Friday, March 22, 2019

Comments by Dr Neil MacFarlane MRCPsych

Showing 35 of 35 comments.

  • Steve…regarding different causes of depression, you are exactly right. But everything I have said above is criticising that current state of affairs in the UK, where a GP can prescribe an antidepressant after a ten-minute consultation.

    I have not prescribed anything for four years, but working as an independent psychiatrist I only prescribed after a minimum 90 minute consultation, and because psychosocial factors were often identified that led to less prescribing not more.

  • Yes, these reports add to other evidence about unwanted effects and dependence, and should be included in any full ‘informed consent’.

    But to respond to Frank Blankenship’s point above, depression is so common that the numbers of people who do not remit spontaneously within 6 months, say, are still quite high in absolute terms.

    He writes ‘if you are drugging 1000 or 100 people for every one person you might, according to theory, be able to “help”, that doesn’t make much sense.’ But in the case of mild-moderate depression it is usually much more about patient choice (better-informed, I hope) than anything coercive which is what ‘drugging’ can imply. If your depression has gone on for 6 months or longer then those (crudely guesstimated) odds will be better.

    I hope everyone accepts that similar arguments apply for psychotherapy. Like most people (I think) I would prefer psychotherapy, but it can be negative too, and it is a fact that quite a few people are very sceptical about it and see many psychotherapists as charlatans.

  • I am not against or for socialism (which I mean in the ordinary sense current in the UK, not the Marxist sense of ‘real socialism’). It is Dr Moncrieff and her anti-diagnosis colleagues who stress political reform as being of primary importance, so I do think anyone wanting to scrutinise their statements needs to take politics into account.

    Let me try again to address: “[no]…evidence for a subset we can identify for whom antidepressants work”. There may be such a subset, but the point is that with published RCTs we have now, we cannot identify the characteristics of that subset.

    I would go further and say that because there is evidence for antidepressants working in severe depression (https://www.ncbi.nlm.nih.gov/pubmed/2684085, repasted from above) then to me that does support the idea of a ‘subset’ in people with mild-moderate. Many conditions have a spectrum of severity from subclinical and mild to moderate and severe.

    For mild I guestimmate the chances of you being in this subset might be 1 in 1000. For moderate it might be 1/100. But the longer your depression goes on the more likely you would be in it.

    My own depression lasted 2-3 years and I didn’t try antidepressants (or formal psychotherapy). I am pleased that I did not expose myself to the risk of being on them for a long time, but cannot be 100% sure that I did not lose out on the chance of making the episode shorter.

  • Yes, the ‘burden of proof’ has not been properly applied, because of Pharma marketing and other activities, and it is certainly reasonable to be suspicious about this paper.

    I think antidepressants are overprescribed by 10x and maybe more, in the UK, but that was the position of Dr David Healy and others before Dr Moncrieff came onto the scene 10 years ago

    People with clinical depression should get some support (as they do in the placebo arm of a clinical trial), and if they do not recover within a few months, either psychotherapy or medication is reasonable.

    However, ‘support’ costs money because it involves paying people for their work, and in fact is more expensive than medication overseen by very brief visits to doctors.

    Dr Moncrieff does not advocate providing such support, because she does not believe in depression as a mental disorder. She believes money should be generally redistributed. That is socialism combined with ‘Drop the Disorder’, and what I pointed out in my ‘neoliberalism’ piece is that it is also attractive to tax-cutting right-wing politicians, who cherry-pick the ‘Drop the Disorder’ but leave out the socialist redistribution.

  • This is my point: ‘It may well be that only a small number of treated patients [in the group] are getting the improvement (beyond placebo/natural remission/comparator), and if they are then their treatment-associated improvement could be very significant clinically.’

    I think Dr Moncrieff routinely and misleadingly omits to point this out: she failed to comment on the issue below.

    There is evidence that people with more severe depression do respond more to certain physical treatments. The best RTA I know on this was the 1989 NIMH study which was not directly Pharma-funded: https://www.ncbi.nlm.nih.gov/pubmed/2684085

    Dr David Healy appears to hold that antidepressants are wholly placebo for mild-moderate depression. I am not convinced that we can be so sure about this.

