Foreign Correspondents

Recently, two more waves of criticism have broken onto the beach of opinion concerning mental health services and practice. Allen Frances has mourned approval of DSM-5 in his Psychology Today blog and the British Journal of Psychiatry has published a paper by members of the UK Critical Psychiatry Network. What is notable about both of these is that they give further voice to criticism of conventional mental health services by those who have spent years providing and researching them.

Those of you following our posts on Nutrition and Mental Health know that we ended the last one, on ‘history’, by saying that the two of us are essentially devoting our research lives to re-inventing the wheel. It is old knowledge that good nutrition is essential for mental health, and it is really old knowledge that improving nutrition can improve mental health. We are going to spend the next few blogs outlining the science and rationale that supports the role played by nutrition in wellness as well as the expression of mental illness. This information will provide modern scientific validation for the conclusions drawn by some of our ancestors, described in the previous blogs.

In the film Avatar, scientists are keen to exploit the moon planet Pandora which is inhabited by 10-foot-tall blue humanoids called Na'vi.  To do so they create Na'vi human hybrids called “Avatars” which are controlled from afar by genetically matched humans. When the scientists decide to destroy the eco-system of the planet to gain access to valuable minerals, war breaks out between the humans and the Na'vi. At this point the main character, Jake, who operates an Avatar, has to choose whose side he is on.  Eventually Jake's life is saved and transformed by the Tree of Souls, which the humans are trying to destroy. Why are Avatars in the news again? The latest innovation from psychiatric research is using computer-generated avatars to help people who hear aggressive voices.

What does the new DSM-5 have in common with an Alfred Hitchcock mystery?  They both use a plot device, a “MacGuffin,” to drive the story. Hitchcock explained a MacGuffin as on the one hand “ridiculous”, “non-existent”, “empty” and inherently without meaning, and at the same time the central point around which the entire story turns.  Which narratives, and whose, are served by the "diagnosis MacGuffin”? Are there more socially desirable alternatives to replace this particular plot vehicle? 

Following Richard Bentall’s inspired Open Letter to Stephen Fry, we – a group of people who have (and still do) use mental health services, who work in mental health, or who work as academics... or fall into more than one of those categories – have decided to write a parallel Open Letter to the BBC and other media organizations about their coverage of mental health issues. We need as many signatures as possible!

In Belgium, patients with mental health problems mostly receive drug treatment despite the emphasis in international guidelines on the importance of psychological approaches. Currently one in ten Belgians takes antidepressants. That makes Belgium the European leader when it comes to antidepressant prescriptions and costs our country 300 million euros annually. This has been a glaring concern for our Minister of Health. From January 1, 2016, all psychologists and psychotherapists in Belgium will need to register in an official list. This should slash the number of unqualified therapists and help more Belgians stay off antidepressants.

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...

Most people reading this blog will have heard or read the quotation attributed to Hippocrates: “Let food be thy medicine, and medicine be thy food.” Whether or not this ancient Greek physician actually made that comment 2500 years ago is something that we cannot determine. But it certainly is a statement that is coming back into favor in the current era.

At a time when psychiatrists are considering whether suicidal behavior constitutes a disorder rather than a symptom, there is strong evidence that physicians have far higher rates of suicide than the general population, with psychiatrists found to be at the highest risk of suicide. In light of this information, you may be asking yourself, as I am, whether it would be wise to conduct a brief mental state examination of any physician we consult (particularly any psychiatrist) as a way of ensuring our physical and emotional safety? To this end I have prepared a quick diagnostic test that you may carry in your pocket or purse for easy administration next time you are visiting a health professional.

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.

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.

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.

For several decades, since the days when I was a patient, I have seen and heard how an obsession with questions damages psychiatry. Many of us have been asked the same questions day after day, year after year: ‘Do your thoughts seem faster than normal?’, ‘Do you ever have thoughts in your mind which are not your own?’, ‘Do you feel anxious?’, and so on. Hearing only what a patient says under questioning when frozen by paralysis, or subject to the hyper-arousal of anxiety, the professional misses the opportunity to hear the threads of something new, the possibility of weaving with the patient a narrative of hope and recovery.

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.

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.

In 2009, my friend Leonie’s 22-year-old son Shane killed himself and another young man after taking Citalopram for 17 days. Eighteen days after Shane’s death, Psychiatrist Dr Michael Corry publicly stated his view that he could not have done what he did had he not been on Citalopram. Initially Leonie admits to thinking he was mad. How could medicine prescribed by a doctor have anything to do with what had happened to her son?

In the 40 years since I was wrongly - and catastrophically - "diagnosed" and "treated," I've seen one after another announcement of supposed "progress" in the "science" of understanding and treating "mental illness" come and go — first trumpeted, then with nary a mention, failing to hold their ground and falling away to the mists of time along with the people and the lives they'd ruined. People will continue to suffer and die if the public do not wake up and have the courage to act as a caring community, and stop regarding human problems as "diseases" to be "cured," rather than as challenges that we share.

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.

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.”

It was May 19, 2003, in San Francisco; the first-ever (we think) symposium on micronutrient treatment to be on the schedule for the annual meeting of the American Psychiatric Association. There was moderate interest. This year, the two of us (both psychologists) presented many, many studies on the use of micronutrients to treat anxiety, stress, depressive symptoms, ADHD, aggression, mood, and addictions. The amount of data differed dramatically from 12 years ago, but the biggest difference was the response from psychiatrists!

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.

In our last blog, we focused on the fact that nutrient supplementation has not only been accepted in the realm of physical health in the past, but it has actually been endorsed by reputable sources such as the Journal of the American Medical Association editors who published the Fairfield and Fletcher articles 11 years ago recommending that all adults take a multivitamin to reduce their risk of cardiovascular disease, cancer, and osteoporosis (note that this is completely inconsistent with very recent studies reported in the Annals of Internal Medicine --- but that’s just the way science works, using different nutrients and different methodologies, coming up with discrepant findings, until facts finally emerge).

Good Pharma is the story of the Mario Negri Institute. Mario Negri was a wealthy patron who on his death in 1960 bequeathed a large sum of money to support independent pharmaceutical research to an upcoming researcher Silvio Garattini. Garattini and Alfredo Leonardi set about building an Institute centred on the new drugs and new techniques. They continue to grow without ever having patented any of their many discoveries or concealing any of the data from experiments that didn’t work out or accommodating any of their trials to industry’s wishes.

The idea that our more distressing emotions can best be understood as symptoms of physical illnesses is a pervasive, seductive but harmful myth. It means that our present approach to helping vulnerable people in acute emotional distress is severely hampered by old-fashioned, inhumane and fundamentally unscientific ideas about the nature and origins of mental health problems. We need wholesale and radical change in how we understand mental health problems and in how we design and commission mental health services.

My name is Tristano Ajmone. I’m Italian and 42 years old. I consider myself a “psychiatric survivor” — a term by which I don’t merely mean that I’ve been through the psychiatric system and got out of it; I really mean that I’ve survived a psychiatric journey in which some of my comrades weren’t as fortunate as me, and they simply died along the way.