Wednesday, April 1, 2020

Comments by Steve McCrea

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  • Lucy gets it 100% correct here. I have never seen a clearer example of the ludicrousness of claiming “mental illness” to be the cause of anxiety/depression/anger/fear relating to this huge, worldwide concern. I wince every time I hear someone say, “Mental health issue can be TRIGGERED” by the Coronavirus fears. Totally “normal” and undiagnosed people are losing sleep, hoarding toilet paper, worrying about finances and the economy, etc. It is NORMAL to be worried about something like a potentially deadly virus and the social disruption it is causing! In fact, people who are NOT worried are the ones making the problem worse!

    This is proof that the MH paradigm is completely bankrupt and needs to be scrapped!

  • Sometimes what you have to do is do anything you can to convince them you agree 100% and are now happy and healthy due to their wonderful interventions, and then escape once they open the door and don’t ever come back! You clearly have sufficient “insight” to understand what they are about and that convincing them is impossible. So the next best thing is to escape their influence in any way you can! Easier said than done, though. WAY easier.

  • Of course, a lot of the “treatments” adversely affect their “patients'” physical health, making them more vulnerable. Not to mention the impact of being given the idea that your brain is permanently broken. It has been shown that having hope and purpose improves health and resistance, too, though this is pretty much common sense. Though it appears not so common in the world of “mental health treatment.”

  • I think that is a legitimate distinction. I was talking about moving from a strong core protest to a larger mass movement. I agree we are not really at a point where that can happen yet, and building a strong intellectually/scientifically viable base is essential to any movement succeeding. It’s just that a lot of people aren’t able to process on the level that is needed to understand the viable base and need their memes and leaders in order to get with the program. It will happen one day, but again, we’re not there yet.

  • There is a difference between pandering and taking the facts of human behavior into full account when planning a strategy. I would challenge you to show big changes happening against the status quo that were not created with emotional appeals to the masses. Of course, there need to be solid, real, honest ideas that have strong logical backing, because otherwise they don’t WORK. But I can’t think of a major change movement that didn’t employ emotional appeals as a big part of their strategy. I could be wrong, of course, but I’m not seeing examples of “intellectual revolution” being successful. I’m open to hearing examples if you have some. Like I said, it’s not my specialty, just going by what I’ve observed.

  • One can be right all day long and get nothing done. That’s how I’ve experienced attempts to change the system from within. I have no interest in denying reality or polling anyone on what they want to hear about psychiatry, and frankly, given my history, I find that suggestion a little disrespectful. I absolutely agree that calling psychiatrists “doctors” or psychiatry “medicine” is a fraud and needs to be called out as such. The question is how you get masses of people on board with that idea. Most people don’t think with ideas, they react with emotions. That’s why a story in the paper about a poor kid living on the streets with his parents gets tons of donations, while a request for an increase in the welfare budget is met with disinterest or scorn. People have to be grabbed emotionally. Facts don’t convince most people of anything much. Most people are driven by emotional “reasoning,” which is one reason psychiatry has been as successful as it has – it appeals to people’s desire to feel like someone understands something that they don’t, and to people’s desire to blame someone/something in a way that keeps them from having to make any significant changes. It’s how people in groups tend to act. You have to get them excited or angry or worried about something or they will roll with the status quo. At least that’s my experience. Maybe I’m just too cynical!

  • You say you learned schizophrenia is genetic? Who told you that, and what proof did they offer? A full review of massive research has shown a complete failure to demonstrate any specific cause for “schizophrenia,” or even significant evidence that “schizophrenia” is even a valid entity for research. Mainstream psychiatrists (including the head of the NIMH, Tom Insel) have recognized that these diagnoses “lack validity,” and some have even proposed dispensing with “schizophrenia” as a diagnosis, or saying that there are “schizphrenias” which have no necessary relationship with each other in terms of cause.

    I’m sorry that OD did not work for you. The folks who invented and developed it have made it clear that 20% of clients don’t respond to OD. You may have been one of them. That doesn’t make the data wrong.

    I’d also be the last to deny that biology COULD cause a person to have hallucinations and aggressive behavior. But calling all such cases “schizophrenia” and asserting that they all have genetic causes is absolutely contrary to actual science.

    If anyone had an agenda, it was the person telling you this stuff.

