Featured Blogs

On April 25, 2014, Jeffrey Lieberman, MD, then-President of the APA, announced that the association had engaged the services of Porter Novelli, a prestigious PR company based in Washington DC and currently operating in 60 different countries. I expressed the belief at the time that it would take a lot more than some PR embellishments to remediate the fundamental flaws in American psychiatry's concepts and practices. In the intervening year and a half, I've been watching the APA closely for any indications of fundamental change; any hint of critical self-appraisal; any suggestion of genuine reform or remediation. But I've seen nothing of this sort. It's still the same old APA, with its same old spurious diagnoses, and the same old assurances that their "treatments" are efficacious and safe, and that the great neurological insights are just around the corner.

The problems that we face in America today are many and they are grave. Mass gun violence grips our communities on a regular basis. A wave of protest against unfair policing policies and police violence directed against people of color and people with mental health and other disabilities. “Zero tolerance” policies in schools that lead to the school-to-prison pipeline. We incarcerate more people than any country in the world, generally for nonviolent offenses. Suicide rates are on the rise in America for the 10th year in a row. These pressing social issues are deeply interconnected and are rooted in trauma, the breakdown of community support, and socioeconomic inequality. We need reform that sees the intersections and addresses the public’s health and well-being across the lifespan.

Toppmøte is Norwegian for ‘summit,’ and Toppmøte2015 is the second of two very successful seminars bringing together professionals, academics, and policymakers with citizens, voters and users of services – under the aegis of the Norwegian ‘Nasjonalt senter for erfaringskompetanse innen psykisk helse’ or “National Centre for Knowledge through Experience in Mental Health.” That’s a rather wonderful organisation, funded by the Norwegian government, which ensures that the experience of people who have used mental health services is reflected in the commissioning, design, management and evaluation of those services.

Psychiatry is the most powerful medical profession in existence. Aside from those doctors who might commit a person because of the fatal health risk they pose to society (i.e., tuberculosis), psychiatrists and their associated mental health professionals are the only medical persons who can legally take away a person’s rights when they have committed no crime. Unlike those doctors who might commit a TB patient, however, psychiatrists can also force their “care” onto another person whether he agrees to it or not. It is a power that is unbelievable in an era where “freedom” is the quintessential goal of humanity. Laws must be changed and the moral implications need to be screamed from the mountain tops, no matter how many diagnoses are accrued for doing so.

In May 2014, the RIAT team asked GSK what the children who became suicidal in the course of Study 329 have since been told. The consent form says that anyone entering the study would be treated just the way they would be in normal clinical practice. In Study 329, the children taking imipramine were by design force titrated upwards to doses of the order of 300 mg, which is close to double the dose of imipramine given in adult trials by GSK or in normal clinical practice. In normal clinical practice it would be usual to inform somebody who had become suicidal on an SSRI that the treatment had caused their problem.

This past Saturday, I was on my way back from Europe to Boston, and while on a stop in Iceland, I checked my email and was directed to a new blog by Ronald Pies in Psychiatric Times, in which he once again revisited the question of whether American psychiatry, and the American Psychiatric Association (APA), ever promoted the idea that chemical imbalances caused mental disorders. And just like when I read his 2011 writings on this subject, I found myself wondering what to make of his post. Why was he so intent on maintaining psychiatry’s “innocence?” And why did it matter?

This article is not going to be about the evils of psychiatric hospitalization or medication. It is about a love story that happened many years ago. It is a story about two people trying to survive in our world and manage within the psychiatric system. It’s a story of two individuals with their own pain and triumphs: Pierre and Shelly.

It's no secret that at the present time, psychiatry is reeling under a barrage of scrutiny and criticism. Their long-standing contention that all significant problems of thinking, feeling, and/or behaving are brain illnesses "just like diabetes," which need to be "treated" with drugs and high-voltage electric shocks to the brain, has been thoroughly discredited. And yet they go on peddling their spurious, self-serving ideology and the products of their pharma partners. The great mystery in all of this is why has the mainstream media been so slow to pick up the story.

If you live on Earth and breathe, then you must overthrow what is mistakenly called “normal” and the mental health industry. Why? Today, our planet is faced with an unprecedented emergency, according to the vast majority of scientists, wise people and just about everybody else. It seems that the general public is paralyzed, and as our leaders continue to procrastinate, we are collectively entering into the beginning of chaos. In order to survive, we must get a little crazy

People hassle me for being anti-medication, and I always tell them I am NOT anti-medication; I am pro-fully-informed choice. But people like things black-and-white. They see me as being against medications, and so I'm telling you why medications may have saved my life yesterday, or at least saved me a whole bunch more trouble.

It is possible that if we ask “What happened to you?” instead of “What’s wrong with you?”, we wouldn’t see much of a change at all. Those people who are inclined to think of mental health problems as illnesses, as something “wrong,” would be able to explain that what happened to you was the cause of the illness; it produced what is wrong with you. It is much more crucial to understand “What is happening for you now?”

The science is settled. Psychiatry has trafficked in proclamation-based medicine, and is fast become the proving ground for corporate interests. You almost have to hand it to these corporations for their largely unfettered success in supporting the financial interests of their shareholders. The job of Big Pharma is not to care for you, protect your wellness, or heal your children. The job of Big Pharma is to win – win at the game of unbridled capitalism – and they have.

