Foreign Correspondents

Disclosure is an insufficient strategy for mitigating bias because bias does not result from the concealment of financial ties but from their effects. Even worse, social psychologists have demonstrated that when individuals disclose a competing interest, they give even more biased advice.

Based on any data from any country it is clear that we have a problem. Mental illness is on the rise. Researchers in the emerging field of nutritional psychiatry have documented the benefits of micronutrients to treat mental illness, showing that micronutrients help treat depression, stress, anxiety and autism and ADHD. Not a single study shows that the Western diet is good for our mental health. Many questions remain to be answered, but we can make some recommendations.

On Monday night, Irish television screened a documentary covering the events leading to the self inflicted death of Shane Clancy & the other young man he killed. In the documentary, psychiatrist Professor Patricia Casey is quoted as saying that she does not believe the SSRI Shane was taking played any role in the killings and that in her opinion they were caused by an undiagnosed psychiatric illness. Professor Casey did not meet Shane when he was alive. She has never spoken to his family, does not have access to his medical records or family history and has not spoken to his doctor.

Doctors in the 1950s and 1960s made psychiatric diagnoses on orphaned children that led to treatment with antipsychotic drugs, and one of the drivers of this seemed to be that the Church got more money from the State as a result. The doctors, of course, also got paid. This feels like a seriously corrupt nexus operating with near impunity on the basis that no one is going to be bothered to investigate the fate of some orphans.

Suicide needs to come 'out of the closet' as a public health issue. But this in turn requires a broad, ongoing community conversation rather than the current status quo of 'experts' talking about us without us. We also need to move beyond the excessive medicalisation of suicide that blames it on some notional 'mental illness'. This is my first post where I introduce myself, telling you a little of how I came to do a PhD in Suicidology. And an invitation to join me in a radically different conversation about suicide, here at Mad in America.

A great deal of the information published on MadInAmerica is devoted to this very important question, so many constructive ideas are often presented. We think that nutrition and diet should always be part of the conversation.

We are constantly hearing that ‘how we eat’ affects our health. The vast majority of studies showing the associations between diet and mental health have emerged in only the last decade, at best. So any professional who graduated over 10 years ago could potentially be completely unfamiliar with this body of research. We are encouraged by the number of professionals starting to pay attention to diet, but we have a long way to go.

This is the final of four installments about the bizarre, ongoing conduct of psychiatrists at Upton House, an Eastern Health psychiatric facility in Melbourne, and the collusion with their conduct by all relevant agencies. This last installment will document the failure, so far, of the State and Federal Governments to intervene in even this most extreme and blatant example of abuse of power by psychiatry. If I, as a Professor of Clinical Psychology with 40 years clinical and research experience in this field, can be so easily dismissed/ignored by the relevant systems in Victoria, what chance do the average users of mental health services and their families have of being heard in this State?

Forced treatment in psychiatry cannot be defended, neither on ethical, legal or scientific grounds. It has never been shown that forced treatment does more good than harm, and it is highly likely that the opposite is true. We need to abolish our laws about this, in accordance with the United Na­tions Convention on the Rights of Persons with Disabilities, which virtually all countries have ratified.

It takes courage and integrity to make changes to your beliefs and approach. In 2008 Professor Roger Mulder, head of psychiatry at Otago University, published research in which he concluded “Antidepressant treatment is associated with a rapid and significant reduction in suicidal behaviours. The rate of emergent suicidal behaviour was low and the risk/benefit ratio for antidepressants appears to favour their use.” In Dr. Mulder's conference presentations last week, he stated that the medical/psychiatric paradigm that has dominated approaches to suicide since WWII has largely failed to influence suicide rates. In Dr. Mulder’s view “New approaches are required – possibly public health, sociological, community or combinations in addition to, or instead of, medical approaches.”

Some readers of Mad in America may be aware that Scientific American published a short blog by me on 17^th November 2014 - Why We Need to Abandon the Disease-Model of Mental Health Care. This blog was rather wonderfully (and slightly embarrassingly) described by Phil Hickey on his website, Behaviorism and Mental Health, as “an important milestone.” My blog attempts to summarise many of the key points of a perspective widely shared on Mad in America: 

Since the 1980s, a type of psychotherapy called Cognitive Behavioural Therapy (CBT) has become dominant. Like it or loathe it, CBT is now so ubiquitous it is often the only talking therapy available in both public and voluntary health settings. It is increasingly spoken about in the media and in living rooms across the country. Yet when we speak about CBT, what are we talking of? For CBT only exists - as we will see - as a political convenience.

In an era of prescribing rights for psychologists will psychology become a more marketable, less tarnished version of psychiatry, a target for pharma marketing and a new distribution channel for psychotropic drugs?

