Sunday, November 17, 2019

Comments by Sleep in the Stars

Showing 19 of 20 comments. Show all.

  • “I would like to imagine a society where, when people have been traumatized or when they run into other sorts of mental or emotional problems, they can turn somewhere and get help from other people that is really helpful. It’s in some ways a simple dream, but I don’t think we can ever get there if we keep imagining that bad “help” is the only kind of problem out there.”

    Thank you for this – this is my dream as well.

    In navigating my own path, my biggest frustration has been trying to find helpful “help”. I can tell you what wasn’t help -involuntary incarceration for my own “protection”, medications that had me climbing the walls and attempting suicide, diagnoses that blamed me for my trauma…but finding healing – that’s been a struggle…not insurmountable – but damn…

    I tend to lean towards “mad pride” (especially when I’m angry at the entire system)…recovery – from what? Healing may be a better word…but it really sucks that so much healing has to occur regarding the “help” I received.

  • Steve – my observation has been that it usually runs the other way. Folks start at FDA with no industry experience. The pay is crap, but they can retire with full benefits fairly young and then segue to a job with a pharmaceutical company or as a “consultant”…which is a significant increase in pay (especially with the words “former FDA…” in your CV). This, of course, might influence a reviewer.

    I think the approval of drugs that are not effective and the minimization of adverse events has more to do with “creative” study designs and the misuse of statistics than bias on the part of the reviewers. For example, with an antidepressant study, certain symptoms, such as suicidality, might be considered an exacerbation of depression and, per the protocol, not recorded as an adverse event. Another example is, for efficacy, a drug may be shown to be statistically significantly more efficacious than placebo – but the efficacy rate is only 20%. In the United States, there is no requirement that a low efficacy rate be clinically relevant – especially if the safety profile is considered acceptable.

  • A couple of points:
    • I was impressed that the authors of this article recognize that pharmaceutical companies are inventing diseases to sell drugs – what I call “creating the need, then filling it”. When I worked at a large pharmaceutical company in Indiana, that company had a blockbuster antidepressant that was going off patent. They created a disorder called Premenstrual Dysphoric Disorder” (PMDD), reformulated their antidepressant, colored it pink and rebranded it with another name.
    • Medical doctors are required to have CMEs to maintain their licenses (similarly, therapists and social workers are required to have CEUs). According to the article below, that while most doctors recognize that CME sponsored by pharmaceutical companies are biased, the majority don’t want to pay the extra cost for non-sponsored CME.
    https://www.boardvitals.com/blog/industry-sponsored-vs-fee-based-cme/
    • Most pharmaceutical companies (at least the mid- to large size) have medical writing groups that create not only CME but also “ghost write” the publications that present study results. They then have some of the more prominent clinical investigators or industry thought leaders listed as the authors. You can usually find the actual author listed in small print under Acknowledgements. At least, now, the major peer-reviewed journals are listing each author’s affiliation and any potential conflict of interest.

  • By law, Big Pharma doesn’t judge products safe, that’s the FDA’s job. The drug company designs and runs the drug development program in accordance with the regulations and guidance from the FDA (as well as international conventions [eg, ICH]).

    That doesn’t, of course, eliminate the bias inherent in having pharmaceutical companies run these programs; however, in the United States, capitalism drives the system and having totally unbiased clinical development programs would involve dismantling the entire system.

    The cost of a Phase 3 confirmatory clinical study is currently around 20 million dollars or higher, depending on the therapeutic area and patient population. Most drug applications require two of these Phase 3 studies along with the preliminary Phase 1 and Phase 2 studies as well as all of the required nonclinical (animal) work and formulation development. An entire program for a new drug (not a generic or “me too” drug or a reformulation to maintain patent protection) can easily run $200 million. Who’s going to cover this cost?

    As it stands, many small research groups developing truly innovative medications perform all of the early development and then need to find funding to proceed. Government funding is scarce, so many turn to partnerships with or acquisition by large pharmaceutical companies when their drugs show promise.

  • I read it as well. I think Icky is a good summation.
    I do have a couple of questions:
    How are questions like “Why hadn’t he asked for our support right away?” “What made him think that he should have that difficult conversation with her on his own?” in any way “right” questions to ask of an adult? What sort of group would encourage this sort of dependency?
    If this is not fiction, did “George”, “Arlene” and (especially) “Melanie” all give their consent to be described in this “conversation”?

