Foreign Correspondents

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.

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.”

The Minnesota Starvation Experiment was conducted at the University of Minnesota during the Second World War. Prolonged semi-starvation produced significant increases in depression, hysteria and hypochondriasis, and most participants experienced periods of severe emotional distress and depression and grew increasingly irritable. It really should not be a surprise to this audience that the brain’s functioning is highly compromised when the body is being starved of food (and nutrients). What we wonder is whether eating a diet of primarily highly processed foods low in nutrients has similar effects.

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.

Is "co-production" public service citizen involvement? Is it individual, ‘responsibilised’ health and social care consumerism? Is it power shifting to communities through participatory governance? Perhaps it’s the ultimate post-modern policy concept. But can it work for mental health?

Twenty-five years before Prozac, 1 in 10,000 of us per year was admitted for severe depressive disorder - melancholia. Today at any one point in time 1 in 10 of us are supposedly depressed and between 1 in 2 and 1 in 5 of us will be depressed over a lifetime. Around 1 in 10 pregnant women are on an antidepressant.

Conflict is a pervasive human phenomenon that is at the heart of much distress and misery. Unfortunately, it is also seldom recognised; obscured by categories of disorder spelled out in systems such as the DSM, or brushed aside by other, fancier (but less accurate) ways of describing psychological turmoil and discontent. The source of psychological distress is not an ill, a disordered, or a dysfunctional mind but a conflicted one.

Delegates attending the International Congress of the Royal College of Psychiatrists at London’s Barbican Centre in June this year will almost certainly not hear about the results of the seven-year outcome of the Dutch First Episode (FE) study widely discussed on Mad in America in recent months.

On 6 January 2014, I published the article “Psychiatry Gone Astray” in a major Danish newspaper (Politiken), which started an important debate about the use and abuse of psychiatric drugs. Numerous articles followed, some written by psychiatrists who agreed with my views. For more than a month, there wasn’t a single day without discussion of these issues on radio, TV or in newspapers, and there were also debates at departments of psychiatry. People in Norway and Sweden have thanked me for having started the discussion, saying that it’s impossible to have such public debates about psychiatry in their country, and I have received hundreds of emails from patients that have confirmed with their own stories that what I wrote in my article is true.

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.

In the last few years I’ve developed a sincere admiration for those youth workers who specialise in working with young people pushed out onto the edge of society. I’ve witnessed, first hand, the ease with which they can broach topics that would leave many of us feeling uncomfortable. The best of them can speak about sex, violence, drugs and exploitation in a real and pragmatic way that signals a deep acceptance and understanding of the dilemmas young people face – with no blame or judgement. This ability to transform the taboo into the ordinary is something I’ve tried to develop in my own work. Through Voice Collective, a project supporting children and young people who hear voices in London, I specialise in training youth workers to do the one thing that can push them far outside of their comfort zone – talking with young people about hearing voices.

In 1972, prisoners at Holmesburg Prison in Philadelphia were paid $3 to have their eyes held open with clamps and hooks while Johnson & Johnson's baby shampoo was dropped into them. In 2011, mothers of newborns were arrested when their babies tested positive for exposure to cannabis, a false result caused by the use of Johnson & Johnson’s Head-to-Toe Foaming Baby Wash. Young men have undergone mastectomies to remove breasts grown as a result of Johnson & Johnson antipsychotics, which were used as a result of Johnson & Johnson's criminal promotion of its drugs for off-label purposes. And now, Johnson & Johnson has announced the removal of carcinogenic chemicals from their No More Tears baby shampoo.

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.