    For mild-moderate I am NOT saying ‘there IS such a thing as an antidepressant’. Just: ‘we don’t know, but what is the point of pillshaming? Let’s offer antidepressants only after providing proper information, including that most episodes naturally remit, and for those who choose the drug offer a 50% chance of having a placebo’.

  • I have three problems with the way Dr Moncrieff comments on antidepressant trials, including this piece.

    To enter Star D, patients had to have DSM Major Depression, of at least moderate severity. But Dr Moncrieff has repeatedly stated that she believes ‘psychiatric disorder’ is scientifically and conceptually invalid: http://www.criticalpsychiatry.co.uk/docs/LanguageOfDisorder.pdf

    Most of her piece assumes that measuring the depression, whether with the originally published flawed measure, or the now ‘unburied’ one, is valid. But by her own arguments, neither set of measures are. How can an invalid concept, or ‘construct’, be validly measured?

    Let us assume, for the sake of my second point, that Dr Moncrieff abandons one of her mutually incompatible opinions and accepts diagnosis is valid and depression can be measured, albeit imperfectly. She tends to assert, with Kirsch, that small improvements on the Hamilton scale are ‘clinically insignificant’: that phrase is not used here, where she writes ‘it is difficult to believe that people treated with antidepressants do any better than people who are offered no treatment’.

    However, the small improvements on the depression scale are in groups, not in individuals. As I understand how statistics operate in randomised controlled trials, we have no way of knowing to what extent the small improvements are shared out, in any treatment group which does better than a placebo or other comparator group. It may well be that only a small number of treated patients are getting the improvement (beyond placebo/natural remission/comparator), and if they are then their treatment-associated improvement could be very significant clinically.

    That is a key reason why I think Dr Moncrieff and others should stop saying ‘there’s no such thing as an antidepressant’, which in my view is a form of ‘pillshaming’: https://drnmblog.wordpress.com/2018/04/18/pillshaming-is-real-heres-a-newish-way-to-reduce-it-and-to-reduce-antidepressant-use/

    Thirdly, it is not true that people in the placebo arms of antidepressant trials ‘are offered no treatment’, as Dr Moncrieff implies here. They are in fact provided with a good deal of interpersonal interaction which amounts to supportive psychotherapy. This is likely to be very helpful to all people in such trials, whether they have a ‘real’ pharmacological response or not, and by downplaying the need for it Dr Moncrieff shows herself to be on the side of those looking to shave a few more percentage points off public funding for mental health services: https://drnmblog.wordpress.com/2018/05/23/how-drop-the-disorder-colludes-with-the-neoliberalism-it-claims-to-oppose/

  • Hi ConcernedCarer…my perspective on this seems to be new here in the UK, and I was concerned to back it up with evidence (or at least the opinions of others) which led to my putting in so many links. I presume you are based in the US: please correct me if otherwise!

    The CPN is not right-leaning: they are mostly ‘leftist’, although within that there is a spectrum. I think what I say can be extended beyond the UK: governments since Reagan/Thatcher have been ‘right-leaning’ in the ‘neoliberal’ sense of looking to cut taxes & they pick on the vulnerable as an easy target.

    There is a long tradition within Marxism of attacking political centrism (‘social democracy’ in Europe) because that, in their view, delays true socialism. That has given rise to unlikely left-right alliances. You could argue that Bernie Sanders’ campaign against Hillary Clinton was of this pattern: although I would say she dealt with that rather clumsily.

    I am more concerned about overmedication than overdiagnosis. I don’t agree that if we abolish the latter then the former will fade away: to reduce overmedication, especially in mild & moderate disorders which should mostly be unmedicated, we need to regulate Pharma and oppose its lobbying. My position is closer to Allan Frances.

    Hence my pointing out that the CPN’s criticisms of Pharma are actually weak. They have managed to ‘market’ themselves into something they are not, somewhat like many ‘academic Marxists’.

    Anyway, thanks for your comments. In the next few months I would like to write something focused more on the US, with US politics & culture as the context.

  • To repeat: I think UK depression is 10x (at least) overmedicated and other disorders are as well, maybe less so, maybe more.

