Friday, January 15, 2021

Comments by ConfoundSequelae

Showing 3 of 3 comments.

  • Reading the conclusion, I have to imagine that the authors as mental health service providers believe that there are two sides of the fence on the issue. One of which is rational, measured, sane, and might only be faulted for expressing too liberal-minded a spirit on the issue. (Theirs. Cmon over, the water’s fine.) And one of which is irrational, unexamined, insane, and resultant from an ultimately false perspective of victimhood where no injury has resulted from either deliberate ignorance (turning the blind eye) or malice of forethought on the part of those who have caused them harm. (“Service-users.”) But, as many of us have learned in conflict-resolution, to fault intention obfuscates the issue(s). For that reason, I’ll try to stick with the logical inconsistencies in the conclusion.

    If it is the case that mental health service providers have “overestimated the strength of the evidence base for antipsychotic medication, while underestimating the seriousness of the adverse effects,” why indeed would we presume that “…Given accurate and honest assessments of both risks and benefits, it should be possible to prescribe antipsychotics in a more thoughtful and collaborative way?” The only way this ever works in favor of prescription is one in which psychosis (in some cases, not all subject to psychiatric evaluation?) is presumed to represent a far greater risk unmedicated.

    Here’s an equivalent statement:

    Our guess at the weight of that there ripe watermelon was clearly too high, we didn’t tare the scale properly. It’s not a ton at all! Our bad. Let’s weigh your grape again… Maybe that there ripe watermelon isn’t heavier.

    I’m not kidding, and I’m certainly not laughing.

    There was no mention of refusal of medication as ‘choice’ in the sense of a thing I as service-user (their term. not mine.) decide. Decision is by definition not collaborative. Either I decide or you do. This sounds like the old way in which if I decide ‘no,’ I’m subject to being overruled by default. The service-user’s suggested new choice, if I’ve understood it correctly is to take medication or be re-educated about medication until taking it (or convincingly healing alternatively somehow while being re-educated about medication. Note: healing *convincingly to the satisfaction of my service-provider may still require medication.) The apparently magnanimous gesture at first flush might very well look like this:

    Old Way:

    Meds by my choice?


    Meds by their choice?

    New Way:

    Meds by my choice?


    Other by my choice with the following proviso: if-and-only-if-other-demonstrated-to-be-greater-or-equally-safe-and-clinically-effective-to-the-satisfaction-of-my-provider-regarding-my-particular-case-of-soforth-etc.-as-demonstrated-by-etal.

    Did you see the fine print? OK, I didn’t notice choice in either way, but the second way makes a better optical illusion. Moving forward…

    Let us disregard for a moment the fundamental truth that the medical-model position is analagous to a virgin birth as far as the biological substrates of *any psychiatric illness. You’ve been so generous as to here concede that the pill itself is not for everyone in your care, clearly–you claim now to have appreciated a potential distinction in pill-candidacy. A new covenant perhaps? ‘We’ll promise to take science (and our Hippocratic oaths) seriously from here on in.’ Note this is not ‘we do promise.’ It balks at going even that far. This is ‘would such a promise satisfy? Let’s have a vote…’

    Incidentally, I seem not at all to have understood stigma correctly. Let me offer a suggestion I consider constructively critical: the definition of stigma is a bit too migratory (as is most psychiatric terminology,) and this particular inconsistency tends to inspire skepticism when used so flexibly. Is stigma what someone feels when they believe themselves sick in a way that society regards as antithetical to the presumed prerequisites for personal autonomy and humanity? Or only applies once treated for sickness, thus acknowledging sickness, and in so doing getting ‘well’? See, because the first one has to do with social and public perceptions the psychiatric and pharmaceutical alliance has wilfully and knowledgably manipulated. Psychiatry itself has done much to enhance, popularize, and enforce this sort of stigma. And the second has presumed identification with a disease category and drug-treatment model of wellness psychiatry and drugmakers support. Invoking ‘stigma’ in the second sense requires that psychiatry holds the answer to our (understandable though regrettable) denialism, and acceptance (to date, ‘take your pill’) is the correct answer, as it has always been, the answer of deference and humility. ‘The spirit willing though the body weak’ etc.. The second sense of ‘stigma’ necessitates psychiatric treatment in the form of medical interventionalism to absolve us of it.

    Your first step to mending trust, if this is what I am or anyone is supposed to take from your article’s conclusion, is woefully insufficient. The correct position to take, if patient trust is the goal (this trust is synonymous and inseperable from your interest in your patients’ wellness): would be one of sincere apology for the lies, intentional and ignorant, that have caused grievous bodily harm and emotional suffering, immediate cessation of all coercive treatment, abandonment of the current biomedical model of psychosocial illness, and the systematic labelling of each occurence in the public domain of all inaccurate and misleading scientific literature subsequently proven to be invalid as such, the active re-investigation of all psychiatric literature published with regard to all drugs currently prescribed including but not limited to your good faith appeals to relevant courts, justice departments, and legislative bodies for the immediate seizure of all documents and internal memoranda from all distributers, manufacturers, researchers and developers of CNS drugs for psychiatric use. You would be expected to accurately and honestly testify to the harm you have witnessed as practitioners. And you would demand to relevant regulatory agencies that the raw data from all clinical trials past, ongoing, and in the future be made publicly available. If your appeals to these agencies are unsuccessful, you would vow to surrender your medical licenses and refuse to practice as physicians as it would become undeniably clear in that case that there will be no means of public accountability for the deceit and bad science that have heretofore determined your harmful treatment-model, thus no possibility for evidence-based medicine, and thus no basis for the mantle of medical doctor which you and your colleagues have abused into outright extinction where the specialization of psychiatry is concerned.

