do quality therapy because the system won’t pay for it???? Isn’t that a pretty damned good reason for scrapping the current system and starting over? You’re sunk in the trap of thinking of “mental illnesses” as medical problems. For the most part, they are not. When they are, the DSM system actually discourages looking for the REAL biological reasons by providing a pseudo-biological “treatment” for a pseudo-biological “disease” which they have no understanding of how to cure or often even treat! But we can’t get funding for actual effective treatment? Something is pretty rotten in Denmark, Richard. I don’t think you’re really facing what we’re up against here. The fact that we’ve all been brainwashed into DSM-style thinking and are forced to employ it to get paid by insurance companies is CENTRAL to why the numbers of “mentally ill” are rising despite (or because of?) the increase in “treatment” rates. It’s like the Sufi parable about the guy who lost his key in the house but is looking outside because the light is better there. We won’t find any answers until we stop pretending we have them, and we won’t improve the situation until actual successful interventions are funded with the money retrieved from the current massive waste of billions on stuff that simply isn’t effective!
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Gee, Steve, I thought you were asking me a reasonable question when you wrote “I’d also love to hear a response to my answer to your question about how to train therapists.” I gave you what I thought was a reasonable answer, but you flew right past that, as if I were some staunch defender of DSM and the current establishment. After our exchanges, you ought to know that just lumping me in with those you oppose is both unfair and guilt-by-association. From my standpoint, it seems you really didn’t want to hear what I said, but wanted another chance to make your own points. This is exactly – exactly – the kind of thing that we both ( yes both of us) deplore when it happens between those who are seeking help and those who profess to want to provide it, that someone has “THE ANSWER” and the other person just needs to acknowledge it.
Black-and-white thinking is a trap and a danger, as I’m confident you well know.
What makes it so hard to say “I don’t fully agree, but you have a point.”? You asked me a fair question, I gave you an answer, and if you re-read it, I bet you’ll say to yourself the solution is not as simple as erasing DSM and having no clear plan to replace it with something better.
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Your answer sounded like you were saying what I proposed was impossible. I think you’re over interpreting – what I was saying was, your suggesting that this would be DIFFICULT TO FUND was essentially giving in to the idea that the current paradigm is unassailable, not that you were defending it. Sorry if it came across that way. My point is that we should FUND WHAT WORKS and stop PAYING for things that don’t work or make things worse. I hope you would agree with me there!
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Richard, many thanks for your comment. You say that the DSM is helpful with some diagnoses like schizophrenia. In my opinion the current DSM definition of this disease is much too arbitrary. I had severe psychotic symptoms (hallucinations and delusions) for about a month many years ago (in 2012), but I seem to have fully recovered since that time. In any case I have never had a relapse and I am able to live independently and work, though I have not been using any psychiatric medications for many years.
Let me add that at the beginning of my psychotic episode I was using a medication which might cause hallucinations and a psychotic disorder (Malarone), but psychiatrists who diagnosed me did not take this into account.
In my opinion there are at least four possibilities: (1) I was misdiagnosed (and this is what one psychiatrist told me many years later); (2) I did have schizophrenia, but I recovered; (3) I have not recovered, but my symptoms don’t significantly impact my functioning; (4) “schizophrenia” is a highly questionable concept.
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Richard, you’ve asked for suggestions.
But what about the suggestion I’ve already offered, which is knowing the difference between cynicism and skepticism?
Why am I repeating my suggestion? Well, in my view, anyone who dismisses serious doubts and criticisms of psychiatry as “simplistic” or “trashing psychiatry” has yet to learn the difference between cynicism and skepticism—which, by extension, means they have a great deal to learn about the problems inherent in psychiatry itself.
In any event, it’s also my view that the last thing the world needs is yet another psychiatric apologist. And perhaps that’s why psychiatry essentially stays the same.
So, what DOES the world need? Information that lets people know that there are MANY VIABLE ALTERNATIVES to establishment psychiatry: somatic work such electro-acupuncture, yoga walking, spending time in nature, avoiding caffeine and alcohol, journaling, discovering spirituality, confiding in friends or family or finding online support groups.
