Friday, March 24, 2023

Comments by Jeremy Wallace, MD

Showing 82 of 82 comments.

  • Strangely this all just flies in the face of the principles of Evidence Based medicine, which is medical practice based on the judicious appraisal of the best available evidence. It never say’s who should be doing the appraising and seems to be quite clear that medical experience and anecdotal evidence are not substitutes for EBM.

    I also pointed out in a post about a similar matter that occured in Finland, how Doctors who go round saying that only they are qualified to appraise the evidence seem very willing to accept evidence from non qualified, zero clinical experienced Drug reps and other industry bosses.

    So there you have hit, Shut up Dr Pies and Dr Pierre!!

  • I think I understand Ted. In a round about way (I quite like the way he writes) he is saying that medicine, of which psychiatry is a part, has become part of a massive capatilist, corporate enterprise that as co-opted sicience, evidence based medicne, doctors and organistations like the FDA, APA; RCpsych, as well as goverments to do their bidding and to not give a shit about us. Indeed we are made to feel we need this stuff they do to us to feel healthy and happy and safe. It is sort of like brave new World.

  • Thanks Sandra, actually I try my hardest to avoid them but it seems quite prevalent in Finland so even a monthly doctors business meeting gets sponsorship so I find it impossible to avoid them all. The meeting in question I deliberately turned up late but ended up walking in on the presentstion.

  • Peter I think medicine is only just beginning to understand the complexties of relationship between gene and environment. Sure you inherit some general psychological or behavioural traits, but Epigenetics would have it that genes will only get switched on in certain environments. Similarly they can be switched off again. The traffic is never one way eg from gene to outward manifestation. Work is going on right now showing how mediatation, positive thinking, therapy etc. can all have effects at the genetic level. In the field of autoimmunity, while you might have a genetetic tendency for an HLA type eg. for psoriasis, it is becoming increasingly clear that just changing your diet and lifestyle can have massive effects on your disease. This operates at a genetic level as much as any other level. The role of your microbiome in all of this, and all their genetic material, adds a layer of complexity that simple reductionist models can never understand.

  • You just know, in your heart, don’t you that this is wrong; that no medicine will take away whatever pain lies within these people; that the knock on consequences of these stimulants will be disasterous; that this is exactly what has been predicited vis a vie the DSM V and creation of catergories; That psychiatry remains in a mess; and that Jeffery Lieberman is either in denial or stupid: perhaps both at once. 🙂

  • The funny thing michael is this, that my boss posted me lieberman’s article after I had posted her links to my first blog post and to the BPS report. This was her response, to post me this. It seemed to say I’m afraid this is what the establishment says about you and your crazy critical views. I was relieved to see your response on the same day and have a chancr to fire off a salvo at this stupidity. Best wishes JW

  • Yes sleep is the key, and you’ve got to wonder how many people are getting labelled and medicated after having a period of sleep deprivation whilst in crisis? I mean what a high price to pay for having a period of not sleeping properly, getting a lifetime of visits to misinformed, patronising doctors and neurotoxic drugs.

  • The very words ‘Scientific Anarchy ‘, indicate that Dr Lierberman is clutching at straws in his whining ad hominem attack on anyone who might be critical of psychiatry, or have come up with a credible alternative. Science is in essence just a way of investigating the world around us, rooted in established principles and methodologies. It is not a political system, though from Lierberman’s opining you’d think it was. Gallileo and Darwin had the book thrown at them for challenging the established view. I think this is similar. Science in essence should be about debate, checking the facts, checking the data, examining the research methodologies, reviewing the hypothesis in light of emerging data. It isn’t anarchy doctor Lieberman, unless of course what you repesent and defend is more political and economic than scientific, which I guess you are saying it is.

  • Thanks Alix I’m very familiar with the British system. The problems you point out, are as B says pretty universal. And they extend well beyond psychiatry into all areas of medical care.

