Foreign Correspondents

Subscribers to Mad in America might be interested in a Keynote Lecture given by Professor Nikolas Rose in Nottingham on May 15th 2013. In this lecture Professor Rose very thoughtfully challenges a number of the assumptions which underpin conventional and contemporary psychiatric practice. He asks five hard questions:

• Is there (really) an epidemic of mental illness?
• Does the path to understanding mental disorder lie through the brain?
• What is the role of diagnosis and of diagnostic manuals?
• Should we seek early identification of those at risk of future mental pathology?
• What is the place of patients, users, survivors, & consumers of mental health systems?

Patient engagement is one of the mantras of current healthcare improvement efforts. Medical students and junior doctors likely think they are doing it better than their elders ever did. They are after all taught communication skills, where an earlier generation wasn’t. In fact, they are taught that they are being taught communication skills. They are taught how to communicate bad news. They are not taught how to hear awkward or bad news. The younger generation are almost certainly worse than former generations of doctors at listening for or actually hearing “the treatment you put me on, doctor, has made me worse.”

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.

In 2007 I returned to school to pursue a bachelor’s degree in psychology. I remember being confused by the over-emphasis on biological treatments for suffering which seemed to me much more spiritual and relational in nature. A few years earlier, my misgivings had been stirred as I sat on a California beach listening to a friend tell me about what it was like to be on Prozac. She told me that she couldn’t really cry anymore, or connect to her deeper feelings. She couldn’t orgasm. I recall my throat closing up, my thoughts running panicky and confused. I was so disturbed by the power of this drug to rob her of her tears and climaxes, experiences I associated with the more private, sacred parts of being human.

The decision by the Institute of Psychiatry, Britain's leading centre for psychiatric research, to invite disgraced Professor Charles Nemeroff to speak at the inaugural lecture of the Institute's new Centre for Affective Disorders has caused a great deal of controversy, news that was recently featured on Mad in America. In the latest development members of the Critical Psychiatry Network in UK have written an open letter to Professor Pariantes, the Director of the new Centre for Affective Disorders, requesting that he cancel Nemeroff's invitation.

It has been a good time to bury controversy. With all eyes on Washington and the fallout from the publication of DSM-5, over here in England the Institute of Psychiatry has been discretely sending out invitations to a lecture. This is not a public lecture; it is by invitation only. And who is the esteemed guest? None other than Professor Charles Nemeroff M.D., Ph.D.

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.

The Critical Psychiatry Network is concerned with the way the controversy over the publication of DSM-5 is being portrayed in the media and by some academic psychiatrists. The issues raised by the DSM are complex and require careful and studied consideration. There are two aspects in particular that concern us. These relate to the portrayal of the controversy as a guild dispute, and the polarisation of the debate as one of nurture versus nature.

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.

The recent furore surrounding publication of the new DSM has provided a much-needed opportunity to discuss and debate crucial issues about how we make sense of, and respond to, experiences of madness and distress. Many psychiatrists, psychologists and other mental health professionals have expressed their dismay about the dominance and inadequacy of a biomedical model of mental illness. Whilst we share these concerns, welcome these debates and support colleagues that are willing to take a stand, The Hearing Voices Network believes that people with lived experience of diagnosis must be at the heart of any discussions about alternatives to the current system.

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 believe the video ‘Voices Matter’ has, quite apart from capturing the spirit of the Hearing Voices movement, filmed the first signs, the first moments of professional interest, hinting at the dangers that inevitably are present when a movement threatens the established order of things.

The decision by the National Institute of Mental Health to part company with the APA’s forthcoming DSM-5 should not be taken as evidence that biological psychiatry is entering a terminal decline. Far from it, as the Director of NIMH Thomas Insel’s blog of 29th April 2013 makes clear, the reason NIMH has opted for its own Research Diagnostic Criteria (RDoC) is because they believe psychiatric patients deserve something better.

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."

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.

The Hearing Voices movement is a beautiful thing, and last year it was 25 years old. What has happened in 25 years? A confidence has grown in a different approach to hearing voices, listening and embracing rather than trying to control and silence voices. Key to this has been Hearing Voices groups and conferences, where people who hear voices are listened to with openness and curiosity. It’s not about telling people who hear voices to throw away their pills if they are taking them, its about creating spaces to listen deeply to what is happening.

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.

The norm in science is that there is free access to the data underpinning experiments. If free access is denied; it’s not science. In the case of branded pharmaceuticals, we do not even know what trials have been done. What is put in the public domain is not data. The selected highlights of a football game and the comments of the pundits afterwards don't change the score. The selected highlights of pharma studies and the comments of pundits routinely change the score.

At the 50th American Psychosomatic Society meeting in New York, Michael Shepherd was speaking. His topic - The Placebo. When the lecture finished, Lou Lasagna said "this paper is now open for questions." Nothing happened. Nobody said anything at all. Lasagna couldn't refrain from commenting: "There are 3 possible explanations. First, you were all asleep and therefore you heard nothing. Secondly, it was so bad that since this speaker has come 3,000 miles you didn't want to embarrass him. Third, it is genuinely so original and new that you don't quite know what to make of it. I'll leave you to decide which it was". What had Shepherd said?

Tension mounts across the ideological divide as D-Day (DSM-5 Day) approaches. The APA has powerful allies on its side. President Obama has just launched Decade of the Brain 2 with the announcement two weeks ago that heralds the arrival of BRAIN ( Brain Research through Advances in Innovative Neurotechnologies). If that’s not enough, those who believe that science will ultimately explain madness can always rely on the media to fawn at their feet.

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.

I hope this will be of help to people who hear voices and their friends and supporters. I also hope it will be helpful to the voices which are parts of many people's lives. Many voices I have come across and the people that hear them are convinced that their voices are spiritual in nature. I take an agnostic position on this, and therefore endeavour to respect different spiritual understandings. My intention is not to explain all voices psychologically but to help people make peace with their voices so they can get on with their lives.

The invitation from the London Review of Books to review Ben Goldacre’s Bad Pharma™ reads: “We were unsure, at first, what a review could add that isn’t already in the book – scrappy summaries and bits of praise are not for us. The book is of sufficient importance that the main thing is to get someone who knows what they’re talking about to present the material confidently... frame the discussion”. My head said it was inconceivable that the LRB wouldn’t take a review, even if it was at odds with the invitation to praise Bad Pharma. But my gut told me the inconceivable was about to take flesh.

The International DSM-5 Response Committee, sponsored by Division 32 of the American Psychological Association — the Society for Humanistic Psychology — now has an online petition against the DSM-5.  This is a truly international effort. Please support the petition by signing it at http://dsm5response.com

A Colorado based company, Sundance Diagnostics, contacted me a few months ago to tell me about work they are doing to develop a genetic test to predict suicide risk when patients are prescribed antidepressant drugs. Their plan is to sequence the entire human genome of about 360 patients and controls to see if antidepressant drug risk can definitively be predicted.