Tuesday, February 7, 2023

Comments by Janne

Showing 10 of 10 comments.

  • That was like reading a horror story. You have gone through a lot. That is a great video and I hope your ideas of continuing your work are successful. People that have courage to go against public opinion are few. Amount of persecution seems not to be small.

    Those being the first at something somewhere always have it hardest. It is very similar to the case of new political parties that become popular. At first they are mocked and ridiculed and even sued at courts. Not being able to silence those that speak against something commonly considered as “good” is frustrating. Good old arguments that worked before become useless and a talk against them becomes common.

    When years go by you can be extremely proud of yourself knowing that you have helped many. That podcast is a great idea. That would get people accustomed to the idea that one cannot just trust someone educated professional and that it is arguments and research and freedom to say those that matter. One cannot simply force something to be true by calling someone with ugly names and mocking her. That learning phase can be stormy, but finally it will calm down.

    It really bothers me that the whole belief that science can prove the necessity of something and that educated professionals can make good decisions for others has been going on for so long. When that happens some personal or political goals are pushed in the scientific evidence base and expressed as objective fact. But those that are interested in these kinds of philosophical problems seem few.

  • What an extremely pleasant way to start a day by reading your article. I have been waiting for that serialized version of your critical psychiatry textbook. I really dislike the idea of spending lots of state money for a narrative of helping when the actual observations contradict that story.

    Telling people publicly what they want to hear and fine tuning words to appear professional like that naming the psychotropic substances by anti-sickness labels is really hideous. Still while listening to it it feels comfortable and tempting and anyone arguing back feels non professional extremist who exaggerates things.

    “We have a situation where the “customers,” the patients and their relatives, do not agree with the “salespeople,” the psychiatrists. When this is the case, the providers are usually quick to change their products or services, but this doesn’t happen in psychiatry, which has a monopoly on treating patients with mental health issues, with family doctors as their complacent frontline sales staff that do not ask uncomfortable questions about what they are selling.”

    I’d give those words a lot more attention, because they might well be a root cause for psychiatry becoming the current always compassionately smiling monster. If a customer is not a real customer, but forced to buy something it is easy to see that those motivations lead into science that is focused on goals of someone else than a customer. What is not as easy to see is the scale of that and how much it has twisted the common reality.

    Do you have any ideas how to correct that motivation? One of my favorite ideas is to force the salary of professionals in those cases where customer cannot choose to relate to the daily happiness of those under their care. That way use of involuntary force could still be allowed which is important for those politicians who believe in insanity defense in courts.

    It horrifies me that this monetary motivation problem is not unique to psychiatry. Many young children who cannot live with their parents and elderly people live in similar places that have been formed without proper guiding invisible hand of free markets. One day we all lose our youth and we are at the mercy of others. Mostly in quite similar conditions as psychiatric patients. You can be a psychiatric survivor or professor of psychiatry for forty years and then you have a similar destiny with forced antipsychotics and anti-epileptic drugs.

  • Hi Robert.

    That would be nice. Making the documentary available here with some way to contact those who made it, would also create the possibility to recommend it to television. Many channels ask opinions of their viewers and have online forms or contact info of staff for that purpose. That could also make profit for those who hold copyrights of that documentary.

    Ole has every reason to be extremely proud. Those hospitals are living proof that listening to the wishes of patients makes a big difference. If there is a hospital where use of force is unnecessary and medication is not needed and patients are happy then it makes other hospitals and arguments of mainstream psychiatrists look really bad.

    If the worst happens and those hospitals have to be closed I hope there is some way to save their legacy.

  • “The hospital really had a tough time until two years ago, when we had a large documentary on the biggest Norwegian television station showing Norwegian people how a psychiatric hospital could be.”

    That really makes me wonder. Could it be possible to ask someone to show that documentary in other countries with translated subtitles?

    Television is the main channel for big audiences and it could make many question their beliefs. Most people are still living in that world where drug free mental health care seems like a fairy tale that can only end in violence and suicides.

