Neil. Thanks for your piece. I agree itās a pity this debate gets so polarised. I agree thereās not enough joint decision making in treatment, and that the myth of chemical imbalance is still promoted. I tend to use the term ill-treatment rather than torture but I agree some coercive interventions can be abusive and amount to torture. Iām more in favour of Engelās biopsychosocial model than you but thatās because I think Linda does not completely understand it. I just think we have to accept that the wish to find a physical basis of mental illness will never go away. But that doesnāt mean there shouldnāt be critical debate and your contribution is very much to be welcomed.
Best wishes
Duncan
I’m certainly not going to undermine your argument, Concernedcarer. I agree with it! What I’m talking about is undermining the person.
Thanks to Nev and Emily for opening up this issue. In the spirit of embracing it, I trust I am allowed to say without being bullied out of it, that we cannot allow what might be called the tyranny of the service user perspective. People should not be undermined in mental health debate. We need to have this debate in the spirit of respect for different views.
Thatās what I meant!
Agree there is uncertainty about some of the side effects of psychotropics. These can be overstated as well.
I didnāt mean that harm done by psychotropics is irrelevant. Itās just that using something that is ineffective may not be a proper measure of harm. Evidence is always open to interpretation and can be overstated because of bias.
Bob
I agree with what you say about the overstatement of evidence, and that people are being duped about the effectiveness of psychotropic medication. However, the harms they cause are a separate matter, arenāt they? I just wonder whether this should have been made clearer.
Best wishes, Duncan
I suppose itās important not to deny the mind-brain problem which is what encourages reductionism, as itās āeasierā to think mental health problems are due to the brain.
I think the reason systems change is complex and I guess unpredictable. I agree critical psychiatry hasn’t had much impact. Essentially because it’s been ignored. Maybe one day people will listen but maybe they won’t. The system is stacked against us but I don’t think that’s why we should give up.
You have been clever yourself, Bonnie, in reclaiming antipsychiatry.
I’m not denying the tragedy of Stuart Dolin’s and others’ deaths, but I’m just not sure how we know they were due to akathisia.
There are objective signs of akathisia as well as the inner restlessness, such as pacing on the spot. I’ve seen this several times with neuroleptics but never with SSRIs. Is it just that I haven’t been looking hard enough?
Surely the issue about antidepressants and suicide/violence doesn’t boil down to whether antidepressants cause akathisia, does it? Perhaps Peter can clarify.
I’ve never seen akithisia with SSRIs. It’s not listed as a side effect in the British National Formulary, whereas nervousness and tremor are. I’m not convinced by Healy et al (2006).
I am aware of akithisia but I don’t think SSRIs cause it unlike neuroleptics, do they?
I’m not a paid ally of a drug manufacturer but do worry that apparent potential side effects of SSRIs such as nervousness and tremor are seen as precursors to suicidality and violence. And, although it may well be difficult to get information about blinding, I’m surprised that Peter doesn’t consider the implications of unblinding for measurement of side effects because he regards it as important when assessing efficacy (as I do).
Buying into idea of chemical imbalance causes psychotropic medication discontinuation
Challenging the biomedical model is not anti-psychiatry http://criticalpsychiatry.blogspot.com/2019/04/challenging-biomedical-model-is-not.html
Neil. Thanks for your piece. I agree itās a pity this debate gets so polarised. I agree thereās not enough joint decision making in treatment, and that the myth of chemical imbalance is still promoted. I tend to use the term ill-treatment rather than torture but I agree some coercive interventions can be abusive and amount to torture. Iām more in favour of Engelās biopsychosocial model than you but thatās because I think Linda does not completely understand it. I just think we have to accept that the wish to find a physical basis of mental illness will never go away. But that doesnāt mean there shouldnāt be critical debate and your contribution is very much to be welcomed.
Best wishes
Duncan
I’m certainly not going to undermine your argument, Concernedcarer. I agree with it! What I’m talking about is undermining the person.
