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The US Food and Drug Administration has announced that there will soon be a public meeting to explore providing drug companies with greater flexibility in promoting off-label indications to doctors. When it comes to prescribing medications to children, and particularly psychiatric medications, this is a bad idea. I write both as a former consultant to the pharmaceutical industry, and as a father who lost a son to the toxic effects of antipsychotics prescribed off-label.

On August 4, 2015, Senator Bill Cassidy, M. D. (R-LA), on behalf of himself and Senator Chris Murphy (D-CT), announced the Mental Health Reform Act of 2015 (S. 1945). The Cassidy bill has now been referred to the Senate, read twice and referred to the Committee on Health, Education, Labor, and Pensions. According to the Library of Congress, S. 1945’s purpose is “to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes.”

I often hear some of these metaphors used about humanity today: Our combined ability to think and act are paralyzed, we the public seem suicidal, we are addicted to oil and consumerism, we are blind to alternatives, we are deaf to the cries of the poor and planet, we hallucinate, such as believing that money and technology are more important than our values. Sure sounds like a disability to me. So maybe the social change movement led by people considered disabled have something to offer now?

What do we owe to shock survivors when they die? We owe them what we owe everyone who underwent an atrocity that is ongoing, that is being visited on others daily—doing something about that atrocity. Given that shock is anything but a legitimate medical procedure, it is minimally a moment to renew our commitment and our pledge to both bring an end to this treatment and to build a world where brain-damaging people in the name of help would be unthinkable.

Psychiatrist Richard A. Friedman's attempt, in his New York Times opinion piece (“Teenagers, Medication and Suicide,” August 3, 2015), to minimize the dangers of antidepressant drugs in causing suicidal thoughts and behavior is wrong on the facts. Friedman is wrong - even according to Friedman - when his argument and numbers are examined. 

Roberto Ferdman recently wrote an article for the Washington Post titled “Why you shouldn’t blame yourself for binge eating.” Long story short, Mr. Ferdman concluded:

“... the next time you find yourself in a rut, and eating too much, know that the unbecoming scene isn’t merely a question of will power – it’s rather, in all likelihood, a matter of your genetic makeup.”

In other words, it’s not you being “lazy” or “weak-willed” or a “bad decision maker” that is causing you to binge-eat. Your binge eating is a consequence of your genes – “a matter of your genetic makeup.” This claim is one of a growing, widespread belief that the definitive way of understanding psychological disorders is by identifying biological correlates and pathologies. However, the evidence strongly suggests that this belief is wrong and dangerous.

Why was the insanity plea nullified in the movie theater killings in Aurora, Colorado? The answer is simple - because the carnage was so horrendous that there was too much public pressure in favor of the death penalty. There was no way the insanity plea would be allowed. Nonetheless, Holmes was clearly and incontrovertibly psychotic and delusional. It was the only reason for the horrendous murders.

Healing from this particular form of iatrogenic injury is a shocking process. It is shocking by nature of the fact that one of the hallmarks of this brain injury is a deep and profound neurological terror. This terror, held in the autonomic nervous system, manifests in a myriad number of forms from individual to individual. Even within the individual it most often shows up in numerous ways — possibly and often impacting every system of the body.

I recently finished reading Joseph LeDoux’s wonderful book Anxious: Using the Brain to Understand and Treat Fear and Anxiety.  LeDoux has written numerous books and articles on fear over many decades now, with an accessible that makes neuroanatomy and neuroscience easy to understand.  LeDoux studies the brain, but readers of this site would want to know that he is dubious about drugs being the answer to ameliorating anxiety or fear.  He raises questions regarding which domains of behavior belong to the brain and which domains belong to mind.

Cultural psychiatry provides a robust critique of a biologically orientated psychiatry. All cultures divide the world up into normal and abnormal; all have some notion of madness, but the idioms used to describe these states and the causes behind them can only ever be understood in the full context of the culture where they take place. It suggests that the very categories which are assumed to be natural occurring forms, are in fact just social and cultural constructions.

A kind of epidemic is occurring in the field of psychotherapy and psychology, with its increasing use of disparate approaches, methods, manual-based formulas and different theoretical schools, each having their own understanding and different treatments. Psychotherapy has come to mean everything and at the same time nothing.

There is a great deal of discussion about youth being diagnosed - by general internists as well as psychiatrists - with ADHD, bipolar disorder, autism, irritability and depression and then joining the ranks of the pathologized and overmedicated on a march towards long-term distress. Less attention has been paid to the 27 million children who, covered by federal and state Medicaid programs, are at high risk due to dangerous mismanagement of second-generation anti-psychotic drugs (SGAs). Recent reports have documented the brutal facts.