  • We are appealing to anyone who is uninformed and who needs to become educated. The world isn’t broken up into those who agree with eliminating psychiatry and those who sing its praises. Most people don’t really HAVE opinions, they make their opinions based on rhetoric they hear from those whom they assume know more than they do. There is no reason not to reframe psychiatry as a human rights abuse because it will garner more support than trying to convince everyone that psychiatry is a fraud (which it is), because we need the general public opinion to turn against psychiatry. That seems to me the most effective, practical way to do it. Any mass movement requires a mass of people to participate, by definition. It seems to me that the way to get a mass movement going is to have memes that people can get behind in large numbers. Take “MADD” for instance. They didn’t argue that no one should drink, they argued that people should not DRIVE drunk. And they came up with the meme of the “designated driver,” which resonated with big numbers of people.

    I’m not a master of group dynamics or mass movements, but it seems to me that people can wrap their brains around the idea that people deserve to have their rights respected more easily than they can that their doctors are a bunch of charlatans, even if the latter is observably true.

    Hope that makes some sense.

  • I personally think the human rights approach is the broadest and would have the most general appeal, especially if combined with honest rhetoric regarding oppression of particular subgroups within the general abuse of rights that psychiatry represents. People want to believe in doctors, but they also want to believe they ave rights which can’t be violated willy-nilly. How we can connect the abuse of rights of the psychiatrized with the rights of people who haven’t yet had that experience is a bigger challenge, but one that I think eventually can be overcome.

  • It’s a classic tautology. Since it’s not “normal” to do antisocial things, anyone doing something antisocial is “abnormal.” But since we’re not allowed to say things like “evil,” we say such people are “crazy” because “only a crazy person would do something like that.” So they did it because they’re crazy, and they’re crazy because they did it. Then, by analogy, anyone who is “crazy” (aka “Mentally ill) is dangerous, because by definition “crazy” things are done by “crazy” people. QED.

  • I do want to distinguish somewhat between you as a layperson saying this vs. a medical professional saying this. You are not purporting to be representing the latest scientific knowledge in the field, so it’s more understandable and less damaging to use analogies to explain things. That being said, I still consider it a damaging framing of the reality of “mental illness.” What you said at the end is much more relevant to understanding most people’s situations – that we have trauma, neglect, and other harm from how we grew up, whether from parents, siblings, school, church, or other institutions. Finding someone to talk to who really understands these experiences is what I’ve found helps people the most. Most folks don’t “need medication,” they need UNDERSTANDING. This is not to say that some people (like you) don’t find these drugs USEFUL. It is to say that the idea that you are “treating a brain malfunction” is simply wrong, both scientifically and sociologically. It is not a “disease” or “disorder” to feel bad, act in antisocial ways, or think unusual thoughts. Some disease states DO cause emotional distress, weird thoughts, or antisocial behavior, but those disease states have specific causes and usually specific remedies. To say that someone “has clinical depression” is totally subjective, and it is highly misleading to create an analogy with diabetes, as diabetes is objectively measurable and has a specific treatment that is effective almost 100% of the time. This is simply not true of “antidepressants” or any of these psychiatric drugs. They are very simply efforts to make someone feel better or act better temporarily. There is nothing observably wrong with the person, and there is nothing specifically being “fixed.”

    I think you’d be far better off telling people that “I’ve taken these pills and they have helped me feel better. That apparently doesn’t happen for everyone. Nobody really knows if there is something biologically wrong with you, but I can tell you that I understand your plight and am very happy to listen. I find that listening and caring for each other is the best ‘medicine.'”

  • This really is the key question. “Medications” are measured intentionally only against “symptom reduction,” mainly, that a person feels LESS of the “negative” feeling or engages in less of the “undesirable behavior.” Quality of life is almost NEVER the overt measure of success. If it were, “medications” would be relegated to last-resort status or banned altogether. One of the great things Bob has done in Anatomy is to demonstrate the massive REDUCTIONS in quality of life with the current paradigm. And to me, what is the point of any “mental health” intervention if the recipient isn’t more satisfied with his/her quality of life as a result? What other measure of “mental health” (if such a thing can even be defined, let alone measured) could be identified?

  • I hear that you’ve had a good personal experience. It concerns me that you seem not to want to hear that not everyone experiences things the same way you do. You write a number of philosophical assumptions regarding the brain, but provide no scientific proof that the brain is the cause of “mental disorders.” If you read the article, you’ll see that the primary difference is that we KNOW that insulin is the singular causal factor in high blood sugar – it can be measured, blood sugar can be measured, and adding insulin or coming up with a way to increase insulin reduces or eliminates the problem in almost 100% of the cases. Add insulin, reduce blood sugar – it is that simple.

