Towards a Hermeneutic Shift in Psychiatry

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I know that this might sound odd coming from a critical psychiatrist, but I believe that psychiatry has a future. Furthermore, I maintain that a good deal of psychiatry as practised now is helpful and that many psychiatrists manage to play a positive and therapeutic role in the lives of their patients. However, I also believe that we are at our most helpful when we depart from the current biomedical ideology that has come to dominate in our profession. As a first step, we need to get beyond the reductionism that currently guides most psychiatric research and education.

Cognitive Behavioural Therapy Does Not Exist

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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.

Changing Society’s Whole Approach to ‘Psychosis’

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Fifteen years ago this month we were sitting together in the basement of Peter’s house. We had felt a sense of despair at the widespread misinformation and atrocious stereotypes that were dominating media coverage of mental health at the time. We felt that our profession had a responsibility to challenge these stereotypes, and that as psychologists we had something unique to contribute. That was the time when research into the psychology of psychosis was beginning to burgeon, and many of our findings challenged not only the stereotypes but – perhaps more significantly - much ‘accepted wisdom’ within mental health services as well.

Implications of the Trans-Pacific Partnership Agreement on Equitable Access to Healthcare

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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.

The Hearing Voices Movement: In Response to a Father – ‘My Daughter, the Schizophrenic’

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There was a heart-breaking and disturbing story in yesterday’s Guardian newspaper entitled, My Daughter, the Schizophrenic’, which featured edited extracts from a book written by the father of a child called Jani. He describes how Jani is admitted into a psychiatric hospital when she is 5, diagnosed with schizophrenia when she is 6 and by the time she is 7, she has been put on a potent cocktail of psychotropic medications.

Witty A: Report to the President

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Faced with questions about the $3 Billion fine imposed on GSK – is it just the cost of doing business? - Andrew Witty snapped back: “Although corporate malfeasance cases end up looking very big, they often have their origin in just… one or two people who didn’t quite do the right thing. It’s not about the big piece. The 100,000 people who work for GSK are just like you, right? I’m sure everybody who reads the BMJ has friends who work for drug companies. They’re normal people… Many of them are doctors."

Do You Still Need Your Psychiatric Diagnosis?

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Do you still need your psychiatric diagnosis? The answer for practical purposes is probably ‘Yes.’ In the current system, diagnosis is essential for accessing services and benefits and, particularly in the USA, for covering your treatment costs. But do you need to believe in your diagnosis? Do you have to accept this particular attempt to explain your difficulties, and to take it on as part of your identity by becoming one of the ‘mentally ill’? since psychiatric diagnoses have been admitted to be non-valid even by the people who drew them up, professionals should not be offering people the ‘choice’ of describing their difficulties in diagnostic terms in the first place. That would still leave people with the right to adopt whatever explanation suits them as private individuals.

‘I’d Rather Die Than Go Back to Hospital’: Why We Need a Non-medical Crisis...

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It was exciting going back to my old stamping ground. Years ago I’d worked in one of the local community mental health teams and had referred many women to the Drayton Park Crisis House. Walking up the steps of the house brought back memories of standing there with desperate and suicidal clients, some of whom had told me that they would rather die than go back into hospital. As you can imagine, to say I had been glad that there was an alternative would have been an understatement.

Screening Pregnant Women for Depression

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Denmark is now screening pregnant women for depression. Given the clear risks and the unclear benefits of antidepressants, the process of screening pregnant women for depression can take on a bizarre dimension. Here, Peter Gøtzsche imagines one of the conversations that might take place.

Me, My Brain, and Baked Beans

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I’ve spent much of my professional life studying psychological aspects of mental health problems. Inevitably, this has also meant discussing the role of biology. That’s my academic day-job. But it’s not just academic for me. I’m probably not untypical of most people reading this; I can see clear examples of how my experiences may have affected my own mental health, but I can also see reasons to suspect biological, heritable, traits. As in all aspects of human behaviour, both nature and nurture are involved and they have been intimately entwined in a complex interactive dance throughout my childhood and adult life.

Forced Psychiatric Treatment (and Protection against it) in Germany in 2013

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For years, people in Germany who act like they are radical antipsychiatry activists have said that in this country psychiatric violent (forced) treatment has been forbidden. Unfortunately, this is not true.

The Empire of Humbug: Not So Bad Pharma

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At the 50th American Psychosomatic Society meeting in New York, Michael Shepherd was speaking. His topic - The Placebo. When the lecture finished, Lou Lasagna said "this paper is now open for questions." Nothing happened. Nobody said anything at all. Lasagna couldn't refrain from commenting: "There are 3 possible explanations. First, you were all asleep and therefore you heard nothing. Secondly, it was so bad that since this speaker has come 3,000 miles you didn't want to embarrass him. Third, it is genuinely so original and new that you don't quite know what to make of it. I'll leave you to decide which it was". What had Shepherd said?

It’s as Bad as You Think: The Gap Between the Rich and the Poor...

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Many of us in the U.K. are mad - mad with anger at the injustice and cynicism of a political system that is turning the gap between rich and poor into an unbridgeable chasm. Mad with anger because the most vulnerable in society are now paying the price for a political ideology - neoliberalism - with their lives. We are mad and angry because they are blamed for failings that are not of their making, but which originate in the system under which we live. 'Psychological' assessments, online cognitive behavioural therapy (CBT) and other forms of 'therapy' are being used to force unemployed people with common mental health problems back to work. Mental health professionals responsible for IAPT (Improving Access to Psychological Therapies) have been relocated to help 'assess' and 'treat' claimants.