    Certainly that documentary seems to have made a big difference there in Norway. I hope that everything with financing ends up well and those hospitals are not closed for political reasons.

  • Yes, that is how science should be working: Someone finds something that contradicts the current research and publishes the results and after a peer reviewing process the mistakes are pointed out or in rare cases the new scientific consensus is formed.

    That process is proven to work in many single cases, but there seems to be some kind of hindrance in some sciences: Strong motivations to believe something like for example income and job and reputation and possibility of being judged by law depending on some well accepted truth causes the peer reviewing group being subjective instead of being objective.

    Those specializing in psychiatry work the most likely as psychiatrists in health care. They constantly give statements that are legally binding and if a citizen opens a legal case against some decision then reviewing if the decision made by the psychiatrist was correct is given to another psychiatrist and reviewing his work is handled in a similar way.

    So the job and the freedom and the reputation of a whole group depends on the consistency of the group and that consistency comes from the consistency of the science behind their decisions. Any major change in the scientific evidence base that would question any part of it would make the whole group vulnerable.

    Which is of course the case with any area of science: But the collapsing of the bridge and the crashing of the spaceship and verifying the cause is much more exact process and not related to moral values like the idea behind psychiatry that some way of feeling or some deed is “good” and some way of feeling or some deed is “bad”.

    Things related to that “bad” are called symptoms and things lessening that “bad” are called “lowering the symptoms” and the substance lowering that “bad” is called “the medicine” and “the help”.

    If that thing considered as “the help” is proven to happen then psychiatry is called “evidence based” and the moral base and subjective words as “good” and “bad” are hiding under a discussion that uses the same words as discussion of hard natural sciences and forgets turning moral values into exact facts.

    That leaves a strong possibility that the thing that sounds “bad” or “good” or in your language “outweights the risks” and is stated as self-evident fact is not objective at all and can cause things considered as “harmful” by everyone in the long term or immediately. Instead of describing and explaining how the system works the focus on medical sciences is on how the system should work and how to cause that change.

    That goes against “there is no ought from is” what is one the most famous deduction errors listed. So at the very same time much of the psychiatric deduction is based on feelings instead of a natural phenomenon and at the very same time there has to be exactness of the natural science and no mistakes done. So there cannot even be discussion about that uncertainty of the basic concepts.

    Let’s take an example. I had read your conversation here about what happens when someone stops using medicine. You claimed that a worsening state of the patient was caused by the relapse and need for medication: Underlying sickness comes back. Others here claimed that it was usually because of dependency on those drugs.

    That is not a question that is a matter of opinions, but the fact that can be studied and fact proofed, because reason of something happening is unrelated to whether thing happening is “good” or “bad” while it can completely change that opinion:

    If the unwell things happening after stopping antidepressants are usually caused by earlier long term exposure to medicine that would change both the opinion about medicines and the opinion about the people promoting them as extremely negative.

    If the things happening after stopping antidepressants are usually caused by underlying sickness and earlier long term exposure to medicine is unrelated then opinion about medicines and people promoting them stays good, but opinion about those resisting the medication and therefore resisting the psychiatrists look really bad.

    Do those extremely unfavorable and extremely favorable consequences of something being true or untrue have an effect on the self correcting nature of the scientific process? Or do they affect only untrained patients that have limited reasoning abilities?

    What has to be kept in mind is that if motives like unfavorable outcomes of something being true prevents autocorrecting of science and is causing incorrectness building inside the evidence base you cannot ask proof for that opinion from anyone working in the area of psychiatry.

    Which is more of the problem than you might think, because the whole fact verifying process of our society lies on the “trusted source” that is the area of experts trained for some specific work field and their consensus.

    Let’s use your fact proofing process as an example.