    If those things once offered were rendered, I’d think a dialogue could begin. If I for a moment considered it likely or even possible that such things might be offered letalone rendered, I would despair that I’d developed delusional thinking. Nevertheless, I might be able to accept that the psychiatrists of this idealized, non-imminent, and regrettably all-but fictive future won’t always and only be profoundly dangerous people, capable of causing something other than harm in the course of standard practice.

    That the conclusion here represents the authors’ notion of ‘progress’ in any recognizable sense of the word is both surprising and offensive.

  • While I’d readily accept your suggestion that GPI as described here would look very different from most modern instances of psychosis (mercurous chloride being an unlikely culprit in modernity,) I’m very confused by your conclusion.

    It still seems reasonable at this point to say that for any individual, there are many potential paths to psychosis. Whether each and every instance of psychosis might be fully explained by physiology and morphology (or has pharmacogenic origins) in a causal sense was not the issue here, I’d thought. More humanistic explanations of at least some instances of psychosis, I’d think and hope, retain their plausibility and validity, at least for the sake of discussion. But the humanistic perspective wasn’t negated in the article above, in the sense that it wasn’t addressed.

    What I’d gotten out of this was the following:

    1) Medical history HAS witnessed and noted something like mental illness of pharmacogenic origin, and on a presumably large, but ultimately unknown scale.
    2) History might well be repeating itself. Modern psychiatric drugs, though perhaps beneficial in short-term use, could be a strong CAUSAL factor in many modern instances of mental illness.
    3) It would be very difficult to pin down causality then, as now, to the drugs because of prevailing notions re: tertiary syphilis and bipolar disorder/schizophrenia respectively.

    I don’t see any loss to my dignity or humanity in those points. In fact, I might incline too much to relief that I probably didn’t encounter an idiopathic psychosis, with causes utterly unknown and unguessable.
    Here’s what I’m beginning to think:
    Individual ambiguities of origin (drug or body/mind or ??) are not at all differences without distinction. But to some extent, those ambiguities a psychiatrist encounters in terms of presenting symptoms or histories of any given patient, are irrelevant in light of the the drugs’ potential impact. The ‘chicken-egg’ problem is, despite its scientific and academic importance, perhaps clinically unimportant today.
    If it is the case that the psychiatric drugs used to treat modern mental illness CAN cause psychiatric symptoms (including psychosis) of variable and unpredictable severity in a (large?) percentage of patients, that *should be sufficiently compelling to steer drug policy and medical practice towards more conservative (read: ‘safe and actually effective’) approaches to therapy. The reasons we haven’t rounded the bend on this yet are largely economic.

    Incidentally, I wonder how much Van Swieten made on his potion of mercurous chloride… (yuk-yuk)

  • Dr. Healy, thank you! I’m presently making my way through “Pharmageddon,” and find myself grimly nodding agreement. In an earlier attempt to conduct my own investigation into the socially-transmitted psychopathology you call pharmacosis, I had called up the US Food and Drug Administration. This was to be my two-year follow-up on a Medwatch report I had submitted to their attention.

    Unsurprisingly, there had been no interim reply from their agency. Unsurprisingly, my report was not to be found in the few awkward attempts to recall keywords and phrases for a search of the records: “quetiapine,” “withdrawal emergent,” “first episode psychosis,” “resolved on re-introduction.” I had lost my tracking #, and so had to come to a point quickly.

    Surprisingly the pharmacologist on the other end of the line was herself surprised to learn that quetiapine (trade name Seroquel) and other AAPs are often prescribed for off-label uses such as insomnia, for which indication she seemed sufficiently alarmed. I made sure to repeat “no prior history.”

    “…and the potential clinical implications–” I pressed.
    “Yes, yes. I’m aware.”

    Her advice was startling in that it seemed both impartial and fairly reasonable. Though perhaps not totally satisfactory, it points a way to public action. Medwatch reporting, she said, was the way to wake the old regulatory watchdog, so-to-speak, though it’s admittedly hard-of-hearing. It is absolutely valid, she insisted, to initiate one as a patient, as I had, or as a doctor, regardless of hard evidence of a pharmacogenic fallout. Mere suspicion that a drug had caused a problem was sufficient to write and submit a Medwatch report.

    I am as skeptical as I think reasonably possible of the FDA’s ability and inclination to resolve such a massive systemic problem. Their public conflict of interest statement is nothing short of ridiculous. It effectively says “it happens here because it must… dearth in the market of qualified professionals, yknow.” (The conclusion and its justification both simply false.) However, it might be the case that they would have no choice but to respond to a massive influx of adverse event reports.

    Being a fair-minded sort, I wanted to post a general appeal in this public forum. If the FDA or its representatives complain as this one had, that they are powerless with insufficient reporting, then I suppose I’m game. If, for no other reason, to figure out if our watchdog is merely hard-of-hearing or also lacks teeth. One more time for US-based readers: “Medwatch.” (And erhmm. Don’t lose your tracking #s like I did…)

    Deep gratitude to Dr. Healy, Robert Whitaker, and all the folks working to sort out this tangle.