Foreign Correspondents

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.

Several of us involved in RxISK.org monitor other groups setting up to offer information on medicines. Some of these, like eHealthMe, offer useful information. As ever, though, pharmaceutical companies are in there early. The Brintellix website is a masterclass in how to appear patient-centered, and patient-friendly. How to move with the times and make the new way of doing things yours.

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.

I really valued the massive Melbourne Hearing Voices conference last week. The theme of reconciliation between voice hearers and mental health workers was a powerful one. This emphasis on creating understanding conversations at the conference was encouraged with dialogues between people on specific subjects - medication, spirituality, psychological approaches to voices etc. - rather than keynotes. It seemed a move away from presentations of competing knowledges, toward a more dialogical conference; a respectful exchange of different viewpoints, feelings and values. When you have a range of views in a presentation it’s less easy to adopt a “good guys vs. bad guys” mentality; you start to see the complexities in more relief. The surprise for me was that I liked it.

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.

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.

There are some things to applaud about the recently released update of the NICE bipolar guidelines, not least the recognition that the diagnosis has been inappropriately applied to children with behavioural problems. Hopefully this will help curtail the worrying trend of using toxic bipolar drugs in this age group. As usual, however, the Guidelines overlook glaring problems with the evidence base for drug treatment in general, and miss an opportunity to stem the diagnostic creep that has come to the UK and Europe via the United States.

In 2012, I found out that the ten biggest drug companies in the world commit repeated and serious crimes to such a degree that they fulfill the criteria for organised crime under US law. I also found out how huge the consequences of the crimes are. They involve colossal thefts of public monies and they contribute substantially to the fact that our drugs are the third leading cause of death after heart disease and cancer.

ADHD (or “Attention Deficit Disorder” - with or without Hyperactivity) is not among the “cutting-edge pathologies” of contemporary clinical practice, such as the addictions, eating disorders, narcissistic disorders, chronic fatigue syndrome, or fibromyalgia; however, in my view ADHD is paradigmatic of the contemporary ethos that some have described as hypermodernity. The advocates of ADHD explain to us that a hyperactive child with an attention disorder is a disturbed and often disturbing child, who does not comply with the adults’ rule, often has his own idea of development, and whose problems, unless they are treated, threaten to undermine his autonomy and self-esteem; the two supreme values of the hypermodern society.

As Michael Fontaine's recent piece illustrates, history has a great deal to teach us about the nature of this complex thing called madness and how we, as a society, might respond to it better. It is not only fascinating to know that modern debates about the nature of ‘mental illness’ are reflected in ancient teachings, we can learn much from seeing the issues aired in a radically different social and historical context.

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.

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.

I want to tell you about a magical tool I use particularly for navigating challenging situations. It's called Non violent communication (NVC). It's a way of understanding and communicating that I've found particularly useful in situations of conflict. I've hyped it up in the first sentence as a magical tool but like all useful things, it's got its limitations too. I guess the key is how and when to use it. So what am I talking about?

A report on antidepressant consumption released on 18 February 2014 by the OECD shows huge increases in prescribing of the drugs across most countries. According to the report a key factor driving this increase is the expansion of the off label use of the drugs for a vastly increased number of indications. While this may not seem like news, I think it warrants some analysis because I think what we are seeing is something more complex than simple market expansion.

The fundamental stance of bio-medical psychiatry remains unchanged since my grandfather’s time – “mentally ill” people managed like stock portfolios, reduced to diseased brains and bundles of genes and biochemicals that can be quantified, manipulated and cured “scientifically” by bio-tech and surgical interventions. Magic bullets as magical thinking.

Ever since I read Mad in America and later Anatomy of an Epidemic by Robert Whitaker, I have been wondering how to spread this knowledge to the masses and how to do this in a way that will make a difference to as many people as possible.

On several occasions I have written about the complexities of antipsychiatry politics, exploring more specifically, how to “do our politics” in a way that moves society squarely in the direction of the abolitionist goal. In this article, I am once again theorizing the “how” of activism—for understanding this territory is critical to maximizing effectiveness. However, this time round, I am approaching it from an angle at once more general and more practical. That is, I am investigating the tools or approaches at our disposal as activists.

Three weeks ago What would Batman do Now covered the issue of suicide in the military – an issue that had Batman missing in action, and...

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.

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.

One of the main arguments for continuing drug treatment for depression, psychosis and bipolar disorder is that you will get worse from stopping the drugs, especially if they are stopped abruptly. These are findings from mainstream psychiatry. However, if we combine this information with the methodology of the randomized controlled trial, we may see that these drug trials do not show efficacy of drugs, and may not be usable to show safety. The positive side to this is that the trials may actually demonstrate the healing power of our own minds.

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.

More than a year on from the release of DSM-5, a Medscape survey found that just under half of clinicians had switched to using the new manual. Most non-users cited practical reasons, typically explaining that the health care system where they work has not yet changed over to the DSM-5. Many, however, said that they had concerns about the reliability of the DSM, which at least partially accounted for their non-use. Throughout the controversies that surrounded the development and launch of the DSM-5 reliability has been a contested issue: the APA has insisted that the DSM-5 is very reliable, others have expressed doubts. Here I reconsider the issues: What is reliability? Does it matter? What did the DSM-5 field trials show?

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?

The Movement for Global Mental Health's objective is to ensure that people living in low- and middle-income countries have access to the best and most effective modern psychiatric drugs and therapies. In pursuing these objectives it assumes that to do so is a neutral project beyond political concerns. China Mills’ book Decolonizing Global Mental Health challenges this view.