  • I’m not a huge fan of 12-step groups. I attended AA pretty regularly about 20 years ago – but never identified as an “alcoholic” (I was using alcohol as a coping mechanism), which, if I made the mistake of saying this outloud elicited one of the many unhelpful and often shaming “slogans” (“your best thinking got you here”, “stinking thinking”, etc.). I also met some of the sickest people I’ve ever met in my life in the “rooms” – and these were the folks with years and years of “sobriety” under their belts.

    As for non-alcohol related 12-step groups…I attended a couple geared towards CSA (holy crap that was a nightmare) and OA (I didn’t overeat, but had an “eating disorder”). I think the problem was trying to force fit trauma-associated symptoms into a pathological framework (not sure if I’ve captured that thought fully).

    I did try a therapist run group – she was my therapist and, in the long run, extremely damaging to me. It was very “new agey” and pretty uncomfortable (in an “icky” way).

    Personally, I agree with the author of this blog (and some of the commenters) in not finding “therapy” groups helpful.

  • The only group “therapy” I found helpful was a time limited DBT skills group that was run like a class. I know a lot of folks have had less helpful experiences with DBT groups – I went in with the mindset that I was going to learn “skills” – and the group “leaders” kept things from veering off the proscribed agenda.

    The most dismal groups were those with “encouraged” attendance during several involuntary hospitalizations. These were typically run by younger, “in training” social workers who “knew what was best” for the “patients” in their group – probably based on reading the case files and assuming that the “diagnoses” assigned fully described the human beings sitting with them. I was “encouraged” to attend “occupational” therapy to help get a job once I was released (ignoring the fact that I had a job patiently waiting for me), “art” therapy where we colored in coloring books (no pencils or pens, of course), and (my favorite) – morning check-in group, where we outlined our “healthy plans for the day”. Of course, they tried to bill me (or my insurance company) for these groups.

    I remember one particularly awful group where a very young social worker was quizzing every “participant” on “how you got here”. An older woman explained that she was caring for her grandchildren because her daughter was drug addicted and could not care for them – she was tired and overwhelmed and tried to kill herself. The social worker piped up in a very cheery voice – “Well, then, this must be like a vacation to you!”

    Years later, I was in a similar situation to the woman in the hospital – single parent, three kids, working full time, no friends or family support – and I was overwhelmed and suicidal. There is no respite for this, at least not where I live. When I reached out for help, I was deemed a danger to myself and forcibly hospitalized. I was never asked about my environment (well, only if I had a gun in the house) – instead I was given several diagnoses and a handful of prescriptions.

  • Thanks Kindredspirit. Before this gets taken down – it goes beyond his website. It’s the online reviews over the years, his being sanctioned and losing his license in more than one state, his prescribing history, etc. Granted, you can’t believe everything you read (especially in online reviews) – but overall, his internet presence suggests something very different from what he presents here.

  • I have been censored and my responses to Dr. Moss removed. I can only assume that it was a single post suggesting that a quick internet search may show that he is not quite the advocate he claims to be (I didn’t even say that overtly).

    I have been silenced by “mental health professionals” like him in the past – which probably contributes to what he called my “bitterness” – this being the wild wild web, I’m not overly concerned, just a little saddened that a site such as this would contribute to that.

    I suspect this post will be deleted as well, but I’m bowing out of this particular conversation and will decide on a case-by-case basis whether or not to read future “articles” by him.

  • Daniel and Julie – I’m sorry you both had negative experiences with TELL. I never contacted them – while I had more than one really bad therapy experience, I always assumed it was due to me and that the behaviors exhibited by those therapists was not egregious enough to warrant reporting them. I did have one that crossed over into pretty unethical behavior, and two subsequent therapists wanted me to report her – but the idea of her testifying that I was crazy and me trying to disprove it made me nix that idea pretty quickly.

    I think abuse in therapy – both implicit and overt – is built into the whole system. I don’t think most of them intend to harm, but they sure are quick to deny it when they do.

  • Perhaps I am bitter – I think not – but if I am, it comes from a place of righteousness. I don’t live a life of bitterness, quite the opposite, but this topic can get a rise out of me.