This shorter-than-usual contribution signifies a departure from my earlier blogs. It is the first in an occasional series that uses semi-fictional clinical narratives to examine some of the difficulties that face people who use psychiatric services in England, and the psychiatrists and other mental health professionals who work in them.

Subscribers to Mad in America might be interested in a Keynote Lecture given by Professor Nikolas Rose in Nottingham on May 15th 2013. In this lecture Professor Rose very thoughtfully challenges a number of the assumptions which underpin conventional and contemporary psychiatric practice. He asks five hard questions:

• Is there (really) an epidemic of mental illness?
• Does the path to understanding mental disorder lie through the brain?
• What is the role of diagnosis and of diagnostic manuals?
• Should we seek early identification of those at risk of future mental pathology?
• What is the place of patients, users, survivors, & consumers of mental health systems?

We are among an increasing number of people around the world who know the importance of holding on to a humanistic idea, and of keeping in mind that people need—first and foremost—other people. People who are willing to take part, to share with us the horror and confusion, to invite the telling of a narrative, and to keep the hope alive.

Today I paid a visit to the Managing Director of Mylan Pharmaceuticals, Lloyd Price. Mylan is the company that manufactured the antidepressant Fluox1 which, according to the NZ government, is the most likely cause of my son's suicide. My dealings with Mylan in the time since Toran died have not been entirely fruitful.

About a year ago, my partner Ron Coleman said to me "let's have a recovery camp." I said "what’s one of those?" and he said "I'm not sure, but let's invent it." And so, from June 7^th to 12^th 2015, we created a community of recovery for a week. The next step is to create communities of recovery around the world — not just as temporary camps, but long-lasting oases within our communities.

In order to explore the current political context of mental health services, as I will be doing in some upcoming blogs, it is necessary to establish what the modern mental health system actually consists of and what function it serves. It is only by tracing the historical development of mental health services, and analysing how and why the system arose, that we are able to fully comprehend its actual purpose.

Global leaders in the critical psychiatry movement met on 18 Sep 2015 for a one-day conference to address an urgent public health issue: the iatrogenic harm caused by the over-prescription of psychiatric medications. We were treated to an expert review of the ways in which the widespread use of harmful and barely (if at all) helpful medicines has become the mainstay of psychiatry’s contribution to society. At gatherings such as this, when people discover I am a psychiatrist I often become a lightning rod for their anger and frustration. It’s okay; it comes with the job, but a couple of things happened at Roehampton which reminded me why this can happen, and why all of this is so much more complicated than the simple black-and-white “Pharma and psychiatry bad, everyone else good.”

We have just celebrated the anniversary of the rapidly expanding global Hearing Voices Movement which was founded more than twenty-five years ago following the ground-breaking research of Professor Marius Romme and Dr Sandra Escher. Romme and Escher have advocated for a radical shift in the way we understand the phenomenon of Hearing Voices; in contrast to traditional, biomedical psychiatry which views voices as an aberrant by-product of genetic, brain and cognitive faults, their research has firmly established that voices make sense when taking into account the traumatic circumstances that frequently provoke them.

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.

One thing that amazes us is that even though information linking nutrition to physical health is quite advanced, and generally very prominent in the media as well as in public awareness, people seem to be surprised when told that nutrients are essential for brain function. It may be silly to remind everyone of this, but we need to begin with this simple fact: the brain is part of the body. But to add some heft to this point, let us also recall that the brain is the organ of the body with the greatest metabolic demands (the heart is second).

In Paris today we have a lot of people mouthing words that come easily: "Je Suis Charlie." For anyone who wants to be Charlie, who wants to get to know what modern politics is all about, by feeling it in your marrow, try reporting an adverse event on treatment to your doctor. Outside your doctor’s surgery/clinic/ consultation room you can believe you are operating in a democracy. Inside the room you may be treated with courtesy and apparent friendliness but you are being treated in an arrangement set in place to police addicts. This is not a domain in which ideals of Liberty, Equality or Fraternity are welcome.

In the film Avatar, scientists are keen to exploit the moon planet Pandora which is inhabited by 10-foot-tall blue humanoids called Na'vi.  To do so they create Na'vi human hybrids called “Avatars” which are controlled from afar by genetically matched humans. When the scientists decide to destroy the eco-system of the planet to gain access to valuable minerals, war breaks out between the humans and the Na'vi. At this point the main character, Jake, who operates an Avatar, has to choose whose side he is on.  Eventually Jake's life is saved and transformed by the Tree of Souls, which the humans are trying to destroy. Why are Avatars in the news again? The latest innovation from psychiatric research is using computer-generated avatars to help people who hear aggressive voices.