  • Erkki Isometsä has probably been too busy since winning, subsequent to your meeting, a pan Nordic prize for services to science! For his lengthy career, conducting high quality research in mood disorders and, especially, for his work in developing depression and bipolar treatment guidelines in Finland. It probably won’t surprise you that these are heavily weighted towards physical treatments.

    Gibbons, R.D. , for the record, has too many conflicted interests, that I’d advise one takes anything he says with a large tablespoon of salt.

  • Ketamine I once probably works, if it does, by rapidly increasing intracellular magnesium. There is some evidence to suggest, what ever the psychocial origins of depression at the bio-cellular level, chronic stress may be wreaking havoc with glutamate and overloading the neurones with calcium. Magnesium, reduces the intracellular calcium, and reverses the effect. So why not just take some magnesium supplements or improve your diet? There is an interesting paper by Eby and Eby, Rapid recovery from major depression using magnesium treatment, Medical hypothesis 2006, 67, 362-370 if anyone is interested. It makes a whole lot more sense than this macho, brain damaging medical culture of giving people a horse anaesthetic and calling it a treatment.

  • As a practicing psychiatrist, I completely agree with everything you say. I think psychiatric training is woefully inadequate for the task at hand. Many of the proffessors leading postgraduate training are the very key opinion leaders beloved and, indeed, created by the pharmaceutical industry. I worry at the lack of depth of understanding of patients’ suffering that many of my junior collegues have.

    I would add some Anthropology to your list of what is needed in education. I did an MSc with Roland Littlewood and one of his (and Arthur Kleinman’s) core concepts shook my world i.e. Cultural psychiatry should not be about trying to find goodness of fit between western categories and the various forms of mental distress around the world, but to take the lens of cultural and social anthropology and look at our own culture and realise that the very catergories we have created and rarerefied reflect the cultural values and norms of own soceity. They are in other words just social constructs.

    Funny, as I wrote this a nurse came in to my room and told me a patient had told her I was the best doctor she had ever met. Nice feedback. I didn’t do much apart from treat her as my equal, listen to her concerns, give her careful, informed advice about what her ‘illness’ really is, to my mind, and how to reduce her medication sensibly and carefully, and I also gave her list of some self help books that I thought might help her.

  • Here are my two ideas.

    1) Write book reviews on Amazon: Good reviews for critical psychiatry books and negative/bad for non critical books like the DSM5. In your negative book reviews make sure to say that a much more informative and up to date appraisal of psychiatry can be found in Robert Whitiker’s books. If enough people buy a copy of anatomy or MIA then the section that shows most customers eventually bought … would show Anatomy or MAI. Why not buy a copy yourelf while you are at it, and send it to a friend, or leave it out in a doctors surgery, Psychiatrists waiting room or whatever.

    2) Open an instagram account. If you use hashtags like depression, schizophrenia, bipolar, psychiatry, anorexia etc. you get access to what I call, ‘the kingdom of the sad’. Interestingly at a phenomological level all those hashtags lead to similar kinds of images (e.g self harmed wrists, skinny legs and tummies, suicide notes i.e. sadness writ large). These are the people you want to reach, so post pictures of joy, messages of hope, take photos of critical book covers, quote your favourite critical writers. I guess you could also hashtag NAMI, APA; RCPsych etc. whislt you are at it.

  • The researchers suggested inducing sleep deprivation could provide a means to test new drugs or methods for helping people who’ve been diagnosed with schizophrenia.

    This is just plain stupid. So many people I see, who have been diagnosed with ‘schizophrenia’, when you ask what happened describe a life crisis, followed by mood disturbance, anxiety etc and also sleeplessness which leads to the psychotic symptoms. Surely the conclusion should be sleep disturbance and ‘schizophrenia’ are one and the same thing.

  • Thank you for this very inspiring story. I heard Jaqui Dillon speak once. She is very inspiring. I remeber something she said, “I have turned my suffering into a gift for others”. That is what you are doing.