    With psychiatric “diagnoses,” there is no known missing substance that needs to be replaced. There is no substance that can reliably replace the mystery “missing substance” and create beneficial results 90% of the time, or even 50% of the time. Compared to placebo, Kirsch’s work showed that ADs are barely better than taking a sugar pill. Compare that to the almost universal success of insulin in reducing blood sugar. Heck, we don’t even know if there IS any chemical causing ANY of these conditions, let alone are we able to MEASURE those chemicals.

    SO the analogy fails completely. There is no SCIENCE saying that “depression is caused by low serotonin,” and lots of evidence saying that it is not. Doctors are GUESSING as to what drugs may or may not be perceived to “help” by reducing the experience of depressed emotions. The analogy with drinking a controlled amount of Jim Beam whiskey daily is a much more accurate one. People DO feel better when they drink alcohol, but there is no “condition” being addressed by the alcohol – it has a general numbing and elating effect on everyone. All psych drugs work similarly – they create effects that some find agreeable, and some don’t. The “diagnosis” itself is made by listening to a list of feelings and behaviors, not by measuring something concrete like blood sugar levels.

    So in essence, the “insulin for diabetes” analogy is a complete deception. Vague philosophical assertions about the nature of the brain (unproven, except that the brain is of course nervous tissue 100%, not a muscle) do not count as hard science. If there is nothing to measure and no reliable approach to improving such a measurement, we’re talking about something VERY different than diabetes.

    Your clients are relying on you for honest information. I don’t believe it is ethical to provide them with unscientific ideas based on your personal belief system. I believe you are responsible for telling them the facts, including the fact that we don’t know WHAT causes “mental illnesses,” or indeed whether they are “illnesses” at all.

  • The irony of the “Decade of the Brain” is that they discovered that the idea of specific “mental illnesses” due to “brain disorders” was wrong. The real results were that the brain is FAR more flexible and malleable than anyone believed, and that experience can change the brain through adulthood. And the most significant brain-healing action we could take for kids is a positive relationship with a mature adult. TOTAL contradiction to what they wanted to find, and of course, these results were largely ignored, except to emphasize that early abuse/neglect “damages the brain,” which serves their narrative if looked at in isolation. If they REALLY applied the lessons from the Decade of the Brain, the DSM would be ditched and we’d be spending a lot of time would be spent improving people’s relationships with each other and creating positive environments that promoted grain health for kids and adults. Who would have guessed?

  • I’d love to have a link to that article posted! I’ll have to look it up, but it is amazing (and yet not surprising) how hard proof of damage is provided and yet to claim that it is “safe” to use something that induced a person to kill his child and almost kill himself! How is that “safe?”

  • Beautiful writing, as usual, Noel! This is the kind of talk I recall back when I initially broke into the field of therapy. I don’t know that this kind of discussion even happens in most peoples’ training these days.

    I do want to point out that one of the many reasons trauma survivors die 20 years earlier than the general population is the drugs they are given/forced to take by the “mental health” system itself. Further physiological and psychological traumatization does not appear to be particularly helpful in “treating” the effects of chronic trauma!

    Thanks for all you do to bring sanity to the crazed world of “mental health treatment.” I wish that all “mental health” workers took their cues from your philosophy.

  • I like the article, great history there. However, I would argue that these efforts at transformation were ultimately coopted and that the basic fundamental beliefs of the system have not changed much at all. Women are still told that their anxiety/depression the the face of childhood sexual abuse, rape, domestic violence, and general oppression by the mainstream of our society are personal problems. They are still proffered new versions of “mother’s little helpers” in the form of benzos and SSRIs. They are still blamed for not “adapting to their roles” properly, and still diagnosed for being “too emotional.” These seminal writers’ critiques are just as valid today as they were in the 70s. We are still waiting for the ensuing “transformation,” and will most likely wait forever for this utterly patriarchal and oppressive system of thought to actually become responsive to the actual needs of clients and society at large.

  • Yes. It was a known concern before it was approved.

