sometimes-either do I. Sometimes. Like police, politicians etc or anyone granted a perceived power over one in a less powerful position-there are good and less good and bad. IMOSeems the question is-are the medications bad-or those who dispense them. That seems to be sometimes missed. thank you for the thoughtful reply.
You might benefit reading my post-and the smart replies. Or maybe not.
excellent point.
TY for a great reply
Difference between a therapist -and a physician? Physician is responsible for having to make the decision. A therapist on the other had-observes and comments on it. If therapists were legally liable for this misinformation-they might be more circumspect.If you cant spread truth, dont spread make believe. These are risk/benefit decisions. Ask all the people who take them -and hate them bo the multitude of terrible side effects-wt gain, metabolic syndrome, TD.Ask them why they still prefer to be on them???Many people can get off them, should get off the, should never have been placed on them as a result of garbage psychiatry. hype (I am a psychiatrist). That said-this stuff-is ridiculous at best and destructive at worse. So do no harm does not apply to “therapists”? Do you want to be medically responsible for this opinion? If one person reads this-stops their medication-and god forbid has a terrible outcome-take a look in the mirror.The last person who argued with me after their misguided incomprehensible point-stooped to saying “what do you know-you spelled Thelonious Monks name wrong”. Ha-I guess they could not get the joke…If you are out there-read his biography.
You seem awfully cranky-perhaps an antidepressant might help.
Your comment, and article in general should be relegated to alternate facts. That you write this, well you should be ashamed of yourself. I have treated many schizophrenics, as have colleagues, and NOBODY just gives them pills.
Also, I can quite guarantee you have never saved a homeless , tossed off by their family schizophrenic , with an antipsychotic-and yes ritalin, and saved his life-and be thanked. Not once.
Non alternate fact- little (tho not none) discussion of psychotherapy on this site leading to destabilization of psychotics. Google adverse outcomes in psychotherapy for references. Have seen it in my practice with therapist trying to get “at the root conflict” only to have me have to increase the medication.
The saying is in research, if you dont know a truth, the least you can not disseminate false information. Something you should consider in your baseless diatribes against the most monolithic bastardization of psychiatry.
How about lets start a blog about a fact-the support of torture of detainees by psychologists. At least here there are facts.
Dogma and vituperative condemnation are the true enemies of genuine understanding.
This is a quote-of yours.
Perhaps rather than proffering inaccurate baseless hypothesis-which are both inaccurate and odd, you might start by reading your own quotes.
Really-what do you ..know? Nothing. You call this the truth? Read Socrates-the first thing a scientist attempts to understand is a definition. You no clear understanding ie a way to define , of any terms you write of.
I suggest you read more, and hollar less. As I often end my comments-it is easier to burn a house down than build one. From what I have read, you have built nothing. The only thing remaining from this article is the smell of burning wood
Beautifully written-and heart felt.
I would suggest you amend your statement about psychiatry and allopathic medicine to include “Some”.
You seem to be to deep a thinker to be positing reductionistic perspectives.
We never are who we were. We are always missing and yearning.
Thank you for the share.
TM
Many papers have been show to show a correlation between stress and the prevalence of cancer.
While not as many, a few have posited a theoretical mechanism. Stress has been shown to likely reduce efficacy of killer t cells.
That said-there is no evidence, nor credible mechanism to show how benzodiazepines cause cancer: it is called…a correlation..
If anything, there would be an easier way to show that benzodiazepines reduce cancer rates-if one wanted to look at the science.
Yet another MIA baseless attack on psychopharmacology. There are easier ways to do it than this article.
TM
Hi Steve,
Thank you kindly for the comment. I read the literature differently. If you look at Quitkins study in journal of clinical psychiatry 2005-remission rates (not response) can be read as anywhere between 66 and 90 percent. This is a number that more closely represents my findings in my practice. The key here was to use sequential trials when on AD failed.
In comparison, the only met analysis I know of looking at psychotherapy remission rates is Wampold in J affective disorder-where remission rates are not even mentioned. DeRubeis does talk of remission rates, but the numbers (as in other studies) can at times be misleading. For example if a few patients of the cohort fully respond, the number who did not go into remission is not clear. DeRubeis would not provide me that data saying it would be published. It never was.
If you can find me raw data on remission rates in MDD using psychotherapy, that would be appreciated.
I think many in the field believe CBT is very helpful in reducing recurrence. I think far fewer believe it to be significantly different from other psychotherapies, or placebo in mild forms of MDD,
As far as side effects, again I think the literature would disagree with you. If you google scholar search adverse response to psychotherapy, you will find a number of papers in reputable journals by smart people.
So how can it be best done? By not being an ideologue which is a problem for those who post on this site. Having researched this question since I do both psychotherapy and psychopharmacology and don’t care which works- I would say that patient preference sometimes makes a difference. The degree of genetic loading sometimes makes a difference. The degree of social support often makes a difference and duration and frequency of illness is likely a major factor in the eventual need for medication use.
None of these rules are steadfast. If they were, I too would be an ideologue.
Thanks for the reply. Any credible literature to the contrary would be enjoyed. If not , I would be yet another on the site, just mad and closed to suggestion.
Monk.
Do the editors read the papers-or just headlines?
Dear sirs,
1. 40% dropped out-so we dont know if they got better-or even worse from CBT. The latter being plausible due to the moderately large body of work published on worsening symptoms from psychotherapy.
2. At follow up-the “intervention group” , based upon the BDI scale would be considered to be mild-to Moderately depressed. Seeing that these numbers are averaged, it would seem reasonable to wonder how many remained moderately depressed-after CBT.
Having discussed this issue on the phone with Dr. DeRubeis ( major proponent of CBT in depression), he has yet to publish data to show the effectiveness -at all-in getting patients with moderate to severe depression-into REMISSION.
I do not think any respectable clinician would be proud of touting getting a diabetic or hypertensive to be moderately sick as a goal.
While this site continues to assail antidepressants without any scientific basis (while all agreeing upon the fact that they are both overprescribed, and can and do make symptoms worse in many people), -the first
call from a therapist treating a suicidal patient is most often-to the psychiatrist for meds.
It is sad such a mindful forum continues to publish such irrational exuberance.
As noted in my prior posts-strong on speculation, light on science.
“With a few exceptions, psychopharmacology researchers have shown no interest in studying the way these drugs alter normal mental functions and emotions”-except ? 100’s of papers on the effect of antidepressants in non clinical and clinical populations.
Of course antidepressants are dangerous. Is this news? MIA-are they dangerous, or do they do nothing?
Which of the ideological perspectives shall one take??
In my opinion, a poorly thought out editorial mistaken for science.
Antidepressants save many lives, and are also over prescribed. You will find camps that swear to both-and they are both equally valid.
It is not more complex than that.
It is not because patients are told this. What happens in real life is that patients stop taking the medications (as any sensible person would do for all pills-they are a nuisance), feel much worse , then go back on them.
It is only part of the “argument”. It is not an argument, it is a fact based upon 27 years in practice. Some people stop them, do fine, and don’t go back on them. Some people can not tolerate life without them. That is a clinical fact. To make assumptions on how those patients should live their life I believe is terrible. There is ample evidence about the problems these pills cause. To say a patient is brainwashed seems a bit of a stretch, and logic would seem to go against the point you are making.
Thank you kindly. Would be fun. Your moderator (who seems a very decent and lovely person) knows how to reach me if sincere in the suggestion of some suds or other beverage.
Warmly,
TS Monk.
Thank you kindly for you thoughts.
Firstly-I do not understand what you mean”Psychotherapy is a person to person relationship. It is not a concretized thing, like a pill.”, or maybe we disagree.
There is a very large data base regarding the neurobiology of human interactions, and the damage caused by their ruptures.Naomi Eisenberger,s wonderful work. There is Panksepps work as well.To my thinking, relationships are concrete things-albeit beautiful ones.
As far as neuroleptics. As I have mentioned in the past-consider watching the moving interview of one of my idols-Tom Harrell by Charlie Rose. Tom is not the only person who will swear by the life saving (and affirming) aspects of antipsychotics.
Tom is a paranoid schizophenic. He can not function without his mellaril–at all. He stops them-he does not function.There is little doubt about this to either him or those who know him. Also I suspect you know of “An unquiet mind”.Tom Harrell, Kar Redfield Jamison-thes are a few high profile cases of people who feel their life were saved in part by “toxic psychiatry”. I am sure you would agree, these are not the only people in the universe who have been helped by toxic pills.
Yes, neuroleptics are toxic, to this I believe strongly. But as physicians, we get paid to look at a risk and benefit. It is not easy.Unlike psychologists, we have to live with our decisions to give toxic drugs to people when we know they are dangerous- and toxic. Because of that I use them always as a last resort. I often wonder if my conservative approach may even do harm.
