Foreign Correspondents

On the 7th of November, Robert Whitaker was here in Copenhagen to officially launch the Danish translation of his book, . While we were celebrating the day, in another part of Denmark, psychiatry was preparing its attack. A professor of psychiatry Poul Videbech, one of our finest, specializing in depression with a particular emphasis on electroshock, was busy writing a review. The title of his review is “The Boy Has No Clothes On” and as you can imagine with such a title, the review is hardly going to be favorable, indeed it smacks of condescending paternalism framing the well-worn scenario for establishing psychiatric supremacy.

Julia has received a lot of media attention in the last few days as a result of her blinded RCT published in a prominent journal, the British Journal of Psychiatry, showing that micronutrients were better than placebo at improving ADHD and mood symptoms in adults. But what interests us far more is the amount of public emails we get as a result of this work. And the theme running through almost every email is that the child/adult/husband/wife has tried all kinds of medications and the symptoms are still there and, often, getting worse. Could the micronutrients help?

In the New York Times’ recent autobiographical account of a “bipolar” woman’s struggle the main message is that the current mental health care system has some real problems but that the general paradigm from which this treatment model has emerged is not to be questioned. Anyone who knows my work knows that I have a real problem with this paradigm, believing that it generally causes much more harm than benefit. So, what is it then about this story that grabbed me? I recognized that if we read Linda’s story while holding a different paradigm, then this story reveals what I believe are some of the most fundamental issues at the heart of this epidemic of “mental illness” that so pervades our society.

Prescription drugs like antidepressants, antipsychotics and so-called ‘mood stabilisers’ are widely promoted as good for your health. But the history of prescription and recreational drug use is more intimately intertwined than most people recognise. Attempts to disentangle the two have created a false dichotomy – with prescription drugs, at least some of them, set up as the ‘angels’ that can do no wrong, and recreational drugs cast as the ‘demons’.

I think I have underestimated just how hard it can be for people to approach mental health problems from a psychological and social perspective. The longer I work with people who are experiencing severe psychological distress, the more they teach me about the difficulties involved in breaking away from an “illness” mindset. Medications, by and large, are still the mainstay of helping people with psychological troubles despite an increasingly widespread acceptance that psychological problems are not medical problems. Mental illness is an “illness” only in the same way that love-sickness is an illness.

This column is partly a report on the marketing of Abilify, the atypical antipsychotic that has become America’s best-selling drug.   It’s also an appeal for advice and feedback from the RxISK and Mad in America communities, and a call for some brainstorming about strategy.  The plans laid out by drugmakers Otsuka and Lundbeck for Abilify’s future, and the cooperation they’re getting from leading universities, are alarming enough to me that reporting on them seems inadequate.  We need action, although I’m not sure exactly what kind.

Stephen Fry’s exploration of manic depression (in the current BBC series on mental health, ‘In the Mind‘) has drawn both praise (because of his attempts to destigmatize mental illness) and criticism (because he appears to have a very narrow biomedical understanding of mental illness).  I have sent an open letter to the actor which challenges some of his assumptions about mental illness, and offers a very different understanding to that promoted in his recent television programme.

This has got to stop. Around the world a million people die from suicide each year and the response internationally is to pour more funding and channel more people into psychiatric services. Three large studies have now found that the more we spend on mental health services the higher our suicide rates. In addition, a recent study has completely discredited claims that 90% of those who die from suicide are mentally ill at the time of their death. We need to use this evidence to stop the expansion of psychiatry as a suicide prevention measure.

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).

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?

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.

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.

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.

‘Diagnosing’ someone with a devastating label such as ‘schizophrenia’ or ‘personality disorder’ is one of the most damaging things one human being can do to another. Re-defining someone’s reality for them is the most insidious and the most devastating form of power we can use. It may be done with the best of intentions, but it is wrong - scientifically, professionally, and ethically. The DSM debate presents us with a unique opportunity to put some of this right, by working with service users towards a more helpful understanding of how and why they come to experience extreme forms of emotional distress.

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.

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.

Often it is a relief to get an understanding of how we have developed a psychological problem, and it is especially good if we can feel that there is a reason for the problem that it is understandable. When I suffered from a phobia, it was a relief to understand that I probably had linked fear to an insect when I was a child. And it was even more satisfying when I understood that there was nothing wrong with my brain — that the problem was in what I had experienced. It was in my “software.”

In my last post, I argued that the single most damaging effect of psychiatric diagnosis is loss of meaning. By ruthlessly divesting experiences of their personal, social and cultural significance, diagnosis turns ‘people with problems’ into ‘patients with illnesses.’ Horrifying stories of trauma, abuse, discrimination and deprivation are sealed off behind a pseudo-medical label as the individual is launched on what is often a lifelong journey of disability, exclusion and despair.

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.

As I see it this website is about filling the gaping hole in the official literature on mental health problems and their treatment. Since these problems were declared to be diseases, ‘just like any other’, academic papers present them as if they were simply technical glitches in the way the brain or mind works. They can be identified by ticking a few boxes, and easily treated by tweaking the corresponding defect with a drug or a few sessions of quick-fix therapy. What it is like to experience these problems and their treatments is nowhere to be found. Yet in post after post on this site among others, we hear about the harm produced by drugs that are prescribed for mental health problems.

This series of blogs outlines a scandal that brings out the limitations of RCTs and evidence based medicine. Here are the first four installments, with two more to come shortly.

Over the years of my explorations into psychosis and human evolution a very interesting irony became increasingly apparent. It is well-known that people who fall into those deeply transformative and chaotic states typically referred to as “psychosis” often feel, at different points throughout their journeys, that they have received a special calling to save the world, or at least the human race. Indeed, this experience played a particularly prominent role in my own extreme states, as well as within those of at least two of my own family members. From a pathological perspective, this is often referred to as a kind of “delusion of grandeur,” though in my own research and writing, I have come to feel that the term “heroic (or messianic) striving” is generally more accurate and helpful.

Around the world, drug regulatory agencies spend billions of dollars engaged in activities which purport to ensure the safety, efficacy and quality of legal drugs. If the goal of regulation is to protect public health and safety, there can be no argument that it has failed. Safe drugs are not associated with annual rises in mortality and morbidity, effective drugs are not associated with increased prevalence of the conditions they are designed to treat and with greater chronicity of those conditions, quality drugs are not discovered to be contaminated with solvents months after their manufacture and release to the market. Effective regulation does not see companies repeatedly breaching standards and shrugging off sanctions.

Today is the fourth anniversary of the suicide of my only child. Supporting someone dealing with the grief of losing a child to suicide can be challenging. For all those who have been hurt by well-intentioned comments or interventions, I want to offer the following suggestions to friends, family and helping professionals.

In the 1950s, when the drugs we now call ‘antipsychotics’ first came along, psychiatrists recognised that they were toxic substances that happened to have the ability to suppress thoughts and emotions without simply putting people to sleep in the way the old sedatives did. The mental restriction the drugs produced was noted to be part of a general state of physical and mental inhibition that at extremes resembled Parkinson’s disease. Early psychiatrists didn’t doubt that this state of neurological suppression was potentially damaging to the brain.