    My new Blog piece shows how Dr Moncrieff and other supposedly ‘critical’ psychiatrists and psychologists are in reality much closer to ‘mainstream psychiatry’, or even part of it. See the many positive comments from UK non-psychiatrists below it:

    https://drnmblog.wordpress.com/2018/05/23/how-drop-the-disorder-colludes-with-the-neoliberalism-it-claims-to-oppose/

  • Paul Salkovskis is one of the most respected clinical psychologists in the UK, and Irene Sutcliffe has a history of OCD, anxiety and depression. They spent time on their thoughtful but critical Blog piece, so why doesn’t Lucy Johnstone respond there: https://www.nationalelfservice.net/mental-health/power-threat-meaning-framework-innovative-and-important-ptmframework/ …?

    Lucy Johnstone is misleading in her account of the Blog piece which contained the phrases ‘trauma porn star’ and ‘pay our mortgages’. The ‘first edition’ was arguably ambiguous and both were removed in the second edition, which did however clarify that ‘TPS’ described the experience of a survivor. Neither referred to the PTMF, but subsequent Twitter comments and attempts by Lucy Johnstone to suppress some of them suggested that some service users/survivors did make that connection: http://asylummagazine.org/2018/05/welcome-to-the-cmht-by-ria-dylan-and-pippi-elliot-designed-by-rachel-rowan-olive/

    As for the ‘misogynist’ comments & cartoons by ‘Senior Professionals’, I haven’t seen those so could a link(s) be provided?

  • Yes, this 5 minute video is very good, about a fictional person with a history of childhood sexual abuse and self-harm/relationship problems.

    As others have said here, mental health funding has gone down in the UK, and I believe that the increasing loudness of ‘abolish diagnosis’ talk may have partly caused that.

    Psychiatrists and (increasingly) psychologists are the ‘gatekeepers’ & if politicians hear such talk from them…well any reduction in taxes on the majority is welcome.

  • Auntie Psychiatry is right in that PTMF is closely allied to ‘Down with Diagnosis’. But Steve McCrea is also right that an alternative is being smuggled in.

    Going through the main document finding words such as ‘trauma’ helps identify what that is. ‘Trauma-informed’ is key even though ordinary ‘PTSD’, as a DSM no-no, is rejected. However, great stress is placed (p.201) upon ‘a new category of Complex Post-Traumatic Stress Disorder (Complex Trauma for short)’.

    ‘Our argument is that the great majority of the experiences that are described as ‘symptoms’ of ‘functional psychiatric disorders’ (and many other problems, including some examples of criminal behaviour) can be understood in this way, but with no assumption of ‘mental disorder’’

    So, ‘Complex Trauma’ is NOT a diagnosis. Anyone who disagrees will be blocked on Twitter, as two UK psychiatrists have been by Lucy Johnstone. I don’t think other UK psychologists, never mind service users or psychiatrists, will be completely convinced.

    Reality check here for US (and maybe UK) readers: PTMF is not official BPS policy, but it appears to have come across as such. From the last 2 months I estimate that 0.3% of tweets by the BPS have referred to it: from the BPS Clinical Psychology Division, 1.5%.

  • I respect Dr Gotzsche as a researcher but the issue is what will work at a societal level.

    I respectfully ask commenters to read the pieces about depression on my Blog. My goal would be to reduce ‘antidepressant’ prescribing (in adults) by 90% over, say, five years, and keep reviewing the evidence.

    Dr G may have achieved this limited success in his own Danish back yard, but he is largely ignored by the BBC and mainstream media in the UK. Even he must be thinking there might be something about the way he puts his research across.

  • How does a ‘moderate’ aim of reducing antidepressants and bipolar prescribing by 90% sound? Maybe within five years. I don’t know enough about other drugs in the US to suggest goals right now.

    I will be blogging about what I regard as Dr Moncrieff’s false suggestion that reducing diagnosis will reduce prescribing. I used to work with the learning disabled (mentally retarded in US) and they are overmedicated on a ‘drugs-based model’, mostly to calm behaviour, without diagnoses.

    Szasz was an extremist, like Phil Hickey. As I have stated, his ‘just a construct’ view came in before Pharma. When Pharma became dominant he had to patch up his extreme libertarian views by saying the ‘Pharmacracy’ was an exception that had to be regulated.