    I am a psychiatrist. I have, these days, zero belief in the biological paradigm. Every day I see how damaged people are by their diagnoses and the consquent narrative it offers of chronicity and hopelessness. It’s bedfellow, the discourse that says, “you must take these medications for the rest of your life”, is equally disabling, indeed in a more concrete way. Most days I support people coming off meds. I very rarely prescribe now. But its hard working in system that thinks differently.

    So your message of hope is very powerful. It does get better.

  • The 2 week grief thing just demonstrates what a hocus Pocus pile of horsecrap the DSMV actually is. I defy anyone to get over grief in two weeks for a start. Secondly the expression of grief is so culturally constructed that as a diagnostic enity it has little purchase outside of the boardroom where the psychopaths who wrote the DSMV reside. In Sicilly for example after the death of her husbund a woman must where black for the rest of her life. Will this be giving Italian psychiatrist a headache, “where some colour for godsake or It’ll be the prozac for you!”. Do yourself a favour, through it out the window.

  • I am a psychiatrist, who in the last few years has “seen through psychiatry” as Szaz once put it. I continue to work in the field as I have mortage to pay and kids to feed and ever increasingly try and move my clinical encounters beyond diagnosis towards the meaning of symptoms and the suffering. I was rather irked recently, when in a job appraisal, my younger and more inexperience senior doctor, starting saying, “well we know you are very good at reducing medicatio, but do you feel comfortable making a diagnosis and would you know how to start someone on medication?” Well, after floundering around for a couple of minutes, this anti-diagnostic diatriabe suddenly errupted from me… Sure I can make a diagnosis, but does that diagnosis have any validity? And does a diagnosis have any bearing on the persons actual suffering? Are you able to ask a patient, ” not what is wrong with you, but what has happened to you?”

  • Hi Phil, great review. What gets me is how so many professionals with transcultural backgrounds seem to be party to this . Arthur Kleinman in the 1970s talked about the category fallacy, i.e. the very catergories we use to describe mental distress can not themselves be seen as culture free entities. If you take an example like protracted grief, it says much about how we should be in relation to loss as a society. I am sure at root is an economic equation which mearly looks at days off work. In cross cultural studies of course there is wide variation in responses to death. It seems sad to try and level all those out into one global response.

  • They are as good as useless as antidepressants (an exgerrated placebo at best), they make you kill yourself or someone else, they are impossible to come off, they screw up your developing childs brain etc.etc. Why do doctors keep prescribing them and why do people keep taking them?

    Sleep well, eat well, excercise, socialize, meditate, cut back on alcohol, explore the meanings behind your sadness, let go.

  • Anogagnosia is a badge of honour! but strictly speaking by definition if you wonder if you got it you don’t.

    Good on you for having a go. I wouldn’t even try as there are too many better books to read.

    Like you I think if one concludes with absoolute clarity that this is all just brain disease it leaves little room for further exploration. Recovery narratives, Gene studies, neuropathology, biochemical studies all point to a very different conclusion. Makes me wonder how he can be so sure.

  • I once heard you speak at a bioethics conference in Helsinki and was duely impressed. Actually it inspired me to read more. Great to see you’ve written a book.

    I’ve been wondering about how much of the overall problem lies in the relationship between big pharma and government. How much, through finicial incentives, pharmaceutical companies are able to lobby governments and manipulate health policy. Doctors in many instances are just civil servants carrying out the will of the state.

    e.g. I read an article about the use of Tamiflu as a swine flu vaccine in Finland where the population are a pretty compliant and trusting bunch. There was massive uptake of the vaccine resulting in a marked increase in the incidence of narcolepsy, particulary in children. In an almost foot note to the article they mentioned the finicial ties between GSK and the Finnish governmant advoisors for this vaccination program. This to my mind was the real scandal.

    All the best,


  • Peter, I work in Finland and regret to inform You that those sharks are here too. Sadly Open Dialogue is more-or-less confined to some tiny corner of Lapland. I work in the Helsinki area where many seem welded to a biological model of mental illness. The current national care guidelines for Schizophrenia have nothing of an open dialogue approach rather it is all diagnosis and drug treatment focused. I have asked around as to why with such good outcomes open dialogue isn’t more widespread. Someone told me they were at a meeting when Open Dialogue was presented and the approach was accused of being ‘unethical’ because ‘schizophrenia is a brain disease and it is wrong to withold treatment from them’. Jaakko Seikula himself has also admitted that the outcome results have been accused of being ‘too good to be true’. Luckily he remains quite sanguine and philosophical about it all.