    “Those who developed akathisia or who had any suicidal tendencies were excluded from the trial data on the basis that they would otherwise obscure the results of the drug’s success in treating depression. Yet the German licensing authority, the Bundes Gesundheit Amt (BGA), on scrutinising the results, expressed concerns about the drug’s safety. On May 25, 1984, according to Lilly’s internal documents, a letter from the BGA stated: “During the treatment with the preparation [Prozac], 16 suicide attempts were made, two of these with success. As patients with a risk of suicide were excluded from the studies, it is probable that this high proportion can be attributed to an action of the preparation [Prozac].”

    https://www.theguardian.com/theguardian/1999/oct/30/weekend7.weekend1

  • I agree. It is not absolute poverty, but the power differential from income disparity that causes the greatest distress. The sense that you are somehow unable to succeed at life because the rules are rigged against you separates you from others, while working together with others struggling toward the same goals brings people together in a sense of community that is what really helps people feel good about their lives.

  • So being unable to provide sufficient resources to survive, being worried about losing electrical power or heat or even housing, being unable to eat sufficient food and having no recourse, all of these things could make a person more “depressed?” Golly, jeepers! These poor people must have chemical imbalances, mustn’t they? Or they need to sit and have someone understand the difficult feelings associated with having your family lose their home or slowly starve to death?

    I’m glad this research has been done and is published, but how many times to we have to study the obvious? Anyone with half a brain could figure out that poverty feels like crap and will lead to more suicides. Time to DO something about it instead of continuing to blame the victims of our heartless economic system!

  • I have known plenty of people who were on “maintenance antipsychotic treatement,” in fact, almost anyone who had been to an ER for “psychotic symptoms” got on one. Many were forced to take them and had no choice. A lot of foster kids are put on them daily for behavioral problems that have nothing to do with psychosis. Old folks in nursing homes are put on them to manage difficult behavior, again without any “psychotic disorder” diagnosis or even symptoms. It is no myth. It is true that many people (like mathematician John Nash) go off antipsychotics as soon as they are safely away from the authorities. But the standard recommendation I’ve seen for ‘psychosis’ or ‘bipolar disorder’ is “maintenance antipsychotic treatment.” And those who refuse to “comply” are pressured, manipulated, or incarcerated for it. There is no myth involved here.

  • The main valuable expertise I’d be looking for is the ability to convey interest and compassion while I told my story. And from psychiatrists, I can count the ones I’ve see do this on one hand and still have a couple of fingers left over. Most counselors/therapists these days are also bought into the DSM and have stopped talking about unconscious motivations and life goals and sense of purpose and spend their time on “symptom reduction.” It’s a sad situation, and I would value the clients’ expertise over the “mental health professionals” at least 9 times out of 10. Most of what I learned about therapy, I learned from clients letting me know what they felt helped and did not help. There is no other standard for success. It should be the #1 most valued information there is, not relegated to third place after “research” and “clinical expertise.”

  • It is interesting that they refer to “clinical expertise” but to “patient preferences.” What about “patient expertise?” or “Patient knowledge?” It seems that framing a patient’s/client’s decisions as “preferences” is disempowering, in that it implies that the patient’s information is irrational or emotionally-driven, rather than being rationally-derived information based on the patent’s own experiences and knowledge base. A normal power distribution would require the patient and the therapist to negotiate an agreement on the actual facts of the situation, assuming each one had an expertise of their own that legitimately informs the mutual understanding of both the problem and the possible solutions. “Preferences” is a very weak term for what is being expressed by the clients in these situations.

    Additionally, the author neglects to observe that the “evidence base” for “EBPs” is based on the categories in the DSM, which psychiatry’s own leaders (like Tom Insel at the NIMH) and the DSM introduction itself acknowledge to be invalid, heterogeneous categories of behavior that do not necessarily indicate any commonalities between those who “qualify” for a particular diagnosis. So saying that “X treatment is more effective for major depression than Y treatment” becomes a nonsensical statement, since depending on which client with that diagnosis presents to you, the required “treatment” may vary wildly.

    If you really want to do “evidence-based treatment,” you have to start with a legitimate grouping of candidates for study. Absent that, the “scientific evidence base” for these therapies is worse than useless – it is actually deceptive.

  • Don’t know that I was always “eager” to see my therapist, but what was clear is that my therapist, who was wonderful, was focusing on doing whatever she could to help ME meet MY goals. She never told me what to think or believe, never told me what I should or should not do, never criticized me for making a particular decision. She was genuinely INTERESTED in finding out more about me, and even when there were some hard times going through material I would most certainly have avoided without her being there, I always knew she was on my side and would make it safe for me to say whatever was on my mind.

