Foreign Correspondents

This blog is a review of Gary Greenberg's book, Manufacturing Depression: The Secret History of a Modern Disease. I wrote it originally in 2010, but it was never published. By publishing the review now, I hope it will provide a useful reflection for those who have already read Manufacturing Depression, and an incitement to read the book for those who have not.

Until recently the history of psychiatry was a neglected backwater whose murky depths were explored largely by psychiatrist. The impression conveyed by books such as Tuke’s Chapters in the History of the Insane in the British Isles, Macalpine and Hunter's Three Hundred Years of Psychiatry: 1535 - 1860, Berrios and Freemen's 150 Years of British Psychiatry 1841 - 1991, or Fuller Torrey and Miller's The Invisible Plague, is one that sees psychiatry and modern systems of mental health care as the inevitable outcome of progress through scientific thought, a (white European male-led) narrative from darkness and ignorance to enlightenment and knowledge.

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.

I’ve spent much of my professional life studying psychological aspects of mental health problems. Inevitably, this has also meant discussing the role of biology. That’s my academic day-job. But it’s not just academic for me. I’m probably not untypical of most people reading this; I can see clear examples of how my experiences may have affected my own mental health, but I can also see reasons to suspect biological, heritable, traits. As in all aspects of human behaviour, both nature and nurture are involved and they have been intimately entwined in a complex interactive dance throughout my childhood and adult life.

I read some Hegel in a reading group a few years ago and was bowled over by it. So I was excited to find a book that analyses Hegel’s ideas about the nature of madness, and wanted to review it even though it was written 20 years ago. Hegel may not have been the first to have made this point, but for me his writing brings home, more clearly than any other thinker, the intrinsically social nature of human thought and existence.

Those of you who read the New York Times may have seen its coverage of the British Psychological Society’s recent report, ‘Understanding Psychosis and Schizophrenia: Why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help.’ The report has been widely welcomed and many have seen it as a marker of how our understanding of these experiences is changing. The report has not been without its critics. We (Editor Anne Cooke and co-author Peter Kinderman) are coming to New York this month to launch the report in America.

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 BMJ states that it takes on average eight weeks from submission of an article to publication. The review process for Restoring Study 329 took a year, with a three-month review process involving six reviewers to begin with, and then a further four reviews in a four-month process, leading to a provisional acceptance in March that was withdrawn.

This is the final of four installments about the bizarre, ongoing conduct of psychiatrists at Upton House, an Eastern Health psychiatric facility in Melbourne, and the collusion with their conduct by all relevant agencies. This last installment will document the failure, so far, of the State and Federal Governments to intervene in even this most extreme and blatant example of abuse of power by psychiatry. If I, as a Professor of Clinical Psychology with 40 years clinical and research experience in this field, can be so easily dismissed/ignored by the relevant systems in Victoria, what chance do the average users of mental health services and their families have of being heard in this State?

So now we know Soderbergh’s movie Side Effects is not so Black/Noir after all – more Fifty Shades of Grey. Emily Hawkins (Rooney Mara) is put on Ablixa by her psychiatrist Jonathan Banks (Jude Law) and while on it kills her husband. She apparently murders him while sleep-walking triggered by Ablixa and sleep walking being a perfect defense against murder she is acquitted.

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 new Danish psychiatric law which has been under development for a while has just been passed by the government and is due to be implemented on 1^st June 2015. However the road to this new law, ostentatiously to improve the rights of the patients, has had an interesting history. Denmark was on its way to achieving the dubious title of European champion in the number of people subjected to physical restraints according to the European Committee for the Prevention of Torture.

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.

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.

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.

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.

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?

We find ourselves in very interesting times with regard to our understanding of mental health. We find ever more heated, passionate and polarized discussions taking place with regard to the so-called mental disorders — how or even whether to try to classify them, which factors are generally helpful in recovery vs. which factors are generally harmful, what does “mental disorder” or “mental illness” even mean, and what does “recovery” even mean. Given the way my own mind works, I find it helpful, when such conundrums appear, to try to take the issues all the way down to the most fundamental assumptions and experiences that give rise to them, and then try to reconstruct an understanding that is more conducive to meeting our needs. This discussion, then, is an attempt to do just that.

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.

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.

Pharmalot has just posted a piece - 'Controversial FDA official, Tom Laughren, retires.' This is a must read for anyone with anything to do with mental health - both the post and the comments afterwards where some have posted that they still believe the Black Box warnings on antidepressants arose because of pressure from the Church of Scientology rather than in response to the data.The post will likely seem boring to many. But the comments won't - they seethe with anger.

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.

The simple act of defining doctors or patients concerned about adverse events as “critics” is a rhetorical stroke that marginalizes concerns – makes you a one-percenter rather than one of the ninety-nine percent. The pharmaceutical market is the least free market on earth.

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.

By 2002 GlaxoSmithKline had done 3 studies in children who were depressed and described all three to FDA as negative.  As an old post on Bob Fiddaman’s blog reproduced here outlines, several years later they undertook another study in children in Japan. (Editor's note: This is a re-print, by David Healy, of a post by Bob Fiddaman)