    Have to leave this now…will be blogging on the various aspects…you can subscribe to my posts which won’t average more than one a week. drnmblog.wordpress.com/2018/04/30/the-inflamed-mind-by-ed-bullmore-book-review/

  • Yes, I suggest that extremist language such as Peter Gotzsche’s ‘depression pills can’t cure anything’ cause unnecessary distress to people with depression who opt for medication, often comes across as ‘depression doesn’t exist’, and doesn’t address the issue of adequate support.

    Of course there is some valid criticism of drugs in Dr Moncrieff’s work (as in that of many others), but the call to move towards a ‘drugs-based model’ and away from a ‘diagnosis-based model’ is in keeping with ‘depression doesn’t exist’. That is not just ‘pillshaming’ but also ‘diagnosis-shaming’.

    Dr Moncrieff has been criticised for suggesting that ‘to reduce benefit levels’ is a primary aim of psychiatry: http://philipfthomas.com/?p=68 . Her response was not entirely convincing: https://www.madinamerica.com/2016/01/what-disability-benefit-trends-tell-us-about-psychiatric-treatments-and-the-economy/

    Dr Moncrieff evades the fact that the complaint I linked to is about the ‘final answer’ claims for antidepressant efficacy in the February 21st Lancet study (Cipriani et al), not the separate complaint about ‘withdrawal’.

    I have not looked at the RADAR trial in detail as I have not prescribed antipsychotic medication for nearly a decade. But, as Dr Moncrieff acknowledges, the so-called ‘Critical Psychiatry Network’ (CPN) has been near-silent on key aspects of pharmaceutical company behaviour since mid-2013. If there is near-silence on Pharma and antidepressants then how credible is CPN research on antipsychotics?

  • Dear Phil

    Sorry, but it is you who have failed to substantiate your ad hominem attack on the overwhelming majority of psychiatrists as complicit in the ‘hoax’. That, I believe, is what a reasonable person would understand from your repeated use of the term on your Blog.

    You now state ‘…when psychiatrists promote these statements, they either don’t realize that they’re false (in which case, they’re not too bright), or they are being deceptive. As I don’t consider psychiatrists as a group to be particularly obtuse, the deception conclusion is inevitable.’ To me, that is poor psychology: intelligent people selectively attend all the time.

    Some intelligent professional psychologists seem prone to selective versions of history in which mental health and neurodevelopmental diagnoses were solely invented by medical doctors. The version which follows Foucault (as in the PTMF) is useful to distract from other histories which include non-medical psychologists. Stephen J Gould’s ‘Mismeasure of Man’ is one example of the latter.

    Another is Szasz’s ‘Myth of Mental Ilness’, which I have already referred to as showing that psychiatry in the early 1960s was not allied to the pharmaceutical industry, but to psychotherapy. Even in the second edition of 1974 I can find only one reference to drugs.

    Since the 1980s an alliance between establishment psychiatry and Pharma has led to massive overprescription of medication, especially in the United States. Although, for me, your writings usefully add to the deconstruction of that overprescription and its recent causes, your black-and-white insistence on the ‘hoax’ and your call to abandon all mental health diagnosis undermine those who seek reform now, rather than waiting for Utopia.

    Best wishes

    Neil

  • Dr Moncrieff points out the authors’ links to pharmaceutical companies, but the implied claim in her books and other articles over the last decade, that she is primarily concerned to reduce overmedication in mental health practice, is questionable.

    The UK’s ‘Critical Psychiatry Network’ of which she is co-chair, has known about complaints to the Royal College of Psychiatrists, concerning their ‘false, misleading and irresponsible’ statements about ‘antidepressants’ for nearly two months: http://www.drnmblog.wordpress.com/2018/03/27/rcpsych-oligarchy-now-appears-to-be-deliberately-misleading-while-spinning-its-response-to-my-complaint-about-its-statements-on-cipriani-et-al/ .