P.S. Psychiatry no longer controls of the narrative, something people are slowly realizing that, for the most part, is to the good of mankind.
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Hi Birdsong –
here’s what you wrote earlier–
“Richard, knowing the difference between cynicism and skepticism is a very useful skill to have when trying to make sense of just about anything.”
Now you’ve said that that was a kind of suggestion – I didn’t read it that way and it wasn’t written as one. I agree that there’s a difference and I’m reasonably sure that I know the difference as you clearly do.
I agree that there are many viable alternatives to establishment psychiatry. If one size fit all, there’d be just one thing everyone should do.
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Richard, how does that justify:
1) The gross over prescription of psychiatric drugs?
2) The large number of people now suffering life-altering side effects and/or protracted withdrawal?
3) That the majority of psychiatrists or general practitioners do not provide adequate informed consent about the possibility of potentially life-altering side effects or protracted withdrawal?
4) That the majority of psychiatrists and general practitioners neglect mention the many no-drug alternatives?
These are the harsh realities too many people are wrongfully forced to face because of psychiatry’s neglect despite what you seem to think are its benign intentions.
P.S. It might do you some good to consider this:
If psychiatry weren’t causing so much undue misery there’d be no need for MIA.
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Richard, I find it telling that you haven’t addressed any of the four questions I posed. Could that be because you don’t know what to say—except to criticize the critics?
I also suggest that in the future you refrain from using deflective terms such as “black or white thinking”, “simplistic” or “trashing psychiatry” to characterize critiques as these terms aren’t neutral; they function rhetorically to subtly discredit critics of psychiatry by framing them as irrational or extreme.
One of the most effective therapeutic skills is to recognize that what may seem irrational or extreme to you as clinician may, in fact, reflect the truth for millions of people whose experience with psychiatry reflects the lived reality of psychiatry—one many, if not most, psychiatrists are unwillingly to face.
I invite you to revisit the questions I asked and respond to them directly. That would be a more constructive and respectful way to engage with those whose experiences challenge the status quo.
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I’m not here to defend psychiatry, so please don’t put me in that position.
There’s not a single thing you’ve written that suggests to me anything other than a contempt for the field, and I would not presume to try to offer you an alternative idea until or unless you displayed the slightest evidence of a view that differs from yours in the slightest.
Not all exchanges are productive, and I have no wish to persuade you that there might beg other ways to think about these issues.
I respect your views and assume they are based on what must have been horrible experiences. I don’t expect this to be any consolation, but I don’t believe they are universal.
It’s your right to respond to this, but please be aware that I don’t intend to respond again in this chain. If you re-read all the things you’ve written to me and imagine they were written to you by someone else, that might help you see what I mean.
I wish you well.
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Richard, psychiatry deserves all the contempt it receives.
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Problems inherent in psychiatry:
1) Operates from a biological framework that has yet to be proven biologically despite billions of dollars over many decades.
2) Condones the use of stigmatizing labels that harm more than help because they have no biological validity.
3) Prescribes addictive substances claiming these “correct chemical imbalances”.
4) Seeks to protect its own guild more than the people it claims to serve.
Seems like psychiatry already has all the ingredients to epistemically gaslight the uninformed.
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I would add 5) Diverts attention from significant social issues and interpersonal issues that can and should be addressed if we really care about “mental health,” whatever that means.
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Agree 100%. The systemic denial of social-emotional reality is what psychiatry does best.
It’s psychiatry’s own brand of lunacy.
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“Some people, based on their experiences, have some powerful criticisms of psychiatry, and some are cynical, too.”
Conflating realism with cynicism is psychiatry’s own brand of lunacy.
It’s refusal to let go of its own cynical attitude towards those who disagree with it reveals its defensiveness more than any commitment to truth.
P.S. Any cynicism towards psychiatry is psychiatry’s own fault.
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Psychiatry as an industry has proven quite cynical!
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That’s because the very nature of psychiatry is cynical—a reality many more people are finally discovering with each passing day.
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It is very cynical to claim “knowledge” you don’t have just so you can sell services or drugs, and to attack those who point out reality as somehow “insane” for not going along with your propaganda.