  • Sometimes I wonder if we shouldn’t just rip up all we know about ‘schizophrenia’ and start again; from the person, from the symptoms, from the beginning, perhaps taking, what Jo Moncrieff calls, a drug centered approach to these medicines, as opposed to a disease centered approach. These are not diseases we are dealing with, the drugs are not antipsychotic but rather drugs with effects on dopamine systems, a by-product of which might be symptom control. And if there is no disease there is no need for life long adherence, but a real need to develop services that get people understanding their symptoms in the context of their experience, providing problem solving, functional rehabilitation, family interventions, mindfulness based treatments, spiritual care… basically anything which prevents this chronicity. The current system seems to promote chronicity through the promotion of a disease model. The drugs may play a role but only as tools to manage symptoms and therefore built into careplans from the beginning should be an exit stratergy for helping people get off the drugs without provoking another relapse. The science as you suggest seems to support this view. Very little science really supports the traditional disease based model of psychosis care.

  • This is fascinating (and, as above, disturbing). It beautifully demonstrates that the flow of ‘biological abnormality’ to signs and symptoms just isn’t so. All sorts of confounding and mitigating factors get in the way, not least of all the person’s expectation of how he should respond as a ‘schizophrenic’.

  • I heard recently that big Pharma are now putting less resources into developing drugs for psychiatric disorders and turning their attention to anticholesterol drugs.

    Statins along with psych drugs however remain some of the most controversial products on the market, possibly reducing risk of death from an MI but raising the all cause mortality of the patient.

    But hey, lets not worry about death as there is money to be had in this here treatment. We also give doctors something to give the patuients so they can have the illusion of doing something. Why would a doctor want to waste his time talking with the patient about diet and suggesting healthy ways of eating or living. The great bonus here is multinational food companies like Nestle have hijacked the diet industry too and in turn lobbied governments to promote their low fat, low nutrion , high sugar, chloestrogenic diets. Its win win win all the way down the line.

  • Thank you Sera for your brave courageous story. My wife has just given birth to our third baby 5 weeks ago. She came out early, small, feeding poorly and failing to thrive. This required a spell in hospital all worrying stuff. What made it worse is that the Nurses seemed to lack any understading of what a fragile sensitive time this was and behaved in a bullying way even seemingly blaming my wife for the problem though she had bent over backwards to try and feed the baby. This just undermined her confidence and sent ´her into a tailspin for a while in turn disturbing the important bond between baby and mother. That we are both health care professionals, well educated, responsible with two children who are flourishing didn’t enter into it. We were labelled a problem and more so because we complained. Now baby is on some kind of watch list at the health centre and we keep being told to give her more formula which we try and avoid. It’s all just short term risk management, cobvering their backs with no insight into the real situation. It made me realise that lazy doctoring is not eclusive to psychiatry. It’s everywhere. Also to say with all three of my babies I have had intrusive images mand fears of harm. With the first I found it disturbing. Now I understand it somehow and sort of welcome the thoughts and pass through them in some buddhist kind of way, knowing they are thougts and they are not me. It’s hard being a human why does modern medicine make it harder.

  • The title of this lecture says it all…it’s bullshit from beginning to end. Miami University, Numerhoff, Big pharma, IOP are all chasing the money. Why is no one chasing the truth? What happened to all our noble values?

  • One of the things that stands out from the ‘Open dialogue’ outcome studies is how many people are back in work/ education within a few years of treatment. You’d think any Government would realise the economic benefits of such an intervention, lessexpensive hospital bed days, less long term disability payments, more people contributing to an economy.

  • This is a mainstream journal, and its editors surely wouldn’t publish this discussion unless they knew that the scientific evidence warranted it.