    Neither Dr Moncrieff, nor the other co-Chair, Dr Hugh Middleton have supported the complaints. This failure to significantly criticise pro-pharmaceutical bias by UK psychiatrists appears to go back to, at least, 2013, when Dr Charles Nemeroff MD gave a prestigious lecture at London’s Institute of Psychiatry (IoP). Dr Carmine Pariante MRCPsych (of the IoP) simply wrote a letter to ‘dear Joanna’, and neither Dr Moncrieff nor her co-Chair ever referred (to my knowledge) to the corrupt GSK-funded psychiatrist again: http://freepdfhosting.com/5be73b1bf4.pdf

    A few days ago I left a brief comment on Dr Moncrieff’s Blog, with a link to my mildly critical Blog post on ‘Pillshaming is real’
    ( https://drnmblog.wordpress.com/2018/04/18/pillshaming-is-real-heres-a-newish-way-to-reduce-it-and-to-reduce-antidepressant-use/ ). That comment is still being moderated. I will now attempt to leave a brief comment below this (duplicate) piece on her Blog, with a link back here. If Dr Moncrieff declines to allow my comments through moderation then it will be clear to all that the ‘Critical Psychiatry Network’, under its current co-Chairs, seeks to impose a narrow and misleading version of ‘critical’ discourse.

  • Pharma-psychiatry is resurgent in the UK as well. Dr Ed Bullmore FRCPsych is a Professor at Cambridge University and a leading ‘immuno-psychiatrist’. The UK Amazon ‘About the Author’ for his new book ‘The Inflamed Mind’ fails to mention that he has worked half-time for GlaxoSmithKilne (GSK – the makers of Paxil and Wellbutrin) since 2005: http://www.amazon.co.uk/Inflamed-Mind-radical-approach-depression-ebook/dp/B07BH9GQHK/ref=cm_cr_arp_d_product_top?ie=UTF8

    Amazon UK have not published my 2-star critical review, more than three days after I submitted it. In that time, two anonymous five-star reviews have appeared.

    In my Blog review (900 words) I critique the book as ‘could have been written by a drug rep’ (pharmaceutical company representative). If ‘immuno-psychiatry’ is really valid then cheap generic anti-inflammatories such as ibuprofen should be trialled first. Bullmore and GSK probably want to bring new patented drugs, possibly dangerous ones, onto market: https://drnmblog.wordpress.com/2018/04/30/the-inflamed-mind-by-ed-bullmore-book-review/

  • John Herbert…yes, Gotzsche is a major researcher. If you look at his recent article on ‘antidepressants’ (the first link I gave, above) the title says ‘It’s Unlikely That ‘Antidepressants’ Have a True Effect on Depression’. But towards the end he writes ‘depression pills can’t cure anything’. There is a big difference between the two which, for me, undermines his credibility.

  • Rachel…I am pretty sure that I have come across all that you describe in my clinical experience. It is implicit in my piece that people should be told about 1. efficacy & placebo effect 2. potential harms. Unfortunately the linked problems of Pharma & psychiatric self-interest prevent us giving good figures for either, and if we carry on denying the reality of pillshaming they will be able to distort it in the way(s) you suggest.

    Extreme statements such as ‘depression pills can’t cure anything’ seem to come across very often as ‘depression doesn’t exist…maybe you’re malingering’.

    Of course not all discomfort can be eliminated, but I am questioning how effective the statements of Gotszche & others are, as much as how accurate they are.

  • The message about poor efficacy and suicide risk for children appears to have got through directly to professionals in Denmark.

    But for adults it is far from clear whether very black and white ‘depression pills cannot cure anything’ ( https://www.madinamerica.com/2018/01/antidepressants-effect-depression/ ) messages will work, or even be counterproductive: https://drnmblog.wordpress.com/2018/04/18/pillshaming-is-real-heres-a-newish-way-to-reduce-it-and-to-reduce-antidepressant-use/

  • Sorry if unclear. I try to avoid jargon etc, but inevitably get drawn into it when responding to a professional (albeit retired) such as Phil Hickey. My Blog is at http://www.DrNMblog.wordpress.com .

    Of course there are serious ‘power imbalance’ issues when psychiatry is used as ‘Social Control’, but there are for other law enforcement agencies as well, in any society with inequalities. And there are many problems with both voluntary and forced ‘drugging’, especially the influence of Pharma.

    It seems a bit unreal to be even discussing with someone stuck in the ‘abolish psychiatry’ mindset that the UK left behind in the 1980s.