    What you seem to be seeking is some “trusted source” that gives you the exact fact that you can then repeat. That seems to be your method of fact checking and it depends completely on the source you trust being trustworthy. That means that you can believe that things said there are true even if you do not check them yourself.

    As we have seen here your behavior pattern is that you will find those that say that something you have read is not true and cite them the source you find you can trust. And because your way of fact proofing is that source you trust and you already know what it says there is true there really is no way of changing your opinion.

    That is extremely likely the very same process that many doing peer reviewing repeat when reviewing an article. The claim is compared with the words of some source they think that is trustworthy and then those words are repeated.

    There lies the problem. Those questions still are not matter of words and can be verified, but still a method of fact proofing happens by comparing the words with some pre-existing text source and then repeating them.

    Therefore there really is no way of anyone here making an argument you would find convincing.

    Your verification method is exactly the same as Wikipedia and dictionaries and newspapers and textbooks use. Concept of “trusted source” is the main method for fighting against nonsense and misleading information.

    It would be interesting to hear a story of what happened when Gøtzsche tried to publish his findings about mortality. Many of his other writings are accepted, but reputation is everything for any organization and for every magazine. Losing reputation means losing the customers and being left out from important discussions. Was his article cut down in the scientific peer review process or before that and left unpublished?

    For those publishing medical science opinions of those working in the field mean a lot. Losing their support and respect could mean the end of the magazine. That problem with motivations with psychiatrists being the trusted source and still having strong unscientific motives exists therefore also with the medical magazines and scientific organizations.

    If you read his Wikipedia page it tells a story how Gøtsche was expelled from the board of the scientific charity organization and from the organization. Many resigned with him as a protest. That losing a job seems to be a common story for anyone speaking against scientific methods of psychiatry and their treatment results. That kind of fact proofing by an invisible hand that hurts makes psychiatry very authoritative and exclusive.

    That requirement of trusted sources and not angering them as a proof of acceptable behavior and scientific validity is not that much different from Russian requiring newspapers to use a source that the government accepts. Endangering his job is not something many are willing to do. Guarding against wrong and dangerous opinions turns easily from preventing misinformation to promoting it.

  • I agree with you. Accusations that psychiatric drugs kill would really need good public article with sources and ability to debate. It is not okay to have to buy the book just to be able to verify something.

    That amount of number of deaths is not directly from any research but an estimation that Gøtzsche made based on research. This is from a book “Deadly psychiatry and organised denial” chapter 14. He went trough individual studies about added mortality on older people ordered by medicine group and used Denmark 2013 data to check amount of drug users on that age group. Then he multiplied those and compared numbers to another causes of death.

    For example for older antidepressants users he used two studies:

    Antidepressant use and risk of adverse outcomes in older people: population based cohort study BMJ 2011;343:d4551 https://www.bmj.com/content/343/bmj.d4551

    “Absolute risks over 1 year for all cause mortality were 7.04% for patients while not taking antidepressants, 8.12% for those taking tricyclic antidepressants, 10.61% for selective serotonin reuptake inhibitors, and 11.43% for other antidepressants.”

    (3.6% of treated patients dead in a year when compared to untreated)

    And:

    Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women’s Health Initiative study Jordan W Smoller et al. Arch Intern Med. 2009.
    https://pubmed.ncbi.nlm.nih.gov/20008698/

    “Tricyclic antidepressant (TCA) use was associated with increased risk of all-cause mortality (HR,1.67 [95% CI, 1.33-2.09]; annualized rate, 14.14 deaths per 1000 person-years). There were no significant differences between SSRI and TCA use in risk of any outcomes.”

    (0.5% treated patients dead in a year when compared to untreated)

    Latter study had a lot smaller drug induced death rate, but according to Gøtsche that was most likely explained by more vague classification and younger patients and patients that lacked many typical risk factors. So he used value 2% of antidepressant users dead in a year of people older than 65 years old when calculating his estimation. For antipsychotics and benzodiazepimes he used 1% dead in year in similar age group based on other studies.

