Foreign Correspondents

My son is dead. He hanged himself at 17 but meh… whatever… that’s yesterday’s news and I’m totally over it now. I don’t long for...

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.

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.

Would you accept money "with no strings attached" from a robber who, in the act of stealing, happened to kill some of his victims? Would you accept money that has been stolen? Would you accept sponsorships from tobacco companies for a meeting about lung diseases? Few doctors would. Why is it then that most doctors willingly accept sponsorships from drug companies that have earned much of their money illegally while being fully aware that their criminal activities have killed thousands of patients, the very people whose interests doctors are supposed to take care of?

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.

When the idea that selective serotonin re-uptake inhibitors (SSRIs) might make people feel suicidal first started to be discussed, I admit I was sceptical. It didn’t seem to me the drugs had much effect at all, and I couldn’t understand how a chemical substance could produce a specific thought. Because these effects did not show up in randomised controlled trials, they were dismissed and few efforts were made to study them properly. Then some large meta-analyses started to find an association between the use of modern antidepressants and suicidal thoughts and actions, especially in children.

‘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.

I want to follow up my first post by outlining the principles of possible alternatives to psychiatric diagnosis – that is, alternatives in addition to the most obvious one, which is simply to stop diagnosing people.

If we call someone mentally ill, in some ways we may be recognising their predicament as a powerful one, and their need for support. However, we may also be judging their state of mind as faulty. But what if what seems a faulty mind is much more than that? We can go deeper than trying to say what is wrong with someone, how ill they are, or what category they fit into. We can instead ask: How do parts of them feel? What might different parts of them need? And what are the contexts in which these experiences have emerged?

When a pharmaceutical company discovers a potential new drug, they undertake a mammoth project. The aim is to amass sufficient evidence that national organizations such as the FDA will approve sale of the drug, and the type of disorders for which it can be openly prescribed – the so-called “on-label” uses. In order to encourage companies to undertake this risk, governments place a pot of gold at the end of the rainbow.

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’.

In a bold and unprecedented move for any professional body, the UK Division of Clinical Psychology, a sub-division of the British Psychological Society, issued a Position Statement today calling for the end of the unevidenced biomedical model implied by psychiatric diagnosis. In brief, the argument is that the so-called ‘functional’ diagnoses – schizophrenia, bipolar disorder, personality disorder, ADHD and so on - are not scientifically valid categories and are often damaging in practice.

I had an epiphany the day I first saw my son in a coffin after his suicide. The moments following his hanging himself were...

Doctors in the 1950s and 1960s made psychiatric diagnoses on orphaned children that led to treatment with antipsychotic drugs, and one of the drivers of this seemed to be that the Church got more money from the State as a result. The doctors, of course, also got paid. This feels like a seriously corrupt nexus operating with near impunity on the basis that no one is going to be bothered to investigate the fate of some orphans.

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.

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.

Being an ex-accountant I am always interested in figures (not to mention that prescribed benzodiazepine drug addiction has played such a major part in my life). According to a yearly booklet released by the Home Office in the UK, benzodiazepine drugs accounted for more deaths than ALL the so-called hard drugs put together.

I believe if the public really knew and understood the reason why we who have survived medically-induced harm, and who do not have the human right to — with real evidence — legally expose this, they would support psychiatric survivors and help us to put an end to what has been called ‘the tyranny of good will.’

Sometimes regarded as “treatment,” psychiatric bullying and harassment can no longer be considered as such. During the past two decades, the often devastating effects of psychiatric bullying and harassment have evidenced themselves on the wellbeing of consumers, and the climate of mental health facilities.The advent of mandatory anti-bullying policies in schools and workplaces has shifted thinking towards an acceptance that bullying occurs, causes harm and should not be tolerated. Could the development of anti-psychiatric bullying policies in mental health institutions make psychiatric abuse visible and create a zero tolerance culture?

Health systems are extremely hierarchical and, rather than empathy, the dominant approach to people's difficulties is based on top-down management practices which assume experts know what is best for people. I am hopeful that we can help people within the mental health system and other parts of society to strengthen their empathic ways of relating. However, I've noticed how easy it is for me to get self-righteous about mental health workers who are more 'medical' or 'expert-lead' in their approach. I realise that if I really want to help change things for the better I, too, will need to understand people who seem to be my opponents.

Faced with questions about the $3 Billion fine imposed on GSK – is it just the cost of doing business? - Andrew Witty snapped back: “Although corporate malfeasance cases end up looking very big, they often have their origin in just… one or two people who didn’t quite do the right thing. It’s not about the big piece. The 100,000 people who work for GSK are just like you, right? I’m sure everybody who reads the BMJ has friends who work for drug companies. They’re normal people… Many of them are doctors."

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.

"From years of personal and professional experience, I must tell you my biggest fear is that we’re massively misunderstanding the emotional and mental suffering of children and teens. We’ve taken their feelings, thoughts and suffering and transformed them into symptoms, diagnoses, reductive theories and then prescribing them an array of psychiatric drugs with dire short- and long-term consequences. We’re drugging their emotions, their thinking and their quest for meaning into disabling silence."

We have come to believe that technology can eradicate all human suffering and provide unblemished and everlasting happiness. We have paid for this irrational expectation with our autonomy, our dignity and our ability to endure.

Right now in Britain there is a controversy shaping up between the commercial and financial interests of big managed-care corporations and the need to care for vulnerable people in the community, people with conditions like dementia and long-term psychoses. Conflicts of interest are nothing new in the contested field of mental health, but this one threatens not only quality of care, but the well-being of low paid workers, mainly women, who are employed as support workers.