As far as literature-having done research for many years, I believe (as do many researchers) that the published data surrounding clinical trials are either misleading, or analyzed with improper statistics. That was the touchstone of this blog. If you wait for the literature to support or assuage your concerns, I don’t think that will ever occur. The problems in published literature are beyond this discussion.
Might I suggest the alternative approach-to try and understand what the/an illness is that is being treated, and how all therapies (neuroleptics included) interface with the problem at hand. That seems to be the agnostic, rational approach to the problem. Again, just my opinion.
Are there those in psychiatry who are reckless about prescribing psychotropic medications. Yes, I know them and try not to socialize with them because the ensuing dialogues make me uncomfortable.
My disagreement with many on this site is the conflagration of poor diagnosis and reckless treatment by some psychiatrist, or perhaps even many, with the maligning of drug therapies. Its wrong, and harmful to people who are on the fence about the decision on to take, or not to take.
About psychotherapy-I find it interesting that you feel bad outcomes are a result of the patients reenactment. How about the therapist reenactments? Lack of mention of the negative effects of talk therapy for me, is one of the “elephants in the blog”. Unlike medication where you can say “you gave me this, now I have tardive dyskensia” or “I took this and wound up with serotonin syndrome”-except the most abusive of situations (sleeping with patients and the like), patients have no recourse against the subtle acting out therapist. To me that is even more dangerous in ways, because it is harder to pin down.
About psychotherapy research. In brief, a very frequently cited paper by DeRubeis which propertied to show that CBT worked as well as medication in severe depression-was misleading. When I discussed this with him, he said further clarification would come out in a subsequent paper. It never did. He needs to write, and there is enormous pressure to do so for many reasons. That said, I would consider being circumspect about any research regarding any therapies unless they pass a sniff test. Meta data and meta analysis are even worse. This is both my opining and an opinion shared by many (not most) in the research community.
To close, I think that all the emperors in the field of mental health are standing naked-and I try to pay attention only to the child who sees it. As noted, my opinion is that science is the only child to be trusted at the table. As Feynman once said (paraphrasing)’ I spent a whole lifetime studying one tiny thing, and maybe got it partially correct”. I think to many over reach when positing positions about human behavior, mental illness, what is happiness, or how (or if ) to treat it. All I kind of know, is that most of what I read-seems wrong.
Anger has no place in science, and serves only to distort logic. It saddens me to see the amount of anger driven messages on this blog. People have been harmed by psychiatrists. They deserve to be angry, as would I. Yet, he same is undoubtably is true about psychotherapists-again, rarely if ever mentioned.
“Made in America”- would be my prefrence-a more constructive approach perhaps. I grew up listening to the Grateful Dead-I guess I am an optimist from it all.
Hi Dr. Whitacker. Nice to cyber meet after all this time.
So, some thoughts (pardon my jagged writing style, as I spent more time studying music than english).
It is hard to define a false narrative in science when only selective data are being used. As you know, this has been my point of contention about this blog, and your book (which I believe was helpful in the narrative it stimulated-though I stand by my opinion that it was misleading to the general public. Perhaps a friendly fire sort of thing).
I will push back on you in the sense that the “damage it is creating” is something you can not clearly define. I am a staunch opponent to reckless use of medications. That said I use them both frequently -and judiciously in my practice. That psychiatric medications can be harmful is both factual and something I agree with-totally. Why I read the book. I can also add I have written one of the few papers on their mechanisms of action. The fact that they likely work in part on altering gene expression is interesting, enlightening, yet sobering and concerning.
On this I also disagree.Society is not to answer the question about correctness of science. The obvious historical reference is Germany in the 30’s. No, science-at its most beautiful is a political, and bound only to creative destruction (to use Schumpters economic phrase). Thus on this point I would firmly disagree.
As far as your MIA author population-some have been gracious, informative and downright friendly to me for my persistently and pervasively
pointed disagreements. That said–you have no authors who are proponents of the essential need of psychiatric medications for many whose lives have been saved. That is a clinical fact, and one only needs to ask the patients who they have helped. That the side effects are so unpleasant, and people insist on staying on them is suggestive of the importance of these medications in a subset of patients lives. By not making this abundantly clear in MIA, I believe you diminish the important work that you are trying to do.
So yes, psychiatry has in many circles been utterly corrupted as an institution by its ability to charge 350 for a xanax prescription . One of the reasons I left academia after 25 years .
On the other hand, psychotherapy has been equally corrupted by teaching people how to reframe their misery-only to encourage them to lead a tolerably miserable life. Or to say patients are not motivated to change, or given labels that are terrible, poorly understood and destructive. To include the vast literature on the perils of psychotherapy on this site I think would make it a more balanced blog.
I do not hear the equally important, and prudent railings against psychotherapy on this site, a form of treatment that is even less well understood , has its dangers present in a more pernicious fashion, and has been shown in many papers to be potentially dangerous-too.
Thank you kindly for the book, and the nod. If you are in NYC would be glad to discuss over a beverage.
TSM
Agreed. Psychiatry needs a major overhall. Robert Whitaker provides nothing but partial analysis, and no synthesis (one T)..
Thank you for the thoughtful, constructive reply.
Let me say (having just come from a meeting with a college on developing biomarkers for stress that could be inexpensively obtained), that as a psychiatrist, most of my treatments are-talk.
Talk has its limits. Medications have their limits. I am agnostic, and have spent 30 years as a neuroscience researcher trying to come up with an answer to your question.
In brief-we are getting closer to developing a more comprehensive understanding of how the mind works, and the underpinnings of what it means to say-its not working. It is not far from Freud’s original declaration of love and work.
That said-and having taught this for years, what should be replaced with Robert Whitaker’s somewhat helpful and often abrasive and misdirected book is an educational system that teaches what I taught. To that I was met with great resistance from colleagues on “both sides of the isle”. Pharmacologists and cognitive therapists who got paid a lot of money to practice what they preach-without understanding hardly anything about what they were doing.
It is very very hard, and laborious task to understand mental life, and mental illness. The path was paved by Freud in scientific psychology. I have the good fortune to have been befriended by the top neuroscientist in the country. I initially trained in Eric Kandel’s lab.
Do people want to hear the complexities of this issue? Not on this blog, as I have offered on multiple occasions to debate Dr. Whitaker on the points he presents. Not in academia where drug money or the rock stars of psychotherapy teach (though Becks recent paper on the need to understand the basis of CBT was refreshing).
No, the only people who care are the patients I have helped, either directly, or by clarifying misinformation often in the lay press, and often (tyhoug by no means always), on this site.
Again, thank you kindly for asking the pointed question-if not this, what?
Monk.
I will be short about this-again Robert Whitacker falls on his own sword, on his own site.
Cognitive dissonance is the inability to hold two contradictory beliefs. Robert Whitaker , while railing against the very flawed institution of psychiatry, provides NOTHING to replace it.
It is his dearth of understanding about what makes people unhappy, that allows him to rail against windmills.
Dr. Whitacker, my suggestion to you if you want to be constructive, is provide a paper ,science based, on what should supplant the agreed mis handling of mental illness propagated by psychiatry.
You have not, and likely will not. It is easier to knock down a house, than to build one-which you have not.
TS Monk.
Nail on the head.
I left academics after 25 years because much/most of it is fueled by drug money. I agree whole heartedly, until the mind/brain is understood-good treatment will never be adequately defined- and the bloggers will continue to rant at the windmills, never once building one.
Thanks
Thank you kindly Dr. Hoffman.
Interesting that others who disagree with me have disabled my ability to reply to their comments.
I am still waiting for Ms. Beachy’s comment on her view of Tom Harrell’s documented gratitude for his psychiatrist, and his mediation to allow him to grace us with his genius (see interview w
I think the lack of reply is a stronger reply upon reflection.
Best,
TM
Hi Saul.
Simple-he is wrong in cherry picking data, and not providing a plausible scientifically testable hypothesis. It took me over 20 years to get a modicum of an understanding of how antidepressants work and had to review over 10,000 papers putting together a model that is still far from complete.
I am fairly sure Dr. Whitaker has never done anything close to that amount of work as a scientist, nor seen a fraction of the patients I have seen over a 27 year career. He just posits his pondering and panders to angry people-some very justified in their bile, some less so.
I appreciate your thoughtful prose. This is my answer to you query. He is a journalist just as Kramer was in writing his prozac book.
Dr. Hoffman,
May I offer some words from experience?
It is useless to try to convince angry people by logic. They need to be accepted, not engaged.
My hope is that my occasional comments on this site lead perhaps one person to actually think rather than to rail with vitriol about things they know little about. If I was misdiagnosed or mistreated by a psychiatrist, perhaps given thorazine and had permanent TD I would be pissed off ,too. Hopefully I would be able to eventual realize that that is not an indictment of a therapy that has not only harmed, but helped many.
Good luck in your posts.
