Wednesday, October 23, 2019

Comments by philroy

Showing 15 of 15 comments.

  • It looks (to me) like the White House didn’t necessarily single out and block this particular petition, but created just one response to cover 33 different petitions regarding recent gun violence. See the copy of the response at: https://petitions.whitehouse.gov/response/message-president-obama-about-your-petition-reducing-gun-violence

    Near the top, it says:
    “OFFICIAL WHITE HOUSE RESPONSE TO
    Start the process to enact Federal Gun control reforms. and 32 other petitions
    A Message from President Obama about Your Petition on Reducing Gun Violence”

    If you follow the “32 other petitions” link, it looks like none of the other referenced petitions say anything about problems with psychiatric drugs. So it might(?) have been just a (stupid) oversight that they missed the point of this particular petition when they scooped it together with all the others. That’s not an excuse, but it’s not as bad as specifically shutting down this petition in particular.

  • A rather generic Official White House Response was added to the petition webpage, advocating, among other things, for easier access to mental health care. That completely misses the point of this petition. A link was provided for further feedback. I submitted the following feedback:

    Hi. I signed the petition titled: “Launch a federal investigation in to the relationship between school shootings and psychiatric drugs”. In the Official White House Response, President Obama is quoted as saying: “We’re going to need to work on making access to mental health care at least as easy as access to a gun.”

    Here’s the problem with that: The track record of current mental health care practices isn’t that great, so better access to it won’t necessarily help much. My understanding is that some of the shooters in recent decades were already on psychiatric drugs when they did the shooting. Current mental health care practices certainly didn’t sufficiently help them.

    Maybe the psychiatric drugs just didn’t do enough to help those shooters’ pre-existing impulses. But it’s possible the psychiatric drugs are actually making things worse: For example, do a web search for akathisia and violence, and you’ll see mainstream and medical links that psychiatric drugs can affect this. If that connection is real, action is desperately needed to address this. If that connection isn’t valid, it needs to be carefully researched and debunked once and for all.

    So if you want to increase access to mental health care as a response to violence, please make sure that increased access to mental health care will actually help, and not worsen, the problem of violence. Please do what the petition urges: “Launch a federal investigation into the relationship between school shootings and psychiatric drugs”.

    Thank you.

  • I’m both amused and aghast at studies that use time to discontinuation as a primary (or the primary) outcome. I wonder if they have ever included placebos in discontinuation studies.

    (Or candy or ice cream, for that matter. A small dose, e.g. 1/2 cup, of Ben & Jerry’s every day — rotate the flavors, individualized to person’s preference — would score very well on time to discontinuation for most people, without too much metabolic impact. It might help improve a variety of other scored measurements too.)

  • Dr. Torrey reads MadInAmerica? Cool!

    Hi, Dr. Torrey, okay, schizophrenia is a brain disease as you say. Fine. So please characterize that brain disease for us. Is it anything like Alzheimer’s, with established accumulations of protein plaques? Or Parkinson’s, with established loss of dopamine-generating cells? Or Creutzfeldt–Jakob disease, established as caused by infectious prions? Admittedly, some neurological disorders are idiopathic, meaning we don’t know for sure what causes them. But can’t you say much useful or specific at all about the nature of what you call the brain disease of schizophrenia?

    Are you really asserting that anosognosia can be ascribed to 14 separate biological brain contributors? That seems excessively broad and not very useful. I’m sure you’re familiar with the well-known paper by respected researcher John P. A. Ioannidis titled “Why Most Published Research Findings Are False”. Maybe some of these anosognosia studies should be checked for reproducibility. And after decades of trying, schizophrenia researchers still can’t come up with any clearly established mechanisms, causes, or decent diagnostic biological tests?

    Or you could take the attitude that (at least according to us boring secularists) since ALL thought, emotion, motivation, and behavior is generated by the brain, then maybe being excessively closed-minded, or persistently annoying, is a type of “brain disease” too. For most states of mind, there are no distinct boundaries between psychological, neurological, biological.

    Even if we hypothetically agree that some person’s thinking is “disordered” but they aren’t aware that it’s “disordered”, what do you suggest we do about it? Force them to take drugs that dull them and can cause permanent tardive dyskinesia? Or drugs that can cause metabolic syndrome and diabetes? And other well-known disabling side effects? How “well” are these drugged patients turning out? What quality of lives do they live?

    I don’t agree with everything NIMH director Tom Insel says, but even he agrees that the current drugs don’t work well at all, and it doesn’t look like there are any decent replacements or improvements on the horizon, as the pharmaceutical companies are bailing out on future psychotropic research. And Insel thinks the current DSM diagnostic system is kind of a mess too.