    This was way back in 1982-3 before the DSM took over and when therapists actually listened to their patients. I know there are a lot less such people out there these days. If I were screening a therapist, my first question would be their opinion on the DSM diagnostic approach. If they showed any respect for the DSM, that would be it for me. And if they started talking about “mental illness is a disease, like any other” or “insulin for diabetes,” I’d run from the room!

  • Did I not read fairly recently that receiving “more intensive psychiatric care” actually leads to an INCREASE in suicide attempts? It seems to me that psychiatric care encourages a belief that one’s situation his hopeless and intractable and that one can personally do nothing about it. At least blaming it on bad toilet training meant you had a chance to get over it. Now it’s all in your warped brain and the only “hope” is that the drugs might make you feel a little better, if they don’t kill you in the process.

  • Absolutely! Even within their own framing of things, which of course, lacks any real scientific basis, there ought to still be the expectation that TREATMENT WILL IMPROVE THE SITUATION! It’s probably the first and easiest place to attack psychiatry, without even getting into the DSM idiocy. If I have a skin rash and take a drug for it, the skin rash NEEDS TO IMPROVE! If it doesn’t improve, WE NEED TO DO SOMETHING DIFFERENT. Why does this reasoning not apply to psychiatry?

  • Great point! When working with foster youth, I often found the kids accused of “assault” by staff in institutions when a very short investigation proved that the child was fighting back against the staff assaulting THEM! But that part never got recorded in the logs, did it? “History is written by the victors.” Certainly, the residents of any kind of institution are not the “victors” and their version of history is never recorded by the institution’s staff.

  • After reading the article, the answer is clearly “nothing,” unless by “adding” you mean “providing yet further distractions and justifications for avoiding looking at environmental/social/spiritual causes.” It also appears to avoid looking at ACTUAL physiological causes of emotional distress, such as poor diet, thyroid issues, anemia, sleep problems, etc.

    They mention early on something about “issues of the relationship between mind and brain,” and yet the actual research seems to be all brain, all the time. Not one more word about “mind” in the entire article.

    In other words, “Meet the new boss, same as the old boss.” Nothing new to see here.

  • It seems important to distinguish between medical ERRORS (doing the wrong thing or overlooking something) vs. medical HARM (patient has a worse outcome despite following standard medical practice) vs. MALPRACTICE (doing something that the doctor knows or should have known is harmful, or failing to inform patients of risks of medical harm prior to treatment, etc.) Most medical harm is NOT due to errors, it’s due to adverse drug effects. And of course, those drug effects are MALPRACTICE if they result from neglecting to do proper differential diagnosis, or failing to provide proper informed consent to the patient. The medical profession has tried to reframe medical HARM as medical ERROR, even though most of the harm is done by standard medical practice. This appears to be an intentional effort to downplay the dangers and inadequacies of standard medical practice and to make it seem that failures and harm are due to a few “bad apples” rather than the standards of care being inadequate and frequently dangerous and corrupt.

  • Why should you automatically trust them? Isn’t trust earned by trustworthy behavior? Isn’t one of the “deficits” of “borderline personality disorder” (as they frame it) a difficulty deciding who can and can not be trusted?

    It is clear that these people don’t really know what they’re doing, and they get very insecure when anyone starts making it clear that they don’t, they get defensive and start blaming the person telling them the truth. It’s like The Emperor’s New Clothes! Lord help anyone who points out that the King is naked!

  • I think you start by pointing out the power differential overtly, acknowledging your power advantage and the general advantage of the other staff people and asking how they think it will affect the conversation. I would then humbly ask what YOU can do to make it more comfortable or easier for people to say what they are thinking without feeling like they might get into trouble. But I think the first discussion would be a huge one, if it gets going, and will pull you in the direction you need to go. I think the main thing is to bring it out in the open as an unavoidable fact of life, and get them talking about how it affects their experience. It will be a lot more interesting than Nietzsche, I’m thinking!

  • Another psychiatric success story! How can these people not see when their “treatment” fails utterly? In what other profession are the professionals allowed to blame their failure on the person/machine/process they are supposed to be fixing? “The bridge collapsed because it was a span-resistant river.” “We couldn’t fix your breaks because they are repair-resistant.” “You were poisoned because our chef had the misfortune of serving health-resistant food.” Come on, who the hell else would ever get away with it?

