Foreign Correspondents

There are very few things considered more taboo in the world of mental health than the suggestion that problematic family dynamics can lead to a child developing a psychotic disorder. And yet, when we look honestly at the history and research of psychosis and the broader concept of “mental illness,” it becomes apparent that there are few subjects in the mental health field that are more important. I’d like to invite you, then, to join me on a journey into this taboo territory, dividing our trip into three legs. In the first leg (Part One), we’ll go back in time to explore how such a crucial topic has become so vilified, and then embark upon a flight for an aerial view of some of the most essential findings of the last 60 plus years of research that look at the links between problematic family dynamics and psychosis.

Good Pharma is the story of the Mario Negri Institute. Mario Negri was a wealthy patron who on his death in 1960 bequeathed a large sum of money to support independent pharmaceutical research to an upcoming researcher Silvio Garattini. Garattini and Alfredo Leonardi set about building an Institute centred on the new drugs and new techniques. They continue to grow without ever having patented any of their many discoveries or concealing any of the data from experiments that didn’t work out or accommodating any of their trials to industry’s wishes.

So now we know Soderbergh’s movie Side Effects is not so Black/Noir after all – more Fifty Shades of Grey. Emily Hawkins (Rooney Mara) is put on Ablixa by her psychiatrist Jonathan Banks (Jude Law) and while on it kills her husband. She apparently murders him while sleep-walking triggered by Ablixa and sleep walking being a perfect defense against murder she is acquitted.

Health systems are extremely hierarchical and, rather than empathy, the dominant approach to people's difficulties is based on top-down management practices which assume experts know what is best for people. I am hopeful that we can help people within the mental health system and other parts of society to strengthen their empathic ways of relating. However, I've noticed how easy it is for me to get self-righteous about mental health workers who are more 'medical' or 'expert-lead' in their approach. I realise that if I really want to help change things for the better I, too, will need to understand people who seem to be my opponents.

Academia has long been the official search engine for knowledge. Here supposedly are the ivory towers where seekers after truth, men and women intellectuals, teach new generations and carry out learned research, to add to the sum of human wisdom. It also has a longstanding history of questionable relationships; from those with the arms trade, to continuing over-reliance on big pharma psychiatric research funding.

When a pharmaceutical company discovers a potential new drug, they undertake a mammoth project. The aim is to amass sufficient evidence that national organizations such as the FDA will approve sale of the drug, and the type of disorders for which it can be openly prescribed – the so-called “on-label” uses. In order to encourage companies to undertake this risk, governments place a pot of gold at the end of the rainbow.

A new generation of multilateral and bilateral trade agreements is likely to significantly threaten access and cost of healthcare, and limit signatory Governments sovereignty to prioritise health care policy to protect and improve the health of citizens. The Trans Pacific Partnership Agreement (TPPA), a Pacific Rim regional trade agreement involving 12 countries — including New Zealand, Australia and the US — is one such agreement, and it has the potential to significantly alter the domestic environment for health policy-making.

There is a hunger out there for a foundational critique of psychiatry—something that pulls no punches, minces no words. That is, there is a hunger for a reasoned antipsychiatry position. Something that explains how we ended up here, provides solid evidence that psychiatry should be abandoned, and begins theorizing what we might do instead.

I’ve had some criticism of the recent Doctor Munchausen posts. They’re not fair on doctors. Many people have told me of lives saved by good doctors. It’s not fair to tar these good doctors with the brush of a few Dr Munchausens here and there. So there’s bad doctoring and good doctoring and great doctoring. What would great doctoring mean?

The idea of spending more time as a bureaucrat in the US Embassy in Iceland did not appeal to me. I longed for the freedom that academics have. While pursuing that dream I stumbled into the world of international media, “chemical imbalance”, book publishing and a greedy professor of psychiatry which was a prelude to my second annus horribilis.