    Ah what wistful thinking!

    Here’s a link to a 1997 article by Joanna Moncrieff that essentially asserts somethink similar re: lithium use and Bipolar.

    High time we reappraised all our models of ‘mental illness’ and how these drugs work.

  • I have met Jakko Seikkula, he is a lovely gentle man, and I have asked him about this issue, namely why dooes the rest of Finland seem to ignore these excellent results. Indeed a country like Finland which leads the way with education, mobile technolgy, socail care etc, with a small, coherent population is well placed to lead the world in psychosis care. Unfortunately, my guess is that, Big Pharma have bought the Finnish government and lobby powerfully for biomedical approaches. It is said that when jakko Seikkula presented his findings at a conference people told him the Tornio Group were being unethical for witholding meduication or that his results were too good to be true. This is of course heresay. Anyway it is all rather sad. Methinks Mad in America and anatomy of epidemic need a Finnish tranlation as I am not sure one exists. Finnish patients need to know that there are some alternatives, and to hold their government and medical proffessionals to account, to demand better, more humane, patient centred care. E.g. at the recent Finnish psychiatrists Association annual meet up I noticed a talk which I didn’t attend called, ‘ect as yet a still underused form of treatment’ I mean I ask you where is this all heading?

  • Dear Sandra, as a fellow clinician I welcome this and your proposed future posts as I think many psychiatrists who adopt a critical approach are honestly trying to work out how best to use drugs in a way that benefits their patuients while minimising harm. I currently work in Finland and can I say, that sadly it is not all open Dialogue here. Indeed I have seen some of the most terrible polypharmacy I’ve ever witnessed in my clinical life. At the moment I am in a rehab post and nearly every patient I try lowering the dose a bit. Unfortunetely my other colleagues are not of the same mind, saying things like, well if the patient is stable why rock the boat. that is why this sort of guidance for sensible and judicous use of meds is required right now. There are however many thorny issues to tease out. I notice you miss out of your reading list joanna Moncrieff who has written a number of very thoughtful books about psychiatric medication, their history, pharmacaology etc. Worth a read.

  • I think I understand what you are saying Milt. The problem lies with all the shame around mental health issues, and how to talk about it without alienating others through their prejuidice. Perhaps one could say “I am a sensitive, caring person who has undergone trauma and for me there is no shame in that” ??

  • One potentially interesting subplot to this shared gene theory/myth is that this rather puts the nail in the coffin of the notion that these are all separate rareified disorders. As I commented to a friend, it leaves us with one unified disorder, lets call it unhapiness, and surely you can’t argue that this is purely caused by genes alone.

  • This is very good and clear summary of the position in genetics in psychiatry, but I wonder if you comment on the DISC1 (disoreded in schizophrenia!) gene, which a colleague of mine is always going on about. I think he’s talking crap, but he has lots of ‘science’ to back up his arguments, and I only have conjecture.

  • I’m so glad you posted this. I was recently very annoyed by an article in the Finnish press with graphs showing a correlation between rising SSRI prescriptions and falling suicides. It just seemed so idiotic. My initial thoughts were to draw up some graphs demonstrating equally compelling correlations between changing patterns of alcohol use, falling Body mass index averages, meat consumption etc. Nor did they stratify the data in anyway so we were unable to see if suicide was actually on the increase in the young, but dropping in other groups for instance. This is a country remebemer which has had its fair share of school shootings and other violent incidents. I think the debate about the safety of SSRIs needs to intensify here too.

  • Thanks for this. I got rid of the TV ages ago. It hurts my brain so. I occassionally watch stuff by the webb or listen to the radio. Do you know Max Keiser and Stacy Hurbert by the way? Their brand of renagade economics that tells it like it is and demonstrtaes that modernity and liberal capiltalism has spun wicked, pointless webb of lies and misery. They are funny too. Here’s a link to the keiser report on you tube.

    I also recommend the ‘truth about markets’ a weekly radio show on resonance fm which can be found on line or downloaded as a podcast. It’s the only thing that makes any sense of the madness of post modernity.