TM
1950s, when his manic-depressive episodes really began to be a problem. But for the purposes of discussion, if he had been treated that way, I actually think his creative output would have been diminished. Lithium acts like a blanket on the brain for many people. When Monk eventually was prescribed it, later in life, it contributed to an unwillingness or a lack of desire to play.
Really? Lithium acts like a “blanket” and “it contributed to an unwillingness to play”-really?
1-Thank you for the article-had not read it.
2. Ask the many people who take lithium, even at the expense of its bad side effects-of which there are many-and still they refuse to change
3.Did this person have access to Monks medical records? No. Nellie and TMjr have valid opinions, but they are opinions.
Your comment does little to enlighten, is uninformative other than to introduce me to an article I had not seen. I have read the book.
Why not READ TOM HARREL’S ACCOUNT OF WHAT LIFE IS LIKE OFF HIS MEDICATIONS? Terrible and he would not be able to play “as long as I take my medications I can stay on the bandstand”.
I will be fascinated by your opinion to this brilliant trumpet players testimony that his playing would be impossible to do without this anti psychotics. His band mates attest. See the Charlie Rose interview with Tom.
Your comment is yet another reason why this site is not taken seriously. I found a pearl on the beach-the beach is thus made of pearls..
Whitaker’s book has exposed many things that needed to be exposed, and in that sense served a good purpose.
What he did not do, nor do followers of him and this site, is replace their polemics with something positive-thus MAD in america.
Whitiker cherry picks data, the same way the field of psychiatry often does. I spent 25 years as a neuroscience research, having apprenticed under Eric Kandel.
Really smart people ask more questions then they ever answer. Whitaker’s book has that in reverse in my opinion, and has little if any credibility as a brain researcher.
Does he know anything about the brain or mind from a science perspective? No.
I have written and worked on inflammation, the mechanisms of antidepressant action and the dangers of psychotherapy. I have written 3 papers in 25 years-because that is how hard it is to understand these things.
I can tell you, I found no evidence the Dr. Whitaker understands anything about mental illness, its diagnosis, how to treat it or whether such a thing even exists-as a scientist. He can write as a philosopher if he chooses, but should label himself as such. What he contributed was very valuable, what he has done to improve things has been very limited at best, and very destructive at worst.
Thanks kindly for the thoughts.
Thelonius Monk was able to play music when he took his medication.When he was off it he only could play one song over and over in one key and was non functional. The same held true for Bud Powell. Monk was grateful for what his psychiatrists did for him. You may want to read a bit before you write.
Hi Saul,
Thank you for your thoughtful reply. I taught clinical neuroscience in a major teaching institution. After 15 years I left due to the pressure posed to teach algorithms instead of a measured, thoughtful approach.
The railing against psychiatry is often justified, the lack of an intelligent attack on psychiatry, and psychology is rather sad.
Dr. Whitakers book is a prime example of substituting one mythology for another. Only science in its purest sense attempts to be apolitical, and forever questioning.
Mad in America pretty much sums up the problem with this site, and the book it is based upon. Science? Has shown angry people preferential scan the environment for hostile cues.
Cancer is a heterogenous disorder, yet it has a recurrent theme of a disinhibition of cell division (among other things). Inflammation may in fact be a recurrent theme in all types of depression-or it may one day proven to be not. Note the wonderful work of the …..psychologist Naomi Eisenberger on the initiation of an inflammatory cascade as a result of social rejection.
This is yet another mostly useless commentary based upon misinformation and crankiness. Inflammation may have nothing to do with depression, but until someone connected to this site posits a science based theory, those involved will and should be seen as having the same hubris commonly seen in the field of psychiatry .
Having spent over 20 years studying inflammation and mood disorders, I don’t recognize anyone associated with this site as having done credible research to dispute the inflammatory hypothesis. It is easy to blow up a building, it is harder to build one.
Build a building, and then the scientific community may listen.
Firstly, it your note is not confrontational-it is poorly done.If you had read the thread that is exactly what I wrote.A physicians job is to share risk and benefit ,and often they don’t.
That said-it is a big arrogant of you (and many on this site) regarding the comment about Robert Whitaker’s book.I have read it.It is sensationalistic and not based upon one shred of scientific fact.It is tantamount to a birther or conspiracy theorist.It is a collection of information, then slanted with poorly thought out assumptions.
Robert Whitaker will never be confused with being a scientist, and to boot, he has an agenda.My child know to always argue against ones own hypothesis.He accomplished what he wanted-press, hopefully some money and some notoriety.
Even if there is a rise in medication, and mental illness in america (not clear vs reporting rates)-so is the prevalence of breast cancer and medication used for that as well.
Im my opinion a poorly written book that garnered press, and will be forgotten along with what I write and what has been written for years in the past.There were 3 theories of gravity-none of those who posited them thought theirs would be “the answer”-only Whitaker knows the answer to this? Shame for the distress he caused people by just adding confusion and positing nothing but attacks instead of actually thinking through what he wrote about.
My last post.Thank you all for the thoughtful conversation.
The fort hood killer was a psychiatrist-that should not be an indictment of either psychiatry or psychiatric medications.There are terrible and corrupt psychiatrists-many are not.
The same holds for teachers,priests and and politicians:anyone or any field where there is a power discrepancy is dangerous-but I believe not always nor inherently.
Thank you for your kind and thoughtful comment.
Yes-that is the matter.Informed decision making.My point about this paper is it is irrelevant to that excellent point as there is no information that can be intelligently used to help a patient decide what to do.I don’t care if someone takes my recommendation for an antidepressant or not-its their choice.
This paper implies science of which I can not find any included.Not to demean the sincere effort of the authors ,but the paper s pseudo science and can sadly be misinterpreted by those who would benefit from benzodiazapines not to take them.
Thank you kindly for the exchange.
I do.Most dont.I have my patients tested for food allergies and we have just published this.
There are many papers in the psychiatric literature on using fish oil
The problem is that depression is a heterogeneous disorder.Most likely some patients have an inflammatory endophenotype This can be both nature and nurture induced.A good paper was written and published this week on early childhood abuse and resetting of the immune response by Baumeister in molecular psychiatry.
Sadly, things change slowly.The hierarchy in psychiatry controls the education of new physicians.For years that meant everyone could be cured by psychoanalysis.Then it was valium.Then SSRI.Psychiatrists get paid to give out pills.It just how it is.That said-that does not make the pills bad.Rather (as i wrote) it is the implementation of them that can be harmful.
The only study that would alter my opinion about this specific issue is if rodents were treated with benzodiazapins in appropriate doses,stopped and then had their cognition checked.While translating rodent into human data has its own problems, it would at least than suggest a cause and effect.To further that hypothesis one would need to find a molecular mechanism to explain it.
Skewering psychiatry and the medications as is routinely done on this site is both pathetic and mostly counterproductive.The attacks are never cojoined with a more productive approach to treatment.As I mentions-ALL treatments have risk.Fish oil can be very dangerous as well by altering killer t cell function and can cause bleeding.Having used them extensively in clinical practice-they can be both anti, and pro inflammatory (see all the blogs about them causing skin rashes)
The reasons people present baseless vitriol about medications on this site can only be guessed at.
Thank you for your thoughtful comment.
I am a geriatric psychiatrist.I have treated well over 10,000 pts over a 28 year period.
What you wrote is a reiteration of my comment-there is an association.Association is not cause.Drop an apple-there is no apple magnet underneath the ground.
Partially treated depression, and poorly treated insomnia have both been associated with progression of cognitive decline-not the medications used to treat these problems.Its that simple.There was a recent publication implying allergy medications increase dementia rates.It has the same problem as this paper.Inflammation (as I noted) can be neurotoxic due to the biological cascade I noted.
This is not to say that psychotophic medications are necessarily safe.In fact, it is not clear that they are.The mechanism being epigenetic alterations of the genome.The only question in my opinion is risk/benifit. What is better ,what is worse.That is a clinical decision that we get paid to do.This paper, as I wrote is misleading and should not have been published as it serves as fodder for sensationalists trying to skewer the field of psychiatry.
This issue of long term effects of antidepressant use is still being uncovered.It likely is similar to the use of NSAID in that long term use is likely not good.On the other hand, untreated pain has well been show to be detrimental to ones healthy.
I am not a big fan of pills and use CAM and non pharmacological interventions (esp diet and exercise) whenever possible.That said-it does not always work and aging,this paper in my opinion is misleading and should not have made it into the literature.Open access is good-poorly thought out conclusions are less helpful.
Another trash research report showing association and not cause and effect.Nobody on here seems to actually want to think these papers through.Rather they lavish in being ideologues.
The more thorough appraisal of this report is that benzodiazepines are prescribed for anxiety.Anxiety is often co-morbid with depression.Depression over time is neurotoxic through inflammation and IDO activation resultind in elevated quinolinic acid and Kynurenic acid which are destructive to neurons.