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Propaganda works wonders for psychiatrists who don’t like admitting there’s little justification for the majority of its so-called “medications”.
This being the case, it’s highly irresponsible and deeply unethical to prescribe substances that are known to not only cause life-altering side effects but are also highly addictive when numerous non-drug alternatives exist.
But propaganda works wonders for psychiatrists who already know the answer to the following question: “What is psychiatry without its drugs?”
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They made a choice back in 1980 to go down the medical pathway. It has not worked out, but now they are so financially and professionally overcommitted (sorry, bad pun!) that they can’t afford to back away from their belief system, no matter what evidence contradicts it. The financial incentives are all on their side, and they’ll continue to pass off this DSM/biological BS as long as it pays well. THAT is cynical, I suppose. But it seems to be the truth!
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Cynicism gets a bad rap. But if critics of psychiatry are labeled cynical for questioning the DSM or the medicalization emotional distress, then what do we call a system that pathologizes normal reactions to adversity, pushes drugs with known harms, and deflects accountability with vague promises of “future research”?
The truth is psychiatry has long operated with its own kind of institutional cynicism—one that prioritizes billing codes over healing, compliance over autonomy, and symptom suppression over understanding.
Needless to say, there are times when cynicism makes all the sense in the world.
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“Made You Worse”, latest short video from Dr Josef @taperclinic
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Richard, how do you make sense of a world full of people needlessly prescribed cocktails of psychoactive drugs for years on end when there are no definitive biological tests to prove their necessity?
No need to answer if your explanation is as evasive as your blog.
P.S. Being evasive may be comforting, but it makes no sense when people’s lives are on the line.
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“How similar or identical do the apples have to be?”
All studies have Inclusion/Exclusion criteria that must be met.
“Are the subjects for the study being paid?”
The FDA frowns on paying subjects so it isn’t done much.
We did a study on people who twisted their ankle and had to return to the Immediate Care 1 week later. But if the ankle is better people won’t come back, so the study paid them $50 if they came back. Other studies gave people who didn’t have transportation bus vouchers.
“but half of group A dropped out and only 3 did in group B. That’ll need an explanation.”
If you loose patients because of serious side effects, it has to be reported to the IRB and if they think it is unsafe they won’t allow the study to continue. All investigators are also notified of serious side effects. However, if you loose patients for silly reasons then you and your study coordinator didn’t do a good job selecting patients and they may not offer you more studies.
“Also, how do the researchers know if I’m really taking the treatment in the prescribed way?”
Patients are told to bring the bottles back at every visit and you count the pills and record it. They are usually given diaries to record any side effects and missed pills. The study sponsor hires a company that monitors paperwork and pill counts.
“It’s not often noted, but almost every study I’ve ever read has a section in which the authors discuss (a) what they already know to be some of the flaws in the study ”
Those aren’t flaws, they’re limitations. Excuses as to why they didn’t do better. It’s like saying we would have done better if we had more patients or the study was longer than 6 weeks.
“have to decide who’s trustworthy and who’s not.”
You’re right. I wouldn’t trust a guide on making sense of research written by someone who admits to reading few studies from beginning to end.
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thanks for these constructive comments
Just about any study, even an excellent one, will have flaws and/or limitations. The challenge for me is to what extent those feature still allow me to make good use of the findings. Neither patients nor providers should feel like a study has to be squeaky clean to be helpful.
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Every study has limitations. Honestly acknowledging them is good science.
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Richard, you say you’re not here to defend psychiatry, but that’s exactly what your blog attempts to do.
Emphasizing the complexity and limitations of randomized controlled trials may sound balanced, but it’s also a convenient way to distract from the impossible-to-deny reality that psychiatric drugs have in many instances caused more harm than good—harm that too few psychiatrists are willing to acknowledge, either to themselves or to their “patients”.
Being even-handed sounds great, but why should anyone trust research trials on psychiatric drugs when the majority are financed by pharmaceutical companies and/or reviewed by psychiatrists with ties those same companies—especially when psychiatry also has a long history of diagnostic overreach?
So please tell us all:
Which part of this sorry situation spells “good science” to you???
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