    Calculating causes of mortality is not always easy. For example there are Finnish register based studies with results that usage of antidepressants and antipsychotics lowers mortality of schizophrenia patients.

    Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study Jari Tiihonen et al. Am J Psychiatry. 2016.
    https://pubmed.ncbi.nlm.nih.gov/26651392/

    “Moderate and high-dose antipsychotic and antidepressant use were associated with 15%-40% lower overall mortality, whereas chronic high-dose use of benzodiazepines was associated with up to a 70% higher risk of death compared with no exposure.”

    So there are two highly different story lines and the both sides try to explain what is wrong with the reasoning of the other group and causes of it.

    “Mad In America” and similar groups accuse that majority of psychiatry research is poorly made pointing the exact mistakes in research methods and studies like not having proper placebo group because everyone is medicated and “unmedicated” patients not really being unmedicated, but sometimes using more medication than the “medicated” group or being abruptly withdrawn and that withdrawal caused deaths and hospitalizations should be calculated as drug caused deaths and hospitalizations.

    “Mainline psychiatry” what seems to be your information source accuses groups like “Mad in America” for twisting the results and cherry picking data. Among that storyline drugs are safe and save lives and only problem with succesful treatment is that patients do not follow their treatment plan and do not understant that they need for medication.

    That is the world the majority. Permission to talk publicly on newspapers and on television and on science magazines is mostly given to latter group and any professional speaking publicly against treatment standards is usually forced to lose his job quickly and removed from his positions for making wrong and dangerous claims.

    In that storyline those who oppose psychiatry and call it nonscientific and corrupted do not understand science and are antipsychiatric sensationalists and conspiracy theorists thinking with their emotions and not with their reason.

    Sometimes I wonder if there is any way for typical people to confirm which side is right. Part of the problem is that reading scientific text is complex and evaluating it needs lifelong commitment to subject or personal experiences. Another part of the problem is that those texts are source of income for their authors. And for that I do not mean the typical “money combined with wrong motivations corrupts”, but simply the problem that we saw here:

    Someone says something and to confirm that one has to buy access to article or book. Then that source says something and to confirm that yet another access to another data has to be bought.

  • “Depression is a complex, heterogeneous disorder with biological, psychological, and sociocultural determinants and risk factors.”

    Do you know what happens if one puts million people to study and write always new minor details about something and then makes them repeat what they have read from other similar minor detail producers?

    Does there appear to be visible red line connecting all the dots or does the subject start looking more fuzzy and more complex than it really is? Physics can make accurate predictions and check them to falsify claims and keeping researchers on line with reality, but psychiatry does not have as solid self correcting mechanism.

    Thomas Schnell, I’d suggest you start by reading drug info. You’ll find that in main menu. There is an extremely good collection of studies with sources that answer to most of those exact claims you are doing, because they are not as unheard here as you may feel. Not every article here has every detail.

    “””
    “Psychiatric drugs are so widely used that they incapacitate hundreds of millions of people around the globe.”

    Dr., would you cite the source and the page #? Thanks
    “””

    If you are interested in those sources and you get not answer here you might want to read his books. They have sources. This Mad In America is based mostly on work of Robert Whitaker so those main menu pages likely do not contain that. Robert Whitaker is usually nicer with his words than Peter C. Gøtzsche, MD and does not as directly talk about deaths.

    It is healthy habit to be careful and doubtful when facing something unfamiliar, and I hope that you’ll be interested enough to dive deeper to check all the facts until you are satisfied.

  • I am waiting that Critical Psychiatry Textbook series. You are writing important books as is Robert Whitaker. It is not easy for uneducated people like me to try to go trough complex studies in foreign language just to be able to argue with those that make decisions.

    When educated calm and nice professional says “that is studied a lot and it is safe and proven to help” the other side is quite helpless. “Don’t you want to get better? It is normal to be scared of medicines at first and it takes time to find the right medication, but they help you.”