That is how this goes.Paper should not have been published.
Summary=
Benzodiazepines are often overprescribed-they likely do not lead to dementia and certainly this article provides not one shred of evidence to say it does.
Many, or most (but not all) people working with clients, or patients in the field of mental health disorders will likely follow the Wille Sutton rule-go where the money is.Freud, for all his short comings and overreaching was one of the few researchers in the field who actually just tried to understand what people were suffering with.
To quote Claude Bernard–no model of illness, no logical treatment.It seems one fad rolls into the next.
Another ridiculous article on this equivalent to Fox news blog.
Neuroscience has shown the significant contribution inflammation has to psychiatric disorders.In doing so it has allowed a rational for treating mood disorders with anti inflammatory agents, be they antidepressants, fish oil, music or meditation.
Neuroscience has also helped clarify the underpinnings of behavioral genetics, and the effect of intimacy and rejection on the brain.
Yet another misguided, and ill informed opinion piece.
It is meant to be both disparaging and accurate.Ask Dr.Berezin to proffer a reference in a peer reviewed journal to support any of his ideas suggested in this blog.
There are none.That is not to be disparaging-but to be accurate.
I have friends who are scientists, (such as my mentor Eric Kandel)who have spent a lifetime understanding mental illness.
The clear irritation expressed is due to the misleading information presented under the guise of pseudo science.
As mentioned-lets see a review of the hundreds of papers discussing the dangers of psychotherapy.
And I have had my modicum of success as a research and clinician-without being an ideologue.
Thank you for your deeply thought out reply.Did you read either Caspi or Lesch’s work on the genetics of major depression prior to writing your ..comment? No, because it takes time,effort and it does not allow one to hide behind a few big words.
Sadly you are allowed to put this information into the public domain.I occasionally read this journal as a source of information for my students.
Your understanding of the mechanisms of antidepressants is minimal at best.Your article is so replete with hyperbole it is no surprise that you do not publish this fantastical thinking in a peer journal.
It is sad that you use your M.D. to give the illusion of “medical expertise”.Why not label it as is-a forum to advertise that you like doing psychotherapy.An intervention that has many papers on its adverse effects.May I suggest you write a paper on that? Will never happen since you might loose business.
I suggest you read nature neuroscience rather than yet another book that extols the talking cure.Real educators give a balanced approach to an issue.Ideologues only proselytize on how terrible psychiatry is.What have you contributed based on science? Nothing.The irony is I am a psychotherapist.
Unlike others who write opinion pieces ,I notice that there are many who think your piece is baseless.Also, you don’t reply to those who are more informed about this issue than you are.
I suggest you consider both retracting this, and reconsider how you teach your students.I also you suggest watching the you tube of a colleague, Bob Sapolsky on depression.You might see how an open and fun class is taught on the topic.
They are if they have a prior history, as do humans.
To Professor Read-
1.You have no idea what depression is.That is a fact.It is also a fact that nobody does, yet most people do not write with such officious pedantry.
2.There is a large bevy of literature on the dangers of psychotherapy.Are you going to write a searing missive on all the people who have had terrible outcomes talking to a “therapist”? No.Fortunately many others do, and have as have I.
3.That so many take medications AND have terrible side effects would seem to suggest to an open mind that while the side effects are truly unpleasant (sometimes due to improper dosing by primary care doctors), they continue to take them.Not to makes them feel worse.
4.I am a psychoanalyst and neuroscience researcher.I have no skin in the game to eviserate any treatment that alleviates persistent pain.You on the other hand have a vested interest in skewering the ‘medical model”.Your reason is fairly apparent.
When you write a paper on how to define depression, what it means, and how best to treat it and submit it for peer review we will then see the result.
This opinion piece is vacuous.You might consider the effect you had on someone not wise enough to see your obvious bias.
I am a psychiatrist, and I am one of the most disappointed ones in my own field.I have spent years in academics teaching a humanistic approach to working with those in distress:at times fading fancy in psychiatry.It has indeed become a field hypertrophied in medication management at its worst, but life saving for the many people whose lives have been saved by lithium etc.
That said, I should share that your vitriol and saber rattling aginst windmills of the greater academia in psychiatry holds very little weight:you provide not a shred of credible research to replace the currently flawed system.The reason is that it is easier to knock down a home than to build one.
Do you know what is “normal” and what is not, and how to measure it? Shall we say all are normal and just inappropriately “labeled”?
What data have you published that presents a credible scientific model of mental distress that can inform clinicians and patients how best to proceed?
The current structure is deeply flawed, as is Whitacker’s temper tantrum.Maybe his next volume will give equal time to the adverse outcomes of talk therapies and the labels used for personality disorders.
A nicely written, and sober appraisal of where we are in analyzing outcome data regarding the treatment of mental disorders.
As someone who is a neuroscientist, psychotherapist and psychopharmacologist (and I suppose somewhat obsessive in trying to figure out things), it is clear that all we have now is different ideological camps trying to support their “skin in the game”.All the while downplaying the significant risks of the interventions they use (psychotherapy perhaps having the greater long term risk, and pharmacology the great short term-though it may be a toss up).
As the great medical scientist Claude Bernard noted in the early 1800’s, that until we have models of disease states, we have very little.Without models,the arguments will go on for the next 100 years as they have gone on for the past.
Thanks for the well written piece.
MP
As I have written to other such opinion pieces:mental pain/distress causes both a diminished quality of life, and potentially death in cases of suicide.
As a research psychiatrist for 25 years I feel it is reasonable to state that all opinions of all treatments are profoundly flawed, and biased by one for or another by ideologies.
As Claude Bernard stated almost exactly 200 years ago:with no model of a disorder, there can be no logical nor scientific method for treatment.
Bitterness towards medication use impales those whose life it saved and enthusiasm for psychotherapy does a disservice to those lives it potentially wasted.In the spirit of Bernard-the obverse can be suggested as well.
Blogs are for ideologues.Time might be better spent understanding a model for these problems, and thus a logical approach to treating them.
Hello Dr.Brogan,
As a clinical neuroscientist,teacher of neuroimmunology,a practitioner CAM, practicing psychiatrist and having worked on modeling of major depression, your piece struck my curiosity.
It is true all that you write.It is equally true that it is as flawed because of its conceptual simplicity.
And I find it vacuous and destructive since it is written in a pseudoscince “down to earth”style.
Where is the science to support your “holistic” approach? What does that even mean? Have you yourself done a study on “your method” that could be scrutinized by the scientific community? Have you published your “countless patients” who became suicidal from medication? Do you have a theory that can separate worsening symptoms from medications from worsening of the illness?
Since many myths that needed to be destroyed,fortunately are,were or will be,your column leaves nothing to replace them but hyperbole and vitriol.For the perhaps 4 people in the world whose life have been saved by these medications, you have now possible planted the seed for maybe one of them to stop them.I hope there is no negative repercussion for your tacit encouragement for them to do so.
In summary,you attack everything and leave not a shred of scientific data,theory or evidence to replace what truly needed to be replace.Run and eat well and meditate?And the scientific basis of that helping …….everyone?A hyperbolic ,vapid piece that sadly will be taken to heart by those who do not realize you provide nothing better-based upon science.Only hyperbole.
Dr.Bracken,
Thank you for the thoughtful paper presented.Unfortunately, it can be construed by many (including myself) as promoting what you are attempting to debunk.
As a practicing clinical psychiatrist who has taught neuroscience for over 20 years, is a trained psychoanalyst, has seen thousands of patients,and is a defendant of those who ridicule the field-I find your paper to be yet another that moves us and patients-nowhere.
The paper is to my thinking, yet another fancy form of pseudoscience.Nothing more, or less.I believe your intentions are good, but significantly misdirected.
Until there is a model of the brain/mind, nobody has the right to say which is the right direction.It could be do nothing at times like Lacan, or a lobotomy or insulin shock.The point of science is to remove mythology.This paper does the reverse:it dresses it up.
Focus on meaning,values,relationships? Lets do what Einstein called a thinking experiment.Remove biology from the brain-and which of those three remain? None.Problems of persons ,not brains.Repeat the same experiment.As is in the worst of neuroscience, your paper ends with-words, not solutions.As Freud wrote in his “Project”-until his and others theories stand the scrutiny of science,they are just concepts at best, and mythology at worst.
I suggest after you have read 15000 or so papers in neuroscience, and have mastered the concepts proffered (unlikely)which cares less about whether someone gets pills or talk therapy, then you reconsider what you wrote.My patients and students thank me because I do not discuss hermeneutics with them, but rather we have about how the brain works, how dualism is destructive, and what sort of things we can to to improve peoples lives.
That said, while strongly disagreeing with your perspective as backward looking, I appreciate the heart and effort put forth.
sometimes-either do I. Sometimes. Like police, politicians etc or anyone granted a perceived power over one in a less powerful position-there are good and less good and bad. IMOSeems the question is-are the medications bad-or those who dispense them. That seems to be sometimes missed. thank you for the thoughtful reply.