Making even basic chemicals was beyond us for millennia. But once the process was cracked, discoveries and inventions came thick and fast. Making chemicals that could be used to treat diseases was beyond us for even longer but the pace of discovery began to pick up in the middle of the nineteenth century. The realization of what needed to be done to give a chemical a chance of becoming a medicine led to the hunt for a Magic Bullet.

According to the APA, intermittent explosive disorder is characterized by angry aggressive outbursts that occur in response to relatively minor provocation. This particular label has an interesting history in successive editions of the DSM. Psychiatry needs illnesses to legitimize medical intervention. And where no illnesses exist, they have no hesitation in inventing them. And since they invented them in the first place, they have no difficulty in altering them to suit their purposes. Of course, almost all the alterations are in the direction of lowering the thresholds, and thereby increasing the prevalence.

The image is so familiar it is a stereotype: The physician’s desk, piled high with copies of medical journals, where she or he reads the latest research updates between patients. Medical science, it is said, progresses so quickly that if practitioners do not keep up their knowledge base will be obsolete within five years. But is the reading of journals useful? Can it potentially inculcate misinformation as much as progress? Is the knowledge gained worthwhile?

There appears to be increasing acceptance of the idea that lithium prevents suicide, and even that it can reduce mortality rates. For a toxic drug that makes most people feel rather depressed, this seems curious. I did wonder whether it might be having this effect on suicide by sapping people of the will to act, but the proposed effect on mortality seems completely inexplicable. A closer look at the evidence, however, suggests the idea is simply not justified.

The Low Histamine Chef published a post yesterday: The vagus nerve inflammation connection. I was tickled to get a list of various self-hacks on how to stimulate the vagus nerve. Once the vagus nerve is stimulated we calm down! It’s like magic. The vagus nerve is implicated in all sorts of stress.

This weekend I am celebrating the twenty-fifth anniversary of the Americans with Disabilities Act. Let us get a little bit crazy now! I am introducing a new segment where I boycott so-called normality. Our choice, our only choice, and we always have a choice, is what kind of madness we want.

Only five states remain in which Assisted Outpatient Treatment (AOT) laws have not yet gone into effect -- Massachusetts, Maryland, New Mexico, Connecticut and Tennessee -- and the pressure to start these programs in CO and NM is now very heavy. This article will address the push towards forced treatment for vulnerable populations who are at a high risk of being re-traumatized by these laws. It will also attempt to put a human face on the issues of stigma, labeling and the downward spiral that distressed individuals can get locked into when positive rather than punitive pathways are not made available to them.

While the outcome is disappointing, the revised UN prison rules reflect the stage we are currently in with regard to the incorporation of the CRPD standards elsewhere in the UN system. Some premises derived from the CRPD are brought forward, but the bottom line remains the same, to the detriment of people labeled with psychiatric diagnoses.

In recent years, we've seen an increasing number of articles and papers from psychiatrists in which they seem to be accepting at least some of the antipsychiatry criticisms, and appear interested in reforms. It is tempting to see this development as an indication of progress, but as in many aspects of life, things aren't always what they seem.

As researchers and practitioners, we are deeply troubled by the continuous narrowing of options available to people experiencing emotional difficulty. We believe that a variety of mental health approaches should be available to people from all walks of life and that we need to involve ordinary people in new kinds of conversation on this topic.

Maltreatment is broadly defined as being “characterized by sustained or repeated exposure to events that usually involve a betrayal of trust.” It includes not only physical and sexual abuse, but also emotional abuse, including exposure to domestic violence, humiliation and shaming, as well as emotional and physical neglect. The way maltreatment is defined has great significance in the way we think about the connection between childhood experiences and adult mental illness. The word “trauma” itself may convey a kind of “not me” response, but when the term is defined in this way, we see that these experiences are, in fact, ubiquitous.

For many clinicians like myself, families come to us with insurance that they seek to use in addressing psychological issues. As most know, in order to utilize the insurance benefits, a diagnostic code has to be billed that is specifically assigned to the identified patient, who in my case is a child or adolescent. As has been widely documented on MIA and other venues, this presents many challenges/controversies, both of an ethical and etiological origin. But this article is about a very specific concern, one that is inherent in the categorical, disease-based model, but also one that continues to depict the human person as a set of parts, not a dynamic, holistic being constantly interfacing with his or her environment.

The importance of the gut microbiota for physical health, mood, and perhaps cognitive capacity is a recent discovery. There are still plenty of unknowns. Given that so much of the American diet is based on processed foods, each food additive needs to be interrogated to determine its impact on the microbes in the gut, general inflammation, and mood and behavior. It might be easier to eat lots of nut, fruits and vegetables and avoid the processed foods and artificial sweeteners and start enjoying yogurt (the stuff without the high fructose corn syrup).