Foreign Correspondents

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.

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?

Through the ISPS listserve, I read a blog this morning written by Thomas Insel, director of the NIMH. The way he described people I daily meet in work and in my own life created a rising pulse, so I decided to find out some more about his thoughts and practice. I am not saying that what I read on his blog is unknown to me, but still it made me wonder how on earth is it possible to invest so much money - and resources - in research which is so distant from practice, and so far away from humanistic and holistic ideas and theories.

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!

Last year I visited the United States on a Winston Churchill Travelling Fellowship to explore ‘alternative routes to mental health recovery’ and to visit a range of peer-led, alternatives to the medical model, with the aim of using the knowledge gained to help develop alternatives in the UK. Looking back, all the organisations and services I visited came about because groups of people in the US decided they wanted something different to conventional mental health services, and then decided to work to make that dream a reality.

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

There are terms in psychiatry that are designed to portray violent and distressing events as benign, and normal human rights, feelings and behaviours as threatening – things I think we need to name for what they are. The term ‘antidepressant’, for instance, shapes the way we think of these drugs. It renders the fact that they can worsen depression and cause suicidal thinking and behavior counter-intuitive, and makes people skeptical of claims they don’t work and make distressed people feel worse.

I’ve had some criticism of the recent Doctor Munchausen posts. They’re not fair on doctors. Many people have told me of lives saved by good doctors. It’s not fair to tar these good doctors with the brush of a few Dr Munchausens here and there. So there’s bad doctoring and good doctoring and great doctoring. What would great doctoring mean?

There is a hunger out there for a foundational critique of psychiatry—something that pulls no punches, minces no words. That is, there is a hunger for a reasoned antipsychiatry position. Something that explains how we ended up here, provides solid evidence that psychiatry should be abandoned, and begins theorizing what we might do instead.

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.

We are constantly hearing that ‘how we eat’ affects our health. The vast majority of studies showing the associations between diet and mental health have emerged in only the last decade, at best. So any professional who graduated over 10 years ago could potentially be completely unfamiliar with this body of research. We are encouraged by the number of professionals starting to pay attention to diet, but we have a long way to go.

Based on any data from any country it is clear that we have a problem. Mental illness is on the rise. Researchers in the emerging field of nutritional psychiatry have documented the benefits of micronutrients to treat mental illness, showing that micronutrients help treat depression, stress, anxiety and autism and ADHD. Not a single study shows that the Western diet is good for our mental health. Many questions remain to be answered, but we can make some recommendations.

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.

This means that what ADHD proponents present as validation of a diagnosis of a real and treatable disorder is in fact a placebo effect caused by an ostensibly scientific label, which exists in synergy with an efficient, legal drug. The ADHD label produces this placebo effect because its diagnosis is based on behavior that in reality could be observed by anyone. What is observed sounds "scientific"; it is easily understandable and highly obvious. When the diagnosis is turned into an action plan, we forget that there is nothing scientific about it and that its evaluation is purely subjective and clinical; that it creates a great many false positives, and that a drug prescribed in half of the cases indeed does have serious side effects.

"The Antidepressant Era" was written in 1995, and first published in 1997. A paperback came out in 1999. It was close to universally welcomed. It was favorably received by reviewers from the pharmaceutical industry, perhaps because it made clear that this branch of medical history had not been shaped by great men or great institutions but that other players, company people, had been at least as important.

This is an article written by a woman named Anne-Marie. I am publishing it here because it epitomizes what RxISK.org, a company I have founded, is all about. It tells of one woman extraordinarily getting to grips with a problem she has on treatment. My hope is that when RxISK.org is up and running we will be able to make it easier for people like Anne-Marie to engage with their doctors to solve problems like this.

A century ago Freud and Jung made us aware of the biases underpinning what patients say. Not everything should be accepted at face value. In particular claims of abuse may not be based on reality. We needed experts – analysts – they claimed, to tease out what is real from what is not. The Catholic Church was once intensely hostile to Freud, but when it came to child abuse adopting a Freudian approach was very convenient. But while Freud essentially denied that real abuse was taking place and got away with it in his life-time, the Catholic Church has learnt to its cost that many claims of abuse are real.

What distinguishes the pharmaceutical industry from the producers of other potentially harmful products, is the fact that, governments have passed legislation allowing detention of potential customers and forced administration of its product to consumers who do not wish to purchase it. Imagine if goverments passed laws allowing other industries to detain potential customers and force them to use their products.

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.

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.

Recently the problem of publication bias has been shaking the foundations of much of psychology and medicine. In the field of pharmacology, the problem is worse, because the majority of outcome trials (on which medication approval and physician information is based) are conducted by pharmaceutical firms that stand to benefit enormously from positive results, and run the risk of enormous financial loss from negative ones. Numerous studies have found that positive results tend to be published, while negative ones are quietly tucked under the rug.

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?

It would be a shame if Andrew Scull’s Madness in Civilization did no more than draw well deserved applause for his authorship and historical expertise, and a prominent place in the bibliography of madness. My own copy of Madness in Civilization arrived last week, and it is great; comprehensive, brilliantly written, lots of colourful and many disturbing illustrations. Madness’ continuing story, “From the Bible to Freud, from the Madhouse to Modern Medicine” is told as never before, but there seems to be something missing...

As we approach world hearing voices day 2013 Karen and I are in Canada. We have just enjoyed running a preconference workshop for about 100 people in Winnipeg. I am sitting in my room before breakfast writing this piece and as I sit I am thinking back twenty-three years ago; I am in a psych unit in Manchester and I have a new support worker called Lindsay. By then I had been a psych patient for almost ten years and was fast approaching spending the rest of my life in the system. My support worker had convinced me to go to a new group that was starting in Manchester called a hearing voices group.

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.