You might benefit reading my post-and the smart replies. Or maybe not.
excellent point.
TY for a great reply
Difference between a therapist -and a physician? Physician is responsible for having to make the decision. A therapist on the other had-observes and comments on it. If therapists were legally liable for this misinformation-they might be more circumspect.If you cant spread truth, dont spread make believe. These are risk/benefit decisions. Ask all the people who take them -and hate them bo the multitude of terrible side effects-wt gain, metabolic syndrome, TD.Ask them why they still prefer to be on them???Many people can get off them, should get off the, should never have been placed on them as a result of garbage psychiatry. hype (I am a psychiatrist). That said-this stuff-is ridiculous at best and destructive at worse. So do no harm does not apply to “therapists”? Do you want to be medically responsible for this opinion? If one person reads this-stops their medication-and god forbid has a terrible outcome-take a look in the mirror.The last person who argued with me after their misguided incomprehensible point-stooped to saying “what do you know-you spelled Thelonious Monks name wrong”. Ha-I guess they could not get the joke…If you are out there-read his biography.
https://www.researchgate.net/publication/257729137_Increase_in_Brain-derived_Neurotrophic_Factor_in_Patients_with_Schizophrenia_Treated_with_Olanzapine_A_Systemic_Review_and_Meta-analysis
You seem awfully cranky-perhaps an antidepressant might help.
Your comment, and article in general should be relegated to alternate facts. That you write this, well you should be ashamed of yourself. I have treated many schizophrenics, as have colleagues, and NOBODY just gives them pills.
Also, I can quite guarantee you have never saved a homeless , tossed off by their family schizophrenic , with an antipsychotic-and yes ritalin, and saved his life-and be thanked. Not once.
Non alternate fact- little (tho not none) discussion of psychotherapy on this site leading to destabilization of psychotics. Google adverse outcomes in psychotherapy for references. Have seen it in my practice with therapist trying to get “at the root conflict” only to have me have to increase the medication.
The saying is in research, if you dont know a truth, the least you can not disseminate false information. Something you should consider in your baseless diatribes against the most monolithic bastardization of psychiatry.
How about lets start a blog about a fact-the support of torture of detainees by psychologists. At least here there are facts.
Dogma and vituperative condemnation are the true enemies of genuine understanding.
This is a quote-of yours.
Perhaps rather than proffering inaccurate baseless hypothesis-which are both inaccurate and odd, you might start by reading your own quotes.
Really-what do you ..know? Nothing. You call this the truth? Read Socrates-the first thing a scientist attempts to understand is a definition. You no clear understanding ie a way to define , of any terms you write of.
I suggest you read more, and hollar less. As I often end my comments-it is easier to burn a house down than build one. From what I have read, you have built nothing. The only thing remaining from this article is the smell of burning wood
Beautifully written-and heart felt.
I would suggest you amend your statement about psychiatry and allopathic medicine to include “Some”.
You seem to be to deep a thinker to be positing reductionistic perspectives.
We never are who we were. We are always missing and yearning.
Thank you for the share.
TM
Many papers have been show to show a correlation between stress and the prevalence of cancer.
While not as many, a few have posited a theoretical mechanism. Stress has been shown to likely reduce efficacy of killer t cells.
That said-there is no evidence, nor credible mechanism to show how benzodiazepines cause cancer: it is called…a correlation..
If anything, there would be an easier way to show that benzodiazepines reduce cancer rates-if one wanted to look at the science.
Yet another MIA baseless attack on psychopharmacology. There are easier ways to do it than this article.
TM
Hi Steve,
Thank you kindly for the comment. I read the literature differently. If you look at Quitkins study in journal of clinical psychiatry 2005-remission rates (not response) can be read as anywhere between 66 and 90 percent. This is a number that more closely represents my findings in my practice. The key here was to use sequential trials when on AD failed.
In comparison, the only met analysis I know of looking at psychotherapy remission rates is Wampold in J affective disorder-where remission rates are not even mentioned. DeRubeis does talk of remission rates, but the numbers (as in other studies) can at times be misleading. For example if a few patients of the cohort fully respond, the number who did not go into remission is not clear. DeRubeis would not provide me that data saying it would be published. It never was.
If you can find me raw data on remission rates in MDD using psychotherapy, that would be appreciated.
I think many in the field believe CBT is very helpful in reducing recurrence. I think far fewer believe it to be significantly different from other psychotherapies, or placebo in mild forms of MDD,
As far as side effects, again I think the literature would disagree with you. If you google scholar search adverse response to psychotherapy, you will find a number of papers in reputable journals by smart people.
So how can it be best done? By not being an ideologue which is a problem for those who post on this site. Having researched this question since I do both psychotherapy and psychopharmacology and don’t care which works- I would say that patient preference sometimes makes a difference. The degree of genetic loading sometimes makes a difference. The degree of social support often makes a difference and duration and frequency of illness is likely a major factor in the eventual need for medication use.
None of these rules are steadfast. If they were, I too would be an ideologue.
Thanks for the reply. Any credible literature to the contrary would be enjoyed. If not , I would be yet another on the site, just mad and closed to suggestion.
Monk.
Do the editors read the papers-or just headlines?
Dear sirs,
1. 40% dropped out-so we dont know if they got better-or even worse from CBT. The latter being plausible due to the moderately large body of work published on worsening symptoms from psychotherapy.
2. At follow up-the “intervention group” , based upon the BDI scale would be considered to be mild-to Moderately depressed. Seeing that these numbers are averaged, it would seem reasonable to wonder how many remained moderately depressed-after CBT.
Having discussed this issue on the phone with Dr. DeRubeis ( major proponent of CBT in depression), he has yet to publish data to show the effectiveness -at all-in getting patients with moderate to severe depression-into REMISSION.
I do not think any respectable clinician would be proud of touting getting a diabetic or hypertensive to be moderately sick as a goal.
While this site continues to assail antidepressants without any scientific basis (while all agreeing upon the fact that they are both overprescribed, and can and do make symptoms worse in many people), -the first
call from a therapist treating a suicidal patient is most often-to the psychiatrist for meds.
It is sad such a mindful forum continues to publish such irrational exuberance.
As noted in my prior posts-strong on speculation, light on science.
“With a few exceptions, psychopharmacology researchers have shown no interest in studying the way these drugs alter normal mental functions and emotions”-except ? 100’s of papers on the effect of antidepressants in non clinical and clinical populations.
Of course antidepressants are dangerous. Is this news? MIA-are they dangerous, or do they do nothing?
Which of the ideological perspectives shall one take??
In my opinion, a poorly thought out editorial mistaken for science.
Antidepressants save many lives, and are also over prescribed. You will find camps that swear to both-and they are both equally valid.
It is not more complex than that.
It is not because patients are told this. What happens in real life is that patients stop taking the medications (as any sensible person would do for all pills-they are a nuisance), feel much worse , then go back on them.
It is only part of the “argument”. It is not an argument, it is a fact based upon 27 years in practice. Some people stop them, do fine, and don’t go back on them. Some people can not tolerate life without them. That is a clinical fact. To make assumptions on how those patients should live their life I believe is terrible. There is ample evidence about the problems these pills cause. To say a patient is brainwashed seems a bit of a stretch, and logic would seem to go against the point you are making.
Thank you kindly. Would be fun. Your moderator (who seems a very decent and lovely person) knows how to reach me if sincere in the suggestion of some suds or other beverage.
Warmly,
TS Monk.
Thank you kindly for you thoughts.
Firstly-I do not understand what you mean”Psychotherapy is a person to person relationship. It is not a concretized thing, like a pill.”, or maybe we disagree.
There is a very large data base regarding the neurobiology of human interactions, and the damage caused by their ruptures.Naomi Eisenberger,s wonderful work. There is Panksepps work as well.To my thinking, relationships are concrete things-albeit beautiful ones.
As far as neuroleptics. As I have mentioned in the past-consider watching the moving interview of one of my idols-Tom Harrell by Charlie Rose. Tom is not the only person who will swear by the life saving (and affirming) aspects of antipsychotics.
Tom is a paranoid schizophenic. He can not function without his mellaril–at all. He stops them-he does not function.There is little doubt about this to either him or those who know him. Also I suspect you know of “An unquiet mind”.Tom Harrell, Kar Redfield Jamison-thes are a few high profile cases of people who feel their life were saved in part by “toxic psychiatry”. I am sure you would agree, these are not the only people in the universe who have been helped by toxic pills.
Yes, neuroleptics are toxic, to this I believe strongly. But as physicians, we get paid to look at a risk and benefit. It is not easy.Unlike psychologists, we have to live with our decisions to give toxic drugs to people when we know they are dangerous- and toxic. Because of that I use them always as a last resort. I often wonder if my conservative approach may even do harm.
