Foreign Correspondents

On Monday night, Irish television screened a documentary covering the events leading to the self inflicted death of Shane Clancy & the other young man he killed. In the documentary, psychiatrist Professor Patricia Casey is quoted as saying that she does not believe the SSRI Shane was taking played any role in the killings and that in her opinion they were caused by an undiagnosed psychiatric illness. Professor Casey did not meet Shane when he was alive. She has never spoken to his family, does not have access to his medical records or family history and has not spoken to his doctor.

I was recently surfing the internet and came across an Etsy ad selling a lobotomy tool set - hammer and orbitoclast. I was tempted to make the purchase and indulge my penchant for this historical “apparatus” especially given its rise as heroic therapeutic intervention for three decades. It was a mere $168.00. Although I didn’t buy the historical torture device, that ad left me with one penetrating realization: psychiatry is here to stay.

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.

Dr Paul Offit, chief of the Division of Infectious Diseases and Director of the Vaccine Education Center at Children’s Hospital in Philadelphia, recently published a book called: “Killing Us Softly: The sense and nonsense of alternative medicine.” It also goes under the title: “Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine” The book presents some evidence on alternative medicines like homeopathy, Chinese herbs, chiropractic adjustments and, of greatest interest to us, the evidence for and against nutrient supplements for the treatment of illness.

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?

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.

People have used psychoactive substances to dull and deaden pain, misery and suffering since time immemorial, but only recently, in the last few decades, have people been persuaded that what they are doing in this situation is rightly thought of as taking a remedy for an underlying disease. The spread of the use of prescription drugs has gone hand in hand with the increasing medicalization of everyday life, and a corresponding loss of the previous relationship that people had with psychoactive substances.

If antidepressants are effective, and people with depression are more likely to be prescribed them, then you would expect the consequences of depression to start to lessen. One of those consequences, according to government statistics, is being out of work. But what we see is quite the opposite: Increasing use of antidepressants correlates with increased numbers of people with depression who are out of work and claiming benefits, and increasingly on a long-term basis. And this is at a time when disability due to other medical conditions has fallen.

It’s funny how things turn out. I would never have anticipated becoming interested in the way in which psychological treatment is provided to people. A benign comment by a manager at the beginning of my clinical psychology career, however, piqued my interest and things have never been the same since.

‘I Don’t Believe in God, But I Believe in Lithium’ is the title of Jamie Lowe’s moving account of her manic depression in the New York Times. The piece reminds us how devastating and frightening this condition can be, so it is understandable that the author put her faith in the miracle cure psychiatrists have been recommending since the 1950s: lithium. The main problem is that there is no study in which people who have been started on lithium have been compared with people who haven’t.

In an era of prescribing rights for psychologists will psychology become a more marketable, less tarnished version of psychiatry, a target for pharma marketing and a new distribution channel for psychotropic drugs?

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.

What if your doctor told you about data collected on antidepressants AFTER they had been released on the market. New Zealand data that shows aggression and death are as common as dizziness in reports from doctors about adverse reactions to antidepressants. That suicidal ideation and suicide attempt are as common as insomnia. Imagine you were told that while being exposed to these risks, the data showed that the most likely adverse reaction you would experience would be that the drug didn't work or stopped working. How might your decision on this particular treatment option be affected?

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.

Of all the beliefs that I have had about my experiences, the belief that I was ‘schizophrenic’ was the most damaging. In adopting the story that others told about me, and abandoning my own sense-making process, I held on to a belief that both hid my traumatic life experiences and rendered them irrelevant. Does it matter if we sometimes slip into the language of illness when we all agree that these experiences are meaningful, personal and have value? Yes. It does.

In a recent blog, we talked about the fact that nutrition and poverty are linked, and how poor nutrition is likely a mediator variable in the relationship between poverty and illness. In other words, it is the suboptimal nutrition associated with low income which likely explains much of the vulnerability to mental and physical illness. Today we want to tell you about an amazing American program that is making great strides in addressing this issue.

This shorter-than-usual contribution signifies a departure from my earlier blogs. It is the first in an occasional series that uses semi-fictional clinical narratives to examine some of the difficulties that face people who use psychiatric services in England, and the psychiatrists and other mental health professionals who work in them.

From 1951, a system designed for heroin and cocaine addicts – prescription-only status – was applied to all new drugs. Why? These were after all the first truly effective drugs in medicine. But the ability to do good came with a likelihood of doing harm. There was a trade-off to be made between risks and benefits. The new complex trade-offs could not be put on to the label of a drug or even captured in a forty page package insert. They needed to be individual to each person.

We want to start an international initiative to promote the writing of recovery stories in every country, with the ultimate goal of sharing at an international level the most compelling ones from each country. Our proposal is born from an awareness that recovery stories are necessary today in order to give back to mental sufferance its meaning and transparency, to fight the biographical opacity of biological theories (the broken brain) and to guarantee decisional power to those who are offered (or imposed) mono-dimensional or dehumanizing treatments.

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.

Over the last decade, people have commonly made statements to me of the ilk — “What bugs me about antipsychiatry people is they only care about tearing down; there is no commitment to actually helping people” — Which suggests that there is a serious dearth of awareness about antipsychiatry.

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.

Those of us who question psychiatry’s relationship with medication may be be dismissed as ‘Pill Shamers’ or branded as irresponsible and dangerous voices by those who are convinced medication is the only way of treating someone’s ‘illness’. The debate can feel like a fight between two intractably opposed sides, giving the impression that we must either be ‘for’ or ‘against’ medication. Unfortunately the information and space needed to explore our complex relationship with medication – as practitioners and people – is in short supply, making the concept of informed choice a bad joke. Over the next two years, we will bring together a book made of contributions from people who have successfully taken control of their use of medication.

The marketing departments of pharmaceutical companies focus in on the ring-bearers just as the Eye of Sauron focused in on Gollum and later Frodo. Once the Eye fixes on a ring-bearer, it hypnotizes him into submission. If any demur, it directs its Black Riders (Medical Academics) to enforce compliance with its Will.

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.