    What do you think of the findings of decent numbers of people originally diagnosed with schizophrenia who went on to significantly or completely recover without the use of drugs? Isn’t that a wonderful insight worth researching further? Or do you instead believe that all of those people who recovered actually were misdiagnosed and instead had brief reactive psychosis? If that’s the case, isn’t that a huge wake-up call for psychiatrists that they’re potentially misdiagnosing huge numbers of patients? What do you think of the “supersensitivity” hypothesis by which abruptly stopping neuroleptics can bring on symptoms greater than were ever there originally?

    My own tentative belief is: “It’s the wiring, stupid.” Billions of neurons and trillions of connections being made, patterns constantly formed and altered by good experiences and bad, sometimes getting too stuck into unhelpful feedback loops (maybe with a possible dollop of genetic or epigenetic differences influencing to some degree, but not in themselves creating an unavoidable destiny).

    The exciting discovery of ongoing considerable neuroplasticity suggests that significant healing might come from healthy interactions, healthy environment, processes of “working through” rather than being dismissed and shamed and drugged for expressing perspectives that bear hallmarks of non-consensus reality, but often carry symbolic meanings for those who will stop to listen. For example, I’m ticked off by numerous accounts of people with psychosis who had real physical injuries or illnesses that were dismissed as delusions and left untreated, just because their descriptions included unusual figurative language that others were unwilling to really hear.

    How about it? Drugging may suppress the initial symptoms for some, but at a huge personal cost in long-term quality of life for many. If you really want to help these people rediscover effective and rewarding lives and long-term health, it’s time to look in new directions. Maybe considering more seriously some of the alternative perspectives expressed here might help.

    – Phil

  • I’m touched by this article. It may indeed be that a place that best serves people with long psychiatric histories will be quite different from one that best serves people experiencing their first psychotic episode.

    The article didn’t directly discuss what at rate medications at Soteria-Alaska were tapered (if at all). I may be mis-inferring, but are/were many of the people there just coming off the drugs cold turkey? That sounds like almost like a recipe for psychotic crises, as Whitaker’s book suggests. Were possibilities ever discussed of instead assisting clients with a much more gradual and individually adjusted taper?

    Even if the current incarnation of Soteria-Alaska is potentially not the best setting for attempting that, I hope we can somehow discover what settings, and what time-scale processes, do offer the best hope for assisting those who want to successfully taper off of psychiatric drugs.

  • Thank you for your thoughts. I agree generally that trying to avoid hospitalization is a reasonable goal. No worries that you don’t have a more specific response.

    I think my question stems from a more general concern that for some people (particularly some people with noticeable or visible emotional difficulties or “symptoms”), it can be more difficult for them to interact effectively, to find and maintain the resources and relationships needed to sufficiently heal and thrive in daily life. That ongoing difficulty can then lead to more frequent crises, for which hospitalization is indeed often a poor respite (which I have too-slowly learned for myself).

    I realize I’m expanding here to an excessively broad and probably rhetorical question: How does a society best help distressed people to recover and thrive? How do more chronically distressed, isolated and overwhelmed people discover or learn the internal persistence and effectiveness with which to build the resources and healthy relationships needed to sufficiently thrive? How is it determined what people might need some kind of ongoing support or assistance from others to order to cope and thrive to a reasonable degree, versus some a more temporary healing or skill-building process after which they can be more self-sufficient at these important life tasks? And how is that help best provided?

    I’m not expecting concrete answers to these broad questions. (Maybe I’m just “venting”?) Generally, when I hear about various alternative approaches (such as Open Dialogue for example), I feel curiosity and hope for them. I also often wonder to myself about their perspectives on these various issues, and about their respective ideal visions for broader healing in this world.

  • Sandra,

    I’m curious if you heard of any concerns expressed about people potentially becoming “over-dependent” on the Open Dialogue services, and how they handle that concern.

    It seems to me that in the U.S. at least, there are often concerns (coming from a “behaviorist” perspective) that “rewarding” help-seeking behaviors, with actual kindness and understanding, may “reinforce” those help-seeking behaviors, supposedly keeping people from developing a more independent self-sufficient coping style.

    I dislike this behaviorist perspective, a notion here that if a person is coming to the hospital “too often” due to crises, then the hospital needs to intentionally be made less appealing, less helpful, to them, to discourage them from over-using it. Most psych hospitals don’t do a good job of meeting people’s emotional needs anyway, but I worry that some of that is *because* of the hospital’s (excessive?) fear of fostering excessive “patient dependency”. It seems like America in particular highly values the notion of rugged self-sufficiency. People who don’t sufficiently live up those “values”, who struggle due to ongoing unmet needs necessary to thrive (or even in learning and developing a healthy “inter-dependency” with others) are too easily ignored, dismissed, scorned, or shamed.