As far as literature-having done research for many years, I believe (as do many researchers) that the published data surrounding clinical trials are either misleading, or analyzed with improper statistics. That was the touchstone of this blog. If you wait for the literature to support or assuage your concerns, I don’t think that will ever occur. The problems in published literature are beyond this discussion.
Might I suggest the alternative approach-to try and understand what the/an illness is that is being treated, and how all therapies (neuroleptics included) interface with the problem at hand. That seems to be the agnostic, rational approach to the problem. Again, just my opinion.
Are there those in psychiatry who are reckless about prescribing psychotropic medications. Yes, I know them and try not to socialize with them because the ensuing dialogues make me uncomfortable.
My disagreement with many on this site is the conflagration of poor diagnosis and reckless treatment by some psychiatrist, or perhaps even many, with the maligning of drug therapies. Its wrong, and harmful to people who are on the fence about the decision on to take, or not to take.
About psychotherapy-I find it interesting that you feel bad outcomes are a result of the patients reenactment. How about the therapist reenactments? Lack of mention of the negative effects of talk therapy for me, is one of the “elephants in the blog”. Unlike medication where you can say “you gave me this, now I have tardive dyskensia” or “I took this and wound up with serotonin syndrome”-except the most abusive of situations (sleeping with patients and the like), patients have no recourse against the subtle acting out therapist. To me that is even more dangerous in ways, because it is harder to pin down.
About psychotherapy research. In brief, a very frequently cited paper by DeRubeis which propertied to show that CBT worked as well as medication in severe depression-was misleading. When I discussed this with him, he said further clarification would come out in a subsequent paper. It never did. He needs to write, and there is enormous pressure to do so for many reasons. That said, I would consider being circumspect about any research regarding any therapies unless they pass a sniff test. Meta data and meta analysis are even worse. This is both my opining and an opinion shared by many (not most) in the research community.
To close, I think that all the emperors in the field of mental health are standing naked-and I try to pay attention only to the child who sees it. As noted, my opinion is that science is the only child to be trusted at the table. As Feynman once said (paraphrasing)’ I spent a whole lifetime studying one tiny thing, and maybe got it partially correct”. I think to many over reach when positing positions about human behavior, mental illness, what is happiness, or how (or if ) to treat it. All I kind of know, is that most of what I read-seems wrong.
Anger has no place in science, and serves only to distort logic. It saddens me to see the amount of anger driven messages on this blog. People have been harmed by psychiatrists. They deserve to be angry, as would I. Yet, he same is undoubtably is true about psychotherapists-again, rarely if ever mentioned.
“Made in America”- would be my prefrence-a more constructive approach perhaps. I grew up listening to the Grateful Dead-I guess I am an optimist from it all.
Hi Dr. Whitacker. Nice to cyber meet after all this time.
So, some thoughts (pardon my jagged writing style, as I spent more time studying music than english).
It is hard to define a false narrative in science when only selective data are being used. As you know, this has been my point of contention about this blog, and your book (which I believe was helpful in the narrative it stimulated-though I stand by my opinion that it was misleading to the general public. Perhaps a friendly fire sort of thing).
I will push back on you in the sense that the “damage it is creating” is something you can not clearly define. I am a staunch opponent to reckless use of medications. That said I use them both frequently -and judiciously in my practice. That psychiatric medications can be harmful is both factual and something I agree with-totally. Why I read the book. I can also add I have written one of the few papers on their mechanisms of action. The fact that they likely work in part on altering gene expression is interesting, enlightening, yet sobering and concerning.
On this I also disagree.Society is not to answer the question about correctness of science. The obvious historical reference is Germany in the 30’s. No, science-at its most beautiful is a political, and bound only to creative destruction (to use Schumpters economic phrase). Thus on this point I would firmly disagree.
As far as your MIA author population-some have been gracious, informative and downright friendly to me for my persistently and pervasively
pointed disagreements. That said–you have no authors who are proponents of the essential need of psychiatric medications for many whose lives have been saved. That is a clinical fact, and one only needs to ask the patients who they have helped. That the side effects are so unpleasant, and people insist on staying on them is suggestive of the importance of these medications in a subset of patients lives. By not making this abundantly clear in MIA, I believe you diminish the important work that you are trying to do.
So yes, psychiatry has in many circles been utterly corrupted as an institution by its ability to charge 350 for a xanax prescription . One of the reasons I left academia after 25 years .
On the other hand, psychotherapy has been equally corrupted by teaching people how to reframe their misery-only to encourage them to lead a tolerably miserable life. Or to say patients are not motivated to change, or given labels that are terrible, poorly understood and destructive. To include the vast literature on the perils of psychotherapy on this site I think would make it a more balanced blog.
I do not hear the equally important, and prudent railings against psychotherapy on this site, a form of treatment that is even less well understood , has its dangers present in a more pernicious fashion, and has been shown in many papers to be potentially dangerous-too.
Thank you kindly for the book, and the nod. If you are in NYC would be glad to discuss over a beverage.
TSM
Agreed. Psychiatry needs a major overhall. Robert Whitaker provides nothing but partial analysis, and no synthesis (one T)..
Thank you for the thoughtful, constructive reply.
Let me say (having just come from a meeting with a college on developing biomarkers for stress that could be inexpensively obtained), that as a psychiatrist, most of my treatments are-talk.
Talk has its limits. Medications have their limits. I am agnostic, and have spent 30 years as a neuroscience researcher trying to come up with an answer to your question.
In brief-we are getting closer to developing a more comprehensive understanding of how the mind works, and the underpinnings of what it means to say-its not working. It is not far from Freud’s original declaration of love and work.
That said-and having taught this for years, what should be replaced with Robert Whitaker’s somewhat helpful and often abrasive and misdirected book is an educational system that teaches what I taught. To that I was met with great resistance from colleagues on “both sides of the isle”. Pharmacologists and cognitive therapists who got paid a lot of money to practice what they preach-without understanding hardly anything about what they were doing.
It is very very hard, and laborious task to understand mental life, and mental illness. The path was paved by Freud in scientific psychology. I have the good fortune to have been befriended by the top neuroscientist in the country. I initially trained in Eric Kandel’s lab.
Do people want to hear the complexities of this issue? Not on this blog, as I have offered on multiple occasions to debate Dr. Whitaker on the points he presents. Not in academia where drug money or the rock stars of psychotherapy teach (though Becks recent paper on the need to understand the basis of CBT was refreshing).
No, the only people who care are the patients I have helped, either directly, or by clarifying misinformation often in the lay press, and often (tyhoug by no means always), on this site.
Again, thank you kindly for asking the pointed question-if not this, what?
Monk.
I will be short about this-again Robert Whitacker falls on his own sword, on his own site.
Cognitive dissonance is the inability to hold two contradictory beliefs. Robert Whitaker , while railing against the very flawed institution of psychiatry, provides NOTHING to replace it.
It is his dearth of understanding about what makes people unhappy, that allows him to rail against windmills.
Dr. Whitacker, my suggestion to you if you want to be constructive, is provide a paper ,science based, on what should supplant the agreed mis handling of mental illness propagated by psychiatry.
You have not, and likely will not. It is easier to knock down a house, than to build one-which you have not.
TS Monk.
Nail on the head.
I left academics after 25 years because much/most of it is fueled by drug money. I agree whole heartedly, until the mind/brain is understood-good treatment will never be adequately defined- and the bloggers will continue to rant at the windmills, never once building one.
Thanks
Thank you kindly Dr. Hoffman.
Interesting that others who disagree with me have disabled my ability to reply to their comments.
I am still waiting for Ms. Beachy’s comment on her view of Tom Harrell’s documented gratitude for his psychiatrist, and his mediation to allow him to grace us with his genius (see interview w
I think the lack of reply is a stronger reply upon reflection.
Best,
TM
Hi Saul.
Simple-he is wrong in cherry picking data, and not providing a plausible scientifically testable hypothesis. It took me over 20 years to get a modicum of an understanding of how antidepressants work and had to review over 10,000 papers putting together a model that is still far from complete.
I am fairly sure Dr. Whitaker has never done anything close to that amount of work as a scientist, nor seen a fraction of the patients I have seen over a 27 year career. He just posits his pondering and panders to angry people-some very justified in their bile, some less so.
I appreciate your thoughtful prose. This is my answer to you query. He is a journalist just as Kramer was in writing his prozac book.
Dr. Hoffman,
May I offer some words from experience?
It is useless to try to convince angry people by logic. They need to be accepted, not engaged.
My hope is that my occasional comments on this site lead perhaps one person to actually think rather than to rail with vitriol about things they know little about. If I was misdiagnosed or mistreated by a psychiatrist, perhaps given thorazine and had permanent TD I would be pissed off ,too. Hopefully I would be able to eventual realize that that is not an indictment of a therapy that has not only harmed, but helped many.