  • Somehow, I found the entire article alienating from the start. The language is very “clinical,” and there is a confusion between social conditions and “mental health diagnoses” that the authors never begin to address. If loneliness is caused by social conditions, then how does it even become a “mental illness?” If “mental illnesses” as defined by the DSM can be caused by loneliness, which is itself caused by adverse social conditions clearly identified in the research, how are they “illnesses” at all? Should they not instead inform the need for changes in the social structure that is increasing the difficulty people are having creating meaningful relationships?

    A lot of fancy words that seem to obscure more than they illuminate.

  • It seems likely that such a group would not be fully successful unless it started with a full discussion of the power dynamics entailed in you being the “professional” and organizing the group. It is apparent from your description that they patients viewed you as the “expert” regardless of any provisos you may have put out there. In fact, your ability to frame the conversation in terms of your role is already an exercise of power over the participants. Unless this set of assumptions, which may have largely been unconscious or subconscious, are fully deconstructed, the group as you envisioned it was unlikely to develop.

    Of course, if you HAD conducted such a discussion, your hierarchical peers would have felt their power threatened and almost certainly would have shut you down, just as they did with the “du” vs. “Sie” issue. Why would it bother them for you to use informal pronouns, except to the extent that it threatened their role as the “experts” speaking down to the “patients?”

    I have to wonder what Nietzsche himself might have said about the process.

  • This is why I’ve said again and again that psychiatry itself is not the enemy, it is only one manifestation of the enemy. The real enemy is AUTHORITARIANISM, the belief that people have the right to order about and take advantage of those below them in the power structure, and the belief and experience of those below that they must acquiesce to such behavior or be punished or ostracized from the group. Regardless of the name and stated purpose of a group, the ability of the group’s membership to hold the group’s leadership accountable is essential to any movement toward justice and equal rights to be successful. In other words, we have to have our own house in order before we’ll succeed at changing the external circumstances. And that is not an easy task!

  • It is also very important to note that these “differences” are AVERAGED over large numbers and are generally quite small. There is a huge overlap between the “disordered” and the “normal” population on any such measure. In other words, even if the average brain size of an “ADHD” diagnosed child is smaller, there are many “ADHD” diagnosed children who have larger brains than the average “normal,” and many “normal” kids who have brain sizes smaller than the average “ADHD” diagnosed kid. When you then take into account that the “ADHD” diagnosed population contains large numbers of kids on stimulants, which we know decreases brain size in the area of the basal ganglia, even these average differences reflect nothing at all.

    SO in other words, it’s all smoke and mirrors. There is no “difference in the brains” of “ADHD”-diagnosed kids. It’s all PR.

  • But there IS a point in telling parents that their kids have a “brain disorder,” even though this has been disproven decades ago: they will be more willing to accept and administer a drug to their child. That is the ONLY purpose for this deception to have continued this long, and the fact that it does continue makes the intentions of the profession eminently clear.

  • Where did they ever come up with that 51% suffering from trauma statistic? The real answer is in the 80-90% range from everything I’ve ever read. Did he provide a reference or was he just spewing hot gasses from his mouth?

    The “It’s not all about medication” meme is just a cover for the fact that “medication” prescriptions are 99% of a psychiatrist’s business these days. My experience (and I have a lot from advocating with foster youth) is that the vast majority of psychiatrists exist solely to prescribe and “monitor” drugs, though the term “monitor” must in most cases be used very, very loosely.

  • They need to believe in their doctors and in “Science.” It violates basic mythology for most people to question that doctors are knowledgeable scientists with their patients’ best interests at heart. We have to undermine this mythology before any real change will happen. I do feel bad that kids have to deal with parents who are deceived, but most parents are trying to do the right thing and need to be educated. Of course, there is a minority of parents who are more interested in controlling and subduing their children than in helping them live well, and such parents get very little sympathy from me.

  • The 6% (I actually think it was more like 6.7%) was from a file review, and only included those reactions noted in the kids’ files. Naturally, there would be doctors who would not notice these symptoms or would not write them down, and also kids/parents who did not report them or did so in a way that the doctor did not make the connection. So if 6% of doctors both knew and recorded these reactions, clearly the actual number so reacting would be considerably larger.

    That being said, even a 6% rate is large enough that it ought to be discussed at every “informed consent” conference with parents and children considering this “treatment.” Of course, many doctors don’t really do an informed consent consult in the first place, but even those who do rarely if ever mention to watch for psychotic symptoms as an adverse effect. In 20 years of experience as an advocate for foster youth, I never once heard or saw it mentioned to any of the 20% of kids in care who were diagnosed with “ADHD.”