  • Great post. For me at my lowest. loneliest ebb it was roots revival reggae music from the 1970s that blessed my ears. An evangelical upbringing in Africa helped me connect with both the biblical themes and the notion of repatriation. At times it seemed that the narrative of black redemption echoed my own journey. For me the wilderness was my own ‘madness’, the exodus my journey out of it. The reggae beat seemed to calm my heart and align my brain waves. the message was upbeat and positive. It is hard to pick one tune that I love more than any other.

    I think Bob Marley is, of course, the most outstanding and his music provides a soundtrack to my life. Interesting you call your post Redemption songs, because his tune Redemption song has a line that I think should be a motto for the survival movement: ’emancipate yourselves from mental slavery, none but ourselves can set us free’.

    Culture’s ‘I am alone in the wilderness’ provided comfort and spoke to that huge sense of isolation I felt from my fellow man whilst in the thick of it.

    And I leave you with something by lee scratch perry who had is own manic, psychotic, ganja fuelled breakdown in the 1970s and demonstartes clearly that madness is no barrier to sustained creativity and genius. Here is a track ‘disco devil’ with some rare footage of him at the height of his breakdown.

  • Thank you Andrew for your Honesty. There are many of us who work in places that contradict our core values, and if we went now, away from the place of our work, perhaps the only compassionate voice would be removed. My reading of recovery narratives is that it is often one good person, an OT or support worker for example, who leads the person suffering from mental distress to a better place, or is, at least, the catalyst for recovery. Being in a position of leadership you are also best placed to try an effect change, be it through example, education or speaking truth to power. I stay because I want the system to change and I want to be part of that change. Me not being there won’t stop this happening. Of course your life and mental health and mental health is also important, so if you do decide to stay you will need to find some allies at work and external support.

  • Thank you jacqui and all the other commentators. My wife and I read this over the weekend, and in discussing it my comments were that it was clear he was looking for a label for his daughter and seems happy to have found one, that I as an infant would probably want to kill my brother if he was ‘normal’, treated differently and diverting so much attention away from my unusualness, and that we have no idea what went on behind the scenes of that family. Well it turns out we do have some idea and one never sees smoke without fire. I think the whole thing is utterly disturbing and more so that a left leaning, liberal newspaper like the Guardian should, uncritically, publish, such an article.

  • I think that you are being very generous to Dr. torrey re: his sexism. Anti-intellectual with a veneer of ‘scientism’ (i like your neologism) does sound like a dangerous world view though, especially when you are in a postition of power. And thanks for the appreciation and to Belinda too. There are a few of us who have ‘seen through psychiatry’ as Szaz says.

  • As a psychiatrist I must confess to being more than a little disturbed by F. Torrey and his revisionist view of science as well as his ability to sling such stones from within the confines of such a fragile Glass house.

    I personally thing anosagnosia is being misapprproiated as a term for ‘lack of insight’ in psychiatric disturbance and, as such, simply demonstrates lazy thinking and back to front logic which would make Hughling’s Jackson turn in his grave.

    Just to clarify a few points I have never read the national geographic though enjoy some of the photography within it’s pages.

    I think this following sentence is deeply offence and misogynist “Another woman, trained as a mental health professional, briefly examines some scientific data and concludes it is wrong because it conflicts with her deeply held social belief system. This is denial.” To suggest that all women are unable to appraise a scientific paper is just so out of step with contemporary views on sexual equality it makes it hard for me to take anything F. Torrey has to say seriously.

    I am a mental health professional and I am not convinced about the biological basis of psychiatric illness. Does this make me a denier? I rather think like Sandra that instead of denying I struggle daily with big and complex issues and trying to make sense of what is essentially a very murky area of medicine. Most of all I want what is best for my patients and I can see that so many of them have been hurt by a system that claims to be helping them. As such anyone who refuses to hear the voices of those that have been through the system writing off their refusal to take drugs as a neurogical disorder rather than a personal choice to avoid troubling side effects is the one who is in denial.