Good luck in your posts.
TM
1950s, when his manic-depressive episodes really began to be a problem. But for the purposes of discussion, if he had been treated that way, I actually think his creative output would have been diminished. Lithium acts like a blanket on the brain for many people. When Monk eventually was prescribed it, later in life, it contributed to an unwillingness or a lack of desire to play.
Really? Lithium acts like a “blanket” and “it contributed to an unwillingness to play”-really?
1-Thank you for the article-had not read it.
2. Ask the many people who take lithium, even at the expense of its bad side effects-of which there are many-and still they refuse to change
3.Did this person have access to Monks medical records? No. Nellie and TMjr have valid opinions, but they are opinions.
Your comment does little to enlighten, is uninformative other than to introduce me to an article I had not seen. I have read the book.
Why not READ TOM HARREL’S ACCOUNT OF WHAT LIFE IS LIKE OFF HIS MEDICATIONS? Terrible and he would not be able to play “as long as I take my medications I can stay on the bandstand”.
I will be fascinated by your opinion to this brilliant trumpet players testimony that his playing would be impossible to do without this anti psychotics. His band mates attest. See the Charlie Rose interview with Tom.
Your comment is yet another reason why this site is not taken seriously. I found a pearl on the beach-the beach is thus made of pearls..
Whitaker’s book has exposed many things that needed to be exposed, and in that sense served a good purpose.
What he did not do, nor do followers of him and this site, is replace their polemics with something positive-thus MAD in america.
Whitiker cherry picks data, the same way the field of psychiatry often does. I spent 25 years as a neuroscience research, having apprenticed under Eric Kandel.
Really smart people ask more questions then they ever answer. Whitaker’s book has that in reverse in my opinion, and has little if any credibility as a brain researcher.
Does he know anything about the brain or mind from a science perspective? No.
I have written and worked on inflammation, the mechanisms of antidepressant action and the dangers of psychotherapy. I have written 3 papers in 25 years-because that is how hard it is to understand these things.
I can tell you, I found no evidence the Dr. Whitaker understands anything about mental illness, its diagnosis, how to treat it or whether such a thing even exists-as a scientist. He can write as a philosopher if he chooses, but should label himself as such. What he contributed was very valuable, what he has done to improve things has been very limited at best, and very destructive at worst.
Thanks kindly for the thoughts.
Thelonius Monk was able to play music when he took his medication.When he was off it he only could play one song over and over in one key and was non functional. The same held true for Bud Powell. Monk was grateful for what his psychiatrists did for him. You may want to read a bit before you write.
Hi Saul,
Thank you for your thoughtful reply. I taught clinical neuroscience in a major teaching institution. After 15 years I left due to the pressure posed to teach algorithms instead of a measured, thoughtful approach.
The railing against psychiatry is often justified, the lack of an intelligent attack on psychiatry, and psychology is rather sad.
Dr. Whitakers book is a prime example of substituting one mythology for another. Only science in its purest sense attempts to be apolitical, and forever questioning.
Mad in America pretty much sums up the problem with this site, and the book it is based upon. Science? Has shown angry people preferential scan the environment for hostile cues.
Cancer is a heterogenous disorder, yet it has a recurrent theme of a disinhibition of cell division (among other things). Inflammation may in fact be a recurrent theme in all types of depression-or it may one day proven to be not. Note the wonderful work of the …..psychologist Naomi Eisenberger on the initiation of an inflammatory cascade as a result of social rejection.
This is yet another mostly useless commentary based upon misinformation and crankiness. Inflammation may have nothing to do with depression, but until someone connected to this site posits a science based theory, those involved will and should be seen as having the same hubris commonly seen in the field of psychiatry .
Having spent over 20 years studying inflammation and mood disorders, I don’t recognize anyone associated with this site as having done credible research to dispute the inflammatory hypothesis. It is easy to blow up a building, it is harder to build one.
Build a building, and then the scientific community may listen.
Firstly, it your note is not confrontational-it is poorly done.If you had read the thread that is exactly what I wrote.A physicians job is to share risk and benefit ,and often they don’t.
That said-it is a big arrogant of you (and many on this site) regarding the comment about Robert Whitaker’s book.I have read it.It is sensationalistic and not based upon one shred of scientific fact.It is tantamount to a birther or conspiracy theorist.It is a collection of information, then slanted with poorly thought out assumptions.
Robert Whitaker will never be confused with being a scientist, and to boot, he has an agenda.My child know to always argue against ones own hypothesis.He accomplished what he wanted-press, hopefully some money and some notoriety.
Even if there is a rise in medication, and mental illness in america (not clear vs reporting rates)-so is the prevalence of breast cancer and medication used for that as well.
Im my opinion a poorly written book that garnered press, and will be forgotten along with what I write and what has been written for years in the past.There were 3 theories of gravity-none of those who posited them thought theirs would be “the answer”-only Whitaker knows the answer to this? Shame for the distress he caused people by just adding confusion and positing nothing but attacks instead of actually thinking through what he wrote about.
My last post.Thank you all for the thoughtful conversation.
The fort hood killer was a psychiatrist-that should not be an indictment of either psychiatry or psychiatric medications.There are terrible and corrupt psychiatrists-many are not.
The same holds for teachers,priests and and politicians:anyone or any field where there is a power discrepancy is dangerous-but I believe not always nor inherently.
Thank you for your kind and thoughtful comment.
Yes-that is the matter.Informed decision making.My point about this paper is it is irrelevant to that excellent point as there is no information that can be intelligently used to help a patient decide what to do.I don’t care if someone takes my recommendation for an antidepressant or not-its their choice.
This paper implies science of which I can not find any included.Not to demean the sincere effort of the authors ,but the paper s pseudo science and can sadly be misinterpreted by those who would benefit from benzodiazapines not to take them.
Thank you kindly for the exchange.
I do.Most dont.I have my patients tested for food allergies and we have just published this.
There are many papers in the psychiatric literature on using fish oil
The problem is that depression is a heterogeneous disorder.Most likely some patients have an inflammatory endophenotype This can be both nature and nurture induced.A good paper was written and published this week on early childhood abuse and resetting of the immune response by Baumeister in molecular psychiatry.
Sadly, things change slowly.The hierarchy in psychiatry controls the education of new physicians.For years that meant everyone could be cured by psychoanalysis.Then it was valium.Then SSRI.Psychiatrists get paid to give out pills.It just how it is.That said-that does not make the pills bad.Rather (as i wrote) it is the implementation of them that can be harmful.
The only study that would alter my opinion about this specific issue is if rodents were treated with benzodiazapins in appropriate doses,stopped and then had their cognition checked.While translating rodent into human data has its own problems, it would at least than suggest a cause and effect.To further that hypothesis one would need to find a molecular mechanism to explain it.
Skewering psychiatry and the medications as is routinely done on this site is both pathetic and mostly counterproductive.The attacks are never cojoined with a more productive approach to treatment.As I mentions-ALL treatments have risk.Fish oil can be very dangerous as well by altering killer t cell function and can cause bleeding.Having used them extensively in clinical practice-they can be both anti, and pro inflammatory (see all the blogs about them causing skin rashes)
The reasons people present baseless vitriol about medications on this site can only be guessed at.
Thank you for your thoughtful comment.
I am a geriatric psychiatrist.I have treated well over 10,000 pts over a 28 year period.
What you wrote is a reiteration of my comment-there is an association.Association is not cause.Drop an apple-there is no apple magnet underneath the ground.
Partially treated depression, and poorly treated insomnia have both been associated with progression of cognitive decline-not the medications used to treat these problems.Its that simple.There was a recent publication implying allergy medications increase dementia rates.It has the same problem as this paper.Inflammation (as I noted) can be neurotoxic due to the biological cascade I noted.
This is not to say that psychotophic medications are necessarily safe.In fact, it is not clear that they are.The mechanism being epigenetic alterations of the genome.The only question in my opinion is risk/benifit. What is better ,what is worse.That is a clinical decision that we get paid to do.This paper, as I wrote is misleading and should not have been published as it serves as fodder for sensationalists trying to skewer the field of psychiatry.
This issue of long term effects of antidepressant use is still being uncovered.It likely is similar to the use of NSAID in that long term use is likely not good.On the other hand, untreated pain has well been show to be detrimental to ones healthy.
I am not a big fan of pills and use CAM and non pharmacological interventions (esp diet and exercise) whenever possible.That said-it does not always work and aging,this paper in my opinion is misleading and should not have made it into the literature.Open access is good-poorly thought out conclusions are less helpful.
Another trash research report showing association and not cause and effect.Nobody on here seems to actually want to think these papers through.Rather they lavish in being ideologues.
The more thorough appraisal of this report is that benzodiazepines are prescribed for anxiety.Anxiety is often co-morbid with depression.Depression over time is neurotoxic through inflammation and IDO activation resultind in elevated quinolinic acid and Kynurenic acid which are destructive to neurons.