    Those studies about medicines are particularly tricky. If there are two RCTs and the both say that “this lowers symptoms” then without extra knowledge not found in those studies one cannot separate that one way of lowering symptoms leads to early death and rest of life depending on others and the other way of lowering symptoms leads to being able to work and behave as reasonable citizen.

    For almost any reader or listener lowering symptoms is always a good thing and means that patient is improving. Idea that lowering symptoms can destroy someone’s health is really foreign. And even more foreign idea is that worsening sickness (relapse) can improve health in long term.

  • I hope that one day someone does similar research to predict risk of antipsychotics withdrawal symptoms and their severity.

    All the most important results published here on Mad In America site (like this) should really be collected in one place here, because currently they just disappear soon after publishing and are hard to find afterwards hindering the educating.

    When combined evidence against current medical model would be in few easy to find places then it could be reused and spread without extra effort. There are dozens of important articles here, but only regular followers know about them.

  • Thank you Gøtzsche. I truly appreciate these articles that analyze science behind biases in easy to understand way. If psychiatry text books are one day to be corrected, that must happen using scientific method by pointing out mistakes that had been made and not just telling about awful experiences we have that can always be dismissed as subjective opinions.

    The one thing I find horrifying is that why science is not correcting itself like it should do? Are there some cases where wishes of those who do it overwrite the way how it should work?

    When one of your books was published here in Finland, local Psychiatry Union made it look bad calling it sensational and telling that it was full of mistakes and half truths and was one sided and had anecdotes with no way to check if they were true. They called psychiatry you described as a fictional.

    That makes me wonder. It is not hard to watch people and make notes and not all research is made by private organizations seeking for profit. Harms those drugs do are not some hard to see entities requiring years of training to see. They are not hidden behind enormous benefits. Unlike modern physics or mathematics, they do not require complex machines to measure.

    I like idea of calculating that number needed to harm. But there is that constant problem that if one side does not care about knowledge, but pursues something else, how can any fact change anything? Everything can be denied with simply calling it with bad names and ignoring it. That is not how it should be. If those that research physics can solve complex questions like whether the light is the wave or the particle then why are those majoring psychiatry not alike?

    I am not scientist like you, but I once made experiment, that I still find so important that it should be repeated in proper environment using patients that are thought needing the medication. Can I tell you a story? I was 25 years old and I had used antipsychotic medicine 10 years against my will. Anytime I tried to lower the dose at first there were three days of elevated mood and lack of sleep and then I completely lost my ability to think and move after four days.

    I started measuring how much I could lower my dose without causing losing ability think and move. I was using 10 mg / day. The next pill was 7.5 mg so they went with 2.5 mg intervals. Using that smaller pill made my life horrible after four days. After lots of testing I invented a method to adjust my daily amount with 0.1 mg accuracy. It required lots of work every day to first dissolve pill at least half a day before in exactly 100 ml of water and then mix it and remove the amount I wanted before drinking.

    Results of my test were that I could subtract 0.2 mg of my daily amount (2 ml of water) without any problems. Limit was 0.5 mg (5 ml of water). That was too much for me to endure. Later I found that by lowering that 0.2 mg I had to wait two weeks until I could lower again. After half a year I was easily using that 7.5 mg that was impossible for me before.

    Feelings I got after succesful experiment were not simply a joy. I felt rage. It was such a simple experiment that any high schooler could do: Using that method it could be tested whether the depedency of medicines is caused by psychosis or caused by medicine. Using that method one could also test if psychosis after lowering medication is caused by medication or something else.

    Testing that with simply one person is not much of an experiment, but I do not really understand why that experiment is not already made with larger group. It would be really important to know how much drug can be safely adjusted and what are individual boundaries. That experiment repeated with different variations would remove lots of superstition that is currently written in psychiatry text books. It could also be used to research how to get off drugs safely. Currently those working at hospitals operate without that basic knowledge.