Is Motivation Worth More Than Expertise?

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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.

Psychiatric Teams Have a Responsibility to Think About the Psychosis/Sexual Abuse Link

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In England, childhood sexual abuse (CSA) has become big news. The increasing understanding of the level of childhood sexual abuse and how this produces mental anguish has of course reached the psychosis arena, and encouraged academic study. Whilst the majority of psychiatrists continue to privilege a biological explanation of psychosis, more and more workers recognise abuse as at least a trigger if not a cause of psychosis. It's important to develop thinking points for teams struggling with, or more generally avoiding, the CSA/psychosis link.

New Research into Antipsychotic Discontinuation And Reduction: the RADAR programme

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For a long time I have felt that there just isn’t a good enough and long enough study on the pros and cons of long-term antipsychotic treatment versus reduction and discontinuation in people who have psychotic disorders, including those who are classified as having schizophrenia. Moreover, there are increasing reasons to be worried about the effects of long-term treatment with antipsychotics. I put this case to the UK’s National Institute of Health Research recently, and proposed that they fund a trial to assess the long-term outcomes of a gradual programme of antipsychotic reduction compared with standard ‘maintenance treatment.’ The NIHR agreed that this was an important issue, and that a new trial was urgently needed. The RADAR (Research into Antipsychotic Discontinuation And Reduction) study officially started in January 2016.

Understanding Psychosis and Schizophrenia? What About Black People?

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In many respects it is difficult to fault the report Understanding Psychosis and Schizophrenia, recently published by the British Psychological Society (BPS) and the Division of Clinical Psychology (DCP)[i]; indeed, as recent posts on Mad in America have observed, there is much to admire in it. Whilst not overtly attacking biomedical interpretations of psychosis, it rightly draws attention to the limitations and problems of this model, and points instead to the importance of contexts of adversity, oppression and abuse in understanding psychosis. But the report makes only scant, fleeting references to the role of cultural differences and the complex relationships that are apparent between such differences and individual experiences of psychosis.

Madness and the Family (Part One): The History and Research of Family Dynamics and...

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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.

The Truth About Antidepressant Research: An Invitation to Dialogue

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The Finnish Psychological Association held a meeting in Helsinki on 1 Sept 2014 titled “Mental Health and Medicalization.” I spoke at the meeting and four days later I sent a letter to another speaker, psychiatrist Erkki Isometsä. Professor Isometsä replied: “I will respond to it in detail within a few days..." As "Open Dialogue" is essential in science, I have published my letter to Isometsä here as well as on my own website, although I didn’t succeed in starting a dialogue.

Looking forward to the Good Ol’ Days

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One of the most remarkable aspects of Robert Whitaker’s (2010) outstanding book Anatomy of an Epidemic was his comparative data that contrasted outcomes for mental disorders prior to the introduction of pharmacological treatments with outcomes for mental disorders after pharmacological treatments became the main, and often only, course of action. I have asked people in workshops to estimate who might be better off – someone diagnosed with what we now call bipolar disorder prior to the introduction of lithium or someone diagnosed after lithium became a standard treatment. Almost without exception workshoppers estimate that the people diagnosed before lithium was available do much worse. Whitaker’s data indicate exactly the opposite. It’s a staggering finding.

Hunting the Woozle, and Open Dialogue 

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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.

Study 329: By the Standards of the Time

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The controversy over “Study 329” on the effects of Paxil in teen depression has raised questions about the state of ALL medical research. I decided to look at the research for the most recent psychiatric drug approved by the FDA, a new antipsychotic called cariprazine or Vraylar.  I located twenty studies of Vraylar on www.ClinicalTrials.gov, the U.S. government-sponsored registry for clinical trials.  Three were still in process, and seventeen were completed.  Not one had shared its results on the government website, a supposedly mandatory step.

A Journey Into Madness and Back Again: Part 1

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During the past 29 years I have been diagnosed with anxiety, depression, PTSD, Biploar II and complex PTSD. I have tried numerous drug combinations and have been through ECT several times. None of this helped me. My road to recovery started when I decided to rebel against conventional psychiatry.

In Time for RXmas: Motivational Pharmacotherapy

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Drug profitability requires three parties to work together – drug companies to make the drugs, psychiatrists to prescribe them and consumers to take them. Too often, though, patients have failed to play nicely and do their bit. They have banged on about tiresome things like adverse reactions and alternative treatments, they have expressed foolish opposition to the very concept of pharmacotherapy and questioned its efficacy. They have become medication non-compliant and undermined the profits of the pharmaceutical industry and the authority of psychiatry. They have been bad and landed themselves on a lot of people’s naughty lists and made the World Health Organization very sad and worried.

What is Critical Psychiatry?

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Over the last twenty years there has emerged a body of work that questions the assumptions that lie beneath psychiatric knowledge and practice. This work, appearing as academic papers, magazine articles, books, and chapters in books, hasn’t been written by academics, sociologists or cultural theorists. It has emerged from the pens and practice of a group of British psychiatrists.