That is how this goes.Paper should not have been published.
Summary=
Benzodiazepines are often overprescribed-they likely do not lead to dementia and certainly this article provides not one shred of evidence to say it does.
Many, or most (but not all) people working with clients, or patients in the field of mental health disorders will likely follow the Wille Sutton rule-go where the money is.Freud, for all his short comings and overreaching was one of the few researchers in the field who actually just tried to understand what people were suffering with.
To quote Claude Bernard–no model of illness, no logical treatment.It seems one fad rolls into the next.
Another ridiculous article on this equivalent to Fox news blog.
Neuroscience has shown the significant contribution inflammation has to psychiatric disorders.In doing so it has allowed a rational for treating mood disorders with anti inflammatory agents, be they antidepressants, fish oil, music or meditation.
Neuroscience has also helped clarify the underpinnings of behavioral genetics, and the effect of intimacy and rejection on the brain.
Yet another misguided, and ill informed opinion piece.
It is meant to be both disparaging and accurate.Ask Dr.Berezin to proffer a reference in a peer reviewed journal to support any of his ideas suggested in this blog.
There are none.That is not to be disparaging-but to be accurate.
I have friends who are scientists, (such as my mentor Eric Kandel)who have spent a lifetime understanding mental illness.
The clear irritation expressed is due to the misleading information presented under the guise of pseudo science.
As mentioned-lets see a review of the hundreds of papers discussing the dangers of psychotherapy.
And I have had my modicum of success as a research and clinician-without being an ideologue.
Thank you for your deeply thought out reply.Did you read either Caspi or Lesch’s work on the genetics of major depression prior to writing your ..comment? No, because it takes time,effort and it does not allow one to hide behind a few big words.
Sadly you are allowed to put this information into the public domain.I occasionally read this journal as a source of information for my students.
Your understanding of the mechanisms of antidepressants is minimal at best.Your article is so replete with hyperbole it is no surprise that you do not publish this fantastical thinking in a peer journal.
It is sad that you use your M.D. to give the illusion of “medical expertise”.Why not label it as is-a forum to advertise that you like doing psychotherapy.An intervention that has many papers on its adverse effects.May I suggest you write a paper on that? Will never happen since you might loose business.
I suggest you read nature neuroscience rather than yet another book that extols the talking cure.Real educators give a balanced approach to an issue.Ideologues only proselytize on how terrible psychiatry is.What have you contributed based on science? Nothing.The irony is I am a psychotherapist.
Unlike others who write opinion pieces ,I notice that there are many who think your piece is baseless.Also, you don’t reply to those who are more informed about this issue than you are.
I suggest you consider both retracting this, and reconsider how you teach your students.I also you suggest watching the you tube of a colleague, Bob Sapolsky on depression.You might see how an open and fun class is taught on the topic.
They are if they have a prior history, as do humans.
To Professor Read-
1.You have no idea what depression is.That is a fact.It is also a fact that nobody does, yet most people do not write with such officious pedantry.
2.There is a large bevy of literature on the dangers of psychotherapy.Are you going to write a searing missive on all the people who have had terrible outcomes talking to a “therapist”? No.Fortunately many others do, and have as have I.
3.That so many take medications AND have terrible side effects would seem to suggest to an open mind that while the side effects are truly unpleasant (sometimes due to improper dosing by primary care doctors), they continue to take them.Not to makes them feel worse.
4.I am a psychoanalyst and neuroscience researcher.I have no skin in the game to eviserate any treatment that alleviates persistent pain.You on the other hand have a vested interest in skewering the ‘medical model”.Your reason is fairly apparent.
When you write a paper on how to define depression, what it means, and how best to treat it and submit it for peer review we will then see the result.
This opinion piece is vacuous.You might consider the effect you had on someone not wise enough to see your obvious bias.
I am a psychiatrist, and I am one of the most disappointed ones in my own field.I have spent years in academics teaching a humanistic approach to working with those in distress:at times fading fancy in psychiatry.It has indeed become a field hypertrophied in medication management at its worst, but life saving for the many people whose lives have been saved by lithium etc.
That said, I should share that your vitriol and saber rattling aginst windmills of the greater academia in psychiatry holds very little weight:you provide not a shred of credible research to replace the currently flawed system.The reason is that it is easier to knock down a home than to build one.
Do you know what is “normal” and what is not, and how to measure it? Shall we say all are normal and just inappropriately “labeled”?
What data have you published that presents a credible scientific model of mental distress that can inform clinicians and patients how best to proceed?
The current structure is deeply flawed, as is Whitacker’s temper tantrum.Maybe his next volume will give equal time to the adverse outcomes of talk therapies and the labels used for personality disorders.
A nicely written, and sober appraisal of where we are in analyzing outcome data regarding the treatment of mental disorders.
As someone who is a neuroscientist, psychotherapist and psychopharmacologist (and I suppose somewhat obsessive in trying to figure out things), it is clear that all we have now is different ideological camps trying to support their “skin in the game”.All the while downplaying the significant risks of the interventions they use (psychotherapy perhaps having the greater long term risk, and pharmacology the great short term-though it may be a toss up).
As the great medical scientist Claude Bernard noted in the early 1800’s, that until we have models of disease states, we have very little.Without models,the arguments will go on for the next 100 years as they have gone on for the past.
Thanks for the well written piece.
MP
As I have written to other such opinion pieces:mental pain/distress causes both a diminished quality of life, and potentially death in cases of suicide.
As a research psychiatrist for 25 years I feel it is reasonable to state that all opinions of all treatments are profoundly flawed, and biased by one for or another by ideologies.
As Claude Bernard stated almost exactly 200 years ago:with no model of a disorder, there can be no logical nor scientific method for treatment.
Bitterness towards medication use impales those whose life it saved and enthusiasm for psychotherapy does a disservice to those lives it potentially wasted.In the spirit of Bernard-the obverse can be suggested as well.
Blogs are for ideologues.Time might be better spent understanding a model for these problems, and thus a logical approach to treating them.
Hello Dr.Brogan,
As a clinical neuroscientist,teacher of neuroimmunology,a practitioner CAM, practicing psychiatrist and having worked on modeling of major depression, your piece struck my curiosity.
It is true all that you write.It is equally true that it is as flawed because of its conceptual simplicity.
And I find it vacuous and destructive since it is written in a pseudoscince “down to earth”style.
Where is the science to support your “holistic” approach? What does that even mean? Have you yourself done a study on “your method” that could be scrutinized by the scientific community? Have you published your “countless patients” who became suicidal from medication? Do you have a theory that can separate worsening symptoms from medications from worsening of the illness?
Since many myths that needed to be destroyed,fortunately are,were or will be,your column leaves nothing to replace them but hyperbole and vitriol.For the perhaps 4 people in the world whose life have been saved by these medications, you have now possible planted the seed for maybe one of them to stop them.I hope there is no negative repercussion for your tacit encouragement for them to do so.
In summary,you attack everything and leave not a shred of scientific data,theory or evidence to replace what truly needed to be replace.Run and eat well and meditate?And the scientific basis of that helping …….everyone?A hyperbolic ,vapid piece that sadly will be taken to heart by those who do not realize you provide nothing better-based upon science.Only hyperbole.
Dr.Bracken,
Thank you for the thoughtful paper presented.Unfortunately, it can be construed by many (including myself) as promoting what you are attempting to debunk.
As a practicing clinical psychiatrist who has taught neuroscience for over 20 years, is a trained psychoanalyst, has seen thousands of patients,and is a defendant of those who ridicule the field-I find your paper to be yet another that moves us and patients-nowhere.
The paper is to my thinking, yet another fancy form of pseudoscience.Nothing more, or less.I believe your intentions are good, but significantly misdirected.
Until there is a model of the brain/mind, nobody has the right to say which is the right direction.It could be do nothing at times like Lacan, or a lobotomy or insulin shock.The point of science is to remove mythology.This paper does the reverse:it dresses it up.
Focus on meaning,values,relationships? Lets do what Einstein called a thinking experiment.Remove biology from the brain-and which of those three remain? None.Problems of persons ,not brains.Repeat the same experiment.As is in the worst of neuroscience, your paper ends with-words, not solutions.As Freud wrote in his “Project”-until his and others theories stand the scrutiny of science,they are just concepts at best, and mythology at worst.
I suggest after you have read 15000 or so papers in neuroscience, and have mastered the concepts proffered (unlikely)which cares less about whether someone gets pills or talk therapy, then you reconsider what you wrote.My patients and students thank me because I do not discuss hermeneutics with them, but rather we have about how the brain works, how dualism is destructive, and what sort of things we can to to improve peoples lives.
That said, while strongly disagreeing with your perspective as backward looking, I appreciate the heart and effort put forth.
Dr.Goldstien