Thanks to Nev and Emily for opening up this issue. In the spirit of embracing it, I trust I am allowed to say without being bullied out of it, that we cannot allow what might be called the tyranny of the service user perspective. People should not be undermined in mental health debate. We need to have this debate in the spirit of respect for different views.
Thatās what I meant!
Agree there is uncertainty about some of the side effects of psychotropics. These can be overstated as well.
I didnāt mean that harm done by psychotropics is irrelevant. Itās just that using something that is ineffective may not be a proper measure of harm. Evidence is always open to interpretation and can be overstated because of bias.
Bob
I agree with what you say about the overstatement of evidence, and that people are being duped about the effectiveness of psychotropic medication. However, the harms they cause are a separate matter, arenāt they? I just wonder whether this should have been made clearer.
Best wishes, Duncan
I suppose itās important not to deny the mind-brain problem which is what encourages reductionism, as itās āeasierā to think mental health problems are due to the brain.
I think the reason systems change is complex and I guess unpredictable. I agree critical psychiatry hasn’t had much impact. Essentially because it’s been ignored. Maybe one day people will listen but maybe they won’t. The system is stacked against us but I don’t think that’s why we should give up.
You have been clever yourself, Bonnie, in reclaiming antipsychiatry.
From a critical psychiatry perspective, I agree! http://criticalpsychiatry.blogspot.co.uk/2012/07/im-not-anti-psychiatrist-or-am-i.html
What about this? What does it mean to say psychotic experiences are symptoms of an illness?
Is this any clearer? Critical psychiatry position on schizophrenia
Of course mental disorder is not brain disease but illnesses don’t need to have a physical basis.
I agree with your comments about Scott in the Stephen Fry ‘Ten years on’ programme http://criticalpsychiatry.blogspot.co.uk/2016/02/complaining-about-dominance-of.html
My critical psychiatry comment on this programme at the time http://criticalpsychiatry.blogspot.co.uk/2016/03/my-baby-psychosis-and-me.html
I’m not denying the tragedy of Stuart Dolin’s and others’ deaths, but I’m just not sure how we know they were due to akathisia.
There are objective signs of akathisia as well as the inner restlessness, such as pacing on the spot. I’ve seen this several times with neuroleptics but never with SSRIs. Is it just that I haven’t been looking hard enough?
Surely the issue about antidepressants and suicide/violence doesn’t boil down to whether antidepressants cause akathisia, does it? Perhaps Peter can clarify.
I’ve never seen akithisia with SSRIs. It’s not listed as a side effect in the British National Formulary, whereas nervousness and tremor are. I’m not convinced by Healy et al (2006).
I am aware of akithisia but I don’t think SSRIs cause it unlike neuroleptics, do they?
I’m not a paid ally of a drug manufacturer but do worry that apparent potential side effects of SSRIs such as nervousness and tremor are seen as precursors to suicidality and violence. And, although it may well be difficult to get information about blinding, I’m surprised that Peter doesn’t consider the implications of unblinding for measurement of side effects because he regards it as important when assessing efficacy (as I do).
Discussion with Ronald Pies on Critical Psychiatry blog at http://criticalpsychiatry.blogspot.co.uk/2015/04/psychiatrists-do-believe-psychosis-is.html
Maybe more the ‘illness model’ rather than ‘disease model’ (see http://t.co/oIQreXtd7W)
See http://criticalpsychiatry.blogspot.co.uk/2013/03/antidepressant-discontinuation-problems.html
I agree. See http://criticalpsychiatry.blogspot.co.uk/2012/10/it-is-not-possible-to-diagnose.html
See http://criticalpsychiatry.blogspot.co.uk/2012/10/e-fuller-torrey-attacks-new.html
See http://criticalpsychiatry.blogspot.co.uk/2012/10/e-fuller-torrey-attacks-new.html