It is appropriate to hold a company or doctors who may be aiming to make money out of vulnerable people to a high standard when it comes to efficacy, but for those interested to advance the treatment of patients with any medical condition it is not appropriate to deny the likely existence of harms on the basis of a failure to reach a significance threshold that the very process of conducting an RCT will mean cannot be met, as investigators' attention is systematically diverted elsewhere.

The most difficult decision I have had to make as a clinician has been to send a person into a locked psychiatric unit for up to 72 hours. The emotional impact affects the individual who is going to be placed on the 72-hour hold, and their family. The emotions that are involved in the process of observing the person, collecting information, and finally making the life-altering decision are powerful and long-lasting for the person making the decision as well. That is, if they are compassionate and involved, and fully aware of the consequences.

All throughout life, trauma defines the negative elements of our environment. Just as responsiveness is the source of healing in the world, trauma is the agent of harm and damage. Trauma consists of abuse: sadism and cruelty; and deprivation: the cold absence of loving which generates the absence of the possibility of tender attachments. Trauma is an assault so extreme that it overrides and rewrites our otherwise healthy play of consciousness. It outpaces our flexibility to adapt, and writes a dark new play in its place.

I have lost interest in making sense. Insofar as anti-stigma entails a reassertion of my apparently forgotten humanity via the retelling of some personal narrative in which I generalize my unique experiences toward some universal wisdom, I have lost interest in the reduction of stigma. I would much prefer it if you didn’t need me to be comprehensible.

The authors of Study 329 began recruiting adolescents for a comparative study of Paxil, imipramine and placebo in 1994 and finished their investigations in 1997. They dropped a large number of their original cohort, so the randomness element in the study must be open to question. Late in 1998, SmithKline Beecham, the marketers of Paxil, acknowledged in an internal document that the study had shown that Paxil didn’t work for adolescents in terms of the two primary and six secondary outcomes they had established at the start of the study. In a nutshell, Study 329 was negative for efficacy and positive for harm, contrary to their succinct upbeat conclusion.

In 1980, the British Medical Journal published a “Systematic Review of the Benzodiazepines” by the Committee on the Review of Medicines. The committee denied the addictive potential of Benzodiazepines and limited their suggestions to short term use. The results have been devastating.

Years ago, a psychiatrist by the name of Theodore Lidz published a book entitled Schizophrenia and the Family.  Unlike many others of his time, he believed that schizophrenic symptoms were not necessarily the result of an underlying disease, but could be caused by dysfunctional parental behavior.  He noted that significant conflict and high levels of tension were not necessarily the cause of symptoms; in certain families, a pattern of “skewed” communication existed in which odd, often unhealthy patterns of interaction and behaviors were allowed and even supported by one spouse, which resulted in a confusing, distorted environment for the children.

I imagine that everybody on this side of the issue knows by now that the eminent psychiatrist Jeffrey Lieberman, MD, Chief Psychiatrist at Columbia, and past President of the APA, called Robert Whitaker "a menace to society." The grounds for Dr. Lieberman's vituperation were that Robert had dared to challenge some of psychiatry's most sacred tenets! But in all the furor, it was largely ignored that in the same interview Dr. Lieberman had said something else that warrants additional discussion.

Probiotics have certainly become quite the rage across the world for the treatment of all kinds of ailments from irritable bowel syndrome (IBS) to infectious diarrhoea to stress to low mood. Some might say that the enthusiasm has been rather slow to develop. Recently, the popular press has propagated the idea that probiotics are the next antidepressants.

Since the mid-1990s antipsychotic medications have been increasingly prescribed for children, adolescents, and adults. The most recent report finds an increase in use for older children from 2006 to 2008. Most of the prescriptions of antipsychotics for children reported by the study were for conditions which had not been approved by the FDA (called off-label use).

If someone were to ask the surviving authors of Study 329 the question: “Knowing what you know now, if you had to do it over, would you agree to participate in that study again?”, many would probably say no. Study 329’s problems started to surface right after it was published. Several doctors wrote letters to the JAACAP Editor with probing questions, mostly centred on the psychiatric side effects of paroxetine, and the measures used to claim its efficacy in treating adolescents. The authors responded and the questioners did not pursue their concerns further. Except one. Next week, fourteen years and two months after it was published, it is about to take yet another hit, when the Restored version is published.

In 2000, behavioral geneticist Eric Turkheimer proposed "Three Laws of Behavior Genetics" based on what he saw as the “nearly unanimous results” of behavioral genetic studies of families, twins, and adoptees. However, critics have argued for decades that most behavioral genetic assumptions, models, concepts, “laws,” and “discoveries” do not hold up under critical examination. In 2015, a group of behavioral geneticists proposed an additional “Fourth Law of Behavior Genetics,” which states that behavioral characteristics are associated with many genes of small effect. Here I propose a “Fifth Law” of behavior genetics—actually, the only “law” one needs to know in order to properly understand this field.

“Mental health” — a misnomer? If you don’t subscribe to the notion of “mental illness,” why “mental health”? Why not the straightforward acceptance that individuals will act in a manner peculiar to each? In short, why not an existential or phenomenological understanding of human behavior as rooted in an individual’s idiosyncrasies and life experiences rather than in her/his brain chemistry?