    I’m appreciative to hear about programs such as Open Dialogue that really try to meet people where they are, understand them, and connect with them. I wonder if Open Dialogue staff share a concern that some people might become “over-dependent” on them and use their services “too often”, or how they conceptualize that issue.

    Thank you.

    – Phil

  • Do we here even fully agree on what “this” movement is, what “our” movement is?

    “Anatomy of an Epidemic” focuses mostly on the ideas that psychotropic drugs don’t work nearly as well over the long run as previously believed, are probably sometimes harmful over the long run, then asks a bit about alternatives to long-term psychotropic drugs.

    “Anatomy” itself doesn’t focus as much on forced medication, forced hospitalization, the traumatization often caused by these things, or civil rights issues. Nevertheless, many people who feel strongly about these issues have gravitated to this website. Other people with strong feelings about long-term drugging, and wanting to see better alternatives offered, nevertheless might not feel as strongly about each of these additional issues. Does that make these people “heretics” in the eyes of other commenters here?

    There seem to be multiple potential movements afoot (sharing an anger with various facets of mainstream psychiatry), overlapping to considerable degrees. But I worry that we’re sometimes tripping over each other, as we assume that if someone else agrees with us on one facet, they must necessarily agree with us on a different facet. And we feel so strongly about our beliefs (many of them burned in by painful experiences of personal trauma and violation) we tend to become angry that our own viewpoint is not equally apparent to everyone else.

    Just as one example, I personally don’t know what to make of the posed question: “Is behavior medical or not medical?” Maybe I’m being too pedantic, but I have to ask: What does one mean when you say “behavior”? What does one mean when you say “medical”? What would “not medical” look like to you? Then what can we envision about what follows from that?

    I’m a science geek, and I like the idea that smart people can get together and devote their lives and careers to learn more about human suffering, and find compassionate non-traumatizing ways of individually and societally reducing some of that suffering (as many have already done in various ways). I know that dealing with people in great distress is itself often stressful, and not everyone has the chops or the skills or availability to offer it. Some of those skills could probably be taught, how to really “be with” someone in distress in ways that help facilitate the healing process. I don’t have to call these people “medical” people. But in a more fair universe, I can imagine a better system with people and processes and bodies of expertise who are much more compassionate and skilled and effective and non-traumatizing in helping us facilitate our own healing processes.

    I’m appalled at instead how badly the researchers went off-base and screwed things up. A personal beef is that in the name of a certain style of “science” (as well as corporate influence, etc.), most researchers have forgotten how to simply ask us about our own first-hand experiences, what is it really like, what kinds of things have helped us, what kinds of things have harmed us, etc. They’re too busy noodling over their favorite closed-ended hypotheses and having us fill out their closed-ended questionnaires, ignoring several elephants in the room when we’re sitting right over here ready to tell them more of our experiences about what helps most.

    But if I’m busy denouncing the stuff that I feel most strongly about, and someone else is busy denouncing some slightly different stuff that they feel most strongly about, how do we even figure how best to come together to decide which “our movement” or “this movement” it is that we’re talking about?

    – Phil

  • I recognize that for many here, the human rights violations that were perpetuated on them are the most egregious thing. If we say “Psychiatry is a human rights violation that must be abolished”, some people will ask “Then how do we help these people who are suffering greatly?” I agree that psychiatry overall is doing a mostly sucky job at helping people who are suffering, and is often harming people. But I think it scares a lot of folks to threaten to abolish a supposed source of “help”, and not have much to offer to replace it. It scares them (including me) to not know where to turn to instead (even though I’m thoroughly discouraged by my long experiences with psychiatry).

    For some people, simply turning away from psychiatry may be sufficient for them to greatly improve the quality of their lives. But for others, it probably won’t be. For me personally, I’m much more interested in seeing people accumulating more good information about what kinds of help actually helps people (and I believe this will be very individualistic), then figuring out how to put more of that kind of help in place. I’m not confident the “peer movement” can sufficiently fill in the gaps. Interacting with highly distressed people is challenging for most people, and a lot of people do it poorly, with poor outcomes. I for one wouldn’t mind some “expertise” involved, if we could ever come to any consensus of what decent expertise might look like.

  • I hear you about the term “service user”. There are a lot of other words and phrases that have similarly been met with anger by lot of people: “patient”, “client”, “consumer”, (others add more terms here here that they haven’t liked?…).