    I stand by all my points above, and I question whether Phil Hickey really wants a ‘substantive debate’ or just wants to vent a longstanding grudge. He seems to imply that his own ‘ad hominem’ attacks upon all psychiatrists are fine because they are aimed at a group, not an individual.

    None of the PTMF psychologists that I have engaged with over here have supported his ‘hoax’ smear (a regular feature, I now see, in his Blog pieces), and I will be surprised if any do in future.

  • ‘Acceptability generally increases when a label catalyzes immediate support experienced as acceptable to the person receiving services’…almost a truism. I have seen ‘borderline personality disorder’ be strongly rejected if it was a ‘diagnosis of exclusion’ from services, and exactly the same diagnosis strongly accepted, even proudly promoted by the person diagnosed, if it led to increased services and acceptance.

    Stephen Gilbert: in my last few years of (private) practice (2008-14) I used to talk about ‘labelling’ etc a lot. Too much, though, and the patient becomes uncomfortable.

    Steve McCrea: yes, I think you do see this in other areas of medicine, albeit less marked. ‘Metabolic syndrome’ rather than ‘obesity’ or ‘type 2 diabetes’ might be an example.

  • Dear Phil

    Yes, a bit sarcastic, but proportionate I believe, to your ad hominem statement that all psychiatrists deliberately deceive: that’s what ‘hoax’ means in both the UK and the US (I’m pretty sure). I could equally well ask what your evidence is for escalating Szasz’s more ambiguous ‘myth’ to that level.

    You foreground drugs, but many psychiatric/developmental diagnoses have little or nothing to do with Pharma: autistic spectrum disorders, addictions (originally, anyway) and ‘personality disorder’, for example. In fact, Szasz’s original concerns were about psychiatry colluding with psychoanalysis, with the aim of social control.

    I wish I had time for a longer answer, especially as your entertaining piece on http://behaviorismandmentalhealth.com/2017/11/28/rebranding-psychiatry/ has led me to reading that BJPsych article for the first time.

    I you read my recent Blog pieces then you will see that I have been far harder on Pharma (Nemeroff, for example) than the PTMF Psychologists that you praise. They appear to have come to a very British ‘gentleman’s agreement’ (a gender-free equivalent doesn’t come to mind) with their psychiatric opposites to avoid such difficult issues: will be Blogging on that in due course.

    Best wishes

    Neil

  • Well you have made things pretty clear Phil: no concessions to ‘moderation’. Like all such extreme Utopian positions it’s quite comfortable, as there’s little danger of it being tested against reality.

    Seems you have little sympathy for those many people who, as I believe, are overmedicated, especially in the US. I guess from your lofty position you think they deserve their fate as they are too stupid, unlike you, to see through the obvious ‘hoax’.

    It’s pretty clear that your position is much more prevalent in the US than in the UK, and I think you are probably wrong in predicting the PTMF will change that. I suspect that more moderate views here will continue to be associated with less overmedication. As for ‘great flaws and injustices in society’, yes, ordinary psychiatrists over here are ‘cognizant’ of social factors, but even Joanna Moncrieff recognises that psychiatry should have a medicalised ‘social control role’ on the way to her particular version of post-Capitalism.

  • Read my Blog pieces and you won’t find claims to ‘mercy, charity’ etc.

    Pharma regulation must include professional prescribers. Its extreme laxity has led in the US to an epidemic (literally) of synthetic opioid dependence and deaths. Any patient with depression, say, is free to read up on information and any reasonable psychiatrist or family doctor will respect choice, within limits. My view is that at least 9/10 people on ‘antidepressants’ shouldn’t be and the same is probably true for bipolar 2.

    I appreciate the ‘freedom’ culture is different in the US, but if I had a recurring tendency to psychosis and limited funds I would rather have been born in the UK. See Allan Frances’ tweet today: ‘Providing easy access to care & decent housing for people with severe #mentalillness is simple humanity.
    And it’s also smart government policy-reducing cost of other services- eg emergency rooms/cops/jails. UK giving high priority to reform. US is shamefully behind.’