In our last blog, we focused on the fact that nutrient supplementation has not only been accepted in the realm of physical health in the past, but it has actually been endorsed by reputable sources such as the Journal of the American Medical Association editors who published the Fairfield and Fletcher articles 11 years ago recommending that all adults take a multivitamin to reduce their risk of cardiovascular disease, cancer, and osteoporosis (note that this is completely inconsistent with very recent studies reported in the Annals of Internal Medicine --- but that’s just the way science works, using different nutrients and different methodologies, coming up with discrepant findings, until facts finally emerge).

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.”

Access to data is more important than access to information about conflicts of interest. It is only when there is access to the data that we can see if interests are conflicting and take that into account. Problems don’t get solved unless someone is motivated for some reason. We need the bias that pharmaceutical companies bring to bear in their defense of a product, along with the bias of those who might have been injured by a treatment. Both of these biases can distort the picture but it’s when people with differing points of view agree on what is right in front of their noses that we can begin to have some confidence about what we have.

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.

The World Health Organisation was established in 1945 to provide leadership on global health matters. According to its Director General Dr Margaret Chan, it...

It isn’t easy coming to a point in your career where you begin to question widely held beliefs about the nature of mental illness, and how it should be treated. Indeed it becomes starkly obvious that, no matter what you think and believe, even know in your heart to be true, the world runs along different lines. Sometimes I can be full of hope for change, but frequently it angers and frustrates; often I am rendered melancholic by the mountain that lies ahead. Let me explain.

What do you do when the media reports stories of children who have killed themselves on SSRIs? Position the stories of these children, not the drugs they were taking, as a suicide risk. Warn that more children will die if mouthy parents are allowed to speak and upstart journalists are allowed to report. And then position psychiatrists as the only people who can talk about suicide without producing an epidemic of self inflicted deaths.

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.

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?

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: 

When the idea that selective serotonin re-uptake inhibitors (SSRIs) might make people feel suicidal first started to be discussed, I admit I was sceptical. It didn’t seem to me the drugs had much effect at all, and I couldn’t understand how a chemical substance could produce a specific thought. Because these effects did not show up in randomised controlled trials, they were dismissed and few efforts were made to study them properly. Then some large meta-analyses started to find an association between the use of modern antidepressants and suicidal thoughts and actions, especially in children.

Evidence that antipsychotics cause brain shrinkage has been accumulating over the last few years, but the psychiatric research establishment is finding its own results difficult to swallow. A new paper by a group of American researchers once again tries to ‘blame the disease,’ a time-honoured tactic for diverting attention from the nasty and dangerous effects of some psychiatric treatments. People need to know about this research because it indicates that antipsychotics are not the innocuous substances that they have frequently been portrayed as. We still have no conclusive evidence that the disorders labeled as schizophrenia or psychosis are associated with any underlying abnormalities of the brain, but we do have strong evidence that the drugs we use to treat these conditions cause brain changes.

A memorandum submitted on the Children And Families Bill by the UK ADHD Partnership (UKAP) recommended that regulations issued to accompany the Children and Families Bill should include a requirement that “all children who receive two fixed term exclusions from school are screened for ADHD and, if appropriate, an assessment process for ADHD initiated.” The UKAP certainly appears to be a group the UK parliament should trust and, on the face of it, there is no reason that parliament should not adopt their recommendation. Except that the UKAP appears to be a front group for pharmaceutical company Shire, who manufacture the ADHD drug marketed as Vyvanase in the US and Elvanse in the UK.

I hope this will be of help to people who hear voices and their friends and supporters. I also hope it will be helpful to the voices which are parts of many people's lives. Many voices I have come across and the people that hear them are convinced that their voices are spiritual in nature. I take an agnostic position on this, and therefore endeavour to respect different spiritual understandings. My intention is not to explain all voices psychologically but to help people make peace with their voices so they can get on with their lives.

The strongest evidence we have as to whether a drug causes a problem does not come from RCTs or any other controlled study but rather from good clinical accounts. Even if RCTs were done by angels, so there was no hiding, no miscoding, nothing untoward, RCTs can still hide adverse events. The onus is on large and powerful corporations who have a lot of resources to pinpoint the populations where the benefit is likely to exceed the risk, if they want to continue to make money out of vulnerable people.