    I don’t want to hijack the original discussion, but I think the dialogue about the underlying practices themselves could be furthered if we could at least identify vocabulary that mental health practitioners and researchers can use, which itself doesn’t inflame. I no longer know what terms are okay to use to refer to persons who have had encounters with the mental health system (whether inpatient or outpatient, whether voluntary or involuntary, whether happy or unhappy about the outcome). I don’t know if anyone would find offensive the phrase I just used, but it’s impractical and unwieldy: a “PWHHEWTMHS” (Person Who Has Had Encounters With The Mental Health System).

    What do others recommend as more acceptable words or phrases, ones which should be acceptable both to mental health professionals and writers, and to people who have had very unpleasant encounters with them? Maybe one of the bloggers here might want to write about this issue for its own discussion?

  • Hi Dr. Forcen.

    In most of Whitaker’s book, his main point isn’t about increased “prevalence” of mental illness at all. It’s much more about the evidence that there is increased CHRONICITY of mental illness. So if you want to explore factors influencing “prevalence”, I worry that might be just side-stepping the more important point.

    As others have already pointed out, “Anatomy of an Epidemic” look at evidence suggesting that most people used to get over depression & schizophrenia much more quickly, and that increased chronicity is largely a more recent phenomenon, one that coincides with, and seems to follow from, the increasingly chronic administration of medications.

    I”ve seen a couple of other reviews of “Anatomy of an Epidemic” that argue over what constitutes an “epidemic”, then refuting the notion of increased prevalence as a way of refuting the “epidemic”. But except for the explosion of childhood bipolar, Whitaker doesn’t focus that much on prevalence. I can’t speak for him, but is it imprecise or poetic of him to use the word “Epidemic” in the book title to describe a vast increase in the CHRONICITY of these disorders (when maybe a stricter definition of “epidemic” refers instead to prevalence)? I don’t know.

    But let’s not get distracted here about the actual content of his book, most of which discusses not prevalence, but a serious problem of increased CHRONICITY, and medications as the being most likely cause of that increased chronicity.

  • Anon, I’m not sure if I follow what your assertion is here. I agree that it’s hard to conclusively “prove” that a drug in any particular instance led to some specific behavior. But are you asserting that chemicals don’t (even sometimes) affect or influence behavior?

    What about alcohol, or PCP, etc.? Are you saying that people’s behavior when on these drugs is influenced solely by their expectations of the drug, and not any actual physiological effects? If sufficiently motivated (say, by payment), could they successfully hide the drug effects on their behavior from those around them? I would think not.

    My understanding is that even in randomized antidepressant studies, the rate of suicidal ideation is higher in people who are given antidepressants is higher than those given placebo. In these cases, the antidepressant group isn’t more depressed than the placebo group, so the difference between the two groups can’t be blamed on the original depression.

  • Studies of different medication tapering rates could potentially be very helpful.

    1. But who’s going to pay for them? The drug companies have no reason to.

    2. Who gets to evaluate whether any symptoms during the taper are due to withdrawal versus a “recurrence of untreated illness”? What biases will the evaluators bring?

    – Phil

  • Hi Dr. Moffic,

    Just a comment related to the Psychiatric Times excerpt that was indeed posted.

    I also saw a Psychiatric Times editorial (May 1, 2012) by Dr. Pies who disputed Whitaker’s notion of an epidemic. My sense is that, for adults, Whitaker doesn’t argue an “epidemic” as meaning literally a rapid growth in “new diagnoses”. His focus is more on the increased chronicity of health problems following diagnosis (and being medicated). This might not meet some people’s strict definition of “epidemic”; maybe it could be argued that Whitaker’s use of the word “epidemic” was not precise enough for literalists. And for children, Whitaker does discuss the false epidemic (using the strict definition of new diagnoses) of childhood bipolar diagnoses.

    A large increase in chronicity is a serious individual and public health problem. It’s very bad if people aren’t getting better as quickly or as easily as they did before medications became prevalent. The editorial by Dr. Pies seems to briefly acknowledge this legitimate concern about increased chronicity, but then goes back to arguing mostly about the use of the word “epidemic” being inaccurate, based on a strict “new diagnoses” definition.

    So if the main argument of Pies and others is that Whitaker used a word imprecisely (more in the colloquial sense and maybe not the strict medical definition), I don’t know if Whitaker would argue that point too much. But let’s not have this argument over word meanings detract from Whitaker’s main point (as I see it), that medication, over the long term, might be greatly worsening the chronicity of mental health problems.

    – Phil