    While I can’t be certain that you are a human (this being the age of “bots” and all), I assume that you are. What makes you think you can’t be both human and a member of a sanctimonious profession?

    I suppose, if you care what some stranger on the internet thinks about you, you could start by stop viewing other human beings as “cases”. You could take off your “MD” hat, actually read what I wrote and respond as a human being (or not respond at all – that’s always an option).

  • Daniel Smith – you wrote: “I actually did go over some of this with another therapist who got it and was helpful, but outside of that you’re almost the only person who really gets it.”

    I think there are actually quite a few people who really get this. While the primary discussions on this site appear to be about psychotropic medications, the abuse (and it is abuse, whether it’s overt or subtle) that happens in psychotherapy is, I believe, systematic and widespread.

  • I found this article to be extremely offensive and the attitude behind it fairly typical of the Pysch MDs I saw over the years. I have been given a slew of diagnoses over the years – never asked for one of them – just wanted relief. These included the innocuous “Adjustment Disorder”, “Major Depressive Disorder”, “Anxiety Disorder”, “Eating Disorder”, “Bipolar” and, of course, being female, having an eating disorder, using alcohol as a coping mechanism, and being suicidal, “Borderline Personality Disorder”. It wasn’t until I received a diagnosis of PTSD that things began to fall into place – not that I think that that label is anymore valid than the others, but it allowed me to reframe how the trauma in my life had led to my mental distress.

    I very rarely share this “diagnosis” with others, I have never asked for special accommodations, I have never stopped working (even went back to work the morning after being incarcerated against my will in a mental hospital for a week). I have never asked for drugs (although, with my history of “recreational” drug use, I would have loved a prescription for benzodiazepines) and have never not taken responsibility for my mental state or actions (quite the opposite, in fact).

    All I wanted was some relief from the constant mental anguish I was in and didn’t understand. Instead I got dangerous psychotropics and was called “resistant” and non-compliant when I complained about the side effects and stopped taking them. Non-medical mental health workers were no better – claiming that they were only thinking about my well being but becoming defensive and outright aggressive when I questioned their methods and/or advice.

    I don’t think I’m an anomaly.

  • I am relatively new to MIA and have been devouring the articles and personal stories for a couple of months now. I was first prescribed Prozac in the late 80’s and was told I would need to be on antidepressants for the rest of my life. The side effects were horrible, but the doctor’s response was to escalate the dose, until I just stopped taking it and lied to him every time I saw him. Since then (and up until about 4 years ago), I was prescribed pretty much every antidepressant on the market and often in cocktails – the worst being a mix of wellbutrin, seroquel and amitriptyline. I withdrew from all of them ‘cold turkey’ and experienced the full range of withdrawal effects, including brain zaps that lasted for months.

    But it wasn’t until tonight that it occurred to me – every single one of my half dozen suicide attempts occurred while I was on one or another antidepressant (or a combination). I had always had suicide ideation, so the attempts appeared to be an extension of that – and the theory was that the antidepressants give you more energy before they elevate your mood which led to the attempts. Only I don’t remember having more energy…I do remember the “flavor” of my ideation changed from “god, I wish I was dead” to a very clear “I need to kill myself”. And it wasn’t until tonight (I’m a slow learner) that it occurred to me to look up each and every one of the drugs I was on…and every single one of them (including the antipsychotics) now have black box warnings for increased risk of suicide. Every Single One of Them.

    Over the past 5 years or so, I’ve come to the realization the my “mental illness” and all of it’s associated symptoms (major depression, eating disorder, dissociation, excessive drinking, psychosis) was a direct result of trauma – and this has been a real eye opener in terms of restructuring how I think of myself and healing myself.

    About 4 years ago, I hit a slump and, at the advice of a therapist, decided to try the anti-depressants one more time. Within a month, I overdosed and spent some time in the local psych ward. By this time, the black box warning should have been on the label for the drug I was on (I haven’t checked when it was added) but at no time was it ever suggested that the drug may have contributed to the suicide attempt.

    The realization that every single psychotropic drug I’ve been on has this potential is an epiphany and I’m watching my self-narrative shift once more as I absorb this information. I feel like shouting it from the rooftop.