Mad Flies and Bad Science

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Tension mounts across the ideological divide as D-Day (DSM-5 Day) approaches. The APA has powerful allies on its side. President Obama has just launched Decade of the Brain 2 with the announcement two weeks ago that heralds the arrival of BRAIN ( Brain Research through Advances in Innovative Neurotechnologies). If that’s not enough, those who believe that science will ultimately explain madness can always rely on the media to fawn at their feet.

Madness and the Family, Part III: Practical Methods for Transforming Troubled Family Systems

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We are profoundly social beings living not as isolated individuals but as integral members of interdependent social systems—our nuclear family system, and the broader social systems of extended family, peers, our community and the broader society. Therefore, psychosis and other forms of human distress often deemed “mental illness” are best seen not so much as something intrinsically “wrong” or “diseased” within the particular individual who is most exhibiting that distress, but rather as systemic problems that are merely being channeled through this individual.

Dreams of a Quick Fix, Gone Awry

The version of psychiatry that many professionals, politicians and laypeople would like to be true is that mental illnesses are specific brain disorders with specific drug treatments, to which they are very responsive if identified early. In reality, the way we categorise mental illnesses is arbitrary, and the diagnostic criteria are over inclusive. Whilst psychiatric drugs can be helpful, the dream of a quick fix by targeted drugs has become a nightmare where we often do more harm than good in the way we use drugs, e.g. against depression, schizophrenia and ADHD.

Recovery: Compromise or Liberation?

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The 90s were labeled - rather optimistically - as the ‘decade of recovery.’ More recently, recovery has been placed slap bang central in mental health policy. Is supporting recovery pretty much good common sense? Or is the term being misused to pressure those suffering to behave in certain ways?

Off-Label in New Zealand

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Before the early 1990’s the use of antipsychotic medications was largely reserved for adults with severe psychotic disorders; unpleasant involuntary movement disorders (extrapyramidal side-effects) and cardiovascular risks appear to have largely limited their use outside these disorders. The introduction and intense marketing of what seemed to be better tolerated and safer (now proven not to be), second generation atypical antipsychotics (AAPs) such as risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole from the mid 1990’s led to a rapid expansion of antipsychotic medication use for a wide variety of unlicensed conditions and in more diverse clinical populations.

If You Are the Big, Big Tree; We Are the Small Axe

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In 2006 I undertook a neuropsychology placement during my Clinical Psychology Doctoral training course. It was in a community brain injury service. I had the fortunate experience of undertaking not only neuropsychological assessments, but also therapeutic interventions and service projects. My eyes were opened in a very positive way. Things suddenly made sense; psychology, interactions, life, all became much clearer. I now understood that we are all unique, not only because of our experiences and views on life, but because of our neurocircuitry. I began to see how our unique cognitive profiles make us who we are.

Hope for Everyone

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I am a very optimistic psychologist, but with reason. For 25 years I've been working with people who have had psychological problems in every conceivable area. Many psychologists have problems with burnout, especially early in their careers. For me, this has been very different. By using the treatment techniques that I do, I feel anti-burned out. It is so gratifying to see people get out of their serious problems, that I look forward to every day of clinical work.

The Curious Case of over 50 Consecutive ECTs in Melbourne

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Over the past few weeks I have been witness to, and increasingly involved in trying to stop one of the most extreme examples of psychiatric brutality I have encountered in my 40 years in this field. And I have encountered quite a few. I suggest you sit down before watching and reading. This is not your usual, run-of-the-mill psychiatric abuse story.

“Let Food Be Thy Medicine” — So Let’s Teach Physicians How to Cook!

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Most people reading this blog will have heard or read the quotation attributed to Hippocrates: “Let food be thy medicine, and medicine be thy food.” Whether or not this ancient Greek physician actually made that comment 2500 years ago is something that we cannot determine. But it certainly is a statement that is coming back into favor in the current era.

The Tragedy of Lou Lasagna

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In 1956, Lou Lasagna was on his way to being the most famous doctor in the United States; an advocate for controlled clinical trials of both the safety and effectiveness of medication, as well as for a revision to the Hippocratic Oath to include a holistic and compassionate approach to medicine. Then, caught in the nexus of reason, regulation, and the pharmaceutical machine, his star fell.

Clipping Care, Not Profit

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Right now in Britain there is a controversy shaping up between the commercial and financial interests of big managed-care corporations and the need to care for vulnerable people in the community, people with conditions like dementia and long-term psychoses. Conflicts of interest are nothing new in the contested field of mental health, but this one threatens not only quality of care, but the well-being of low paid workers, mainly women, who are employed as support workers.

Brand Fascism

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The norm in science is that there is free access to the data underpinning experiments. If free access is denied; it’s not science. In the case of branded pharmaceuticals, we do not even know what trials have been done. What is put in the public domain is not data. The selected highlights of a football game and the comments of the pundits afterwards don't change the score. The selected highlights of pharma studies and the comments of pundits routinely change the score.