  • Apart from ‘psychiatry’s promotion of the hoax that all their “diagnoses” stem from brain malfunctions’ (second paragraph), Philip Hickey provides a good summary of the PTMF, which itself (as far I have read) avoids the accusation of deliberate deception.

    Even if it was qualified by, for example, ‘establishment psychiatry’, such language is likely to alienate many moderate professionals and others. There is now good evidence that extremist statements such as ‘depression pills cannot cure anything’ ( https://www.madinamerica.com/2018/01/antidepressants-effect-depression/ ) cause unnecessary distress: https://drnmblog.wordpress.com/2018/04/18/pillshaming-is-real-heres-a-newish-way-to-reduce-it-and-to-reduce-antidepressant-use/ .

    And ‘antidepressant’ prescribing has doubled (in the UK) in the decade since Joanna Moncrieff’s ‘The Myth of the Chemical Cure’ (2007): attention has been sought and attained, but has that message worked? Or been counterproductive?

    I plan a further Blog piece on ‘pillshaming’ in 7-10 days, and another on the PTMF in 1-2 months.

  • Steve..I recognise much of what you describe, but I don’t have any better terms than ‘extreme scientism’, ‘assertive/aggressive scientism’, ‘excessive faith in the scientific establishment’ etc.

  • Cheers Richard…I have faith in the scientific method, and I don’t agree that involves a ‘major contradiction’, because despite a lot of philosophical effort I don’t accept that the scientific method has been logically grounded. You previously mentioned ‘verifiability’, and part of my faith in science is Karl Popper’s pointing out that ‘verifiability’ is flawed. His ‘falsifiability’ is an improvement, but still not a wholly adequate grounding: https://muse.jhu.edu/article/230187 (paywall…but I plan to Blog on this in the next few weeks).

    I agree that ‘scientism’ is still woolly, of course, as are ST’s recent articles, but he’s getting there.

  • Maybe there are slight but significant US-UK differences in the meaning of ‘scientism’. The second OED definition can be paraphrased, a little provocatively perhaps, as ‘excessive faith in science’: https://en.oxforddictionaries.com/definition/scientism

    I wrote (above) that Sami Timimi’s views have improved. He used to promote ‘Postmodernism’ as the answer to psychiatry’s problems: https://www.blogger.com/comment.g?blogID=18614557&postID=1529516108543990280 . Let us be thankful that he seems to have stopped!

  • Cheers Steve …My position is that false claims about the ‘physical reality’ of psych conditions (and about medication) over decades have undermined the public’s faith in the ‘causal agnosticism’ approach of DSM 3-4, which I still support, I think.

    Consider epilepsy and migraine: often no definitive physical test, but we still diagnose them as brain disorders, and often use medication. http://www.drnmblog.wordpress.com/?s=epilepsy . I get migraine myself, and find the fancy new meds very useful.

    Cholesterol/lipids is another good example of a ‘medical’ condition which seems to clearly fulfil Szasz’s ‘blood test’ criterion: the potential ‘scientism’ here is all about the risk/benefit ratio and misinformation. Near-identical issue about distracting from poverty as in overweight/obesity…which I do regard as ‘real’.

  • Yes, Autism is probably the strongest counter-example to the view that psychiatric/neurodevelopmental diagnostic invention and creep is primarily Pharma-driven. But as I pointed out in 2010 (www.drnmblog.wordpress.com/2010/11/26/is-the-“adult-autism-scan”-available-to-the-nhs-or-not/) there is plenty of potential money to be made from dodgy ‘diagnostic tools’.

    Sami Timimi’s critique of ‘scientistic’ diagnosis has improved since his submission (with Joanna Moncrieff) to the UK’s NICE panel on ADD / ADHD (drnmblog.wordpress.com/2010/04/02/“critical-psychiatry”/) but problems remain. Just one example: he tends to claim that proper (non-psychiatric) medical categories are always adequately grounded in biomedical fact, but what about ‘metabolic syndrome’, which has no specific biomedical test and apparently no clear cause(s): http://www.nhs.uk/conditions/metabolic-syndrome ? Surely ‘anti-neoliberal’ health practitioners like Timimi and Moncrieff should be denouncing this, with me (publicly, from now), for distracting from the well-established links between poverty (in ‘developed’ countries) and overweight/obesity?