What is Mental Illness Today? Five Hard Questions

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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?

Largest Survey of Antidepressants Finds High Rates of Adverse Emotional and Interpersonal Effects

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I thought I would make a small contribution to the discussion about how coverage of the recent airline tragedy focuses so much on the supposed ‘mental illness’ of the pilot and not so much on the possible role of antidepressants. Of course we will never know the answer to these questions but it is important, I think, to combat the simplistic nonsense wheeled out after most such tragedies, the nonsense that says the person had an illness that made them do awful things. So, just to confirm what many recipients of antidepressants, clinicians and researchers have been saying for a long time, here are some findings from our recent New Zealand survey of over 1,800 people taking anti-depressants, which we think is the largest survey to date.

RxISK Stories: If You’re Going to Look After Patients, Man Up

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Pharmalot has just posted a piece - 'Controversial FDA official, Tom Laughren, retires.' This is a must read for anyone with anything to do with mental health - both the post and the comments afterwards where some have posted that they still believe the Black Box warnings on antidepressants arose because of pressure from the Church of Scientology rather than in response to the data.The post will likely seem boring to many. But the comments won't - they seethe with anger.

Why Neuroscience Cannot Explain Madness

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The decision by the National Institute of Mental Health to part company with the APA’s forthcoming DSM-5 should not be taken as evidence that biological psychiatry is entering a terminal decline. Far from it, as the Director of NIMH Thomas Insel’s blog of 29th April 2013 makes clear, the reason NIMH has opted for its own Research Diagnostic Criteria (RDoC) is because they believe psychiatric patients deserve something better.

A Critique of Genetic Research on Schizophrenia – Expensive Castles in the Air

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In the light of the much trumpeted claims that recent research has identified genes for schizophrenia, it is important to review the track record of this type of endeavor. Despite thousands of studies costing millions of dollars, and endless predictions that the genetics of schizophrenia would shortly be revealed, the field has so far failed to identify any genes that substantially increase the risk of developing schizophrenia.

On Creating Universes, Killing Cats and Other Odd Things

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Stephen Hawking believes there are an infinite number of universes and that alien life exists. Nobel Prize winning physicist Neils Bohr’s interpretation of quantum mechanics shows a cat can be alive and dead simultaneously until we fix it in one state through our observation of it. These are ideas that most people would struggle to see as credible science and yet recent literature reviews reveal that physicists are far more trusted than psychiatrists.

Delay of Diagnosis: The Placebo Effect of Behavioral Diagnosis

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This means that what ADHD proponents present as validation of a diagnosis of a real and treatable disorder is in fact a placebo effect caused by an ostensibly scientific label, which exists in synergy with an efficient, legal drug. The ADHD label produces this placebo effect because its diagnosis is based on behavior that in reality could be observed by anyone. What is observed sounds "scientific"; it is easily understandable and highly obvious. When the diagnosis is turned into an action plan, we forget that there is nothing scientific about it and that its evaluation is purely subjective and clinical; that it creates a great many false positives, and that a drug prescribed in half of the cases indeed does have serious side effects.

Madness and the Family (Part Two): Towards a Unified Theory of Family Dynamics and...

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In Part One of this article series, we reviewed the contemporary research into the links between psychosis, problematic family dynamics, and other forms of childhood trauma. After reviewing this research, we find that a very interesting and important question emerges: What do all of these have in common? In other words, is there some common denominator that all of these types of trauma and patterns of problematic family dynamics share, a single underlying factor that makes someone particularly vulnerable to experiencing a psychotic crisis? Indeed, I believe that there is.

Wake Up and Smell the Coffee!

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"I want to change the way we think about mental health care so that any child, whether they have a mental illness or simply need support through a difficult time, can get the right help at the right time." This was said by Care Minister Norman Lamb and quoted by the BBC on March 17th 2015. Mr. Lamb is known to have a son who has suffered mental health difficulties and it may well have come from the heart as much as it did from the election fever which is beginning to infect British politicians. However it says something worth picking up upon. I want to change the way we think about mental health care… and … simply need support through a difficult time. These are important shifts of language, and doubly important when they come from a government health minister.

Odysseus Come Home

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Odysseus was in his 70s. Coming up to the 50th anniversary of a very happy marriage. He had formerly been a respected professional, a...

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.

Elephants and Flamingos

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I am walking through my local park in Copenhagen, Denmark, early in the morning breathing in the fresh smell of damp soil and late summer blooms. I am thinking about my thesis that I have just handed in and the fact that if it is passed I will be a certified psychologist! But, I will not be just any psychologist. I will be Denmark's first official 'Mad' psychologist, joining the ranks of others such as Rufus May, Eleanor Longden, Arnhild Lauveng, and Pat Deegan.

Julia’s TEDx Talk: Time to Get Serious About Nutrition

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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.